students’ experiences in interdisciplinary problembased learning

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Interdisciplinary Journal of Problem-based Learning

Volume 8 | Issue 2 Article 1

Published online: 3-13-2014

Students’ Experiences in Interdisciplinary Problem- based Learning: A Discourse Analysis of Group

InteractionRintaro ImafukuGifu University , [email protected]

Ryuta KataokaShowa University

Mitsuori MayaharaShowa University

Hisayoshi Suzuki

Showa University

Takuya SaikiGifu University

IJPBL is Published in Open Access Format through the Generous Support of the Teaching Academy at Purdue University , the School of Education at Indiana University , and the Instructional Designand Technology program at the University of Memphis.

is document has been made available through Purdue e-Pubs, a service of the Purdue University Libraries. Please contact [email protected] for

additional information.

Recommended CitationImafuku, R. , Kataoka, R . , Mayahara, M. , Suzuki, H. , & Saiki, T. (2013). Students’ Experiences in Interdisciplinary Problem-basedLearning: A Discourse Analysis of Group Interaction. Interdisciplinary Journal of Problem-based Learning, 8(2).

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October 2014 | Volume 8 | Issue 2

ARTICLE

The Interdisciplinary Journal ofProblem-based Learning

Students’ Experiences in InterdisciplinaryProblem-based Learning:A Discourse Analysis o Group Interaction

Rintaro Imafuku (Gifu University), Ryuta Kataoka (Showa University), Mitsuori Mayahara (Showa University),

Hisayoshi Suzuki (Showa University), and Takuya Saiki (Gifu University)

Interdisciplinary problem-based learning (PBL) aims to provide students with opportunities to develop the necessary skills

to work with different health proessionals in a collaborative manner. Tis discourse study examined the processes o col-lective knowledge construction in Japanese students in the tutorials. Analyses o video-recorded data elicited rom threemultidisciplinary cohorts and their learning portolios provided insights into their participation and introspection duringthe discussions. Te results indicate there were two patterns o knowledge construction: (a) co-constructions between stu-dents rom different disciplines and (b) elaborations between students rom the same discipline. Teir learning processeswere mediated by their cultural assumptions, proessional identities, understanding o other proessionals, and perceptiono collaborative learning. Te finding suggests that interdisciplinary PBL has the potential to enhance students’ collaborativelearning skills, and students’ participation is situated within a cultural context.

Keywords: Interproessional education, health proessional education, social interaction in PBL, reflective learning, class-room discourse analysis

IntroductionTe ocus o this study is on examining undergraduate stu-dents’ participation and reflection on learning experiencesin an interdisciplinary problem-based learning (PBL) tuto-rial in the context o Japanese health proessional education.PBL is a learner-centered approach “that empowers learnersto conduct research, integrate theory and practice, and applyknowledge and skills to develop a viable solution to a definedproblem” (Savery, 2006, 12). Interdisciplinary PBL is part ointerproessional learning to develop mutual proessional re-spect and trust, which is essential in patient-centered prac-

tice. In this PBL, each student needs to take an interactiveapproach to learning in order to construct knowledge amongthe different proessionals. In this sense, social interactionand collaborative learning play an important role in multi-disciplinary group student-centered learning environment.

Although the interdisciplinary PBL was designed to os-ter students’ collaborative and active learning skills, we knowlittle about the process o working together amongst studentsrom different disciplines during the tutorial. In this regard,

Leung (2002) emphasized the importance o obtaining abetter understanding o the complex processes o studentsparticipation in the context o student-centered learningHak and Maguire (2000) also pointed out that evidence romethnographic and discourse research approaches are efficientand rational to exploring inside the PBL process.

A small body o qualitative and discourse research on stu-dent learning in PBL identified the emergence o studentsco-constructed knowledge and their highly interactive dy-namics in tutorial groups (or example, Hmelo-Silver andBarrows, 2008; Koschmann et al., 1997; Visschers-Pleijerset al., 2006; Woodward-Kron and Remedios, 2007). For in

stance, Visschers-Pleijers et al. (2006) ound that in a PBL setting collaborative knowledge construction among studentsoccurred more requently than any one student’s elaborationo knowledge. On the other hand, other studies noted sev-eral pedagogical issues o learners’ participation in PBL, inparticular, in non-Western cultural settings (Imauku, 2012Khoo, 2003; Legg, 2005; Remedios, Clarke, and Hawthorne2008). Khoo (2003) pointed out that the successul appli-cation o the PBL methods in Asian schools was impeded

http://dx.doi.org/10.7771/1541-5015.1388



R. Imafuku, R. Kataoka, M. Mayahara, H. Suzuki, and T. Saiki Students’ Experiences in Interdisciplinary PBL

2 | www.ijpbl.org (ISSN 1541-5015) October 2014 | Volume 8 | Issue 2

due to different cultural practices, such as students’ strongconsciousness o assessment during their perormance andlack o confidence in sharing their opinions. With regard toJapanese communication, Midooka (1990) mentioned thatJapanese appropriate behavior is shaped by contextual ac-tors, including the place, the relative status o members, one’srelationship to those people, and their personality. Tat is,the contextual actors would affect Japanese students’ partici-pation in the PBL tutorial. Te previous studies suggest thatstudents’ learning in PBL is a complex phenomenon, and itseffectiveness varies according to the cultural context.

Tereore, we aimed to examine the process o undergrad-uate students’ collaborative learning in interdisciplinary PBLtutorials at a Japanese medical university. In order to achievethe aim o this study, we developed the ollowing researchquestions:

1. How do Japanese students participate in collabora-tive learning activities by working in a team with both

members rom the same and different disciplines inPBL tutorials?2. What are the perceptions o students on learning in

the interdisciplinary PBL tutorials, and how do theirperceptions relate to their participation?

Tis study closely explored the processes o making a prob-lem map in tutorial session 1 and sharing the results o sel-directed learning in tutorial session 2.

Context of the Study

Te context o the study is a Japanese university (Showa Uni-

versity) that comprises our schools:1. Medicine (M)2. Dentistry (D)3. Pharmaceutical sciences (P)4. Nursing (N), Occupational therapy (O), and Physio-

therapy (P)In the third-year (M, D, and P) and second-year (N, O, andP) undergraduate curriculum, each school has a course obasic patient-centered care. A pedagogical approach o inter-disciplinary PBL has been incorporated into the undergradu-ate curriculum since 2009. Te objectives o the course are toacquire the skill to share and communicate the patient’s in-

ormation with different proessionals as a member o medi-cal team and the skill to present an appropriate treatmentand care plan to address the patient’s social, psychologicaland economical condition.

In relation to the PBL process, tutorial session 1 (1),which lasted 90 minutes, started by presenting a group ostudents with the problems o clinical scenario. Trough thegroup discussions and using prior and current knowledge othe content o the scenario, students identified learning is-

sues. Tey then independently researched the learning issuesoutside the classroom (Sel-Directed Learning). One weekwas allotted to the period o sel-directed learning. In tutoriasession 2 (2), which also lasted 90 minutes, they regroupedto share the results o sel-directed learning and make a careplan or the patient.

Te theme o the scenario was rheumatoid arthritis whichcarried across both tutorial sessions o the three groups inthis study. Te patient in this scenario gave consent to shar-ing the examination results o rheumatoid arthritis or thepurpose o education and research. Figure 1 on the next pageshows the details o the interdisciplinary PBL process in 1with the clinical scenarios and task materials, such as videodata o medical interview, and images o X-ray, condition otongue and articulation. In steps 1–3, students discussed thepatient’s problems based on the inormation presented in thescenarios and shared their prior knowledge with other pro-essional students. In step 4, students worked on a problem

by making a problem map that visualized the relationshipsbetween keywords selected rom the scenario. In step 5, theyidentified knowledge gaps and set learning issues.

In the sel-directed learning step (step 6), students neededto study the learning issues related to both their areas o ex-pertise and non-expertise. For example, a nursing studentstudied ways o taking care o an articular rheumatism pa-tient (expertise) as well as oral care and treatment or thepatient (non-expertise).

Figure 2 below shows the scenario and PBL process in 2which lasted about 90 minutes. Students shared the results oindividual study until all objectives had been covered (step

7). Afer each presentation, they had question-and-answertime to better understand the problems. Te members thenread Scenario 2 and made a care plan or the patient to pre-pare or the group presentation (step 8).

Furthermore, an electronic portolio (e-portolio) wasused to enhance students’ reflective learning skills. As shownin Figures 1 and 2, students needed to submit their individ-ual goals or PBL participation beore 1 and to report theirreflection on learning experiences and their aspiration orthe uture study afer 2.

Research DesignResearch Participants

Beore data collection, the authors explained the purposes othis research to the students. Consequently, there were fivegroups in which all members gave consent to video-recordingo the tutorials out o 36 groups. We then randomly selectedthree o these five groups. able 1 provides details on the par-ticipants, including students and tutors. Tere were eight tonine members per group. Tird-year undergraduate student





were rom the Schools o Medicine, Dentistry, and Pharma-ceutical Sciences, and second-year students rom Schools oNursing, Occupational Terapy, and Physiotherapy.

As a pedagogical approach o PBL has been used in under-graduate education at Showa University, the students have ex-perience in learning collaboratively in a PBL setting. However

Scenario 1B (rheumatoid arthritis)

We (the students) heard about Ms. Takahashi’s case history from her doctor in a conferenceroom. The doctor said, “When Ms. Takahashi was 30 years old, she had joint rheumatism, andsince then she has received oral medicine treatment.” Moreover, the nurse in charge said, “I heardher family has taken care of her daily life, but as the joint pain has been getting severer recently, shecan’t sit up by herself in the morning. It’s hard for her to open mouth and to swallow food due tothe inner oral dry symptom. She spent long time for a meal. She was also worried about a sort ofdull sense of taste and frequent coughs. Her family hopes that she can at least receive a visiting careservice.” We obtained some data for Ms. Takahashi, and decided to discuss what we can do for her

b the next conference.

Image data and medical record, medication history, blood test results etc.

Scenario 1A (rheumatoid arthritis) Yesterday, a student group, which consists of members from the schools of medicine, dentistry,

pharmaceutical sciences and health sciences, visited Ms. Naoko Takahashi, who suffers fromsevere joint pain, with her doctor. This is a practice as a part of interprofessional training in thehospital ward.

Step 1a: Read and understand Scenario 1A, imagesand video data

Step 2a: Select keywords from the scenarioStep 3a: Discuss what students know about each keyword

Image data and video material of medical interview

Step 1b: Read & understand Scenario1B, image data and medical recordetc.Step 2b: Select keywords from the scenarioStep 3b: Discuss what students know about each keyword

Step 4: Make a problem map to understand the problemsfrom a holistic viewpointStep 5: Identify the learning objectivesStep 6: Self-directed learning

E-portfolio: Setting individuals’ goals for participation in the PBL tutorial

Figure 1. Te PBL process (utorial session 1)





it was the first time they shared their expertise with membersrom different disciplines. Beore the interdisciplinary PBL,

they had an two-hour induction class to explain the tutorialprocess and the importance o working with members romdifferent disciplines. Te tutors in three groups had more thanfive years’ experience as PBL acilitators.

Qualitative Research Framework

Ethnography

Various social researches on education, communicationand anthropology have pointed out that ethnography is aneffective strategy or better understanding the complexitieso participants’ activities and discourse in a cultural context.

Ethnography is defined as the “science o cultural descrip-tion” in that a hallmark o this approach lies in an in-depthdescription and understanding o cultural patterns within the

particular contexts (Wolcott, 2008). Te emphasis o ethnog-raphy is on closely looking at culture, which can be “shared

patterns o belies, normative expectations and behavioursand meanings” (McMillan, 2008, 276). In qualitative educa-tional research that was underpinned by the ethnographicramework, classroom and educational events were regardedas socially-organized environments in which the culture isshared amongst the participants. We thus identified a PBLgroup as a culturally organized community.

Case Study Approach

Case study approach has a similar philosophy to ethnog-raphy or investigating phenomena in contexts. Yin (1989p. 23) defines a case study as “an empirical inquiry that

investigates a contemporary phenomenon within its realie context; when the boundaries between phenomenonand context are not clearly evident; and in which multiple

E-portfolio: Reflection on their learning and aspiration for their future study

Scenario 2

Each of members in the student group has studied the problems related to the case of Ms.

Takahashi for a few days, and then took part in the conference for hospital ward. We neededto discuss the treatment and care plan for her as a medical team. Taking her environment into

account, we also needed to discuss what support and advice we can provide in relation to her

life at home after discharging from the hospital.

Step 8: Make a care plan and prepare for case presentation (Group presentation)

Step 7: Share what they studied in self-directed learning (Step 6)

Figure 2. Te PBL process (utorial session 2)

able 1. Research participants.

Group 1 Group 2 Group 3

Name Gender Faculty Name Gender Faculty Name Gender Faculty

M1 Female Medicine M3 Female Medicine M5 Male Medicine

M2 Male Medicine M4 Male Medicine M6 Female Medicine

D1 Male Dentistry D2 Female Dentistry D3 Male Dentistry

P1 Male Pharm. sc. P4 Male Pharm. sc. P7 Female Pharm. Sc.

P2 Female Pharm. sc. P5 Female Pharm. sc. P8 Male Pharm. Sc.

P3 Female Pharm. sc. P6 Female Pharm. sc. P9 Female Pharm. Sc.

O1 FemaleOccupational

Terapy N3 Female Nursing O2 Female

OccupationalTerapy

N1 Female Nursing N4 Female Nursing N5 Female Nursing

N2 Female Nursing P Male Physiotherapy

1 Male Medicine 2 Male Pharm. sc. 3 Male Medicine





sources o evidence are used.” Hence, the research scopeshould be narrowed down to a context so as to make anin-depth analysis o the complex phenomenon (Merriam,1988). Since the ocus o this study is on better understand-ing the interactions between students rom different dis-ciplines and their reflection on learning experiences, theintention o case study approach is entirely consistent withthe objectives o this study.

Classroom Discourse AnalysisDiscourse and culture are important analytical aspects ostudents’ participation in PBL tutorial. Bridges, Whitehill,and McGrath (2012) highlighted that analysis o discoursedata would provide deeper insights into the PBL process. Asa means o examining the students’ problem-solving pro-cesses, we adopted the notion o Initiation–Response–Fol-low-up (IRF) sequence and speech unctions (Eggins andSlade, 1997).

In relation to discourse structure, Sinclair and Coulthard(1975) ound that a basic orm o exchange in classroom situ-ation consists o IRF components. Tat is, the teacher asksa question, the student responds, and the teacher then giveseedback. Although IRF model originally describes the struc-ture o teacher-led discourse, it could provide a ramework todescribe student-centered PBL discourse. In particular, su(1994) argues that the third component o an exchange is es-sential to not only classroom discourse but also daily conver-

sation in that it unctions as acknowledgement o the outcomeo the interaction. Tat is, this notion o three-part exchangecan be applied to the analysis o discourse structure in the con-text o student-centered PBL. In addition, Eggins and Slade(1997) provided a detailed analysis o casual conversations byemploying 45 subclasses o speech unctions. We applied theIRF model and the typology o speech unctions to the contexto PBL, and identified key speech unctions. Te essence oanalytical ramework is provided in able 2.

able 2. Key speech unctions in the PBL tutorial.

Move Speechunction

Description Example (text was translated by theauthors)

Initiation(re-initiation)

Question(Elicitation)

Utterance to elicit an obligatory verbalresponse or its non-verbal surrogate.

What kind o disease is Sjögren syn-drome?

Inormative Utterance to provide inormation, report

event, recount personal experience, orexpress belies, eelings and thoughts.

I thought what I studied was a bit differ-

ent rom your idea about an alternativeplan o giving drugs…

Ask orclarification

Get additional inormation needed tounderstand prior move

Do you know how to make differentialdiagnosis o pneumonia?

Ask orconfirmation

Confirm the speaker’s assumption & veriy inormation heard

Do you mean Sjögren syndrome causesrenal ailure?

Develop Expand on a previous speaker’s contribu-tion by adding urther details

I want to add one more thing. Sjögrensyndrome obstructs the secretion osaliva. Due to this, some decayed teetheasily develop in her mouth.

Response Answer Provide inormation demanded in ques-tion, and indicate acceptance o speaker’sreport as a true representation o events

Sjögren syndrome is a sort o autoim-mune disease…

Agree Indicate support o inormation given Yeah. I agree. I think so.

Clariy Give clarification demanded by ‘asking orclarification’ move

Some books said that i patient has inter-stitial pneumonia, we can see this fibrousstuff in her lung on the roentgenogram

Confirm Give clarification demanded by ‘asking orconfirmation’ move

When you see renal ailure, you have tobe careul o the possibility o Sjögrensyndrome.

Challenge Queries or reuses to accept a actual ac-count o events or states o affairs given bythe speaker. Provide negative response to

the speaker’s evaluative opinion.

We need to think about QOL separately. Idon’t understand the relationship be-tween QOL and anemia on the white-board.

Follow-up Acknowledge Indicate knowledge o inormation given Oh. Yes. I see.





An initiation move unctions to start a talk through the in-troduction o a new proposition. In this study, five subclasseso initiation moves (i.e., question, inormative, ask or clari-fication/confirmation and develop) were used as key speechunctions. A responding move is achieved by another speakertaking the floor, such as to answer and agree. A ollow-up movehas the general unction o acknowledging the outcome o anexchange (sui, 1994). Acknowledgement is a ollow-up moveto indicate members’ understanding o the prior exchange andattitude o active listening, which creates a supportive groupclimate (Imauku, 2013). Tereore, in this study, acknowl-edgement is an important speech unction in the tutorial.

Data Collection Procedures

Video-recordings of PBL Sessions

Tree PBL groups were video-recorded to analyze their actu-al engagement in the discussions. Te duration o recordingo each session was approximately 1.5 hours. Te recorders

were set in the corner o the room in order to minimize anydisruption to participants’ interaction and behavior. In orderto record their conversations as clearly as possible, externalwireless microphones were adhered to the wall beside thetable. We selected the segments o students’ discussions onproblem mapping (step 4) in 1 and sharing the results otheir sel-directed learning (step 7) in 2, because sharingknowledge with students rom different disciplines in thesesteps is essential to solving the problems. Conversationaldata o the tutorial sessions were transcribed and translatedinto English by the first author. Ten, each utterance made bythe participants was given a label o speech unctions.

Collection and Analysis of E-portfolio

In order to analyze students’ introspection, the reflective re-ports on their learning experiences were retrieved rom theweb-based system o the e-portolio. Japanese text data weretranslated into English by the first author and qualitativelyanalyzed by coding and categorizing (Strauss and Corbin

1998). exts rom the portolio were careully reviewed mul-tiple times to inductively generate salient categories relatedto students’ participation. Conceptualizing was the first stepo the analytical process to identiy the concepts representingissues and concerns that emerged rom the texts. An exampleo data analysis process is provided in Figure 3 below.

Figure 3 reviews a nursing student’s reflection report inportolio. First, text data were divided into small units according to the meanings, actions, events or ideas (three unitin Figure 3). Second, each o these small units was labeledwith an interpretive description. Last, the labels were cat-egorized into more abstract conceptual groups, such as im-

portance o proessional identity, obtaining expertise, andnon-expertise. At this stage, peer debriefing was used as atechnique to establish credibility and validity o the dataanalysis. Tat is, the authors worked together on the codingo the data to prevent some critical problems o analysis, suchas misinterpretation o data, vague descriptions o codingand biases made by an author.

Findings

Te first purpose o this study was to examine how studentsrom different disciplines work together and make a care plan

Figure 3. Example o data analysis process

In order to provide bettermedical care, in addition topatient’s feeling and socialbackground, I have tocultivate a better understand-ing of the disease and drug.So, to actively share my ex-pertise in interdisciplinary

PBL, I have to deepen know-ledge in lecture. In practicaltraining, I will try to under-stand the role of nurse as amember of medical team inhospital. Then I want to findout what I can do forpatients.

In order to provide better medical

care, in addition to patient’s feeling

and social background, I have to

cultivate a better understanding of

the disease and drug.

So, to actively share my expertise ininterdisciplinary PBL, I have to

deepen knowledge in lecture.

In practical training, I will try to

understand the role of nurse as a

member of medical team in hospital.

Then I want to find out what I can do

for patients.

Medical & pharmaceutical

knowledge is also necessary for

nurse to give a better medical

care

Her expertise (nursing) shouldbe deepened to share the

knowledge with others

She needs to understand the

role of nurse in medical team to

establish her position as a

professional

Importance of

acquiring

non-expertise

Importance ofdeepening

expertise

Professional

identity

Portfolio (original text) 1. Breaking down

into small units2. Labels 3. Categories





or the patient in the PBL tutorial. We ound that two maininteraction patterns o knowledge construction emergedrom three PBL groups: 1) co-construction o knowledge be-tween students rom different disciplines; and 2) elaborationo knowledge between students rom the same discipline.Specifically, in this section, we will demonstrate how thesedifferent patterns o group interaction emerged by exploringthe processes o making a problem map in 1 (step 4) andsharing the results o sel-directed learning in 2 (step 7).

Making a Problem Map in Tutorial Session 1

We examined how collective knowledge was constructedthrough interaction between the students rom different dis-ciplines in the PBL tutorial. First, the students’ interactions in1 (step 4) were examined. A problem mapping is a graphi-cal tool to promote an understanding o the problems by or-ganizing and relating keywords selected rom the scenario.Te students needed to work on making a problem map to

illustrate the problems in the scenario in step 4 (see Figure1). Actively sharing opinions with different proessional stu-dents is pivotal to making a comprehensive problem map othe articular rheumatism patient.

In Figure 4, different colors o circles, arrows, and linessymbolize the school o a student who made contribution tothe problem map. Medical and pharmaceutical students inGroup 1 were considered the dominant members in the dis-cussions, and other members’ opinions appeared not to be su-ficiently reflected in the mind map. In particular, as Figure 4

shows, an occupational therapy (O) student did not makeany contributions to the discussion.

Furthermore, although the patient was positioned at thecenter o the map, Group 1 tended to ocus much more onknowledge o rheumatoid arthritis during the discussion. Fig-ure 4 shows rheumatoid arthritis has our sub-concepts, suchas a chie complaint, causes, treatment, and symptoms. On theother hand, the patient in Figure 4 is only connected to qualityo lie (QOL) and her background. In particular, QOL doesnot have any sub-concept. Tat is, Figure 4 shows that Group 1did not deeply discuss the problems related to the patients andthe relationships between her QOL and medical care o rheu-matoid arthritis. Excerpt 1 on the next page below providesGroup 1’s discussion o making the problem map.

In Move 1, D1 suggested that the members ocused only ontheir expertise to efficiently make the problem map, and thenM1 agreed with D1. From Move 3 to Move 12, our particu-lar members (M1, M2, P1 and P2) predominantly made con-

tributions to the discussions. Tese our members’ opinionsdirectly influenced the mind map in Group 1, and other mem-bers rarely made responding or ollow-up moves in the discus-sions. For instance, in Move 7, P1 shared an opinion that pharmacotherapy, rehabilitation and operation can be connectedto treatment. However, other members did not respond to P1In particular, O1 and N2 did not make any contributions tothe discussion. Tis implies that consensus-building and in-depth analysis o key concepts were not made adequately be-tween members rom different disciplines in Group 1.

Figure 4. Student contribution to the problem map in Group 1

Ms. Takahashi

(patient)

Rheumatoid arthritis

Background

Symptom

Body

Knee

Hands

Joints

Respiration

organ

A chief

complaint

Treatment

Cause

Hereditarynature

Environmentalfactor

MouthRehabilitation

Mouth

Pharmaco-

therapy

QOL

Daily

life

Financial

condition

Life afterdischarge

from hospital

Operation

MedicineDentistry

Pharma.

Nursing

OT, PT





On the other hand, the members in Groups 2 and 3 triedto clariy the relationships between the patient and medicalcare by sharing their opinions with the different proession-als. In Figure 5 each Group 3 student’s proessional schoolin Group 3 is represented by different colors. (See Appendixor Group 2’s problem map.) Opinions rom members romdifferent disciplines were reflected to the mind map. In par-

ticular, dentistry, occupational therapy, and nursing studentswere more actively involved in the discussions than had beenin Group 1.

Te members in Group 3 tried to illustrate the complexrelationships between rheumatoid arthritis and the pa-tient’s QOL. Figure 5 shows that rheumatoid arthritis andQOL are connected to all key concepts. Excerpt 2 depictsan instance o the process o making the problem map inGroup 3.

In Move 1, M5 mentioned that rheumatoid arthritis can beanalyzed separately rom QOL. However, in Move 2, D3 madea challenging move to give another perspective that QOL canbe connected with all key concepts. D3’s contribution prompt-ed members’ participation and made them ocus on the prob-lems o their patient rather than rheumatoid arthritis itselAs a result, QOL was connected to “joint pain” and “house-

work” by M5 (Move 3), “pharmacotherapy” by P8 (Move 5)and “the oral cavity” by M6 (Move 12). Moreover, in Move 13D3 confirmed that all key concepts were related to QOL, andhe shared his opinion that the medical care was conducted tosecure and improve the patient’s QOL. D3’s opinion was ac-knowledged by all members in Move 14. Tereore, Excerpt 2demonstrates that the members in Group 3 could more clearlyrealize the importance o patient-centered medicine throughdiscussion with students rom different disciplines.

Excerpt 1. Processes o making the problem map in Group 1

No. Japanese English translated by the first author ypes o move*

1 D1 なんか領域ごとにやったらいいんじゃない？学部ごとで。最初に関節リウマチっておいて、そっか

ら口の人、薬の人、看護の人で

How about separately working on the mind map? Accordingto each specialty, hmm, I think rheumatoid arthritis is thecore theme. Ten, dental students add something related tomouth, the pharmaceutical student thinks about medication,

and nursing thinks about care service.

I: Inormative

2 M1 そのほうがスムーズにでそうな気がする。それでやってきますか

Yeah, I think we can efficiently make the map in this way. Res: Agree

3 P2 まずは大きなところから Firstly, what is the core theme? I: Elicitation

4 M2 真ん中に関節リウマチってどんって書いちゃえば

I think we can write rheumatoid arthritis at the center o thewhiteboard.

Res: Answer

5 M1 まとめてかいちゃえば、症状と治療と

We can relate symptom and treatment all together [to rheu-matoid arthritis].

I: Inormative

6 N1 自分が言ってる、主訴みたいな

I think a chie complaint connects [to the theme]. I: Inormative

7 P1 あの、治療のとこに薬物治療とか、リハビリとか、手術とか

I think we can put pharmacotherapy, rehabilitation, and op-eration in treatment.

I: Inormative

8 P2 症状と主訴ってつながらないかな

Symptom and a chie complaint can be related together. I: Inormative

9 M2 治療ってなにやるの？ What is treatment [or rheumatoid arthritis]? I: Elicitation

10 M1 リウマチって手術するのかな

Is operation necessary or rheumatoid arthritis? I: Elicitation

11 M2 なんか関節とかはずれち

ゃってとか

I think when the joint dislocated [it will be needed]. Res: Answer

12 M1 あーたしかに。じゃあそこには手術がいるね

Oh, I see. So, we need “operation” on our map. F: Acknowledge

*I-Initiation, Res-Response, F-Follow-up move





Excerpt 2. Processes o making the problem map in Group 3

No. Japanese English translated by the first author ypes o move*

1 M5 とりあえずQOL以外を関節リウマチと結びつけて

First o all, we can relate rheumatoid arthritis to allgroups except “QOL.”

I: Inormative

2 D3 でも全部QOLに結びつきそう、ははは

But, it seems all can connect to QOL, hahaha. Res: Challenge

3 M5 ひざ、関節痛とかによって、あのう、家事が困難みたいなかんじで、なんかQOLに。あと、起き上がれないとかもそうだよね

“Knee and joint pain,” hmm, seem to cause difficultyin housework. So, they can be related to QOL. And,also “difficulty in sitting up in the morning.”

I: Inormative

4 O2 QOLにつないじゃっていい I agree that both o them can connect to QOL. Res: Agree

5 P8 薬物療法とQOLもつながらない？

I think, pharmacotherapy also relates to QOL, doesn’tit?

I: Inormative

6 P9 うん Yeah . . . Res: Agree

7 副作用とかもあるから . . . it includes side effects RI: Develop

8 D3 全部QOLにつなげちゃっていいI think, eventually all can be related to QOL. I: Inormative

9 N5 うん、うん。たしかに全部つながるかもしれない

Yes, yes, all may connect to it. Res: Agree

10 M5 うん Yeah. Res: Agree

11 P8 うん Yeah. Res: Agree

12 M6 あと、口とかも、しゃべりづらかったら…

In addition, I think oral cavity also [relates to QOL]. Ithe patient has difficulty in speaking . . .

RI: Develop

13 D3 QOLを守るためのものだもん All are or securing and improving the patient’s QOL. RI: Develop

14 All うん Yeah. F: Acknowledge


Other

symptomsPharmacotherapy

Difficulty insitting up inthe morning

Knee &

joint pain

Anemia

Losing

weight

Findings of theoral cavity

Side-effect Directionsfor use

Dosage

Financialcondition

Visiting careservice

Difficulty in

housework

Luxation oflong finger

Inner oral drysymptom TMJ

syndrome

Radiocarpal

fusion

Ulnar

deviation

Relationshipwith family

Quality of Life

Rheumatoid

arthritis

Medicine

Dentistry

Pharma. Sc.

Nursing

OT, PT

Figure 5. Students’ contribution to the problem map in Group 3





Sharing the Results of Students’ Self-directedLearning in Tutorial 2

In addition to students’ learning in 1, we explored the pro-cess o students’ sharing what they studied (step 7) in 2Based on the ramework o classroom discourse (see able2), we categorized students’ reciprocal utterances made in

step 7 into five main groups:• question (to members rom different disciplines)• question (to members rom the same discipline)• answer or develop• ask or confirmation or clarification• agree or acknowledge.

able 3, which provides the statistical data o their verbal par-ticipation, indicates that the students in Groups 2 and 3 morerequently perormed (1) question between the different pro-essional students, (2) develop, and (3) ask or clarification. Onthe other hand, students in Group 1 tended to do (1) question

and answer between the same proessional students.In order to visualize the state o their group dynamicsFigure 6 was generated to indicate each student’s requen-cy o verbal participation and member-to-member inter-action. Te size o the circles in Figure 6 represents thenumber o utterances by each member and the thicknesso the lines displays the requency o member-to-member verbal interaction. Te different types o speech unctionsare symbolized with different colors and patterns o the line(Lee and Lee, 2009).

Figure 6 shows relatively poorer interaction between thestudents in Group 1 than other groups. Only M2 made con-

tributions to the discussion actively, whereas D1, N1, and O1did not make any contributions to the discussions in the tu-torial. Moreover, in Group 1, interactions between the sameproessional students, such as between M1 and M2 and be-tween P2 and P3 (see red lines in Figure 6) occurred morecommonly than discussions between students rom differendisciplines. Tus, only certain members were involved instep 7 o the tutorial, and they tended to elaborate each solu-tion between students rom the same discipline rather thansharing clinical inormation and collaboratively producingthe care plan with others.

Excerpt 3 gives an example that an alternative plan o

giving drugs or the patient was discussed only betweentwo pharmaceutical students in Group 1. In Move 4, P2asked P3 about the pharmaceutical eatures o leflunomideResponding to P2’s question, P3 shared actual inormationthat it is an anti-rheumatic drug which can be used insteado Methotrexate. Moreover, in Move 6, P2 asked or clari-fication to P3 about a way o giving leflunomide to a rheu-matic patient. However, P3 also did not know the way oadministration in Move 7. Tus, P2 and P3 could identiy

T a

b l e 3 . A c t u a l n u m b e r o f m o v e s m a d e b y t h e s t u d e n t s .

G r o u p 1

G r o u p 2

G r o u p 3

M 1

M 2 D

1

P 1

P 2

P 3

N 1

N 2

O 1

T o - t a l

M 3

M 4

D 2

P 4

P 5

P 6

N 3

N 4

P T

T o -

t a l

M 5

M 6

D 3

P 7

P 8

P 9

N 5

O 2

T o -

t a l

Q u e s t i o n t o

m e m b e r f r o m

d i ff e r e n t d i s c i -

p l i n e s

0

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Q u e s t i o n t o

m e m b e r f r o m

s a m e d i s c i p l i n e

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v e l o p

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A s k f o r c o n fi r -

m a t i o n / c l a r i fi -

c a t i o n

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A g r e e / a c k n o w l -

e d g e

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7 8





Figure 6. Each member’s verbal participation and group dynamics in 2

M2

O1

P3 P2P1

M1

D1

N1

N2

P6

M4

P5

P4

N3

N4

D2

PT

M3

O2

P8

D3

P9

N5

M5M6

P7

Question (to members from different disciplines)

Question (to members from the same discipline)

Answer/Develop

Ask for confirmation/ clarification

Agree/ Acknowledge

Excerpt 3. Elaboration between students rom the same discipline in Group 1

No. Japanese English translated by the first author ypes o Move

1 P3 なんか若干ちがったよね、代替案 ((P2と))と思っ

て。

I thought what I studied was a little bit different rom

your presentation about an alternative plan o the

medication.

I: Inormative

2 P2 うん。たしかに Yeah, that’s right. Res: Agree

3 P3 なんかその違いは私はシェーングレンをからめて考えるのを忘れてしまっていて

Te difference might come rom the act that I orgot

to take Sjögren syndrome into account.

Continue

4 P2 それはわたしも考えるのを忘れてたけど、メトト

レキサートからレフルノミドって、レフルノミド

ってどういう系統の薬でしたっけ?

I also orgot it. I related Methotrexate to leflunomide.

Which line o medicine is leflunomide?

I: Question

5 P3 えっと種類、系統は一緒で ((資料参照)) えっと

ね。抗リウマチ薬ってやつだ。疾患修飾性抗リウ

マチ薬のなかに入ってるやつで、一応推奨度はA

で、メトトレキサートが効かなくなった場合の代

替薬としては挙げられているかんじかな

Hmm, it is the same kind, line as Methotrexate [reer-

ring to resources]. Hmm, it is an antirheumatic drug,

which is categorized into disease modiying antirheu-

matic drugs. Te level o recommendation is ‘A.’ So,

when Methotrexate does not work, it can be used as

an alternative medication.

Res: Answer

6 P2 たぶんおなじのを参考資料で使ってると思うんだけど、これはどうなんだろう。生物学的製剤の併

用っていうのは考えられるのか、これ単独で使う

のか、それとも生物学的製剤を併用するのか、そ

れともあっちを単独で使うのかっていうのが

Probably, we used the same resource or this learningobjective. Hmm, Biological drug. Can it [leflunomide]

be used with biological drug? Or should it be used

separately rom others?

RI: Ask orclarification

7 P3 そうだね。よくわからないね。 Yeah, I don’t know, either. Res: Withhold

8 P2 だからこれも調べた方がよさそう。 So, we need to study more about it. F: Acknowledge


Group 1 Group 2

Group 3





their knowledge gap with regard to leflunomide. In Excerpt

3, the pharmaceutical students elaborated on a way o giv-ing appropriate drugs to the rheumatic patient. However,the content discussed between them was not shared suffi-ciently with others who were outside the field o pharma-ceutical sciences. As a result, the members had no optionbut to remain quiet during “the specialist talk.”

As compared with Group 1, Figure 6 shows that studentsin Groups 2 and 3 could more collaboratively discuss withtheir members. However, the difference between the active

participants (M4, P4, P5, and P6) and the others (M3, D2

N3, N4, and P) was larger in Group 2. In particular, N4remained quiet and was isolated rom others. On the otherhand, although three members were seen as relatively qui-et participants, more than hal o the students in Group 3could make contributions actively to the discussions. Fur-thermore, interactions among different proessionals oc-curred more requently in Group 3. Excerpt 4 provides anexample o the discussions on the diagnosis o pneumoniabetween the different proessionals in Group 3. In Move 1

Excerpt 4. Co-construction between students rom different disciplines in Group 3

No. Japanese English translated by the first author ype o move

1 D3 この患者さんは、肺炎っていうのは確定？ Can we confirm that this patient has pneumonia? I: Question

2 M6 確定とは言えない、言えなくはないんだけ

ど。要するに、なんだっけなあ。さっきの

薬。((資料を探す))

We can’t say it definitely, hmm, it may be. Tat is, what’s the

name o medicine we discussed just beore?

Res: Answer

3 O2 薬によって、たぶん間質性肺炎が Medicine used or the patient, probably, was related to the

symptom o interstitial pneumonia.

RI: Develop

4 M6 そうそう Yes, yes. Res: Agree

5 薬剤による間質性肺炎を起こしている可能

性がある

Tere is some possibility that medicine causes interstitial

pneumonia.

Continue

6 O2 ((うなづく)) 可能性がある [nodding] Yes, there’s a possibility. F: Acknowledge

7 P8 可能性があるの？ Is there a possibility [o interstitial pneumonia]? RI: Ask or clarifica-

tion

8 M6 可能性が高いね。だって使ってる薬がなん

ていったっけ。((資料参照))

It’s high possibility, because, hmm, what’s the name o medi-

cine we just discussed?

Res: clariy

9 P8 肺炎とは書いてないの？ Doesn’t the scenario say ‘pneumonia’? RI: Ask or clarifica-

tion

10 D3 肺炎ってどうやって確定するの？ How do we confirm i the patient has got pneumonia? RI: Ask or clarifica-

tion

11 O2 なんかこの、繊維状のものが肺の中にあら

われるのが間質性肺炎みたいなかんじのこ

とを、書いてあって

Hmm, some books said that i patient has interstitial

pneumonia, we can see this fibrous stuff in her lung on the

roentgenogram.

Res: Clariy ((contin-

ued to 13))

12 M6 ((うなづく)) [nodding] Res: Agree

13 O2 今回それがこのＸ線のなかにもみれるので Tis time, I can see the fibrous stuff on this roentgenogram ((Response: Clariy))

14 D3 あ [全体的にこれが Oh, overall, this is . . . F: Acknowledge

15 M6 うん [全体的にこれが真っ白になってるのが

Yes, this turned white overall. RI: Develop

16 O2 白いのが繊維状になってる。

[ほんとは写らないはず。

We can see white fiber stuff. I the patient had no problem, it

would not appear on it.

RI: Develop

17 D3 [はい、わかりました OK, I get it. F: Acknowledge

18 じゃあ、これが間質性肺炎で薬剤性じゃな

いかってこと？

So, you mean this interstitial pneumonia is drug-induced? RI: Ask or confir-

mation

19 O2 はい Yes, I do. Res: Confirm

20 D3 はい、わかりました。 OK F: Acknowledge






D3 asked about the deerential diagnosis o pneumonia inthe case o rheumatic patient. Responding to D3’s initia-tion move, in Moves 2 through 6, M6 and O2 pointed outthe possibility o interstitial pneumonia caused by druguse. In Moves 9 and 10, P8 and D3 tried to urther seek orevidence o the possibility o pneumonia. O2 and M6 col-laboratively answered members’ inquiries by mentioningthe presentation o white “fibrous stuff in her lungs on theroentgenogram” (Moves 11 to 16). At the end o Excerpt 4,the members in Group 3 could reach a shared understand-ing o the rheumatic patient who has great possibility o thedrug-induced interstitial pneumonia.

In Group 3, more members appeared to be interested inthe learning objectives related to their non-expertise in ad-dition to their expertise. For instance, although a learningobjective was about the diagnosis o pneumonia, dentistry,pharmaceutical, and occupational therapy students wereactively involved in the discussion. Consequently, they

could conclude that the rheumatic patient has the possibil-ity o drug-induced pneumonia based on inormation romthe roentgenogram. Tereore, more members in Group3 were able to actively participate in the discussions andshare inormation necessary to interdisciplinary approachto health care.

Discussion

We examined the students’ reflection, responses to and per-ceptions o their experiences in the interdisciplinary PBL.From the data analysis o students’ e-portolios, several so-

cial and cultural actors affecting the group interactionsemerged. In this section, students’ perceptions o the learn-ing environment, difficulties encountered in PBL, and pro-essional identity are discussed.

Perceptions of Learning Environmentand Social Relationships

Students’ understanding o other proessionals, perceptionso collaborative learning, and interpersonal relationshipsin the PBL group positively affected their participation inGroups 2 and 3’s tutorials. For instance, in their e-portolios,compared with students in Group 1, more students elt that

working with the different proessional members provided anew perspective or the patient care. Medical and pharma-ceutical students have tended to only ocus on knowledge odisease itsel. However, as Excerpts 5 and 6 show, throughinteracting with nursing and occupational therapy students,they realized the importance o taking the patient’s social andemotional conditions into account when they made a careplan, and the medical and pharmaceutical students sharedinormation between the different proessional members.

Excerpt 5

P6: Trough interaction with nursing and occupationaltherapy students, I could make a more practical careplan which took the patient’s eelings and lie into ac-count. Moreover, I think this PBL gave me really valu-able experience in that I could be aware o the impor-

tance o understanding the problems o the patientrom a broader point o view. (Group 2)

Excerpt 6

M5: In PBL which I experienced in the School o Medi-cine, I’ve ocused only on an appropriate diagnosis andtreatment. Tis time, the scenario describes the pa-tient’s situation in detail, and by knowing viewpoints onursing and physiotherapy students, I could examinethe best care plan or the patient in the line with hercircumstance. . . . Tis experience allows me to under-stand the importance o an interdisciplinary approachto health care and sharing knowledge among the differ-ent proessionals. (Group 3)

Furthermore, as shown in Excerpt 7, M4 became awarethat an attentive listening attitude, including acceptance oand respect or members’ different opinions, was essential ingroup work to create a supportive group atmosphere and tomake a comprehensive care plan or the patient.

Excerpt 7

M4: In this PBL, I realized the importance o acceptingand understanding others’ different opinions rom mine.

And such attentive listening will make a riendly groupatmosphere. By doing so, when a member expresses anopposing opinion, it is possible to urther analyze a topicrom a new perspective. I think i we all take such a sup-portive attitude, we can propose a more comprehensivecare plan which is suitable or a patient. (Group 2)

Many members in Groups 2 and 3 commented that it wasimportant to acquire effective communication and collab-orative working skills or patient-centered care.

Difficulties Encountered in PBL Participation

Students in Group 1 expressed difficulties and points orimprovement o their participation more than positive per-ceptions o their learning experiences in the interdisciplin-ary PBL. For example, Excerpt 8 indicates that P2 could noelucidate pharmaceutical terminology to other membersand she did not sufficiently share the discussion between thesame proessionals as with others. Tis reflection came romher experience o interactions with P1 in relation to lefluno-mide (see Excerpt 3).





Excerpt 8

P2: We could propose specific ways o treatment anddrugs or the patient, but we have to improve clini-cal reasoning and sharing o inormation among allmembers. In particular, I was a member o pharma-ceutical sciences who made a plan o drugs or the

treatment o a rheumatic patient, but I couldn’t givean explanation o drugs to others who are not phar-maceutical students. I should have shared the inor-mation, but it’s hard or me to explain it intelligibly toothers. (Group 1)

Moreover, M2, as expressed in Excerpt 9, elt it was di-ficult to adapt to the new learning environment in whichstudents rom the different disciplines work together in agroup. Specifically, he could not actively make contributionsto the discussions on the contents o other disciplines, andsometimes remained quiet. However, M2 was able to express

his aspirations or uture learning based on his experiencewith difficulties that he encountered in the PBL. Tat is, hisattitude toward collaborative learning has changed throughexperience o learning in the PBL tutorial.

Excerpt 9

M2: As I got used to discussing a case o disease onlyamong medical students, it is difficult or me to activelyparticipate in the discussion o topics which are outsidemy field. I couldn’t sweep away a sort o uncomortableeeling o working with different proessionals duringthe PBL. However, afer the PBL, I realized the impor-

tance o active and collaborative participation to makea better care plan. (Group 1)

In addition to explaining expertise to the members, weound that sociocultural actors affected their participation.For instance, the students rom schools o nursing, occupa-tional therapy and Physical therapy elt it difficult to com-municate with the senior students (that is, M, D, and P). Ex-cerpts 10 and 11 show that N1 and N2 hesitated to share theiropinions with the senior members.

Excerpt 10

N1: I tensed up and was somewhat reluctant to dis-

cuss with the senior members. I worried i my opinionwould disturb the group discussion. Tat’s why I some-times became quiet on purpose, but I know this is not agood idea. (Group 1)

Excerpt 11

N2: I hesitated to ask about what I don’t know and sharewhat I thought with other members. I couldn’t activelycommunicate with third-year members. I could just ex-

press my opinion when the senior members turn thefloor over to me. (Group 1)

In general, the number o moves made by nursing, occu-pational therapy and physical therapy students was less thanothers (see able 3). Tese students tended to be quiet andelt it difficult to actively participate in the discussion with

the senior students. Furthermore, as Excerpt 10 indicatessome students prioritized collective learning activity over in-dividual perormance during the group discussion. Tat isthey sometimes rerained rom commenting on purpose soas not to disturb the flow o discussion.

Development of Professional Identity

Proessional identity involves ways o being and relating inproessional contexts (Goldie, 2012). Interestingly, in addition to Groups 2 and 3, analysis o e-portolio data indicatethat students in Group 1 also appeared to develop their pro-essional identity and realized the importance o an interdis-

ciplinary approach to health care through participation inthe PBL tutorial. For instance, Excerpt 12 shows that O1 emphasizes collaboration among team members with a strongsense o responsibility as an occupational therapist.

Excerpt 12

O1: In this PBL, I realized the importance o not sepa-rating medical proessionals’ responsibilities but col-laboration among team members or patient care. Iwant to make a care plan which considers patient’s lieand background with a responsibility o an occupation-al therapist (Group 1)

Furthermore, as Excerpt 13 below shows, M2 couldconsider deeply what a doctor can do or the patient andlearned that collaborative working skills with other healthproessionals were pivotal to giving comprehensive healthcare services.

Excerpt 13

M2: Trough the PBL tutorial, I really elt that what adoctor can do or a patient is a tiny contribution. I haveto think more about what I can do as a doctor in healthcare site, and I realize the importance o effective com-

munication among other medical proessionals to provide comprehensive health services (Group 1)

Tereore, although students’ verbal interactions amongmembers rom different disciplines in Group 1 were rela-tively poorer than other groups, they could clariy their im-provements as to their PBL participation through reflectionon their experience o the discussions. Excerpts 12 and 13indicate that through working and interacting with membersrom different proessional backgrounds, their proessiona





identities were somewhat developed and their attitudes to-ward learning were changed.

Conclusions

Summary of the Findings

Tis is one o the first studies examining students’ discursivepractice and reflection on their learning in an interdisciplin-ary PBL in Japan. Although there were different interactionpatterns among the three groups, such as co-constructionbetween the different proessionals and elaboration betweenthe same proessionals, this PBL provided the students withan opportunity to understand that effective communicationand collaborative work between the different proessionals isessential to the patient-centered care. According to the anal-ysis o their e-portolios, through active interactions betweenthe different proessionals, students in Groups 2 and 3 devel-

oped their proessional identities. Although the students inGroup 1 could not share the inormation related to their fieldsufficiently with others, their reflection on what they couldnot do in the PBL led to having their aspirations or uturelearning in group study and clinical clerkship. Tat is, theirexperiences o participation in this interdisciplinary PBL andreflective activity have affected their attitudes toward learn-ing and ormation o proessional identities. Te summary othe findings are provided as below:

• Elaboration on knowledge between students rom thesame discipline and co-constructions o knowledgebetween students rom different disciplines emerged

in three PBL groups.• Some students elt it difficult to clearly explain exper-

tise to the other members and communicate with thesenior members.

• Group atmosphere, students’ cultural assumptions,and supportive attitude toward different opinions a-ected their participation.

• Trough the PBL, students realized the importanceo patient-centered practice and interdisciplinary ap-proaches to health care (in particular, effective com-munication among different proessionals),

• Trough working with others, students discovered

different approaches to patient care; and• Students better understood their health occupation

and develop the proessional identities.

Implications for Practice of PBL

Situated Participation

With regard to Japanese communication, Midooka (1990)observes that one’s appropriate behavior in a certain con-

text is shaped by contextual actors, including the place, therelative status o members, one’s relationship to those peopleand their personality. In order to speciy one’s socially ap-propriate behavior in the group, the participant needs toobtain more situational inormation, including who is whowho is good at what, who knows what, and who is easy orhard to get along with (Wenger, 1998). Te findings o thisstudy support the view that the students’ participation in thetutorials was situated in a context o PBL group. We oundthat group atmosphere, interpersonal relationships withmembers, and their cultural assumptions influenced theirparticipation in the PBL tutorials. Many students in Group1 elt it difficult to work collaboratively with members romdifferent disciplines due to their cultural assumptions andsituational actors. As Excerpt 10 shows, N1 tended to remain quiet and adjust her behavior to social expectation othe group. Her ear o making mistakes was not the majoractor in her reticence. Rather, the importance she attached

to the collective sel was evidenced by her anxiety that hercontribution might disrupt the group atmosphere and theflow o members’ discussions. On the other hand, we also observed that members in Groups 2 and 3 actively shared theiropinions to make a comprehensive care plan or the patientFor instance, M4 mentioned in Excerpt 7 that members’ sup-portive attitudes toward others acilitated her participationand learning. Tereore, stereotyping Japanese students areticent and dependent learners in a tutorial setting does notreflect the actual learning processes. Culture shapes the indi- vidual’s interpretation o appropriate behavior in the sociacontext o PBL tutorial (Imauku, 2013). utors thus need to

note that their participation is situated in a certain culturalcontext in order to acilitate students’ learning.

Listening to Learn and Learning to Listen

Moreover, as recognized by M4 in Excerpt 7, listening tolearn and learning to listen are important skills in the PBLtutorials. Te participants perceived that active listening waclosely linked with maintaining group harmony and mak-ing a supportive group atmosphere in a situation o interper-sonal communication. Analysis o students’ portolio thusindicates that an active listening skill is necessary not only toobtain a better understanding o inormation given by speak-

ers but also to create a supportive and respectul group atmosphere. Tat is, it has social as well as cognitive unctions ininterpersonal communication. o date, students’ active sel-expression and (co-)construction o knowledge through dis-cussions have tended to be given more attention in the stud-ies o students’ engagement in PBL tutorials. Tere was a riskthat learning through listening was regarded as verbal dis-engagement and less important behavior than making ver-bal contributions to the discussions (Remedios, Clarke, and





Hawthorne, 2008). Jin (2012) argues that silence is not onlya verbal disengagement, but importantly also a collaborativepractice and a platorm o handling conflict (183). Te find-ings indicate that active listening is one type o engagementthat includes non-verbal behavior (such as nodding, eyecontact, and acial expression) and verbal responses (such asagreement or acknowledge and asking or confirmation orclarification). As the students’ introspection also indicates,active listening is central to interpersonal communication ina Japanese cultural context, and it is also essential to healthproessional-patient communication (Kurtz, Silverman, andDraper, 2005), or an interdisciplinary approach to medicalcare in which students will be involved in the uture. Tere-ore, an understanding o different roles o silence is neces-sary or PBL acilitation. Both verbal contributions and ac-tive listening are the key skills or meaningul participationin the student-centred context o health proessional educa-tion (Remedios, Clarke, and Hawthorne, 2008).

Reflective Learning

Goldie (2012) stated that reflection is an important dynamico personality change in terms o ormation o proessionalidentity. Reflecting on how they respond to new context canlead to change and to become a member in the community opractice (Lave and Wenger, 1991). In this regard, the e-port-olio played an essential role in students’ learning processin this study, because it provided them with an opportunityto realize the importance o collaboration between differentproessionals (see Excerpt 12) and to understand the roles otheir own occupation in a health care site (see Excerpt 13).

Although we ound that students’ experiences in the inter-disciplinary PBL were varied, their proessional identitiescould be developed through reflection on their learning pro-cesses. In order to examine multiple perspectives o identityormation, a portolio requires more interactional context(Monrouxe, 2009). Te provision o eedback can be neces-sary or acilitating their reflection and proessional identi-ties, and the process o their reflection should work throughinteraction with acilitators or peers.

Implications for Future Research

Te PBL tutorials are regarded as places that students can

gain a better understanding o the nature o an interdisci-plinary approach to health care and their own health occupa-tion through interactions with members rom different dis-ciplines (see Excerpts 5, 6, 12, and 13). Te implications othis research are that this PBL ormat has the potential to en-hance students’ collaborative learning skills and proessionalidentities. Teir participation is situated in a cultural context.

Te results were not generalizable due to the small num-ber o participants and quite short length o the implemen-

tation compared with common PBL practice. However, thefindings provided insights into students’ participation andintrospection during the discussions. For urther researchit is worthwhile to conduct semi-structured interviews withstudents and tutors to make more in-depth exploration othe PBL pedagogical approach, including tutors’ conceptionso teaching, students’ conceptions o learning, cultural as-sumptions and process o proessional identity ormation.

References

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Rintaro Imafuku is an assistant proessor in the Medical Edu-cation Development Center, Giu University. He received hisMA in Applied Linguistics rom Monash University, and his

PhD in Education rom the University o Hong Kong. Cur-rently, he is involved in PBL acilitation and medical interviewtraining in undergraduate education in Japan. His main re-search interests are students’ participation and interactions ina learner-centered context, ormation o proessional identi-ties, health communication and interproessional educationAddress: Medical Education Development Center, Giu Uni versity, 1-1 Yanagido, Giu-shi, Giu, 501-1194, Japan.

Ryuta Kataoka is a proessor in the Department o Dental Edu-cation, School o Dentistry, Showa University. He is in charge oundergraduate dental education and interdisciplinary education

among the schools o dentistry, medicine, pharmaceutical sci-ences and nursing and rehabilitation. He is doing clinical activi-ties in the area o oral medicine. His main research interests arestudents’ critical thinking, group dynamics o PBL and e-porto-lio. He is also in charge o the Program or Promoting Inter-Uni versity Collaborative Education entitled “Educating dentists whoare able to work in the super-aged society utilizing IC” o theMinistry o Education, Culture, Sports, Science & echnologyin Japan. Address: School o Dentistry, Showa University, 1-5-8Hatanodai, Shinagawa-ku, okyo, 142-8555, Japan.

Mitsuori Mayahara is an assistant proessor in the Depart-

ment o Dental Education, School o Dentistry, Showa Uni- versity, where he has been since 2008. He gained his DDSand PhD rom Showa University in 2000 and 2004 respec-tively. He was involved in education and research in the De-partment o Oral Histology at Showa University rom 2004to 2008. His main research interests are dental education, in-terproessional education and e-learning. Address: School oDentistry, Showa University, 1-5-8 Hatanodai, Shinagawa-kuokyo, 142-8555, Japan.




18 | www ijpbl org (ISSN 1541-5015) October 2014 | Volume 8 | Issue 2

Hisayoshi Suzuki is an associate proessor in the Departmento Occupational Terapy, Showa University, where he has beensince 2006. He received his MEd rom okyo Gakugei Univer-sity in 2000, and his PhD in Medical Science rom Showa Uni- versity in 2005. His main research interests are occupationaltherapy education, health proessional education and inter-proessional education. Address: Department o OccupationalTerapy, Showa University, 1865 okaichibacho, Midori-ku,Yokohama-shi, Kanagawa, 226-8555, Japan.

Appendix

Students’ contribution to the problem map (step 4) in Group 2.

Takuya Saiki is an assistant proessor in the Medical Edu-cation Development Center, Giu Univeristy. His currentwork mainly ocuses on researching in the fields o MedicalEducation and General Medicine, and he is also involved inundergraduate education such as medical interview trainingand delivering nationwide aculty development programsin medical education or Japanese health proessionals. Ad-dress: Medical Education Development Center, Giu Univer-sity, 1-1 Yanagido, Giu-shi, Giu, 501-1194, Japan.

Pharma.

Medicine

Dentistry

Nursing

OT, PT

50 years oldfemale

Ms. Takahashi

(patient)

Rheumatoidarthritis

Difficulty inhousework

Visitingcare service

Difficulty insitting up inthe morning

Inner oral drysymptom

Difficulty inswallowing food

Narrow extent ofopening mouth

Skinnyfigure

Coughs

Sense oftaste

Mother’s

history

Do not want

hospitalization

Swelling

in Parotid

Sjögrensyndrome

Steroid

NSAID

Loxoprofen Unemployment(husband)

students’ experiences in interdisciplinary problembased learning

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