Project-Based Learning Guidelines for Health Sciences Students: An Analysis with Data Mining and Qualitative Techniques

Characteristics of the project-based learning methodology
Nowadays, professionals in various sectors face numerous (technical, sociopolitical, and economic) challenges arising from globalization in a variety of spheres, such as the environment¹. These issues influence the global spread of diseases, thus diminishing resources, increasing poverty, and necessitating the responsibility to create sustainable societies¹. Health experts have the potential and the skills to ensure the viability of communities by advancing care strategies and techniques on a large scale while contributing to the improvement of people's quality of life². The United Nations has highlighted the need to address these challenges with the active participation of all countries in its Sustainable Development Goals (SDGs) ¹. Health professionals' activities can be linked to many of the proposed goals. Therefore, those who train healthcare students must acquire pedagogical approaches that help students to gain the competencies that will allow them to face these new challenges^1,2.

Among the various existing pedagogical methodologies, project-based learning (PBL)³ stands out as a methodology that helps students develop the competencies they will need to safely and effectively deal with the future challenges of their professions³. PBL is an innovative pedagogical approach that overcomes the limitations of traditional methodologies by transforming the teaching-learning process to make students the protagonists of their own learning. This change helps students acquire problem-solving skills in real-life contexts⁴. PBL is based on the teacher producing research questions⁵ that are included in practical scenarios related to the discipline. The students have to solve the problems in collaborative groups. The final objective is the acquisition of knowledge (conceptual, procedural, and attitudinal) through group work in the resolution of the task or problem⁶.

This approach originated in the fields of education and constructivist psychology, and from those beginnings, it has been adapted to different disciplines⁶. However, implementing this methodology can be affected by a lack of educational resources and infrastructure, and because of this, a hybrid model is sometimes used that combines traditional teaching with PBL^7,8. However, these models have exhibited limitations in the learning experience¹. For this reason, it is important to develop pedagogical protocols that guide and facilitate the use and interpretation of these methodologies. In addition, in recent years, the PBL methodology has been implemented through virtual learning platforms – Learning Management Systems (LMS)⁹ - in what is called Online Project-Based Learning (OPBL)¹⁰.

Project-based learning methodology for university students in the health sciences field
The protocol is important for helping teachers to apply these methodologies and interpret the results arising from the teaching and learning process⁹. The protocol can be used from the beginning of schooling to higher education and can be tailored to different mental, physical, and socioeconomic conditions¹¹. The presented protocol focuses on working with university students in the health sciences. The teaching model is based on organizing learning around projects prepared by the teacher, who serves as an initial stimulus, and from this framework, the student becomes the main focus of their own learning¹¹. The approach is an active, comprehensive, and constructive way for students to acquire basic competencies (conceptual, procedural, and attitudinal) that are closely related to their future professional practice^4,12.

Learning methods are combined to stimulate the acquisition of cognitive and metacognitive competencies related to conceptual and procedural knowledge^4,13,14, all of which contribute to students developing critical thinking, increased motivation toward learning, and autonomy in decision-making and problem-solving¹³. However, one of the keys to the successful application of this methodology is that the projects the teacher prepares must be directly related to real practice, and the students must be given autonomy in how they approach the problems based on minimum initial guidelines^4,9. This means that the teachers need to clearly define the tools for evaluating the students' competencies and to give them guidance about the evaluation criteria that will be used to shape the PBL, as well as to assess how well the evaluation is done^15,16. Furthermore, students benefit from collaborating with their peers to learn to argue and be assertive through debate, thus developing communication and teamwork skills^4,16.

The main aim for university students is to "learn to learn" by dealing with the challenges the teacher sets to facilitate the acquisition of these competencies¹⁴ (which will later be implemented in the future working lives of the students). The results of using this methodology indicate that it encourages autonomy in learning and solving practical problems⁴. An added advantage of this methodology is that it is very effective in helping students acquire competencies, specifically in health sciences, in online teaching and blended-Learning (b-Learning)^17,18,19. This has become especially important due to the COVID-19 pandemic^20,21.

The common elements of PBL can be summed up as follows: (1) first, the concepts related to the project are explained to the students (in online teaching environments, flipped learning experiences can be used); (2) the project plan is defined and analyzed; (3) a review of the supporting theory is carried out, and a plan is drawn up to help understand the object of study; (4) objectives and questions are proposed for addressing the problem; (5) possible solutions are formulated, and the most viable options are evaluated; (6) these solutions are implemented; (7) the results are reported; (8) critical reflection is conducted, feedback is provided, and the process is evaluated, including suggesting new questions; and (9) the process is finished by presenting the work^4,6,13.

It should also be kept in mind that not all students respond in the same way to this type of methodology. Students who are more actively involved in their learning, those who are more critical thinkers, and those who have better interpersonal relationship skills tend to achieve better results²². It is also possible that students who are used to traditional learning methodologies may feel frustrated. This is why students should be given clear working rules and a timetable for the implementation of the project phases from the beginning⁸. As noted above, PBL has been widely used within health sciences degrees, and there is extensive evidence supporting it in the literature^18,23,24. However, some aspects that could be improved have been identified, which are related to clinical skills seminars and the dissemination of experience in the scientific community^25,26.

This methodology seems to have better results for degrees with a higher proportion of internships (for example, nursing vs. medicine, occupational therapy versus psychology or nutrition)³. In addition, recent studies have suggested implementing PBL methodology through joint training projects between different degrees to work on interaction in real contexts. The objective would be the acquisition of multidisciplinary and interdisciplinary competencies^27,28. However, to implement this type of methodology well, the teaching staff must be qualified to implement it, and the students must develop critical and divergent thinking with respect to clinical practice, especially in the case of health sciences^3,15,18,29.

Another important aspect of the implementation is the need to evaluate student satisfaction with the PBL methodology training and analyze their ideas for improvement^19,30,31. More specifically, it has been reported that occupational therapy students have found this methodology essential for their learning as it allows them to learn how to solve similar problems to those they will face in their professional lives, which enhances their motivation³¹. Similarly, a longitudinal study that began in 1993-in which a hybrid model of PBL was evaluated in occupational therapy students-demonstrated that the students had very positive opinions of group learning for their future professional practice⁷. Another study on occupational therapy students found a high degree of satisfaction with the methodology. This is because students think that this way of learning helps them acquire knowledge through practice and enables them to respond appropriately in their future work¹³.

In summary, using the PBL methodology in health sciences courses is key to students' acquisition of professional competencies. Various studies have indicated the steps to follow to prioritize the interventions and the design of the materials to achieve effective, satisfactory learning. Therefore, it is very important to monitor students' learning processes to detect early or potential problems with learning and address them. Educational Data Mining (EDM) and mixed-methods analysis techniques should be used for monitoring, the essential fundamentals of which are discussed below.

Educational Data Mining techniques
When LMSs are used in either e-Learning or b-Learning teaching models, a series of logs or log files are generated that capture each of the student and teacher interactions. These logs are evidence of the learning behaviors and can be analyzed using EDM or Learning Analytics (LA)³² techniques. These techniques allow the teacher to learn what student interaction exists, how much interaction exists, and what is the quality of the interaction³³. In particular, EDM techniques make it easier to discover students' learning behavior patterns and their interactions⁴. EDM techniques can be used to study different profiles^35,36 (oriented toward students or oriented toward educators).

The final objective is to provide feedback for the instruction, evaluate the course content structure, analyze elements that have been effective in the learning processes, classify the type of students, and identify needs for the guidance and monitoring of learning. This helps in determining each student's most common learning patterns and the frequency of errors, which can then be used to tailor the most appropriate educational responses. One of the things that EDM techniques can be used for is monitoring students' learning processes to offer appropriate help via mentoring. EDM techniques include supervised learning techniques (prediction or classification techniques)³⁷ and unsupervised learning techniques³⁶ (clustering techniques)³⁸. Using EDM techniques in teaching processes that include active teaching methodologies, such as PBL, has been shown to be very effective for studying individual student behavior and student behavior in collaborative groups¹⁰.

The application of computer-assisted qualitative analysis techniques
In the last two decades, quantitative and qualitative techniques, or a combination of the two, have been applied in research in what has been called mixed methods³⁹. The use of mixed methods for data analysis is especially useful when dealing with complex problems of analysis, such as monitoring students' learning behaviors. The use of these methods allows for the transformation of qualitative data, such as student feedback from open-ended questions in a survey, into qualitative data, and the analysis of the data with different data visualization techniques⁴⁰. A variety of computer-assisted (or -aided) qualitative data analysis software (CAQDAS) can be used to facilitate data transformation and analysis⁴¹.

A summary of the procedure for teaching through the PBL methodology, the analysis of learning behaviors, the use of EDM, and computer-based qualitative analysis techniques is shown in Figure 1.

Figure 1: PBL work and the use of EDM and computer-based qualitative analysis techniques. Data collection and processing applying EDM and text mining techniques in e-Learning and b-Learning teaching environments. Abbreviations: PBL = project-based learning; EDM = Educational Data Mining; DB = database; e-Learning = online classes; b-Learning = blended classes (online and physical classes). Please click here to view a larger version of this figure.

Three research questions were posed in this study: RQ1: Are there significant differences in the learning outcomes and satisfaction of health sciences students studying occupational therapy depending on whether the PBL methodology is implemented via e-Learning versus b-Learning, considering the effects of students' prior knowledge? RQ2: Do the clusters of participants found match the learning outcomes, learning behaviors, and perceived satisfaction as a function of teaching modality (e-Learning vs. b-Learning)? RQ3: Are the students' suggestions for the improvement of the PBL methodology different depending on the teaching modality, e-Learning versus b-Learning?

The following protocol can be used by teachers in healthcare and can also be modified to work with students in other knowledge areas.