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Learning Discourses and the Discourses of Learning

CHAPTER 11

A CASE STUDY OF A MEDICAL PBL TUTORIAL

TUTOR AND STUDENT PARTICIPATION

In the context of the increasing globalisation of Australian medical education and the greater use of PBL (problem-based learning) methods, there is a need to investigate how students and tutors manage their participation in PBL tutorials. This case study examines the oral participation in PBL tutorials of third-year undergraduate medical students at an Australian university by identifying the prescribed PBL curriculum at the Australian university and also examining how the participants apply the prescribed PBL approach in their tutorial. The study selected a PBL group which consists of Australian and overseas students, and employed follow-up interviews as well as recording and observations of the PBL tutorial. The analysis of the oral discourse patterns involved the application of Eggins and Slade’s (1997) speech functional theory which allow us to identify the participation patterns of students and tutor.

INTRODUCTION

Problem-based learning (PBL) approach has been recently introduced in some Australian medical education programs in order to foster students’ decision-making strategies, reasoning skills and self-directed learning skills through small group discussion. The implementation of PBL tutorials as a new part of the curriculum is an interesting pedagogical issue, because the major objectives for medical students in the PBL curricula are different from those of a traditional classroom. For instance, PBL tutors typically play the part of a facilitator for students’ learning, whereas students take on the roles of ‘teacher’ as well as learner through tutorial discussion (Legg 2005). That is, due to the educational differences between the PBL curriculum and the traditional classroom, the participants, including tutors and students, need to understand their roles in PBL situations, as well as what will be appropriate types of contributions for them to make in the interactions.1

However, not all PBL groups can apply the theoretical PBL curriculum which stresses the self-directed learning of students due to some pedagogical problems, such as tutor-dominance or the imbalanced participation among students in a tutorial (Lycke 2002; Hendry et al. 2003). The focus of this chapter is on investigating tutors’ and students’ participation in one PBL tutorial by analysing the actual PBL discourse (Imafuku 2006). The case study reported here uses Eggins and Slade’s (1997) speech functional theory and Christie’s (2000) classroom discourse model which allow identification of the characteristics of the PBL group’s participation. Specifically, this chapter will address two principal research questions to compare the prescribed PBL approach outlined in the guidelines of an Australian university with the actual oral participation of the tutor and students: (1) How the PBL approach is prescribed as a pedagogical method in university documents; and (2) To what extent these principles of the PBL curriculum are then applied by the participants in the tutorial context.

LITERATURE REVIEW

As mentioned above, PBL discourse patterns are significantly different from the discourse in a traditional classroom which has a strong feature of IRF (Initiations-Replies-Feedbacks) discourse pattern, as identified by Sacks et al. (1974). It seems that the different discourse features are related to some differences in the learning objectives and in the roles of participants in the PBL and traditional curricula. In contrast to the purpose of obtaining knowledge from the teacher’s input in a traditional classroom, PBL curricula propose three major objectives for the students: to gain deep clinical knowledge, to foster reasoning skills and to develop self-directed learning skills (Evensen et al. 2001). Many studies have reported that the PBL approach allows medical students to accomplish the three objectives better than in a traditional classroom curriculum (Blumberg and Michael 1992; Koschmann et al. 1997; Frederiksen 1999; Hmelo and Lin 2000).

In addition to the typical objectives of the PBL approach, the roles of PBL participants are overtly different from those in a conventional classroom. A central role of the tutor as a facilitator in a PBL class is to scaffold the student learning (Gelula 1997; Wilke and Burns 2003). Allen and White (2001) specify the tutor roles in relation to content processing, for instance, to use questions to probe the reasoning process and to indicate relevant resources. Furthermore, another role of the PBL tutor is also to monitor and coordinate the group dynamics. For instance, Allen and White (2001: 81) suggest that the facilitating role of the tutor is to encourage all students to participate in a discussion, to help the group to plot its course and to provide feedback.

With regard to student roles in PBL tutorials, students in PBL tutorials basically need to understand the case scenario, identify their lack of knowledge and what needs to be known, specify their learning objectives and analyse the clinical issues through their discussion (Caplow et al. 1997). Renko et al. (2002) stress that assigning the students to different roles, such as a chair (or leader), scribe or discussant, promotes students’ clinical learning in the PBL tutorial because they can obtain peer feedback on the clinical ideas proposed by group members. The chair is to keep the discussion on track and to encourage all students to participate (Allen et al. 2001). It is also important for a scribe or other group members to monitor the process of students’ learning by providing feedback to each other (Renko et al. 2002).

In terms of implementation of the PBL curricula, students and tutors may have some difficulties in adjusting to the PBL approach, including their participation in the tutorials (Duek 2000; Treloar et al. 2000; Hendry et al. 2003; Khoo 2003). Lycke (2002) indicates a dysfunctional PBL group may arise when a tutor dominates the interactions or when some students have insufficient skills to activate their prior knowledge. As for student participation in the tutorial, Hendry et al. (2003) argue that managing the balance between quiet and dominant students is important in a successful tutorial. In order to solve these problems, they stress the importance of understanding students’ learning-style preferences and social identities.

CONCEPTUAL FRAMEWORK

As a means of examining the nature of participation patterns of students and tutors in the PBL tutorial, this study will employ a conceptual framework which is based on an integration of Christie’s (2002) theory of classroom register and Eggins and Slade’s (1997) speech functional theory. Christie (1997, 2002) analysed classroom discourse by following Bernstein’s (1996) notion of the regulative and instructional registers employed by participants. The regulative register is related to the instrumental functions to determine the directions, sequencing and pacing of activity, such as do you have any questions?, listen to me or let’s move on to the next part. On the other hand, the instructional register is concerned with the ‘content’ that builds the substance of the teaching-learning activity (Christie 2002). Following Christie, from a speech functional perspective, the regulative register contains only one type of move – the opening move. On the other hand, the instructional register encompasses a variety of speech functions. With regard to the instructional register, I will apply Eggins and Slade’s (1997) clarifications of the speech functional analysis in order to analyse the tutorial context from a functional-semantic perspective.

Eggins and Slade (1997) regard the move as a unit of discourse organisation in terms of the speech function. As Figure 1 shows, Eggins and Slade classify the criteria of speech functional analysis into three types – opening, continuing, and reacting moves in the instructional register.

Figure 1 Integration of model of the classroom discourse (Christie 2002) and speech functional analysis (Eggins and Slade 1997)

At the first stage of the speech function network, it is necessary to identify a distinction between opening and sustaining moves, shown in Figure 1. The opening moves function to initiate talk through the introduction of a new proposition. On the other hand, the sustaining moves function to continue negotiation of the same proposition. The sustaining move can be classified into two sub-groups. A continuing move is achieved by the speaker who has been holding the floor, whereas a reacting move is achieved by another speaker taking a turn. In other words, this speech functional option is available when turn transfer occurs.

On the basis of the above categorisation, this chapter will focus on the speech function choices of speakers in the PBL tutorials. In other words, the study will examine the general picture of how social relationships between PBL participants are negotiated from a speech functional perspective.

METHODOLOGY

This study selected a PBL group which consists of two overseas (O = overseas student) and four Australian (A) medical students and their tutor (T), who is an Indian-born native speaker of English, and sought the members’ participation in this research. The medical students were in their third-year and were aged between 20 to 22 years of age, and the situation was at a clinical teaching site. With respect of the students in the PBL group, both overseas students are from Malaysia, and three of the Australian students have Asian backgrounds in that their parents are from Asian countries or the students themselves have immigrated to Australia from Asian countries at an early age. Information about the PBL students is shown in Table 1.

Table 1 Background information of the PBL students

The setting of the PBL tutorial which was investigated involved two tutorials which constituted a sequence on the topic of HIV infection. This study will focus on the first tutorial, which lasted for approximately 30 minutes, where the students gain an understanding of the case scenario and identify their learning objectives for the next tutorial. The group did not have anyone fulfilling the chair or scribe roles, as is commonly outlined in descriptions of the educational procedures of PBL tutorial in the tutor handbook, but the participants discussed the clinical topic together.

In this study, three main data collection procedures were used: gathering textual data, video tape-recording the PBL tutorial and stimulated recall (follow-up) interviews. In order to identify the PBL approach prescribed by the Australian university, information was obtained from the tutor’s handbook, a student handbook and the website of the Medical Faculty of this Australian university. The actual PBL participation in the group was explored by analysing the discourse patterns found in the recorded data. Furthermore, interviews with four out of six PBL students (A1, A2, A4 and O1) enabled me to analyse additional in-depth data which is unavailable from the recorded data, such as students’ thinking processes and their evaluations of other participants’ contributions at specific points during the tutorial.

THE MEDICAL PBL APPROACH PRESCRIBED BY THE AUSTRALIAN UNIVERSITY

At this Australian university, the medical curriculum for students in first- and second-year emphasises acquisition of basic medical knowledge (pre-clinical years). On the other hand, the third-year is the first clinical year of teaching and learning, and the curriculum maximises teaching and learning opportunities at the clinical sites based on small group activities, including PBL tutorials (Student Handbook 2005). In other words, in order for students to develop the ability to translate knowledge, which they have developed in their first- and second-years, into practice, the PBL approach is implemented in the clinical contexts. A feature of the PBL approach at this university is that the PBL curricula starts in the third year of the medical course in order to consolidate the student’s basic and clinical science knowledge in the clinical environment.

The Tutor’s Handbook (2005) describes the curriculum of the third-year of the Australian university as being structured around a pattern of two PBL tutorials per week, with a new clinical scenario introduced each week. In the learning process at hospital sites, the Faculty of Medicine (2005) stresses that the PBL curriculum allows students to develop self-directed learning and team-work skills. Furthermore, the 2005 student handbook suggests that the PBL approach emphasises ‘meaning’ (understanding) more than ‘reproduction’ (memorisation).

The student handbook also emphasises that it is important for students to understand the educational process of PBL. The two categories of PBL tutorials – paper-based and patient-based cases – are outlined in the 2005’s tutors’ handbook, with each case involving two tutorials, as mentioned above. In the paper-based PBL, students discuss a sample clinical problem which is provided by the tutor. At the first tutorial of the paper-based case, students firstly gain an understanding of the case scenario, including the context and terminology. Secondly, they arrange the explanations into a tentative solution as well as identify the causes of the medical problem. Learning objectives are also identified through their discussion. At the subsequent tutorial, students share the results of their private study and discuss the solutions to the clinical issue.

In the patient-based PBL, students select patients and examine clinical cases found in their tutorial handbook. This PBL approach is sometimes referred to as ‘case-based learning’ (Student Handbook 2005). The real patient scenario is still a sample, but it is based on a real case and always includes real patients in the learning process. In this kind of PBL, students are required by their tutor to find a real patient in the hospital, similar to the one in the case (as found in the tutorial handbook) as part of their learning for the week. By comparing the ‘real case’ scenario with the result of the clinical examination of real patients which the students have investigated, the learning objectives are identified in the first tutorial. At the subsequent tutorial, as in the paper-based PBL, the students integrate the information gained from their private study and analyse the clinical case.

In terms of the PBL tutors’ role at the Australian university, the Tutor Handbook (2005) outlines the tutor as being required ‘to ensure students’ learning through each tutorial in a logical manner by a step-wise approach’. In particular, this handbook stresses that the PBL tutor needs to have the skills of not just teaching knowledge, but ‘facilitating student learning, promoting critical thinking and promoting effective group functioning’. Furthermore, guidelines on how tutors can facilitate discussion in PBL tutorials are also provided and are shown in Table 2.

This medical faculty describes students in a PBL tutorial as being assigned to three roles: chair, scribe and group members, and these are to be rotated during the semester. The first role is the chair, whose function is to manage the discussion. For example, the chair is described as ‘being responsible for stimulating participation and guiding decisions as the leader’. The second role is the scribe who makes short notes on the discussion. The scribe focuses on summarising what the group members discuss, rather than actually becoming involved in the discussion. The other members, referred to as group members, are required to actively participate in the discussion, for example, by giving information and asking questions (Tutor Handbook 2005). The detailed description of each PBL student role is shown in Table 3.

 

  • Accept silence to make time for students to think;
  • Try to ensure that open-ended questions are used;
  • Ask probing questions: ‘What aspects of the case need to be discussed further?’
  • Elicit student’s reasoning: ‘Why are you asking that question?’
  • Ask students to explain their use of medical terminology;
  • Encourage students to explain mechanisms and causes of patient’s problems and pharmacological and surgical interventions; and,
  • Do not dominate the group.

Table 2 Guidelines for tutors to facilitate group discussion

Table 3 PBL student roles at an Australian university (Tutor Handbook 2005)

On the basis of the objectives of the PBL curriculum, the educational procedures, participants’ roles in the discussion and the discourse patterns in PBL specified by the Australian university are overtly different from those in a traditional classroom. In particular, the pedagogical context of PBL is distinctive in that the tertiary institution emphasises the student’s self-directed learning and the tutor’s role as concentrating on facilitating students’ learning (Student Handbook 2005; Tutor Handbook 2005).

ACTUAL PARTICIPATION IN A PBL TUTORIAL

As an illustration of Duff’s claim (this volume) that language professionals need to better understand actual discursive practices, this chapter provides an illustration of how participants engage in the PBL curriculum outlined by the Australian university, as described above, through an analysis of participants’ oral participation in the PBL tutorial. Following the conceptual frameworks of Eggins and Slade (1997) and Christie (2002), the analysis covers three main issues: the tutor’s and students’ overall participation, the discourse in the regulative register and the discourse in the instructional register.

OVERVIEW OF SPEECH FUNCTION CHOICES

Firstly, this study will identify the dominant and less active participants by looking at the total number of moves which participants took during the PBL tutorial. A ‘move’ is defined as a unit of discourse organisation that a speech functional pattern expresses (Eggins and Slade 1997). That is to say, the participant who takes more moves is seen as a more speech functionally dominant participant in the tutorial.

In terms of the social relationship between the tutor and students, Figure 2 indicates that the tutor is dominant in the tutorial in comparison with the students. A total of 169 moves (49% of the total moves) are taken by the tutor. On the basis of the information in Figure 2, from the perspective of students’ participation, A1 (21%) and A4 (12%) are reasonably dominant and A3 (8%) is somewhat dominant, whereas O1 (3%), O2 (3%) and A2 (4%) can be considered as less active participants in the PBL tutorial. Interestingly, both overseas students (O1 and O2) are categorised as less active students in the PBL tutorial. As Treloar et al. (2000) indicate, the participation of the overseas students might be influenced by some academic factors, such as language difficulties, social communication networks and learning preferences.

Figure 2 Total number of moves in the PBL tutorial

REGULATIVE REGISTER

The regulative register, as mentioned above, contains only one type of move, namely, an opening move which functions to initiate talk through the introduction of a new proposition. In other words, language use in the regulative register is to manage the progress of the classroom activity through employment of a question, statement, offer or command. Figure 3 shows that 10 out of a total of 11 instances of language usage in the regulative registers in the PBL tutorial are taken by the tutor. Even though A4 took one regulative move, it is the tutor who controls the PBL activities.

Figure 3 Opening moves in regulative register

The tutor employs two types of speech functions in the regulative register: statements and questions. Three main functions can be identified for the tutor in the regulative register. The first function is to keep the current activities on track, for instance, ‘Now, take a history. Just with this current scenario’. The second function is to direct the next activity, for example, ‘We’ll move on’. The last function of statements related to the regulative register is to evaluate students’ work, for instance, ‘Good work’. The questions by the tutor function mainly to direct the next activity by asking the students, such as ‘So, what are we going to do now?’

One reason why the tutor dominantly regulates the PBL activities within the context may lie in the fact that this PBL group does not assign the chair role to a group member. Despite the prescription by the university that students should be assigned a chair role in the PBL tutorial, the tutor mostly covers the chair role in this PBL group. Some studies of the PBL approach suggest that allocation of student’s chair role leads to effective PBL processes in terms of students’ clinical learning (Allen et al. 2001; Renko et al. 2002; Savin-Baden and Major 2004; Legg 2005). In particular, Renko et al. (2002) stress that by assigning the students to different roles, including the chair, lack of student participation, cohesion and interaction can be minimised in a PBL tutorial. However, from the students’ perspective, in my case study, the tutor’s regulation of the PBL tutorial is regarded not as a negative factor of the group dynamics, but rather as a helpful direction for their learning. For instance, as Excerpt 1 below shows, A4 noted that having a student as chair did not function well in their earlier PBL tutorials in semester one, and that, on the contrary, when the tutor assumed the role of chair, he would prompt all group members to participate in the discussion. The sequence is as follows:

Excerpt 1

A4:   we did have we try scribe and chair role before, but we found that it didn’t work too well, especially, we change every session. So, all we all contribute and check with the tutor, and then sort of pull altogether and he gives feedback to us, work a lot better.

Furthermore, A1 notices some difficulties in students’ taking the chair role, because students do not know how to deal with the chair role due to insufficient clinical knowledge and experience. A1’s claim can be seen in the following excerpt:

Excerpt 2

R:     what do you think about the tutor’s chair role?

A1:   I think it makes things a lot easier, because it gives us some sort of directions, because it’s difficult for us as very young students to know what’s important about different topics, whereas tutor are more experienced. So, he can sort of give us some sort of framework which is very useful. I found so much better way, I like it.

Therefore, the students in this PBL group perceive the tutor’s chair role not as a dysfunctional factor of the group dynamics, but as an effective way to promote the discussion in the PBL tutorial. For example, as A4 mentioned above, the main usage of the regulative register by the tutor allows all students to concentrate on the discussion in the tutorial. Moreover, as A1 claims above, the tutor can provide an appropriate direction in the PBL tutorial based on his clinical knowledge and experience

INSTRUCTIONAL REGISTER

The instructional register is defined as language usage related to the ‘content’ that builds the substance of the teaching-learning activity (Christie 2002). From a speech functional perspective, the instructional register contains four types of moves: opening, continuing, responding and rejoinder moves. The following sections will focus on an analysis of the features of the opening and reacting moves, including rejoinder moves and responding moves, which were taken by the PBL participants in this study.

Figure 4 Opening moves in the instructional register

In an opening move, to initiate talk with a new proposition, a question, statement, offer or command will be used. Figure 4 shows that the tutor overwhelmingly takes the opening move related to the instructional register in the PBL tutorial.

In his usage of the opening move, the tutor, as Figure 4 indicates, employs many questions, because he tends to elicit detailed information related to the clinical scenario from students by questioning. For example, at the early stage of the tutorial, the tutor used some questions to examine the clinical scenario from different points of view:

Excerpt 3 shows that the tutor allows the students to analyse a patient’s symptom and history in the clinical scenario from various aspects by asking questions about viral infection, rash and meningitis. The tutor’s question to introduce a new proposition can thus help the students’ learning in the PBL tutorial. Furthermore, the tutor’s questions in the opening move may have the function of keeping the discussion on track. By presenting an appropriate point of view to analyse the clinical scenario, the tutor’s question thus helps the students to avoid straying from the main theme.

Most statements made by the tutor in the tutorial are related to giving his opinion about the clinical scenario. Seven out of 10 statements which the tutor made in the PBL tutorial have a role that emphasises the important points of understanding the clinical scenario. That is, the tutor tends to indicate what the students should focus on in the PBL tutorial by giving his opinion. O1 perceives that it is necessary for students to obtain the tutor’s contribution. The sequence is found in Excerpt 4 below:

Excerpt 4

R:     How did you feel about tutor’s contribution today?

O1:   Today? Umm, he summarised a lot of things which are important, because we tend to have a lot of information. If we don’t know whether it is important or not, he gave us a correct direction.

R:     Um, so, were you satisfied with the tutor’s contribution?

O1:   Yes

The opening moves in the PBL tutorial were mostly taken by the tutor. In other words, the fact that the starting point of most new propositions is from the tutor indicates that the topic flow in the discussion is somewhat controlled by the tutor. Specifically, the questions aim to elicit clinical knowledge from the students, and the statement is employed to indicate which information is important in the clinical scenario. With regard to the role of the tutor, as the interview data shows, the students evaluate the tutor’s initiative in the discussion as being instructive for their learning.

A reacting move in a PBL tutorial is found when turn transfer occurs (Eggins and Slade 1997). The speech functions in the reacting move may encompass the demand for further details, the offering of alternative explanations of the prior move, or the indication of supporting or confronting responses. Table 4 indicates the speech functional choices by the participants in the reacting move.

Table 4 Speech functional choices in the reacting move

Firstly, most instances of ‘clarify’ are produced by the tutor while some students (A1, A3 and A4) often use ‘resolve’ in the PBL tutorial. According to Eggins and Slade’s (1997: 213) definition, ‘clarify’ has the discourse purpose of ‘getting additional information needed to understand a prior move’. On the other hand, ‘resolve’ has the discourse purpose of ‘providing clarification or acquiesce with information’. Their speech function choices in the reacting move show the characteristics of the participation of the PBL tutor and students. By using a clarifying move which demands more detailed information about a prior move, the tutor tried to help the students understand the clinical scenario in more depth. In response to the tutor’s clarifying move, the students tried to provide additional information for the prior move through employment of a resolution. Secondly, as Table 4 shows, the students have constantly contributed by using ‘develop’ in the tutorial. A developing move expands on a prior speaker’s move by providing examples or offering further additional information (Eggins and Slade 1997). Here, the students seem to add their previous clinical knowledge to the prior move. Finally, a total of 39 agreeing moves, which indicate support of information given, were produced by the tutor.

Excerpt 5 illustrates the pattern of how the participants used the reacting move. In the situation in Excerpt 5, the students discuss causes of a patient’s symptoms in the clinical scenario which has been introduced by the tutor in the prior move. Firstly, by using a clarifying move, the tutor asks about causes of lymphadenopathy which is one of the patient’s symptoms in the clinical scenario (move 47). In response to the tutor’s clarifying move, A4 uses a resolving move to reply that infection is related to lymphadenopathy (move 51). Then, A1 adds the information about a bacterial cause to A4’s prior contribution (move 52). In the next move, the tutor agrees with the students’ prior interaction. Subsequently, A1 and A4 use developing moves to provide additional information about lymphoma to O1’s prior contribution (move 55 to 57).

As Excerpt 5 indicates, the tutor’s clarifying move tends to prompt students’ participation in the tutorial. Furthermore, as was shown in Figure 6, the tutor frequently used the agreeing move, where he took a speech functional role of giving an evaluation of the students’ participation.

In the instructional register, this PBL tutorial can thus be considered one in which the tutor is dominant. The tutor undertakes more questioning, clarifying and agreeing, whereas the students tend to react to the tutor’s initiation of talk by resolving, answering and developing. In terms of the sequential discourse organisation, the PBL discourse pattern in this study may have a strong feature of IRE (initiations-replies-evaluations) as earlier described by Sacks et al. (1974). Specifically, in the PBL group, initiations (opening move) are taken by the tutor. To reply to the tutor’s initiation, the students tend to make a contribution. Then, the tutor indicates his agreement of the students’ reaction.

The classroom which is characterised by the feature of the IRE discourse pattern is controlled by a teacher who has the initiative within the discourse. As Sinclair and Coulthard (1975) claim, the discourse pattern of IRE can be found in a traditional classroom where the information is mainly exchanged between a teacher and students. That is to say, despite the intention of the PBL curriculum being designed in order to promote student-centred learning skills, in this particular PBL class, discourse that is characteristic of a conventional classroom is found.

FACTORS AFFECTING STUDENTS ACTUAL PARTICIPATION

This study found that the tutor’s and students’ oral participation in the PBL tutorial is different from the PBL approach prescribed by the Australian university. One reason for this may lie in the gap between the actual participation and the curriculum design. Firstly, the fact that the third-year medical students at this university engage in a PBL tutorial for the first time may influence the learning processes in this context. Musal et al. (2004) stress that students’ PBL experiences parallel the development of their discussion and studying processes. In particular, the third-year students may have some difficulties in adjusting to the PBL approach at the hospital site because they are at the transitional stage, moving from book to practical learning. That is, for the students at this stage, it is important to understand the educational processes and purposes of the PBL approach.

Secondly, as Hendry et al. (2003) point out, the students’ learning style in this PBL tutorial may be related to the students’ dependence on the tutor. As Except 6 shows, O1 is inclined to listen carefully to others’ contribution due to his tendency to misunderstand the context in the discussion. In other words, even though O1 does not report any difficulty related to his English proficiency himself, it may be one element affecting his participation in the PBL tutorial:

Excerpt 6

O1:   Ah, I guess some people always tend to talk more than other people. And um, some people don’t mind saying things even if they don’t really understand in all contexts sometimes. Like, for me, I don’t really like to say things, because I tend to, ah, misinterpret sometimes. So, even if I tried to answer things, I might be going off different direction.

Furthermore, in terms of content knowledge, O1 stated that the discussion is only initiated by the tutor due to the students’ insufficient clinical knowledge and that it is important for the students to absorb the basic clinical knowledge from the tutor in the tutorial. In other words, O1 mainly concentrates on gaining the clinical knowledge by listening to the tutor’s input in the PBL tutorial.

In contrast to the quiet student’s perception above, the dominant students are generally happy to talk and to ask questions about what they do not understand in the group. A1 mentioned that it is important to share group members’ ideas in the tutorial in order to analyse the topic from different perspectives. Furthermore, A4 emphasises questioning in the tutorial. In particular, A4 has her own checklist which consists of five objectives (pathogenesis, diagnosis, symptom, treatment and prognosis) to understand the clinical topic in every tutorial. However, the dominant students, who stress the importance of active contribution in the discussion, actually made a lot of resolving, answering and developing speech functions that were prompted by the tutor. That is, the tutor’s contribution itself may have influenced these students’ participation.

Finally, the students’ perception of the tutor’s roles in the PBL tutorial is related to their participation. Although this tutorial tended to be tutor-dominant, which is contrary to the prescribed curriculum which emphasises student self-directed learning in the discussion, most students are satisfied with this tutor’s participation. For instance, as Excerpt 7 indicates, A4 noted that the tutor’s input is helpful because it enables the students to grasp what they should focus on in a clinical topic:

Excerpt 7

R:     At this tutorial, there are a lot of tutor’s inputs. So, what do you think about tutor’s input?

A4:   I think it’s valuable. You really need somebody who directs you. Everyone can do the self-directed learning, but to what extent you really need someone to set (boundary). That’s why we found it very helpful. That’s it. As far as I understand, in other tutorial group there are less inputs from the tutor, and I’m not sure how that works.

An important finding of this study is that the students in the PBL group perceive the tutor’s chair role not as a dysfunctional factor of the group dynamics, but as an effective way to promote the discussion in the PBL tutorial.

Therefore, we can conclude that some factors, such as the students’ experiences of the PBL curriculum, their content knowledge and their perceptions of the tutor’s roles, influence their participation. Despite the PBL curriculum that stresses obtaining clinical knowledge through student discussion, the students are satisfied with their own participation and the tutor’s participation in this tutor-dominated PBL class. Furthermore, most students concur that it is useful for them to have the tutor provide the input of knowledge and to manage the directions of the tutorial. In order to bridge the pedagogical gap between the PBL approach prescribed by this university and the actual participation in the PBL tutorial, reconsidering the PBL participants’ roles as well as the balance between tutor and students’ participation will be needed.

Within students’ participation, this study also found an imbalance of participation among the students. In particular, the overseas students were observed in this study as the less active students in the PBL tutorial. As Treloar et al. (2000) observe, the quiet participation of overseas students involves some academic factors. As mentioned above, differences in the students’ learning styles are related to their participation in the tutorial. Specifically, with regard to PBL students’ participation, O1 stressed receiving the clinical information from others (listening), whereas A1 stressed group members’ contributions in the tutorial (asking question and sharing ideas). In relation to the overseas student’s learning style, English language difficulty may influence O1’s participation in the tutorial because he perceives that he tends to misunderstand others’ contributions. It thus appears that O1 has some learning difficulties in terms of English communication, such as listening to others’ contribution. Furthermore, in Excerpt 8 below, O1 claims that the clinical topic, including a variety of information related to it, is an influential factor on his participation, and he was conscious himself that he was a quiet participant in this particular tutorial.

Excerpt 8

O1:   I think some clinical knowledge are very thorough, so, if you talk about non-clinical things, I tend to (get fuzzy), especially biology. Like, today we had a lot of topics, (epidemiology). So, I was like these like things. I don’t remember any more. So, I was quite rather quiet today.

In Hamilton’s (2005) study looking at student oral participation in a medical tutorial, the informants from Vietnam also mentioned that language skills are not a significant problem in their participation and that the development of content knowledge is a key to promoting the students’ effective participation in the discussion. Furthermore, in Duff et al.’s (2000) research examining the linguistic socialisation of adult immigrants training for professional purposes, it was noted that the program stressed the development of participants’ basic content knowledge in addition to their proficiency in English.

This study found that the student’s learning preferences, misunderstanding of others’ contribution and lack of content knowledge are involved in O1’s participation in the tutorial. The findings in this study that both overseas students are categorised into the less active participants in the PBL tutorial are of note in terms of internationalisation of an Australian medical program, and further study needs to investigate the overseas students’ participation, particularly in a group which consists of Australian and overseas students, in PBL tutorials.

CONCLUDING DISCUSSION

This chapter has examined how the students and tutor apply the principle of the PBL approach specified at an Australian university. The main finding that emerges from this chapter is that there is an educational gap between the PBL curriculum and the actual participation of the tutor and students. In other words, the PBL curriculum stresses fostering student’s self-directed learning and team-work skills, whereas this example of an actual PBL tutorial has a feature of the tutor-dominant classroom, such as the tutor’s chair role and the IRE discourse patterns. However, interestingly, the students concurred that the tutor’s roles in the PBL tutorial were helpful for their clinical learning.

This study suggested that some factors may influence the educational differences between the PBL curriculum and the actual participation in the PBL tutorial, such as students’ perception of the tutor’s role. However, although the tutor might have some comments on his own participation and the PBL tutorial, this study could not analyse the participation in the PBL tutorial from the perspective of the tutor, because the tutor was unavailable to be interviewed.

Although we cannot generalise the findings from this case study, I have shown that there is a gap between the actual PBL participation and the PBL approach prescribed by the institution. For further research, this study suggests that we should investigate to what extent the concepts of students’ chair and scribe roles facilitate students’ learning in the PBL tutorial from the point of view of the curriculum design. This study reveals that although the prescribed model of PBL approach suggests that students be allocated different roles, most group members perceive that the student chair role does not facilitate their learning process in the PBL tutorial. Furthermore, on the basis of the findings in this study that all overseas students are categorised into the less active participants, the participation of overseas students in the PBL tutorial should be investigated. As Treloar et al. (2000) point out, overseas students have some difficulties in participating in PBL tutorials at Australian universities. In Australian medical education programs where a lot of overseas students attend, further research on such issues as the PBL approach may shed light not only on PBL curriculum development, but also on participation of overseas students in PBL tutorials.

ENDNOTE

1     Rintaro Imafuku was a postgraduate student at Monash University at the time of writing this chapter.

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Cite this chapter as: Imafuku, R. 2007. ‘A case study of a medical PBL tutorial: Tutor and student participation’. In Learning Discourses and the Discourses of Learning, edited by Marriott, H; Moore, T; Spencer-Brown, R. Melbourne: Monash University ePress. pp. 11.1 to 11.17.

© Copyright 2007 Rintaro Imafuku
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Learning Discourses and the Discourses of Learning

   by Helen Marriott, Tim Moore and Robyn Spence-Brown