Understanding Stuck Moments: Tracing the Learning Trajectories in Problem-Based Learning of Medical Education

• In Event: Educational Responsibilities in Problem-Based Education (PBE): Principles, Practices, and Networks Creating and Supporting PBE

Abstract

Objectives
This paper examines medical students’ discourses in problem-based learning (PBL) tutorials and traces their learning trajectories to deepen the understanding of group dynamics in times of "getting stuck."

Perspectives
Students perceived "getting stuck" in PBL tutorials as negative experiences of confusion, messiness, and being lost (Barrett, 2010). Stuck moments in PBL present to be stagnant, unproductive, and fragmented (Savin-Baden, 1996). PBL in medical education, characterized by authentic complex problem-solving and ill-structured problems, is likely to cause stuckness (Barrows, 2000). The stresses also come from co-construction and co-regulation needed in collaborative learning (Järvelä, Volet, & Järvenoja, 2010). Nevertheless, stuck moments can provide opportunities for learning spaces and transformative progression (Savin-Baden, 2016), bringing both enabling and disabling impact on student learning, and leading to conscious or unconscious responses, including retreat, temporizing, avoidance and engagement (Savin-Baden, 2006).

Modes of inquiry
This paper adopted Interactional Ethnography (IE) as the theoretical base and analytical framework. IE is an interdisciplinary methodology derived from interactional sociolinguistics, educational ethnomethodology, discourse analysis, and ethnography (Green & Bridges, 2018). It looks into the moment-by-moment interactions through which knowledge is (co)constructed (Bloome, Carter, Christian, Otto, & Shuart-Faris, 2005). The "telling case" study is presented and analyzed through an iterative, recursive, and abductive reasoning logic, facilitating a deep understanding of learning behavior, process, and the overall learning context (Mitchell, 1984). This paper traced the trajectories of PBL moment-by-moment and analyzed the discourses to demonstrate the bitter methods of struggling through stuck moments to knowledge acquisition.

Data
The data set consists of the audio- and video-recordings of PBL tutorials of The Bachelor of Medicine and Bachelor of Surgery (MBBS) program at The University of Hong Kong. Data used in this paper include two cases discussed in a Year 2 group and a Year 4 group deliberately. Recordings were transcribed for further analysis.

Results
Discourse analysis revealed that at the stuck moment, the Year 2 students proposed a conceptual framework "V-I-N-D-I-C-A-T-E," an acronym for different categories of diseases (see Figure 1). It is a universal differential diagnostic tool for clinical thinking and reasoning. This framework was used as a scaffold to organize general thinking and reasoning and develop a possible diagnosis for the case problem. However, the role of "V-I-N-D-I-C-A-T-E" in coping with “stuckness” was not a complete success. Students soon missed the key point and got caught in a rigid sequential order, presenting temporizing and avoidance tendency. Further analysis was conducted by tracing one student and the adoption of the conceptual framework. Findings of the Year 4 group demonstrated that students chose different problem-solving strategies from Year 2 group. They went deep into domain-specific areas instead of applying "V-I-N-D-I-C-A-T-E" as the domain-general analytical tool.

Significance
This paper explored the stuck moments of collaboration in solving complex medical problems, revealing the "black box" (Hak & Maguire, 2000) of the group process in PBL. It provided insight into engaging students in facing stuck moments with respect to metacognition, skill improvement and emotional support.

Author

• Ye Liu, University of Hong Kong