A Unique Approach to Project-Based Learning (PjBL) in a Veterinary Anatomy Course

Abstract

Introduction

Project-based learning (PjBL) is a teaching methodology designed to engage students in solving real-world problems, acknowledging that students are active agents of their learning process. This methodology has historically been popular in architecture and industrial sciences; however, its use in teaching veterinary anatomy is scarcely published.

Methods

Using information and communication technologies, the PjBL methodology was implemented in a first-year veterinary anatomy course. The methodology included teamwork and the selection of a routine object in the veterinary clinic at the beginning of the academic semester. The project’s goal was to analyze the object and associate it with both a domestic animal species and an anatomical region, along with making and presenting a video or a simulation model about the object.

Results

More than 80% of students prefer active learning classes compared to traditional classes. In addition, 66% and 86% of students indicate that PjBL allowed them to improve their understanding of theoretical content for the first and second years of post-implementation, respectively. Students’ self-assessment indicates that more than 80% of the students (first and second year post-implementation) felt they were responsible for the execution of the project, able to conduct research, and able to develop autonomous learning skills. After 2 years of PjBL implementation, failure rates in the course decreased by 21%.

Discussion

In general, PjBL results show that veterinary students prefer active learning activities that allow them to learn in a team-based learning process as well as to develop soft skills such as self-learning, responsibility, and teamwork.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-021-01205-1.

Introduction

Project-based learning (PjBL) was created in the sixteenth century to support the training of architects in Italy. Around the nineteenth century, this methodology began to be used in the USA in the teaching of agriculture and industrial arts, and was subsequently applied in primary schools in order to solve real-world problems [1, 2].

Toledo and Sánchez [3] point out that since 2010 there has been a significant change in higher education in Europe, with a new model that focuses education on what students do; PjBL, an active learning methodology, is an effective tool for acquiring the knowledge and skills that society is demanding from students.

PjBL is a teaching method in which students acquire knowledge and skills by working for an extended period of time to investigate and respond to a real-world, interesting, and complex question, problem, or challenge [4]. Several authors have contributed to the development of this methodology [5–7]. For its implementation, different stages have been defined, among which the following elements are highlighted [8]:

1. Key knowledge, understanding, and skills: The project focuses on students’ learning goals, including critical thinking/problem solving and collaboration.

2. Problem or challenging question: The project is framed by a significant problem to solve or a question to answer.

3. Research-based: Students participate in a rigorous process to answer questions and find the right resources to support a hypothesis.

4. Authenticity: The project is framed in the context of the real world.

5. Student voice and choice: Students make decisions about the project.

6. Reflection: Students and teachers reflect on learning, the effectiveness of their research activities, the quality of students’ work, obstacles, and activities to overcome them.

7. Criticism and review: Students give, receive, and use feedback to improve their processes and products.

8. Product publication: Students make their work project public, explain, display, and/or present it in places beyond the classroom.

So far, this methodology has been applied in elementary school teaching [4], and in other fields in higher education, such as computer sciences [9], medicine [10], and engineering sciences with overall positive results when implemented early in the curriculum [11]. In the case of anatomy teaching, the use of projects as a teaching tool is common in cadaver-based studies [12], which in some cases focus on integrating anatomy and pathology topics [13]. Regarding veterinary medicine teaching, problem-based learning (PBL) has been extensively reviewed before [14, 15]. A key difference between PBL and PjBL is that the latter is focused on applying or integrating knowledge while PBL is focused on acquiring it [16]. Regarding active learning in veterinary anatomy, there is little published regarding formal PjBL implementation and its impact on student progress, such as the use of student projects in osteology teaching [17]. Anatomy is a key and transversal subject for a veterinarian, since it is the basis for advanced subjects such as surgery, which is why learning this discipline must be both significant and motivating for students. At Universidad Andres Bello, veterinary anatomy was historically taught following a traditional teaching model, that is, showing concepts that are removed from the reality of the career. This led to high dropout rates for the course, reaching a historical level of 26% and an average failure rate of 59%, resulting in insufficient training and leading to serious deficiencies in the application of this discipline in the professional field. First-year veterinary students regard anatomy as a difficult subject due new and extensive nomenclature, descriptive nature of the subject matter, little interactive activity, and the view that anatomy is a dogmatic subject [17], which is reflected in the overall reduced student performance. In the following work, we propose PjBL as an alternative for the active learning of anatomy in veterinary medicine, demonstrating how it can improve student performance. Our approach is to motivate students to learn veterinary anatomy by participating in a group project that associates clinical instruments with the different topics taught during the traditional course.

Methodology

PjBL methodology was implemented in the veterinary anatomy course in the School of Veterinary Medicine at Universidad Andres Bello, in Santiago, Chile. The study participants were freshmen, during the first year (n = 109, 65 repeaters from the previous year), second year (n = 134, 69 repeaters), and third year (n = 138, 63 repeaters) of PjBL implementation. The research team received human-subject approval from Universidad Andres Bello Institutional Bioethics Committee (Comité de Bioética Institucional).

Control Group

This group corresponds to the students who took the course the year before PjBL was implemented (n = 103). Students in this cohort studied veterinary anatomy in a traditional setting, with theoretical-practical sessions. The course was structured as follows: 6 h a week, in which 2.25 h was for theoretical lectures in a classroom and 3.75 h for practical sessions in a laboratory. Since the semester has 15 weeks, there were a total of 90 h of direct lessons. Practical sessions consisted of groups of five students who were randomly chosen; in each practical session, there were five workstations, each with a particular task, like observing anatomical specimens and memorizing different structures of the week’s contents. Each student needed to complete the five workstations during the practical sessions.

PjBL Methodology

The implementation involved swapping one of the traditional workstations with a PjBL station. It was implemented in the practical sessions of approximately 4 h per week, for 13 weeks in three consecutive years. The students were randomly assigned to groups of five students each. All of the students passed through each of the five stations (four traditional stations and one PjBL station) and thus completed all of the week’s content according to the syllabus. The study during the practical work was autonomous, as the students worked with support material and with teachers and assistants who facilitated the learning process. Each week, students worked on the PjBL station as follows:

Stage 1: Week1, Clinical Object Selection

Students randomly chose a clinical instrument, previously selected by the teacher. Among them were a syringe, a peripheral venous catheter, a stethoscope, an ultrasound transducer, an endotracheal tube, or another clinical object. These objects are routinely used in animal clinic and surgery. Importantly, a solid basis of anatomy is necessary for the proper use of these resources. Students state their names, their study object (e.g., syringe), and group name.

Stage 2: Weeks 2 and 3, Selected Object Analysis

Students do research regarding their selected object to know how it is used, when, and in which anatomical region and animal species. Then, students decide which anatomical region and species they are focusing their project (e.g., femoral region, dog).

Stage 3: Week 3, Project Analysis Continues

In this stage, students research the relation between how object is used in the selected anatomical region (e.g., a syringe is used for intramuscular injection at the dog femoral region).

Stage 4: Week 4

Students propose a question to be answered that is related to the object, anatomical region, and selected species. (e.g., How do you perform an intramuscular injection in the femoral region of a dog?) Then, students create a list of what they need to answer this question, like researching how the object works, its components, clinical procedure, and anatomy of the selected region. This marks the end of the analysis stage and the beginning of the planning stage.

Stage 5: Week 5

Students set an objective that can answer their proposed question. (e.g., Using a simulation, demonstrate the use of a syringe for the intramuscular injection in the femoral region of a dog).

Stage 6: Weeks 5 and 6

Students must define what will be the product at the end of the project, which has to fulfil the objective and answer the question.

Stage 7: Week 6

Students perform a self-evaluation, considering criteria such as manual work, critical thinking, creativity, among others.

Stage 8: Weeks 7 and 8

This stage consists of a detailed plan of the project, which is divided into stages, resources, development times, and achievements.

Stage 9: Weeks 8 to 12

Students work on their project according to the plan.

Stage 10: Week 11

Students write a final note related to the project’s product and if it is related to an interesting learning or relevant idea that was brought as part of their work. Also, students write a projection or future intention related to the project, such as things that can be improved. Finally, students do a second self-evaluation, with the same criteria as in stage 7.

Stage 11: Week 13

Students present the product of their project to their classmates and teachers, where they explain the poster and their final product.

During this whole process, the teacher is present to support and guide students in each stage. Since the first stage is critical for the project’s success, this is where the teacher input is most needed. This framework was adapted from the work done by Stolk and Martello [18, 19]. It is important to reiterate that, during this work, students were still working in the other 4 workstations, using traditional anatomical samples.

Student Grading

Control group grading consisted in three theoretical multiple-choice tests, practical session quizzes, and a final practical exam. In the PjBL cohorts, a project evaluation was included along with the aforementioned evaluations that contributed 20% to the final grade. The project grade consisted of 70% of teacher evaluation and 30% self-evaluation. Teacher evaluation was divided between the project (product and poster) and its presentation. Self-evaluation consisted of questions regarding student commitment to the project and their learning during the project.

Diagnostic Tests and Data Collection

To assess the impact of PjBL on students, a pre- and post-diagnostic test was performed both at the beginning and at the end of the first and second years of implementation (Appendix 1); this diagnostic test was aimed at assessing the student’s achievement of the four learning outcomes (LO) of the veterinary anatomy course (Appendix 2). Both a satisfaction survey and a self-assessment with Likert-type scales were also included (Appendices 3 and 4, respectively).

Statistical Analysis

Data was recorded and analyzed in GraphPad Prism 8. For the pre- and post-diagnostic test, Wilcoxon matched-pairs signed rank test was performed.

Results

Pre-post Diagnostic Test

The results of both the pre- and post-diagnostic tests are displayed in Fig. 1, which shows the percentage of students who passed the test for each LO. Using the Wilcoxon matched-pairs signed rank test, all pre/post changes were statistically significant, with the highest performance of the post-diagnostic test across all LOs (p < 0.0001).

Fig. 1.

Passing (%) of learning outcomes in both pre- and post-diagnostic tests during in the first (n = 78) and second (n = 82) years of project-based learning methodology (PjBL) implementation. Results are expressed as mean + standard deviation. ****p < 0.0001. LO, learning outcome

Student Performance

In the control year, from a total of 121 students, 48 passed the course (46.6%), 55 failed (53.4%), and 18 dropped it. In the first year of PjBL implementation from a total of 128 students, 69 students passed the course (63.3%), 40 failed (36.7%), and 19 dropped it. The second year, from a total of 133 students, 70 passed (60.3%), 46 failed (39.7%), and 14 dropped it. The third year, from a total of 149 students, 99 passed (71.7%), 39 failed (28.3%), and 11 dropped it (Fig. 2a). To further assess the impact of PjBL implementation in the veterinary anatomy course, students were classified according to whether they were taking the course for the first time or had failed the course in the past and were repeating it. Historically, there were no differences in pass/fail rates between new and repeating students. However, after PjBL implementation, the number of both new and repeating students who passed the course was higher than those who failed, with the third year of implementation having the higher number of repeating students who passed the course. Also, historically (control group), the number of failing students was higher than those who passed the course (for both new and repeating students) (Fig. 2a). After PjBL implementation and steadily during the next 3 years, this trend was reversed (Fig. 2b).

Fig. 2.

a Percentage of students who pass, fail, or drop the veterinary anatomy course. Control, n = 121. First year, n = 128. Second year, n = 133. Third year, n = 149. b Percentage of both new and repeating students who passed the veterinary anatomy course before and during the 3 years of PjBL implementation

Satisfaction and Self-assessment

The results of the satisfaction survey conducted in the first (n = 96) and second (n = 117) year of implementation show that 84% and 93% of students, respectively, prefer active learning classes over traditional classes. In addition, 66% and 86% (first and second years of implementation, respectively) of students indicate that PjBL allowed them to improve their understanding of theoretical content. Also, the satisfaction survey showed an overall positive perception of the PjBL methodology, specifically regarding the understanding of veterinary anatomy. This positive perception was higher in the second year of PjBL implementation (Fig. 3).

Fig. 3.

Satisfaction survey results from students in the first (n = 69) and second (n = 117) years of PjBL implementation. Results are expressed as % of the total students surveyed. SA, strongly agree. A, agree. N, neither agree nor disagree. D, disagree. SD, strongly disagree

Since PjBL implementation had such strong approval from students during the second year of implementation, the satisfaction survey was not repeated during the third year of implementation.

As for the self-assessment, it shows that more than 80% of students in the first (n = 100) and second (n = 126) years of implementation felt that they were responsible and fulfilled all their tasks, that they were able to conduct research, and that they developed their autonomous learning skills. Table 1 shows the detailed results for the years 2014 and 2015.

Table 1.

Result of the self-assessment of the first and second years of implementation

	Strongly agree and agree (%)		Neutral (%)		Strongly disagree and disagree (%)
	1st year	2nd year	1st year	2nd year	1st year	2nd year
I was responsible and fulfilled the assigned tasks.	100	99	0	1	0	0
I actively researched anatomy books and scientific journals.	91	88	9	10	0	2
The development of the project allowed me to generate self-learning.	95	100	5	0	0	0

Some noteworthy projects developed during the lessons include a demonstration of peripheral catherization of a dog cephalic vein using a prototype of a thoracic limb with a vein system (first year of implementation, Fig. 4a); a dog doll with auscultation zones on the outside and with rib, heart, and cardiac sounds on the inside for the use of a stethoscope (second year of implementation, Fig. 4b); the demonstration of a peripheral catheterization of a bird using a prototype of thoracic limb, with bones and muscles made of putty and silicone, respectively, and decorated with real feathers (third year of implementation, Fig. 4c). Every project had to be completed in a poster that was shown to their classmates at the end of the course (Fig. 4d).

Fig. 4.

Examples of different projects made by freshmen of the first (a), second (b), and third (c) years of implementing project-based learning methodology. An example of the poster that had to be completed during the practical lessons is shown in d

Discussion

PjBL methodology has been successfully implemented in various contexts and stages of learning, from elementary school to higher education [4, 20]. In higher education, a majority of published experiences are on engineering education [20]. The use of projects during anatomy teaching is a common practice in traditional teaching [12, 13], with active learning implementation aimed at bolstering student motivation [17]. Historically, veterinary anatomy had a higher failure than passing rate, and many students repeated or dropped the course many times. After the first year of implementation, this historical pass/fail trend was reversed and maintained in the following years (Fig. 2a), demonstrating the methodology’s success in engaging students and promoting autonomous learning, which is in line with a previous publication [21]. This high failure rate was in part due to repeating students who failed the course more than once; after the second year of implementation, repeating students had a higher pass rate than new students (Fig. 2b), which was unprecedented in this course. Likewise, the achievement of all four learning outcomes after implementation (Fig. 1) confirmed that working on the project did not interfere with either the anatomical learning or formal requirements; this has been demonstrated when comparing PjBL with traditional instruction [22]. Both self-assessment and satisfaction surveys revealed that PjBL was well accepted by students. The PjBL methodology guided many students to a more clinical understanding of veterinary anatomy. Both the quality and complexity of the projects improved in the first, second, and third years of implementation, allowing first-year students to associate anatomical information and translate it to a functional and practical clinical knowledge.

One of the limitations of this study is that we could not confirm whether the PjBL methodology made an impact on the future academic achievement of the students in courses that relied on anatomical knowledge; however, there is consensus that PjBL indeed boosts the academic achievement of students along their curriculum [23].

Conclusions

Implementing active learning methodologies allows students to play more of a leading role in their learning process. In particular, PjBL allowed students to develop skills in the areas of autonomous learning, teamwork, information search, problem solving, planning, and management of their time and resources. These skills allow a better understanding of veterinary anatomy content and, above all, they are the basis for future academic and professional performance. Indeed, PjBL motivated the student learning process, as the real-world scenarios allowed them to find more meaning in what they were studying. Another positive aspect is that students became familiar with the scientific method, as they had to ask themselves a question and search for valid information to generate a product that responds to the initial question. Finally, presenting and describing the project allowed students to face an audience and answer questions, thus strengthening their communication and expression skills.

Funding

FIAC, MINEDUC-Chile; Grant number: UAB1102

Compliance with Ethical Standards

All participants were asked to read and sign an informed consent form prior to the start of the study. Standards, guidelines, and approval for the use of student cohorts relative to this research were approved by Universidad Andres Bello Institutional Bioethics Committee. This manuscript does not contain images, tables, or figures which are under copyright. All the authors have read and accept responsibility for this manuscript.

Conflict of Interest

The authors declare that they have no conflict of interest.