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Nurse Education Today 34 (2014) 52–56

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Effects of problem-based learning vs. traditional lecture on Korean
nursing students' critical thinking, problem-solving,
and self-directed learning
Eunyoung Choi a, 1, Ruth Lindquist b, 2, Yeoungsuk Song c,⁎
Chosun Nursing College, Gwangju, South Korea
University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
Kyungpook National University College of Nursing, Research Institute of Nursing Science, Daegu, South Korea

a r t i c l e i n f o s u m m a r y

Article history: Background: Problem-based learning (PBL) is a method widely used in nursing education to develop students'
Accepted 18 February 2013 critical thinking skills to solve practice problems independently. Although PBL has been used in nursing
education in Korea for nearly a decade, few studies have examined its effects on Korean nursing students'
Keywords: learning outcomes, and few Korean studies have examined relationships among these outcomes.
Problem-based learning Objectives: The objectives of this study are to examine outcome abilities including critical thinking,
Critical thinking
problem-solving, and self-directed learning of nursing students receiving PBL vs. traditional lecture, and to
Self-directed learning
examine correlations among these outcome abilities.
Design: A quasi-experimental non-equivalent group pretest–posttest design was used.
Participants/Setting: First-year nursing students (N = 90) were recruited from two different junior colleges
in two cities (GY and GJ) in South Korea.
Methods: In two selected educational programs, one used traditional lecture methods, while the other used
PBL methods. Standardized self-administered questionnaires of critical thinking, problem-solving, and
self-directed learning abilities were administered before and at 16 weeks (after instruction).
Results: Learning outcomes were significantly positively correlated, however outcomes were not statistically
different between groups. Students in the PBL group improved across all abilities measured, while student scores
in the traditional lecture group decreased in problem-solving and self-directed learning. Critical thinking was
positively associated with problem-solving and self-directed learning (r = .71, and r = .50, respectively,
p b .001); problem-solving was positively associated with self-directed learning (r = .75, p b .001).
Conclusion: Learning outcomes of PBL were not significantly different from traditional lecture in this small
underpowered study, despite positive trends. Larger studies are recommended to study effects of PBL on critical
student abilities.
© 2013 Elsevier Ltd. All rights reserved.

Introduction logically assess and formulate interventions to impact patient care
(Ozturk et al., 2008; Yuan et al., 2008b). Critical thinking has been
Problem-based learning (PBL) helps students develop critical shown to be enhanced by PBL; it enables students to solve problems
thinking to solve problems in their clinical settings, and bridges the in clinical situations and to provide rationale for their actions
gap between theory and practice (Rogal and Snider, 2008). PBL is a (Cooke and Molye, 2002).
student-centered method of instruction; it is an educational strategy Problem-solving abilities have been shown to be better in students
in which students take responsibility for their own learning and it who have received instruction with PBL relative to those who received
appears to enhance self-directed learning skills (Dolmans et al., instruction by lecture (Uys et al., 2004). PBL resulted in the increase of
2005; Lekalakla-Mokgele, 2010). The self-directed learning aspect of students' critical thinking and self-directed learning, which are needed
PBL encourages the development of nursing students' ability to to solve clinical problems.
think critically, and critical thinking enhances the nurses' abilities to Most studies of PBL have focused on its positive effects on critical
thinking (Jones, 2008; Yuan et al., 2008a). Published studies focused on
⁎ Corresponding author at: Kyungpook National University, College of Nursing, 101 PBL's effects on problem-solving ability and self-directed learning are
Dongin-dong, Jung-gu, Daegu 700-422, South Korea. Tel.: +82 53 420 4978; fax: +82 sparse, and the findings of some of the studies were not significant or
53 421 2758. negative. Choi's (2004) study of PBL versus traditional lecture with 76
E-mail addresses: (E. Choi), (R. Lindquist), (Y. Song).
second-year nursing students showed that the critical thinking scores
Tel.: +82 62 231 7368; fax: +82 62 232 9072. of the students in the traditional lecture group were higher than those
Tel.: +1 612 624 5646; fax: +1 612 625 7180. of the PBL group. Several other studies reported no significant differences

0260-6917/$ – see front matter © 2013 Elsevier Ltd. All rights reserved.

they felt uncertainty about their learning. content-based. struction that employed PBL strategies demonstrated significantly ment or deliberative assessment (Hendricson et al. A nonequivalent control group pretest–posttest design was used Lekalakla-Mokgele. posed reflected highly constructive strategies (at the advanced begin. thinking and problem solving are occasionally viewed as intertwined Tseng et al. has been generally accepted as a standard method of instruction to improve critical Sample thinking. abilities that are targeted by nursing curricula remains of interest. 2008.. directed learning..70). A power analysis determined that the helped the students' problem-solving but not critical thinking required sample size was 44 per group (Cohen. Students who had incomplete data were was questionable for nursing education due to the lack of large high excluded (2 in the PBL group and 4 in the traditional group). Williams. whereas responses of the students in the non-PBL Cronbach's alpha was . In one study by Uys et al. This scale is scored on a 5-point Likert-type . problem-solving. 1999) and in our study a ner level or above). most investiga- traditional education on critical thinking. 1988): Significance among second year nursing students. 2004). responses of students in the PBL group that were given to the problems healthy skepticism. 2008b. problem-solving. ability when PBL is used. improved learning outcomes in Korean nursing students relative to In this study. as a method of instruction. to actively solve problems when instructed with PBL strategies. 2010. and self-directed learning outcomes. Williams. This study explored the effects of PBL on critical Background thinking. ing (Hendricson et al. problem-solving and self-directed learning among Korean nursing students and examined the association among the critical PBL is a process-focused instructional strategy as opposed to thinking. None of the students in either group had a more critical thinking. Choi et al. Dornan et al. Problem-solving is recognized as a critical outcome of importance wherever PBL is mentioned (Solomon. Tseng et al. Therefore. the relationships among critical thinking. of instruction using PBL strategies versus traditional education on ing education to enhance clinical site-based learning and theoretical critical thinking. 2004). it employs small groups that are centered on solving well-integrated clinical problems instead of large groups as Methods in traditional instruction. then its adoption is ought to be continued or of uncertainty about PBL. and to ex. large effect size (Cohen's d = . Cooke and Molye (2002) established that instruction from two junior college nursing schools at the different cities in Korea with PBL motivated students to find new information. If. and self- self-directed learning ability of Korean nursing students. The scale has 20 items in five sub-scales: Intellectual curiosity. problem-solving. (2011) reported that nursing students who received in- abilities. leading to to prevent contamination. however. and self- directed learning. Molye (2002) reported that students felt more pressure to learn and 2002. intellectual integrity. and baccalaureate de- best evidence-based instruction possible to prepare them optimally gree. American Association Colleges of of nursing students in Korea. college. with content delivered mainly through lecture and limited self-directed learning (Uys et al. Choi (2004) showed that PBL been exposed to PBL previously. and power (90%). many students reported that they experienced feelings traditional strategies. problem-solving.05). Also. In other words. and the ability to engage in self-directed Self-directed learning is an outcome in which individuals take the learning is important for success of the health professional student responsibility for one's own learning. Optimal more self-directed learning than nursing students in the traditional pro- strategies to promote the optimal development of these abilities gram. (2004).. students were separated and studied by level of nursing faculties desire to have Korean nursing students receive the education including high school diploma. problem-solving and self-directed learning ability knowledge (Ozturk et al. Cronbach's alpha was found to be . and self-directed learning (Yuan et al. and merged into a single construct such as reflective judg. / Nurse Education Today 34 (2014) 52–56 53 between PBL versus traditional lecture on self-directed learning or group's responses were more often at the novice level. and in their health career after graduation. problem-solving skills and tors studied its effects on critical thinking. as students transitioned accelerated. studies were not found that examined amine the relationship among these learning outcomes. E. These Critical thinking and problem-solving abilities are skills viewed as two studies support that there is an increase in the problem-solving essential for health professionals as the foundation for clinical reason. Students with high school diplomas scored significantly lower for careers as professional nurses. then traditional in. 2006). however there have been few studies examining the ing school. However. and the inter-relationship among these instruction fostered self-direction and lifelong learning skills. participants in the traditional group. in a published literature review that the PBL instructional approach There were no dropouts. Worrell and Profetto-McGrath.71. program to PBL instruction. self-directed learning has been while in school. investigators reported that the PBL group The Critical Thinking Ability Scale for College Students was devel- attained higher levels than the non-PBL group of problem-solving skills oped by Park (1999) to assess dimensions of critical thinking of college in 128 graduate students enrolled in nursing school. Yuan et al. Self-directed learning outcomes of PBL have been shown to be affected In Korea.. but studies of the effects Instruments of PBL on problem-solving in the nursing literature are sparse. prudence. and self-directed learning this study are to explore and compare the effects of PBL versus are mixed. Critical shown to be facilitated by PBL (Yuan et al. Conversely. 2004). 2008b. In one study of 135 first year nursing students enrolled in in- effects of PBL on nursing student learning outcomes. Cooke and problem-solving in first year college students (Lohman and Finkelstein. the purposes of of PBL on critical thinking. The quality randomized controlled trials that have determined its effects analyses were done with 46 nursing students in the PBL group and 44 on critical thinking.74 (Park. (2008b) reported level (α = . and objectivity. research results regarding the effects strategies should be sought and tested. If PBL can be shown to result its than those with college or baccalaureate degrees (Williams. Members of struction with PBL. Most investigations Design of the use of PBL in nursing have studied its effects on critical thinking. in the literature. Nursing. struction should continue and perhaps other alternative instructional In summary. The research compared the effects Critical thinking is one of the essential core competencies of nurs. 2006). 2007). PBL. 2007)... when the effects of PBL were examined. as a strategy. in this quasi-experimental study. PBL has been slowly adopted in nursing schools since the or related to the type of schooling students had prior to entering nurs- early 2000s. PBL is not demonstrated to have outcomes from traditional high school education or traditional university superior to traditional instructional strategies. (2005) found in their qualitative study that PBL in students remain elusive. problem-solving. (2011) found among 120 nursing students that the PBL group had higher scores in critical thinking than the Participants in two groups comprised first year nursing students non-PBL group. The majority of the students. 2004). 2005).

0) . df = 1.085a ing. better problem solving.54 E. 2003) and Cronbach's alpha for our sample was . p = . at the same time. 2008. Analysis of covariance (ANCOVA) was has responses assessed on a 5-point Likert-type scale (1 = absolutely used to compare critical thinking.604. Cooke and Molye. There were no statistically signifi- thinking. p = . At the third session.01) in the PBL group and 18.439). Finally. The faculty had the students debate their approaches and solutions to the prob- lem to help the students increase their understanding of the issues Table 1 within the scenario. Each PBL session was 2 h per week for 16 weeks and The correlation coefficients (r) quantifying the relationships between was facilitated by a faculty member who taught PBL with nursing learning outcome scores were examined. each group presented a solution to the problem from the scenario. The scores may range from 5 to 200 Table 1 presents comparisons of the demographics of the students and higher scores reflected stronger self-directed learning ability. and environmental health.5) 22 (50.3) 0 (0) of PBL group: asepsis.65. with higher score indicating stronger critical thinking ability.070).215. controlling for baseline differences in the abilities. SPSS was used to analyze the data.006a lectures for 2 h per week for 16 weeks on the same content as that Male 8 (17. included 45 items and 5 subscales: Issue specification. Results Self-directed learning had 40 items and 3 subscales: learning plan. 80 years old.94 (Lee. / Nurse Education Today 34 (2014) 52–56 scale of 1 to 5 (1 = absolutely do not agree to 5 = absolutely agree). and evaluation. and evaluation. The results revealed a positive students for 4 years. The 44 students assigned to the lecture group received didactic Gender Female 38 (82.747. line differences in the abilities between groups were statistically The total scores may range from 5 to 225. The mean age was Cronbach's alpha of the developed scale was .20 points mission for the study was received from the university human ethics for students after PBL instruction and increased 0. the protocol was reviewed and ethical per. Critical thinking scores increased 2. advanced information using textbooks and the internet and then In this study. more motivation to find new information.713. however scores in the tra- Students in both groups completed a demographic form.6 yr. lies down in the bed. safety.30. Nearly all participants were female (91. The tool for problem-solving learning scores between the PBL and traditional instruction groups. however this difference was not sta- the participating students.744 hygiene. A (r = . has worn a long leg cast for 6 days due to a Discussion left femur fracture. students in each group read the clinical scenario (Korean (r = . Park.4) 22 (50. df = 1. Written informed consent was obtained from students in the traditional group.6) 44 (100) . Nursing College. vital signs. higher levels of problem solving. and critical ditional group decreased to 1. (SD 1. using pre-test scores as the covar- Prior to data collection. practice.93 (Lee. p = . the differences between groups were worked over 32 h with 4 learning packages developed by the Korean non-significant (F = 1. During the first significant correlation between critical thinking and problem-solving session. reviewed the scenario together to confirm the significant concepts 2002). The PBL and traditional education program tistically significant (F = 3. (SD 2. prior to PBL and traditional lecture instruction. The present study tested the effects of PBL on critical thinking.67 ± 1. each PBL group consisted of 4–5 students.001). probability) and t-test were employed to compare the baseline mea- directed Learning Scale for College Students were developed by Lee surements of demographic characteristics and dependent variables (2003) at the Korean Education Development Institute.83. and increased Based on their current level of knowledge. and between problem-solving and self-directed scenario is provided as an example: learning (r = . Mr. Age 18. higher scores indicate significant. During the second session.90.503.71 18. and self-directed learning skills with first year discussed important factors in the nursing scenario and searched for nursing students in Korea. activity and exercise. Chi-square (Fisher exact The Problem-solving Scale for College Students and the Self. In terms of prior education.3%). and problems. p b .7 yr. students Demographics of students in the PBL (N = 46) and control (N = 44) groups. However. Cronbach's alpha of the developed scale was . Each scale between the two groups. more students had attended an academic high school Data Collection and Procedures than had attended a vocational high school. students in previous studies have explain range of movement (ROM) and the method used to move demonstrated increased involvement in their learning and this led him into the wheelchair again. 2003) and 18. nursing process. Problem-solving approaches were conducted over one semester comprising 16 weeks. One scenario held 4 sessions. tional group. and the traditional method groups. between critical thinking and self-directed learning clinical situation) to identify the major concepts and meaning. there were 46 students assigned to 10 PBL received PBL instruction increased to 2. in the PBL group versus the traditional group. because the base- counterproposal development.31 . df = 1.82 points for committee in Korea. plan and practice. Choi et al.13. iates was used (Table 2). ANCOVA. and self-directed learning skills of students in Vocational 14 (30. in each group role-played the nurse in similar situations to that of the scenario. The faculty member then wrapped up the class and Characteristic PBL Control χ2 (t) p n (%) or M ± SD n (%) or M ± SD answered any final questions the students may have had. She asks the nurse to Using the technique of PBL.273). students and faculty conflict resolution skills (Seren and Ustun.71) in the tradi- Cronbach's alpha for our study sample was . scores in the PBL group increased to 4.66. during the fourth session. p b . p b . Academic 2 (69.57 ± 1. Prior high school Questionnaires were again administered to assess critical think. to more improvements in critical thinking.001). the post scores of who had For the PBL group. cause analysis. finding no significant differences in groups in the presented their work and the faculty encouraged the students to measure of critical thinking may have been due to a number of factors. Park's daughter worries he does not move to frequently. problem-solving. Regarding self-directed learning ability. problem-solving. think critically and gave feedback.001). Mr. problem-solving and self-directed do not agree to 5 = absolutely agree). students in each group problem-solving. The PBL group decreased to 1. a Fisher exact test for least significant difference test. Data Analysis Total scores have a possible range from 5 to 100. To compare the outcomes between the two groups. . and self-directed learning questionnaires cant differences between two groups (F = .364.327 .0) both groups when the semester was finished.

10) 110. baseline comparability between groups. Critical thinking is an ingrained trait and may be difficult to change Limitations (Ravert. In order to promote critical thinking. styles.. a difference in self-directed learning between samples. It is likely that the study was parts).63) 126. most first year nursing students tional methods to simultaneously improve problem-solving and self- are not accustomed to studying in group settings because most of directed learning.03) . the better the problem-solving and critical thinking ability. In the present study. In contrast. Conversely. In this study. Lohman and Finkelstein (2002) found that students' ability to solve the problems was changed in accordance Although learning outcomes showed a trend to improve more in with the case segmentation scheme of the PBL. Further research should.05) 113. 1999).16) 53. Long segmentation the PBL group as compared to the traditional group. 2010). 2006). limitation is the non-randomized design and lack of comparability Enhanced problem-solving ability affects the quality of nursing care in the two groups of students. This outcome could possibly be attrib. and may take more responsibility for their education In our study. problem-solving and self-directed learning. and the control groups. or the measurement of education.72 (12. lasting for over one year with first year nursing students (Yuan et al. That is reflected in the findings of previous of the effects of PBL on critical thinking in Korea have shown no signif. Thus.54 (5. Choi et al. 2004.46) 57. E. and self-directed learning oretical basis of PBL. It is likely that the duration of the the students' level or year in school. Tiwari et al. problem-solving. The correla- Finkelstein. However.364 . consistent with modern theories on learning that ability. To address this.604 .61) 56. A short case segmentation scheme helps students tions among critical thinking.21 (5. ideally. With advancing grade or level of study of the instruction using PBL was too short. senior students may feel discomfort if instructors control the learning fects of PBL on critical thinking outside of Korea. or not enough time passed to assess provided a long segmentation scheme of four parts (Lohman and effects of PBL instruction on student learning outcomes.15 (12.. PBL = problem based learning. However.06 (12. and thus ANCOVA was used. However. . as self-directed learning is so fre- their previous education in Korean high school has been done via lec. Yang. First. Lekalakla-Mokgele. quently employed in nursing education. In the present study. Miflin et al. and self-directed learn- efficiently solve problems. little known regarding the length of time of PBL should be offered in 2005. The higher the self-directed learning long segmentation schemes. group. there were differences between nificantly different. Further.72 (6. Students given a short segmentation scheme of 10 parts underpowered or that insufficient strength or time of instruction improved their solving-problem ability more.64) 1. uted to the fact that it was a hard time for first year nursing students Findings of this study indicate that more research ought to be to move from lecture (as in high school) to student-led tutorials in conducted on the effects of PBL on problem-solving and self-directed PBL (in college). the duration of the PBL instruction was one semester in a self-directed manner (Kassab et al.215 . a F score is from analysis of covariance with pretest scores as covariates. We would be formatted in shorter segments. (16 weeks). Additionally. 2008). to promote critical thinking.13 in the PBL groups in baseline dependent variables.78 (12. 2002). problem solving.. 4 parts).070 Problem solving 112. order to have an effect. PBL cases contained ing were significant and positive. PBL should be more will be needed to more fully examine PBL as an approach to nursing comprehensively and continuously employed in all nursing classes in education and larger representative samples will be needed. students may expect to gradually become better at self- its effects on student abilities was measured in too short of a time frame. critical thinking to solve ture. Further research applied with first year nursing students. we have to adopt proper educa- 2008b. include larger more representative 2005). Participants came from two junior and plays a vital role in the outcomes of the nursing care (Uys et al. most studies (Lekalakla-Mokgele.g. Second. it may be difficult to adapt to PBL teaching and learning problems also will and should be developed. colleges to prevent the contamination between the experimental 2004). studies of the long-term effects of PBL lecture and depended on faculty direction. it may be difficult to are needed in nursing education. the post-test scores increased by 4. though self-directed learning was not sig.95 (14..03) 116. and self-directed learning skills between the PBL group (N = 46) and control group (N = 44)..28 (15. in the control group.30) 125. suggesting no true differences. and employ randomization or other strategies to assure better the two groups was not found. and short segmentation statistically significant differences between the PBL and traditional schemes comprise content details divided into many parts (e.43 (12... research that has shown significant increases The correlation analysis showed significant positive relationships in critical thinking has studied PBL programs having PBL instruction among critical thinking. directed learning.41 (5.439 Self-directed learning 107. / Nurse Education Today 34 (2014) 52–56 55 Table 2 Outcomes of ANCOVA for critical thinking.65 (17.. it may be due to the limited duration of the PBL program. relative to students using PBL strategies were provided.. Results cannot be generalized to other our study. there were not schemes comprise brief content (e. and there are studies showing no significant ef. Additionally. the scores for self-directed learn- ing decreased. emphasize that learning should be self-directed (Dolmans et al. 2010.273 Note. It is recommended that future PBL cases score. 2006). Another a curriculum in a coordinated fashion instead of in individual classes. and may take significantly more time to change critical thinking through the use of PBL instruction than what we carried out in This study has limitations. Variables Pretest Posttest Fa p PBL Control PBL Control M (SD) M (SD) Mean (SD) Mean (SD) Critical thinking 51. A possible explanation for this result was the use of a Conclusions case segmentation scheme. investigators that students respond differently based on the level of icant effects (Choi.49) 114. There is engage in self-directed learning during their first year (Kassab et al.g. Because first year students were accustomed to learning abilities. 2005). problem-solving.31) 3. we suggest that longitudinal studies be settings because it was employed with small samples of first year designed over periods of at least one year and especially when PBL is nursing students at two junior colleges in Korea. believe that well-structured PBL holds promise for nursing education Self-directed learning is one of the ingredients comprising the the. 10 groups.

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