Stuart Mackay, University of Salford

Case Study 8
Problem-based Learning in Radiographer Education:
Testing the Water before Taking the Plunge

Dr Stuart Mackay is Senior Lecturer in the Directorate of Radiography,

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Salford University where he is the Programme Leader for the BSc (Hons)
Diagnostic Radiography programme. He considers that there has been too
great a focus on ‘knowledge’ in the curriculum. He and his team are therefore
trying to put equal emphasis on developing the person as well as giving
students the knowledge and skills needed to become radiographers. The
guiding principle has been that radiography is a practical job and that
students must not only become competent radiographic practitioners but also
lifelong learners.

Introduction explained. Personal reflections of the

This case study will describe the
experiences of a team of radiographer
educators preparing for curriculum change.
It begins with a short history of radiography
education and describes the changes that
have occurred in radiographic practice. It
then explains how the radiographer lecturers
involved in the planning and delivery of a
problem-based learning (PBL) pilot – the
programme team – questioned the ability of
the current curriculum to prepare
radiographers for the next decade. Finding
the present curriculum wanting, it explains
why PBL was selected as a learning method
for the BSc (Hons) Diagnostic Radiography
that would enable the programme team to
equip the radiographic practitioners of the
future with the necessary skills, knowledge
and attitudes.
The curriculum features of the fully
integrated PBL curriculum are described
along with the evaluation methods and
outcomes from the pilot. The learning of the
programme team is then discussed and the
changes to be made to the curriculum as a
result of our experiences on the pilot
programme team conclude the case study
and show how the experience has had a
positive effect on our attitudes, confidence
and teamworking.
Context
The radiographic profession
The radiographic profession, and
radiographer education, have undergone
tremendous development over the past ten
years. Traditionally, radiographers took x-
rays, ensuring that the images were of high
quality, and radiologists read the x-ray
images, making a diagnosis. A
radiographer’s practice was directed and
controlled by the radiologist. Radiographers
were educated for two or three years up to
diploma level whereas radiologists were
medically qualified and had several years’
experience in medicine or surgery before
becoming radiologists.
In the late 1980s and early 1990s
radiographer education moved into the
higher education sector and the qualification

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needed to become a radiographer became
a full time BSc (Hons) degree. Radiographic
practice also changed, with radiographers
developing their role into more complex and
responsible areas of practice e.g. reading of
x-ray images. The degree prepared
practitioners well for the challenges of the
previous decade but will the current method
of educating radiographers be able to
develop the required skills, attitudes and
knowledge for the modern radiographic
practitioner over the next decade?
There are several factors that have, in the
view of the programme team, led to a need
to rethink how we prepare radiographers for
professional practice.
The shelf life of knowledge is lessening each
year according to Goodall (2001), a member
of the NHS lifelong learning policy team.
This means that practitioners learning how
to practice radiography today will find that
much of the knowledge and many of the
skills they have upon qualification will be
insufficient to sustain them through their
working life. They will need to be
comfortable with the principles and practice
of lifelong learning.
There has been tremendous organisational
change in the NHS and this is unlikely to
abate. The latest policy document about the
future of the NHS – the National Health
Service Plan – (Department of Health 2000)
and its implementation for allied health
professionals, which includes radiographers
– Meeting the Challenge – (Department of
Health 2000), encourages these professions
to develop their roles further. New
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consultant practitioner status has been set
up and practitioners are encouraged to
make independent decisions regarding
patient care. Such changes continue to blur
the boundaries of professional roles and
make new demands on practitioners.
The government has also made clear in
these policy documents that
interprofessional working, where teams of
health service workers collaborate for the
benefit of the patient, will need to be a
central feature of the future NHS. The
practitioner of tomorrow will need to have
good interpersonal and teamworking skills
to be able to collaborate productively in
groups.
There have been changes in the
professional responsibility of radiographers
brought about in part by the extension to
the traditional duties and responsibilities of
radiographers requiring them to take a
greater responsibility for patient care and
diagnosis. This is known as role
development. Another driver of this
increased responsibility comes from recent
changes to the legislation – Ionising
Radiation (Medical Exposure) Regulations
(2000) – that governs exposing patients to
x-rays. Radiographers are now legally
required to justify the request for an x-ray
examination and if they do not believe it to
be justifiable they must refuse that x-ray
request. This has brought into focus the
independent practitioner status of
radiographers and increased the need for a
greater understanding and up-to-date
knowledge of both disease and medical
imaging processes.
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Taking all these factors into account, it
becomes clear that the practitioner of the
future will need to posses different skills
from those required just ten years ago. They
are likely to need to be more responsible,
confident, flexible and reflective with an
open and enquiring mind. They will have to
be ready to learn new knowledge and skills
and have the right attitudes for continuing
professional development and teamworking.
But how can we inculcate these necessary
skills in our practitioners of the future?
The answer may lie in using problem-based
learning. This relatively new teaching and
learning strategy, often credited as
originating at McMaster University in
Ontario, Canada in the sixties (Berkson
1993), has many benefits. Many of its values
and features, now described, appear
congruent with the needs of the practitioner
of the future.
The benefits of PBL in
the context of radiographer
education
It became clear to the programme team from
the evidence in the medical literature that
PBL is not only a learning method intended
to improve the academic scores that
participants achieve (Albanese and Mitchell,
Vernon and Blake, and Berkson, all 1993).
The advantages that can be accrued from
PBL are related more to the educational,
thinking and reasoning skills, and to the
interpersonal.
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Many researchers and teachers describe
PBL as an enjoyable way of learning (Marks-
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Maran and Thomas in Glen and Wilkie 2000)
and it has been rated more highly by
students than a traditional curriculum
(Vernon and Blake 1993). If this were the
case then it would certainly be a way of
promoting student learning, as they would
be intrinsically rewarded for their efforts.
This intrinsic motivation might be the reason
why PBL, according to Lewis and Buckley
(1992), encourages deep rather than
superficial learning.
PBL has been shown to improve clinical
thinking in medical practice. In medical
education, students’ clinical reasoning skills
are reported as being better with a PBL
curriculum than with a traditional one
(Vernon and Blake 1993). This may,
therefore, also have an effect on improving
the clinical thinking of radiographic
practitioners
Engel has been involved with PBL curricula
for many years and he cites several other
benefits (Engel 1991). Many of these can
overcome the challenges that are described
above. For example, during PBL students
adapt to and participate in change and are
required to deal with real-world problems
and make reasoned decisions in unfamiliar
situations. The process forces them to
reason critically and creatively and, possibly
due to the integration of subjects in the
curriculum as well as the PBL process, to
adopt a more universal or holistic approach.
These features would enable the practitioner
of the future to be able to adapt to new
technology and new techniques and to be
more comfortable with the process of
change.
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PBL involves student-centred group work
where participants practise empathy and
learn to appreciate the other person’s point
of view (Engel 1991). These are essential
skills for interprofessional teamworking
since professionals need to work with other
disciplines which may have different
philosophies, ways of working and values.
The ability to understand others can also
foster the sort of collaboration which is
needed when working towards the shared
goal of learning.
Through the process of PBL students
identify their own strengths and
weaknesses and take appropriate remedial
action, for example through continuing, self-
directed learning (Engel 1991). These are
the founding principles of lifelong learning
and having practised them during training,
students should be able to continue to use
and improve these skills during their
careers.
As a result of this evidence from the
literature and the experience of the
programme team, it was decided to
revalidate the radiography degree using
PBL as the central educational principle.
However, there were no other radiographic
education centres found which used PBL
for a whole curriculum. So how was the
team to apply PBL to the radiographic
context? As this was an innovation in
radiographer education it was decided to
pilot a section of the PBL programme in
order to ‘test the water’ and iron out any
problems with the curriculum
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The following section will explain the aims of
the pilot and explore several of the
concerns of the programme team.
Defining the issue
The programme team had some experience
of PBL as there were modules and parts of
modules which were delivered through PBL,
particularly in the third year. Yet we were
aware of the limitations of this experience
and that moving to a full PBL curriculum
would involve further development and new
experiences. We decided to pilot a section
of the curriculum and set out four main
aims:
• to inform the curriculum development
process
• to assess the new integrated curriculum
model we had designed
• to identify staff needs
• to explore the student experience.
Each of these aims will now be discussed
and their purpose explained. Much of the
motivation for these aims came from staff
concerns or perceived disadvantages which
are identified in the literature.
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Informing the curriculum the next stage, the setting of learning

development process objectives for self-study. The sixth stage is

The team had written the new curriculum
prior to the start of the pilot which had been
validated through the university quality
assurance procedures and by the
radiographers’ professional body. A process
validation had been selected as the method
of determining the new curriculum. Both the
university and the professional body had an
input to the process during the curriculum
development period of eighteen months.
The PBL curriculum utilised the Maastricht
‘7-Jump’ (Schmidt 1983), a framework for
structuring discussion and study around a
trigger. In this framework students are
presented with the carefully planned trigger
(see Table 1 for sample trigger) and begin by
clarifying terms and concepts within it. They
then define the problem or issue and carry
out a brainstorm around it. This is followed
by a systematic inventory of the ideas or
explanations that have arisen which informs
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the self-study phase. Students then return
for the final stage – reporting back and
discussion to cover the set objectives.
This framework had been used in the
previous curriculum and several staff were
familiar with it. We were aware of other
methods but had selected this one. Was this
the best framework to use? Would the new
staff be comfortable delivering the
curriculum this way?
The programme team is small and has
worked well together for several years. They
have a good range of skills and experience
and a strong feeling of team spirit. During
the curriculum development process there
was concern expressed by some members
of staff – more so among those who were
new to PBL – that their job would change
considerably and that they might not enjoy it
anymore. This tended to be among staff
new to PBL. Might the move to the new
curriculum have a detrimental effect on staff

Table 1. Sample of a trigger from the BSc (Hons) Diagnostic Radiography programme

Mr William Boyd attends the Diagnostic Radiology Department for an x-ray examination
of his right forearm. He has been diagnosed with osteoporosis and is infected with
M.R.S.A.* The clinical indication on the request form indicates a previous fracture of
radius and ulna that is not healing. You are the radiographer undertaking this examination
and are three months pregnant.

Explain how you would safely carry out this examination.

* For the non-medical reader: Methicillin is in a class of antibiotics commonly used to treat
staphylococcus infections. Although this class of antibiotics is very effective in treating most
staph infections, some staph bacteria have developed resistance to methicillin and can no
longer be killed by this antibiotic. These resistant bacteria are called methicillin-resistant
Staphylococcus aureus, or MRSA.

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morale and cause a schism between those
committed to PBL and those with anxieties
about its value? Had we as a team
undertaken sufficient preparation for all staff
to be in a position to make the move to
PBL?
PBL can take two main forms – a pure and a
hybrid form (Glen and Wilkie 2000). The pure
form is where the PBL group tutorial is the
only formal contact students have with staff.
During this contact, triggers are introduced
and discussed for the first time. Students
then undertake private and/or group study
of the learning objectives and return to the
next PBL tutorial session to discuss and
assimilate their and others’ learning. The
programme team did not believe that this
was an appropriate form of PBL to adopt
due to the range of ability of a typical
student radiographer cohort. Currently the
cohort profile is varied with ‘A’ level, Access
and mature students, and students with
accredited prior experiential learning. With
such a range of student ability the rate of
learning varies. Whereas some students
might be able to achieve the learning
outcomes in the time available with a pure
PBL curriculum, we believed that many
would not. The hybrid curriculum
incorporates some lectures, tutorials and
practical work in clinical skills laboratories,
all of which are strategically placed
throughout the module to support student
learning. We selected this latter hybrid form
and were keen to evaluate the performance
of students with this type of support.
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Assessing the integrated
curriculum model
• Subject integration
The new PBL curriculum had enabled us to
adopt an integrated curriculum. The
previous curriculum had separated out the
subject areas within radiography, for
example physics, anatomy, physiology and
pathology, imaging procedures, quality,
research methods. Many of these subject
areas formed discrete modules of 10 or 20
credits with individual assessments. In the
new curriculum we tended to use larger 40
credit modules with generic titles. We
looked across subjects and were able to
remove irrelevant or duplicated material.
This was seen as a very positive step but
had we gone too far or had we not gone far
enough? There were concerns that we
might have ‘dumbed down’ the curriculum
or that we might have jettisoned some
important theory. This was a particular
concern at level one where a lot of the
underpinning theory is delivered.
When debating curriculum content there
was a need for professional openness and
negotiation to determine what must stay in
the curriculum and what could be sacrificed.
The team spent many hours discussing this
issue and finally agreed upon what should
constitute the content of the integrated
curriculum. But there were still several areas
that we wanted to test out to see whether
students would be able to meet the learning
outcomes: examples were image quality,
elements of radiation physics, physiology of
the cell.
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There were also problems with integrating
the factual theoretical components of the
different subject areas at level one. The
team had difficulty writing triggers that
would enable integration of theoretical
components. Yet application of knowledge
would be required in order to safely carry
out radiographic procedures and would
need to be assessed at the end of the
module.
• Learning resources
PBL has different resource requirements
from those of a traditional curriculum. For
our curriculum we were aware that there
would be a need for more textbooks,
anatomical models, radiographs and access
to the World Wide Web. From our previous
experience we were concerned that there
might be other resource requirements we
had not considered. Management of the
teaching staff was also a concern although
we had not significantly increased staff
contact hours by moving to the hybrid PBL
curriculum. This was due to balancing staff
hours between PBL group tutorials and
traditional lecture/tutorials. PBL group
tutorials can be very intense and as
programme leader I was keen to ensure that
staff were not overworked.
• Identify staff needs
Staff had been inducted into PBL using a
range of different methods. Some staff had
visited other PBL institutions in the UK and
abroad as part of their staff development.
The University of Salford had also run
various workshops in-house with invited
PBL experts. Personal communication with
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other individuals and institutions with PBL
experience was also used to inform the
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programme team. This varied input which
had occurred over a two-year period had
given us confidence as a team to put our
experience in the wider context of PBL. In
addition, three of the programme team had
up to five years practical experience of PBL.
Therefore we knew we had identified and
discussed many alternatives and had a
broad view of PBL. This was a factor in our
deciding to go fully PBL and we were
comfortable with the level of staff
development.
There were still staff in the team who did not
have a great deal of experience of PBL and
some who had none. The management of
small groups was something that many of
the team had done in a traditional tutorial
context but not a PBL one. The facilitator
role is one that requires a shift in emphasis
from lecturer as knowledge giver to lecturer
as knowledge broker. This shift had been
experienced by some staff but not by other
members of the team. Another institution
with which we had contact had informed us
that the reason they had not gone to a fully
PBL curriculum was due to the reluctance of
a significant number of their programme
team to make this shift. The pilot would help
us to determine the ability of staff members
to make this change.
One of the skills that is required to be able
to deliver a successful PBL curriculum is
trigger construction. From our
understanding of triggers we felt that, being
the focus for learning, they must be
designed with certain features. They should
stimulate and motivate students to learn,
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mimic real life situations and provide a clear
pathway for students to follow to the
learning objectives. We were beginning to
develop our trigger designing skills but were
aware that this was something that we
needed to improve as it was an important
part of the process.
One of the reported benefits of PBL is that
both staff and students find the learning
process enjoyable (Marks-Maran and
Thomas in Glen and Wilkie 2000). We were
hoping that this would be the case for our
staff and students.
• Determining the student
experience
One of the great unknowns for the
programme team was how students would
perceive a full PBL curriculum. This
curriculum is highly student-centred and
would place the responsibility for the
learning squarely on the shoulders of the
students. However, this might increase their
anxiety and promote an unacceptable level
of stress. Would students find the learning
experience acceptable? Would they learn
sufficiently from it or might the organisation,
intensity or learning resources prevent them
from achieving the learning outcomes? In
small group work such as this the group
dynamics can have a significant effect on
the ability of students to enjoy and learn.
The pilot cohort would be in groups of ten or
eleven. Would this size of group adversely
affect the group dynamics or might it be
conducive to learning? In a student-centred
curriculum it is incumbent upon students to
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take part. If they do not actively engage with
the curriculum this might affect their
success on the programme.
Having described some of the concerns and
hopes of the programme team that led to
our four key aims I will now describe the
curriculum features and discuss and justify
the approach we used to evaluate the pilot.
The approach to the PBL pilot
evaluation
The pilot module was in year one, semester
one of the BSc (Hons) Diagnostic
Radiography programme and ran for eight
weeks. Weekly learning outcomes were
written which were derived from the module
learning outcomes. This provided the team
with a weekly focus for PBL activities and
helped to direct the fixed resources
sessions, trigger and tutor guide. The fixed
resources sessions were organised to
support the learning objectives for each
week. These consisted of clinical skills
laboratories for practical work, key note
lectures and tutorials. Time was allocated
each week for negotiated resources
sessions. These could be used to provide
additional support if required. Students were
given one trigger per week and were
provided with individual and group study
time, fixed resources sessions and non-tutor
facilitated group sessions. They reported
back on their learning related to the learning
objectives in the following week’s PBL
group.
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There were four groups of ten or eleven
students and one facilitator for each group.
Two of the facilitators had no previous PBL
experience but had undertaken some staff
development and two had previous
experience of PBL facilitation. A tutor guide
was compiled to provide the desired
objectives and a summary of the key subject
areas that students needed to cover for
each objective. The guide was designed to
provide some standardisation of learning
objectives across the groups and direct the
facilitators to the depth of knowledge that
students were required to work to for each
objective. This was thought particularly
useful for staff who did not have any
experience in a specific subject area.
The module, although delivered in an
integrated manner, was assessed in
separate subject areas. This was because
students in the pilot cohort were not
following the fully integrated PBL curriculum
and their whole first year would have had to
be rearranged and revalidated. This was not
thought of value as it might have affected
the continuity of their three-year programme
The evaluation of the pilot
To capture the key issues for staff and
students a ‘nominal group technique’
(Dunham 1998) was used. This enables a
range of individuals to put forward their
views on a particular topic by providing a
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structured opportunity for everyone to
participate. A facilitator invites all
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participants to identify issues they think
pertinent. All the issues raised are listed on a
flip chart. Participants then individually rank
their top three issues in order of importance.
These rankings are combined by the
facilitator to produce a group view. This is a
composite of all the individual rankings.
Two individuals from each PBL group were
nominated to represent the group
perspective. They expressed the positive
and negative issues raised by the PBL
curriculum. This allows time to think about
the issues at hand and to contribute without
the pressures of normal group dynamics
such as conformity pressures and
competition while still providing an
opportunity for collaboration and
exploration of the views of others. This
same approach was used with the staff
involved in the delivery of the pilot.
The ‘nominal group technique’ is valuable
for identifying and recording summative
judgements, but the team also wanted a
collaborative and dynamic method for
learning about the issues during the delivery
of the pilot. Weekly reflective group
meetings of facilitators were therefore held
in order to share experiences and to
respond to any immediate need for change.
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Findings benefited from the opportunities that staff

The findings presented will detail the top ten
ranked issues offered by the staff and
student groups through the nominal group
process. These issues are presented in
table form and then described.
• Positive issues
From the perspective of the staff involved,
students, staff and curriculum had each
benefited. As far as students were
concerned, staff had observed students
developing and using their problem solving
and analytical skills along with their key
and teamworking skills, and they had
witnessed their enthusiasm to learn. Staff
had benefited from the experience of
teamworking and felt that this had
improved the effectiveness of their
lectures. The content had been better
focused on the weekly learning outcomes
and the lecturer’s time had been used
more effectively. Staff had found the
experience enjoyable and had learned
from the students. The curriculum had
had been given to get to know their
students and from the formative weekly
feedback. Each member of staff was able
to see the topics that were covered over
the whole curriculum rather than just the
module or subject areas in which they
were traditionally involved.
Students valued the ability to share and
validate knowledge. They had each
studied all of the learning objectives and
felt this was useful as it had aided their
understanding and provided them with
good revision material. This understanding
had also been enhanced by the way the
lectures were focused on the weekly
learning objectives. Their perspective had
been broadened as they were able to see
others’ points of view on the triggers. The
curriculum had enabled them to make
friends and had motivated them to work in
what they had found was an ‘interesting
way’. Their confidence had been enhanced
as a result of presenting back to and being
questioned by their PBL group and
generally their teamworking skills had

Table 2. Positive issues identified by staff

Ranking Positive issues identified by staff

1st Students develop problem solving and analytical skills.
=2nd Promotes teamwork in staff and students,
=2nd Improvement in lectures – content is more focused
– better use of lecturer time.
4th Encourages ‘key skills’ and personal development, such as self-confidence.
5th Enables formative assessment and feedback on students on a weekly basis.
6th Reduces unplanned repetition in the curriculum.
7th Enthusiasm of students to learn.
8th Enjoyable for staff.
9th Staff learn from the students.
10th Lecturers able to see concurrent delivery of topics (across module/semester).
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Table 3. Positive issues identified by students

Ranking Positive issues identified by students

1st
2nd
3rd
Sharing of knowledge.
Covering all the learning objectives aids understanding and assessment revision.
Motivates you to work.
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4th Validation of knowledge.
5th Allows you to make friends.
6th Beneficial when doing presentations as it builds confidence.
7th Enables one to see issues in trigger from different perspectives.
8th Attempts to get people to work as a team.
9th Interesting way of learning.
10th Makes better sense of the lectures.

been developed. However, the use of the
word ‘attempts’ when describing
teamworking could be taken to imply
some doubts or reservations in that area.
• Negative issues
The negative staff issues revolved around
PBL group interactions and resources. The
students lacked some of the essential skills
for effective PBL in that their ability to
‘scribe’, chair, contribute to and give
feedback to the group were limited.
Learning was hampered by lack of
resources for students, and some of the
triggers written by the programme team did
not work well in practice. The group
dynamic was criticised in some groups.

Table 4. The negative issues identified by staff

Ranking Negative issues identified by staff

1st Lack of skills of scribe and chair.
2nd Some triggers were not effective. Possibly due to inherently difficult subject area,
or may be that topics which can be applied in practice are more suitable as
triggers.
3rd More resources required. For example, books, models, x-ray film library, rooms.
4th Group dynamics – some groups didn’t work well together.
=5th Fixed resources. Fundamental aspects of subject areas not always covered. For
example, osteoblasts discussed but basics of the cell were not.
=5th Non-contributors in group
6th Formative assessment of interaction. Doubts about the value of scoring.
Qualitative comments may be better.
7th Quality of reporting back – presentation skills and interaction with learning
materials.
8th Requires large amount of planning time.
9th Lack of participation at assignment time.
10th ‘7-step’ – difficult to follow with merging of steps.

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Table 5. The negative issues identified by students

Ranking Negative issues identified by students

1st Volume of work – if PBL and assignment then the assessment takes priority
2nd Interaction assessment. Is it assessing the correct thing or does it benefit those
with an outgoing personality?
3rd Self-study time not sufficient.
4th Lack of books in library.
5th Quiet students – make little contribution to group activity.
6th Group contract broken early on.
7th Do not get to know those in other groups.
8th Learning objectives not always relevant - leads to wasted time.
9th Needing to do all the objectives.
10th Group contract - tutor deviated from this.

The students identified some negative
issues similar to those mentioned by the
staff, with lack of books in the library and
‘quiet students’ who contribute little being
the main two. They also presented issues
that were the converse of previously stated
positive issues. They disliked needing to
study all the learning objectives from the
end of the session (described earlier in the
Mastericht ‘7-Jump’ framework), and
although they were able to get to know the
students in their group, they said that they
were not able to get to know those in other
groups. The main disadvantages were the
volume of work required and how this was
managed during busy times when they also
had assessments to complete. They were
not comfortable with being assessed by the
facilitator on their performance in the group.
There was also some deviation from agreed
group contracts.
Impact: lessons learned and
benefits gained by the team
The most tangible benefit was the way that
the programme team worked together
during the planning and delivery of the pilot.
There was a very positive attitude which
was particularly important when the
relevance of aspects of the previous
curriculum were discussed and several
topics from staff members’ subject area
were left out. The team reflected on the pilot
outcomes and on the discussions during the
weekly reflective meetings. Organisation of
the curriculum, skills training for students,
and facilitator improvement were selected
as the most important.
• Organisation of the curriculum
The lack of resources identified by both staff
and students – whilst a major problem – is
relatively straightforward to solve. Extra
copies of textbooks are being ordered and
we have a large and growing digitised and
hard copy x-ray image library. The students
have extensive ICT facilities and
recommended websites are being added to
on a regular basis. There are now two
members of the team who have been given
the responsibility of managing resources for
the programme.

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 Continuing Professional Development: Critical Encounters
The team has decided to look again at
assessment of student interaction during
PBL session. The criteria used for the pilot
were formulated for previous PBL modules
and will be revised. Probing the students
further on this issue showed that many had
not looked at the criteria which had been
published in the module handbook given to
each student. This will be highlighted at
student induction.
Students were required to complete
assessments at the same time as working
on a trigger. This meant that they tended to
spend more time and effort on their
assessment than on the learning objectives
from the trigger. The team has now
integrated the assessment scenario and the
final trigger so that they permit study of both
activities. This was trialled in a year three
undergraduate PBL module and was found
to be acceptable to both staff and students.
The timing of assessments is also being
looked at to improve the assessment
loading.
• Skills training for students
The induction programme will be enhanced
with the addition of skills training for
students on how to be a ‘scribe’, chair, and
give feedback to a group. The staff plan to
run a ‘fishbowl’ session in the induction
programme where staff role-play the
different parts and students observe the
skills being performed at an advanced level.
The student ‘chair’ of the group was seen as
a role that, if done poorly, could have a
significant negative impact on the
effectiveness of the group.
LTSN Generic Centre – May 2003
• Facilitator improvement
6
The problem of non-contributors or those
who contribute very little is a perpetual
challenge in our experience of PBL. Some of
the factors which might contribute to this
are different learning styles, the lack of life
skills – mature students appear more
comfortable contributing in the early stages
of the programme than school leavers –
personality differences, students’
intellectual ability, lack of preparation of
material. The team recognises the need to
manage this problem in a sensitive and
positive manner. One of the planned
interventions involves asking for each
student’s opinion (in turn) on the issues
under discussion. Another option is to put
the problem back to the group and
stimulating them to support and encourage
reticent students to contribute. One student
on the pilot suggested that tutors ‘put me on
the spot more’. This would indicate that a
more direct questioning approach might be
beneficial for some students if they are not
contributing.
The team felt that staff development was
important to bring on members of staff new
to PBL and to continually update the
knowledge and skills of experienced staff.
The focus for these activities is likely to be in
two main areas. Firstly, the facilitator has a
major influence on students’ learning and on
the dynamics within the groups. Because of
this, the skills of managing small groups –
such as knowing when to intervene, how to
promote a learning environment, providing
the right balance of support and challenge,
how to motivate students, and recognising
group dynamics – are all important. These
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 Continuing Professional Development: Critical Encounters
are skills which facilitators must continually
update and improve. Secondly, some of the
triggers did not promote the intended
learning and in some cases hampered
students when they were trying to identify
and discuss the pertinent learning
outcomes. This is something the team
needs to improve, for if a trigger is not
effective the whole process can grind to a
halt.
Reflecting upon these poor triggers, we
believe that there were two main problems.
We were not writing triggers that were
pitched at the right level of knowledge for
first year students and were not testing
application of knowledge. Secondly, we
assumed too much knowledge. This
indicates to us that we should include
student input to our trigger writing and that
after a period of time, should build up a
bank of triggers at different education levels
and stages in the programme. We had
considered looking at triggers others had
published for ideas but these appeared to
be too subject-specific and not applicable
to our radiographer curriculum.
There was considerable debate at the
weekly reflective meeting around the
application of the ‘7-jump’ (Schmidt 1983).
The inexperienced facilitators applied the
first five stages (when the students receive
and discuss the trigger for the first time)
rigidly. This was found to stop the flow of
discussion and affect the group dynamic.
Other facilitators tended not to enforce the
‘7-jump’ but let discussion flow freely.
Students doing this tended to have a more
haphazard approach which might affect
their ability to develop a ‘framework for
106
thinking’ that could be applied to future
triggers. The more experienced facilitators,
when sharing their experiences, stated that
they tended to respond to the needs of the
situation and would sometimes stop the
group and encourage a closer use of the
stages. At other times, they gave the
students a free rein. This was something
that developed with experience of managing
PBL groups.
Reflection
These reflections are those of the
programme team and the programme
leader. They are offered as the personal
views of those who have had the
opportunity – as a group and individually –
to consider their principal reflections on the
experience since the pilot was completed
over four months ago.
The outcomes of and the experience of
being involved in this pilot has given the
team confidence – confidence to continue
to develop the PBL curriculum and to look
forward to delivering it in the BSc (Hons)
Diagnostic Radiography programme in
September 2002. The new PBL facilitators
have gained confidence too. They have
begun to learn how to ‘surrender the seat of
authority’ (Mayo et al. 1995) and to move
from the ‘knowledge giver’, the traditional
higher education lecturer role, to
‘knowledge broker’ – the PBL facilitator role.
It was reassuring to discover that there was
concordance between the literature and our
findings in the context of radiographer
education. This included the following
LTSN Generic Centre – May 2003
 Continuing Professional Development: Critical Encounters
anticipated outcomes. Firstly, that PBL has
been an enjoyable experience for both staff
and students, with students stating at the
end of the pilot that they would wish to
continue to learn using PBL. This has had a
positive effect on moral and motivation for
both groups. Secondly, the examination
results of this cohort at the end of semester
one were similar to the two previous cohorts
at the same time in their training. This is
concordant with work showing that
assessment results between traditional and
PBL curricula are not consistently different
(Albanese and Mitchell 1993, Berkson
1993).
The programme team feels that there is a
need to continue to research into PBL.
Some research questions we have asked
are:
• How do different facilitation styles affect
student learning?
• What effect will PBL have on students
when they go out into the clinical
environment ?
• What will be the affect on the attitude of
qualified colleagues towards students
who have experience a PBL curriculum?
• Will PBL have an effect on radiography
students’ clinical skills?
As the programme leader, I was pleased to
see the high level of teamworking,
commitment and co-operation of staff,
particularly between experienced and non-
experienced facilitators and subject experts.
The enthusiasm for PBL shown by staff and
students was clear. Staff made this evident
at the weekly reflective meetings held
immediately after the PBL group meetings.
These were an opportunity to share
LTSN Generic Centre – May 2003
experiences and air problems and we
believe that they brought the team closer
6
together. These meetings now need to be
incorporated into the normal curricular
activities although they are unlikely to occur
with the same frequency as in the pilot
which had such a packed timetable. A
sensibly timed and achievable set of
supporting meetings for PBL need to be
organised. The amount of time spent on
planning the pilot curriculum was significant,
with the trigger-setting meetings being the
greatest drain on time. This leads us to think
that much of the time and effort required for
a PBL curriculum is in the planning rather
than the delivery.
In conclusion, the pilot for the new PBL
curriculum has been a success. It has
shown us our strengths and achievements
as well as areas that we will need to
develop. The students have been positive
about PBL and the experience does not
appear to have adversely affected their
assessment results. It has been enjoyable
for staff to plan and deliver and has
developed confidence in the programme
team to ‘take the plunge’ into the delivery of
the full PBL programme.
107
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