Strengths and weaknesses of Problem Based Learning from the professional perspective of registered nurses 1

OBJECTIVE: to identify competency strengths and weaknesses as perceived by nursing professionals who graduated with a integrated curriculum and competency-based through Problem Based Learning in small groups. METHOD: an intrinsic case study method was used, which analyzes this innovation through former students (from the first class) with three years of professional experience. The data were collected through a questionnaire and discussion groups. RESULTS: the results show that their competency level is valued in a very satisfactory manner. This level paradoxically contrasts with the lack of theoretical knowledge they perceived at the end of their education, when they started working in clinical practice. CONCLUSIONS: the teaching strategy was key to motivate an in-depth study and arouse the desire to know. In addition, Problem Based Learning favors and reinforces the decision to learn, which is that necessary in the course of professional life.

The care practice requires that the nurses be capable of critical thinking in order to choose the best actions to solve the detected problems. In this process, learning to reason in the same way as when one is a professional is one of the most complex phases in cognitive terms and one of the themes that is most related to decision making (1) .
In this context, the Problem Based Learning proposal, PBL, has been established as a learning method whose starting point is a problem or problematized situation of real-life that permits the development of explanatory hypotheses and the identification of learning needs that allow the student to understand the problem better and achieve the previously established objectives. In addition, it permits identifying the principles related to the knowledge acquired and that can apply to other situations or problems. It is a method centered on learning, in which the students play a protagonist role (2) . PBL has evolved as a philosophy, as a form of understanding education and as a learning style (3) .
Many studies collect evidence of the PBL's contribution to teaching quality in medical studies (4)(5)(6) , while there exists less evidence from the nursing sphere based on the perspective of professionals who graduated in the PBL (7) . This study departs from the innovation of a fully competency-based Nursing curriculum, which replaced classes with lectures by PBL in small groups.
This experience involved the transfer from a teaching paradigm centered on the teachers and the contents of the different subjects to another one centered on the students and the basic competences and skills of the professional profile. To conclude the process, the innovation would require a general analysis of the teaching coherence in order to obtain clear criteria of improvement in the teaching and learning process.
The specific objective was focused on identifying and describing the competency strengths and weaknesses the nursing processionals who had graduated with PBL perceive.
The data collection started when the professionals from the first group graduated in the PBL had obtained three years of experience; thus, they were considered in the category of "competent" nurses according to Patricia Benner's Levels of expertise (8) (Figure 1).

Beginner
Has no experience and adopts behaviors driven by standards, rules and needs help to set priorities. This category includes new students and newly hired professionals.

Advanced beginner
Professionals who have already been confronted with a sufficient number of practical situations to observe the significant and recurrent components. Advanced beginners are already able to formulate principles that guide the initiatives for guidelines and guides to follow.

Competent
Possess two or three years of experience in the same circumstances and can evaluate their initiatives. Nevertheless, does not process sufficient flexibility yet, but has the feeling of having knowledge and preparation to face the situations.

Advanced
Their accumulated experience makes these professionals spontaneously perceive the situations as a global whole, which makes them capable of identifying them and making decisions efficiently.

Expert
No longer needs an analytic principle, but intuitively captures the situations, focuses on the core of the problem and acts departing from global knowledge of the situation. Systematic records of expert clinical activities are fundamental to reach new knowledge. Not all professionals are able to reach this level.

Method
An Intrinsic Case Study was chosen, as an innovative program or a school can be a case, and because both have a specific and complex function (9) . The study objective required that the participants had three years of professional experience and the graduates from the first course year that applied PBL had this characteristic.
This length of experience was expected because of the reference of the "competent nurse", who according to Benner has two or three years of experience in the same or analogous circumstances and who, despite lacking the

Results and discussion
The researchers managed to trace and inform 81% of the graduates from the first class about the study, 33% (29 ex-students) of whom participated.
Their valuation of their competences is summarized in Table 1. Departing from the premise that motivation is the product of good teaching and not its requisite, it can be deduced that these professionals' motivation is intrinsic, as they profoundly focus on knowledge, with interest and a sense of importance. They observe that the strategy used has been key to that motivation and agree that teaching means stimulating the desire to have knowledge, creating teaching strategies that intensify and diversify the desire to know, something that favors and strengthens the decision to learn.
PBL furthers the sense of responsibility because it brings the students to self and mutual commitment (14) .
They need to achieve personal and group objectives that will be evaluated among peers and by the tutors.
Although they describe the motivation as a strength, sometimes, they refer to it as a need deriving from the lack of knowledge, as described in the paragraph about the weaknesses. The professionals graduated within this paradigm have incorporated skills and competences that will influence the future of the profession. Since, as students, they engages in the autonomous management of their learning, as professionals, they will also be more autonomous in the management of nursing care and will have elements to break with the historical role of dependence, base everything they do on evidence and gain solid knowledge based on their practice. In the PBL in small groups, the students will not see some themes until reaching the care practice.
Nevertheless, regarding the themes they do manage, analyze and study in debt, they can assimilate the necessary principles and concepts well to face the problem and be able to extrapolate this knowledge to analogous situations. The knowledge they lack, however, add further stress to that any beginner already experiences.

Conclusions
The