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Aug. 2014. Vol. 5, No.4 ISSN 2305-1493 International Journal of Scientific Knowledge

Computing and Information Technology

© 2012 - 2014 IJSK & K.A.J. All rights reserved www.ijsk.org

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DEVELOPING A MOBILE PROBLEM-BASED LEARNING

SYSTEM：A PRELIMINARY STUDY

1 Li-Chun Tang, MS, RN,

2Zu-Chun Lin, PhD, RN,

3Szu-Ying Lai MS, RN

1, 3Lecturer, Department of Nursing, Tzu-Chi College of Technology, Hualien, Taiwan

PhD Student, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan 2Assoc. Prof., Department of Nursing; Dean, Office of Research and Development, Hualien, Taiwan

E-mail: [email protected]; [email protected]

ABSTRACT

Most of the teaching methods used in problem-based learning utilize text and pictures to illustrate

problems. The majority of the feedback and evaluation is based on the traditional pen-and-paper

observations of teachers/tutors. These methods may not generate the best possible results in assisting and

evaluating learning. Problem-based learning combined with mobile technology allows students to learn

and problem solving in a more organized, conceptualized, interactive, and prompted manner. Mobile

problem based learning is a new technology with great application potential across many educational

faculties; this system focuses on nursing education. Nursing education and training is a great expense to

both student and institution. With the advent of the latest technology it is possible to reduce the cost while

improving the learning outcome. For self-motivated learners, the opportunity to improve and enhance

practical skills, critical thinking, and problem solving, becomes accessible anywhere and anytime. The

design process and participants feedbacks are examined in this study. System modifications will be based

on the current feedback for future mobile problem-based system updates.

Keywords: problem-based learning; critical thinking; problem solving; assisted learning system; mobile

technology

1. INTRODUCTION

The purpose of nursing education is to

cultivate nursing staff who are capable of

independent thinking. They must be competent in

the collection, integration, and analysis of data to

correctly determine the health conditions of an

individual to provide an instantaneous, safe,

effective, and cost-effective nursing care, as well as

be able to conform to the changing health care

environment.1,2

Traditional teacher centered face-

to-face teaching methods can rapidly introduce new

ideas, impart knowledge, and resolve doubts.

However, due to time limitations, this teaching

method can easily become a “cramming” style of

education, with insufficient training in critical

thinking. As a result, students may become

incapable of exerting professional judgment and

autonomous thinking when facing variable clinical

working conditions after graduation. 3

In recent years, the Objective Structured

Clinical Examination (OSCE) have been introduced

into teaching and evaluation in medical and nursing

education programs. The Objective Structured

Clinical Examination (OSCE) is a performance-

based evaluation. The main objective of the OSCE

is to assess students’ capability of transferring

classroom and laboratory learning experiences into

simulated clinical practice. 4 The words spoken and

the responses of standardized patients in OSCE can

affect the performance of the students, which may

determine whether or not the students pass or fail

the evaluation. Therefore, the standardized patients

to be more effective should be professional in the

field of medical and nursing. Standardized patients

provide students with a safe channel for learning,

evaluation, feedback and allow for repeated

practice. Training a standardized patient who

conforms to theOSCE is costly, and requires large

amounts of time and effort. In addition, a

standardized patient can be used repeatedly, but

because of geographical constraints, a standardized

patient cannot be used concurrently or in large

numbers. In addition to standardized patients,

computer-simulated instruction is also used to train

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students’ clinical practice. Based on their

functionalities, computer-assisted teaching is

classified into low fidelity (i.e. simulated

dialogues), moderate fidelity (i.e. simulated training

for intubation skills) with incorporated sound

effects, and high fidelity (i.e. using SimMan and

HPS dummies that provide personified expressions,

sensations, and responses).5,6

Human patient

simulators provides an innovative teaching method

for nursing students, they are quite costly. To

investigate the value and need of this expenditure,

A compartaive study was done to examine two

educational interventions: human patient simulators

and interactive case studies. Students in the human

patient simulation group scored significantly higher

than did those in the interactive case study group.

However, no significant difference was found in

student scores betwwen two teaching methods.7

Simulated instruction is not widely applied because

of its time-consuming nature, expensive, equipment

and location constraints, and the lack of technical

support.6 Due to the limitations of conventional

teaching, standardized patients and simulation,

mobile problem-based learning system (mPBL) was

developed to offer a lower cost but timely, context-

oriented, interactive training and learning tool.

PBL was proposed by Dewey, it emphasizes

the importance of initiative, observation, and

imagination for knowledge construction. PBL was

first applied in medical education at McMaster

University, Canada, and subsequently applied to

education in other professions.8 PBL is a student-

centered teaching model which stresses the

significance of motivation and personal

responsibility for learning. PBL allows students to

participate in active learning, to improve their

communication ability, critical thinking, analytical

thinking, creative thinking and problem-solving

skills in diverse learning environment.9

Numerous studies have indicated that

traditional school education systems are narrow

and dissociated from real life. Most knowledge

learned from school has become “inert

knowledge.” This so-called inert knowledge is

knowledge that one has clearly memorized but is

unable to apply.10

In the past, the design and

application of computer-assisted instructional

software lacked situational context. Consequently,

learners were unable to effectively apply the

knowledge and skills acquired to real life

situations. Situational learning stresses the

authenticity of learning activities to cultivate

thinking and problem solving abilities of students.

Jonassen (1998) proposed the concept of

“mindtools”, which emphasizes the incorporation

of computer environments and software

developed with the intention to stimulate critical

thinking and creativity in learners while

reinforcing extended retention and applicability of

knowledge.11

With the development of mobile

communication systems and wireless networks,

people can obtain information from any virtually

location. They can communicate with their

teachers, peers, or others who have similar interests

through wireless mobile communication systems

(i.e. Bluetooth, and wireless local area networks)

and mobile learning devices (i.e. smart phones and

tablet PCs).12,13

The invention of mobile learning

devices allows for more convenient information

searching, rapid integration and application of

information. The critical thinking and problem-

solving skills of student have improved

correspondingly. The rapid technological

development in computers, the Internet, and mobile

learning devices has revolutionized traditional

teaching and learning methods. Combining the

aforementioned properties with PBL offers great

opportunity in the application of innovative

instruction in nursing education. The application

intends to : 1) enhance mobile learning option, 2)

improve access to nursing education materials, 3)

reduce cost of OSCE and simulation in professional

training, 4) encourage the use of current technology

in the educational setting, and 5) enhance human-

computer interface while improving student clinical

skills.

2. PURPOSE:

The aim of this study is to examine the

design and use of a mobile problem-based learning

(mPBL) system. Results of this preliminary finding

will be used for system refine and references used

in other relevant research and designs.

3. LITERATURE REVIEW:

3.1 Problem-Based Learning

In 1968, McMaster University Medical

School in Canada became the first to use the PBL

teaching philosophy to educate its medical students.

Since then, PBL has been widely applied across

various professions.1 PBL is based on 1) real life

context problem, 2) the learning content is

structured around the problem, 3) cooperative, 4)

students assume responsibility for learning, and 5)

teachers act to guide and facilitate learning. 1,14





3

Similarly, Ekhaml ( 2001) & Dochy, Segers,

Bossche, & Gijbel (2003) mentioned that PBL

involves the following actions: 1) the group

identifies the topics of study, 2) time is allotted for

information collection, 3) information is discussed,

deliberated, and applied to solve the problem in a

practical manner, 4) reflection and consensus takes

place within the working group, and 5) group

evaluation of their own performance.15,16

In PBL,

ill-structured and true-to-life problems are used as

the starting points. Students work as a team to solve

the problems through collecting and analyzing

pertinent information applying the knowledge

learned, and integrating newfound knowledge.1,2

PBL is self-directed learning (SDL) with learners in

charge of the process. Learners choose the topics

they wish to study, the channels of information

search, and the methods of solving problems.

Therefore, the roles of the students are as thinkers,

knowledge creators, and evaluators of their learning

outcomes. The roles of teachers are those of

creators, designers, guides, facilitators, supporters,

and evaluators of the learning environment.1 The

‘problem’ in PBL can be used to denote any

situation that stimulates thinking in the learner, in

contrast to the passive transmission of knowledge

in the conventional lecture. 17

PBL facilitates the

integration of theory and practice. It improves

learner attitudes with respect to their responsibility

for learning on their own and trains them in

problem-solving skills.18

The students who

participated in PBL had better positive learning

attitudes and increased knowledge as compared to

students of traditional teaching styles.19, 20

Applying PBL in nursing administration courses

has improved the cognitive integration of students

and their capacities for team coordination.21

Additionally, students who participated in PBL

programs performed significantly better at critical

thinking and comprehension abilities, than students

who were taught using conventional teaching

styles. Their attitudes for true exploration and self-

confidence in critical thinking were also

increased.22, 23

3.2 Mobile Technology in Learning

The Industrial Development Bureau, Ministry

of Economic Affairs (2010) in Taiwan has

suggested that the era of mobile learning has

arrived. Two major technologies have had an

impact on future learning environments: wireless

and broadband technologies and mobile devices. 24

With the development of wireless networks and

broadband, students are able to acquire learning

materials and instruction, and to share content with

their peers. Popular mobile devices, such as smart

phones, PDAs, and tablet PCs, make learning more

convenient, efficient, and interactive. With the rich

development in information technology, real life

situations can be easily incorporated into teaching

materials available to students by integrating

computers, multimedia , and mobile devices. The

cognitive ability of learners has become more

flexible and comprehensive due to the abundance of

audiovisual programs, and the up to date

information.25

A growing trend in online

knowledge synthesis, where students, domain

experts and community enthusiasts meet to discuss

issues and share experiences expedites knowledge

generation.26

Computer situational learning creates

a safe environment for students to make technical

and nontechnical professional preparations before

entering clinical practicum without risking patients'

life.27,28

Mobile devices are being used in medical and

nursing care and clinical education at an increasing

rate. They are rarely used in school education.

Mobile computing increases the degree of work

freedom for community nurses. It acts to facilitate

connections with colleagues or supervisors, and to

provide a more efficient and patient-centered health

care model.29

The impact of the mobile

technologies on barriers to research utilization,

perceived quality of care, and on nurses’

satisfaction was examine. Results indicated that

mobile information technologies increase the access

to resources, reduced the barriers to research

utilization, therefore increase quality of care.30

4. METHODOLOGY

4.1 Materials and System Design

A gastroesophagel reflux disease (GERD)

case was used in this system because it requires

critical judgment to determine the problem and

care. GERD is common but easy to misdiagnose in

adults because its symptoms are similar to gastritis.

GERD is hard to detect in children, since children

cannot describe what they feel and indicators must

be observed. GERD requires medical treatment,

lifestyle change, or surgical treatment. Without

appropriate diagnosis and treatment, GERD may

lead to Barrett's esophagus, a precursor condition

for carcinoma.

The six principles of instructional design

proposed by Jih & Chang (2001) were incorporated

Right Margin

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into the system, to enhance learners’ motivation

and to improve practical application. The six

principles include; 1) encourage participation, 2)

simplify segmentation, 3) highlight approaches, 4)

use key features, 5) control setbacks, and 6) provide

demonstrations.34

Using virtual clinical cases,

multimedia and animation etc. was used to motivate

participation. The case context was segmented into

4 scenes, a method to simplify segmentation, which

was sequentially displayed to focus learners’

attention. Highlight principles was incorporated

into the system by providing the rules (e.g. external

website resources, objective of each scene) of the

system before practicing. Various key features were

applied to enhance learning, including, key

information selection, website resources, tutors,

leaders, concept maps, and texts for reflection.

Given the consideration of control setbacks,

questions were presented in each scene for the

learners to reflect upon. If learners could not

complete the questions, the system leader initiated

the discussion, and the system tutor encouraged the

learners to rethink, and guided them through their

difficulties. Additionally, learners were encouraged

to write down their strengths and weaknesses and

that which they have learned in the final feedback

section. In terms of providing demonstrations, the

system tutor provided positive feedback, tips, and

corrections where appropriate, based on the

responses of the learners. The system was

developed with Client/Server architecture to

establish the website interface. The teaching

materials were developed using Photoshop and

Illustrator. Animated teaching materials were

created with Adobe Flash CS4 and Adobe

Captivate 4. Written interactive teaching materials

were developed with Action Script 2 and integrated

using the ASPX.net website program language with

SQL database. Figure 1 shows the algorithm of the

system, Figure 2-4 are the snapshots of the

program.

4.2 Procedures and Instruments

Twelve participants who previously had

completed face-to-face PBL were recruited to test

the program. They were divided into three groups

(4 people / group), with one Tablet PC per group.

They used Tablet PC to test the system in different

study rooms at the same time. Each participant

completed open-ended questions as follows:

1. What is your opinion of the hardware and

software (monitor size, touch panel, and

weight), feasibility, flexibility of use, and the

Internet connection of this mobile learning

system?

2. What is your opinion on the interface design,

function, and ease of use of this mobile

learning system?

3. What is your opinion on the data search

option, critical thinking and problem-solving

abilities training, group interaction, and

learning objectives in line with the PBL

curriculum of this mobile learning system?

4. To what degree are you willing to use this

mobile learning system in the future?

5. RESULT

5.1 Demographics

In regard to the age of the twelve participants, 1

was 20 years old (8.3 %), 10 were 21 years old

(83.4 %), and 1 was 22 years old (8.3 %.)As for the

computer usage experience, 1 student (8.3%) had

been using the Internet for 3.1 to 6 years; 6 (50.0%)

had been going online for 6.1 to 9 years; 1 (8.3%)

had been using the web for 9.1 to 12 years; and 4

(33.4%) had over 12 years of experience using the

Internet. Eight students (66.7%) owned mobile

devices, and 4 (33.3%) did not. Eleven students

(91.7%) had used mobile devices to go online and 1

(8.3%) had not. 7 students (58.3%) had used mobile

devices for learning whereas 5 (41.7%) had not.

5.2 Feedback

In response to the opinions on hardware and

software, and network connectivity, etc., most

participants agreed that tablets PCs were

convenient due to portability. However, the

monitors were too small, touch panels were

insensitive, unable to zoom in or out, the keyboards

were too small for typing, and the network was

unstable. Further the speed of the system tutors and

leaders narration were too slow. By contrast the

narration of the contextual videos was too fast.

Finally the font size was too small. As for the

perceived ease of use, the participants thought well

of the interface design and its ease of use, but the

font and clicking boxes were too small. The

participants felt that the content was exceptional;

consequently, the time for discussion and reflection

lead to greater knowledge acquisition. Regarding

perceived usefulness of the system, the participants

indicated that the system hyperlinks linked to

empirical and evidence-based websites which

provided useful data. However, most of the

information provided was written in English, and

they had a hard time to read the information due to

language barrier. In addition to using the system in

group practice, it can also be used for self





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motivated learning. They mentioned that the system

was helpful for learning; however, it would better

conform with the spirit of PBL if the system tutor

and the leader were able to respond corresponding

to the questions proposed by the participants. In

addition, selecting crucial factors by checking

options from a list may restrict critical thinking.

This is a weakness in the system design, however,

text frames are provided for reflection prior to the

determination of care management. The participants

were neutral in terms of using the system.

Participants who were willing to use the system

gave the following reasons for their favorable

evaluation: 1) portability, 2) interactive multimedia

platform increased interest and concentration, 3)

improved knowledge recall, and 4) the system

could provide self directed practice for enhancing

problem-solving abilities. Participants who were

unwilling to use the system stated their concerns

over the insensitivity of the touch panels, which

resulted in excess time spent on drawing the

concept map. Many students were unable to afford

the new technology required to access the mPBL

system.

6. DISCUSSION

The participants felt that the Tablet PCs made

learning more flexible. However, some hardware

issues made them impractical for group exercises.

Providing each person with their own mobile

device could overcome the difficulties inherently

involved in the sharing of one small monitor among

many people. Additionally, a weak network signal

reduced the speed of page loading on the Tablet

PCs. This study used ASUS Eee PCs with a 10-inch

1280 x 800 WXGA LCD touch screen. The AUSU

Eee PC weighed only 680 g, but the touch panel

was not as sensitive as that of an iPad, and it did not

have a zoom function for images or text.

Furthermore, the wireless network coverage area at

the study site was small and unstable. The findings

of this study from the aspects of the monitor size,

font, and network connection speed were consistent

with those of previous studies.35-38

Mobile learning

is a growing trend; the adequacy and functionality

of the hardware and software is crucial to the

successful implementation of mobile learning

applications. In addition, the establishment of

wireless campuses, communities, and cities are an

urgent matter.

For perceived ease of use, the interface

design is intuitive. The interface also provides

functions for real-time data search and group

discussion. However, the limited selection of

symptomatic options limits the level of critical

thinking. The participants responded that too much

text was required in the group discussion and

reflection portion of the learning module. Due to

the insensitivity of the touch panels and the small

monitor size this use of the reflection portion in the

module was found to be excessively time

consuming.

Regarding perceived usefulness, the

participants found that the system increased their

motivation to learn at all times, and was a helpful a

learning tool. The learning effect can be maximized

if the interaction and the depth and scope of the

database can be extended. The mPBL system

utilizes tutors, leaders, text input for reflection,

concept maps, and student module feedback. The

mPBL is significantly different from ePBL, which

focuses on choosing a single correct answer and

clicking accordingly. The interactivity of current

mPBL system was unlike conventional PBL. To

overcome this problem, a more intelligent system

with a more complex decision tree database needs

to be compiled. Although the mPBL algorithm did

not have a complex decision-making tree, it

remains extremely useful as it can save student

work, upload, and print the responses with concept

maps. Teachers can the nurse this information to

better understand students’ decision making

process, and to discuss related issues with them.

Participants with a self directed learning

motivation found that the mPBL system provides

opportunities for group interaction, self-directed

learning, and training for critical thinking. This

finding is in accordance with the study of Shi

(2005)39

and Yang, Kuo, Yang, Yu & Chen

(2009).17

Using an ePBL approach not only

prepared users to think critically, but also gave

them the opportunity to work collaboratively in

dealing with real world situations.

7. CONCLUSION

Nursing educators especially value practical

clinical care training as it allows students to apply

theoretical knowledge to real-life situations. This

type of learning is effective; however, the balance

between the learning needs of the students and the

safety of the patients must be addressed. Therefore,

nursing educators are challenged with providing

practical and effective instructional methods and

learning opportunities for students. Problem-based

learning is the bridge to connect learners with real

life situations and enhance learners’ critical





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thinking skills. Mobile technology can support PBL

in various ways.

This design paper is an exploration into the

development of a mPBL system. Initial feedback

suggests that students will benefit from mPBL if

the system is accessible, convenient, low cost, easy

to operate, real life context and, highly interactive,.

Appropriate modifications to the system will be

based on the suggestions of the participants. The

modified system will be used as an intervention

tool to compare students’ self-directed, critical

thinking, problem-solving and group interaction

learning outcomes with traditional face-to-face

PBL. It will be further tested using different mobile

devices for user acceptance level.

Acknowledgment: This study was funded by

National Science Council (99-2511-S-277-001),

Taiwan. The authors thank the participants who

contributed their useful insights to this study.

Conflicts of Interest: This research received

research funding offered by National Science

Council, Taiwan. There is no any commercial

source which is related directly or indirectly to the

scientific work which is reported in the manuscript.

Moreover, neither the authors, nor any members of

the authors’ family, nor any individual or entity

with whom or with which we have a significant

relationship has a financial interest in the subject

matter discussed in the manuscript.

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preliminary study. The J of Health Sci. 2011;13

(2): 114-123.

38. Irinoye O, Ayandiran EO, Fakunle I, Mtshali N.

Nurses’ Perception and Barriers to Use of

Information Communication Technology in a

Teaching Hospital in Nigeria. Comput, Inform,

Nurs. 2013; 31 (8): 351-355.

39. Shih BY. The Research of Acceptance Model

of Mobile Learning of College Students of

Computer and Non-computer Majors. J of

National Pingtung University of Edu. 2005; 23:

31-63.


http://itriexpress.blogspot.com/2011/03/blog-post_6240.html

http://itriexpress.blogspot.com/2011/03/blog-post_6240.html

http://sprouts.aisnet.org/785/1/TAMReview.pdf.%20Accessed%20September%2020

http://sprouts.aisnet.org/785/1/TAMReview.pdf.%20Accessed%20September%2020




8

Figure 1: Algorithm of the mPBL system





9

Figure 2: Case introduction

Scene 1: Case introduction Proceed

mPBL system





10

Figure 3: Physical assessment and lab data

Physical assessment, Chest X-Ray, EKG,

GI test, Lab data

External resources

System tutor: After an initial physical assessment with his physician

and a nurse, he is sent for blood testing and other examinations





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Figure 4: Select content information and reflection

System tutor: Please select key information and write down your

thoughts in the blanks





12

Figure 5: Upload concept map

System leader: Let’s integrate the

information we have collected and

uploaded in the concept map

Review group work for scene 2

Upload concept

map here





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Figure 6: Group discussion and reflection.

Tutor: We now know more about Mr. Wang’s condition.

Let’s reflect on the following issues

What is the

relationship

between

ulcers and

GERD?

What is the relationship

between Barrett’s esophagus

and GERD?

What are the differences

between GERD and

NERD?

External references


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