What drives students’ self-directed learning in a hybrid PBL curriculum

Evidence supporting Problem-based learning (PBL) fostering students’ self-directed learning (SDL) in hybrid PBL curricula is inconsistent. To explore the influence of PBL in a hybrid curriculum on students’ SDL, the authors investigated the following: (1) students’ self-assessed SDL ability, (2) students’ perceptions of the influence of curricular components on SDL, and (3) the relationships between curricular elements and SDL. The research questions were explored both quantitatively and qualitatively. All year 1 (n = 93) and year 2 (n = 93) students in 2004 were invited to participate. Participants completed a 53-item questionnaire addressing (a) self-assessment of their SDL ability, and (b) perceived influence of individual curriculum elements on individual study and SDL. Student and faculty focus group interviews (FGIs) were conducted. Students rated their SDL skills highly, particularly identifying knowledge deficits, learning skills and strategies, and managing study time. Students thought lectures helped in selecting study topics and learning for the tutorial case. Other components including tutors, unit/case objectives, tests, and tutorial discussions, were seen as influencing what to study and the learning process. No significant difference was observed in the responses between year 1 and 2 students. Among the six curriculum components, tutorial discussion and objectives were weakly correlated with with SDL ability. Findings from students and faculty focus group supported the perceived positive influence of the curriculum on SDL. This study found that students’ perceived SDL ability was positively influenced by several components of the hybrid PBL curriculum. However, further investigations are needed for a clearer understanding of the specific effects of the hybrid PBL curriculum on students’ SDL.     

A study of critical reflection in health professional education: ‘learning where others are coming from’

A dominant focus of clinical education for health professional students is experiential learning through an apprentice model where students are exposed to a range of clinical scenarios and conditions through observation initially, and then through supervised clinical practice. However experiential learning may not be enough to meet the need for health professionals to be flexible, self-aware and understanding of alternative perspectives or ‘where other people are coming from.’ Critical reflection skills are recognised as a way of thinking and a process for analysing practice, that enables learning from, and redeveloping professional practice in an ongoing way. This paper describes and examines the effect of a three hour per week, six week critical reflection program, grounded in knowledge paradigms of postmodernism, reflexivity and critical theory, on third year undergraduate physiotherapy students’ experience of their first clinical placements. The theoretical basis of the program provides a potential bridge with which to link and broaden the established framework of clinical reasoning theories. Within the program, students’ critical reflection discourse focused on notions of power, hierarchies, connecting with others and relationships. Their feedback about the effects of the program highlighted themes of validation and sharing; a break in clinical performance and a broadening of their spheres of knowledge. These themes resonated with students’ overall experiences of learning in clinical placements and provide some evidence for the inclusion of critical reflection as a valid and worthwhile component of early clinical education.     

How Clinical Instructors Can Enhance the Learning Experience of Physical Therapy Students in an Introductory Clinical Placement

Purpose There is little understanding of how physical therapy students are influenced by clinical instructors (CIs) particularly at the outset of their clinical learning. The purpose of this study was to evaluate physical therapy students’ perceptions of their learning experiences during an introductory clinical placement. Methods: Subjects were 51 physical therapy students participating in an introductory clinical placement following the first unit (semester) of a 2-year, entry-level Master’s program. Each day of their placement, students completed a questionnaire based on Brookfield’s Critical Incident Questionnaire. Students were asked when they felt most engaged or distanced, what actions of others were most affirming or puzzling, and what surprised them about the placement that day. Two evaluators independently read and coded the entries in all questionnaires, and then collaborated to establish themes related to the behaviors of the CI. Results: The CI could enrich the students’ experiences in the following ways: (1) prepare them by introducing, explaining, demonstrating, or allowing them time to obtain information. (2) Confirm learning by providing feedback and recapping. (3) Provide “hands on” experiences appropriate to students’ knowledge, skills and comfort. (4) Challenge students by questioning, discussing possibilities, or providing time for reflection. (5) Respect students, value their input and allow them an appropriate level of independence. (6) Demonstrate professional behavior related to communication, evidence-based practice and continuing education. Conclusions: Physical therapy students value CIs who involve them in patient care; confirm, challenge and prepare them for learning; respect their input and model professional behavior. These authors contributed equally to this work.     

Factors Affecting Students’ Evaluation in a Community Service-Learning Program

A community service-learning curriculum was established to give students opportunities to understand the interrelationship between family and community health, the differences between community and hospital medicine, and to be able to identify and solve community health problems. Students were divided into small groups to participate in community health works such as home visits etc. under supervision. This study was designed to evaluate the community service-learning program and to understand how students’ attitude and learning activities affected students’ satisfaction. The results revealed that most medical students had a positive attitude towards social service and citizenship but were conservative towards taking the role to serve people in the community. Students had achieved what they were required to learn especially the training in communication skills and ability to identify social issues. Students’ attitude towards social service did not affect their opinions on the quality of the program and subjective rating on their achievement. The quality of the program was related to the quality of learning rated by the students.     

Early learner perceptions of the attributes of effective preceptors

Medical education in the US has adapted to the shift of patient care from hospital to ambulatory settings by developing educational opportunities in outpatient settings. Faculty development efforts must acknowledge learners’ perspectives to be effective in improving teaching and learning. Clinics provide important and unique learning opportunities, but also present different challenges for preceptors (i.e., physician teachers) and learners. Multiple studies have identified characteristics of effective preceptors of ambulatory care medicine. However, most of these studies were conducted among residents or students with clinical experience. To investigate preclinical, second-year medical students’ perceptions of preceptor quality, we conducted an exploratory qualitative study using analysis of student learning journals. The purposive sample included 120 medical students in a private, Midwestern medical school in the United States. Learning journals of 110 students for two semesters were reviewed. Five attributes of an effective preceptor emerged: (1) Demonstrates professional expertise (2) Actively engages students in learning (3) Creates a positive environment for teaching and learning (4) Demonstrates collegiality and professionalism (5) Discusses career-related topics and concerns. Our findings suggest preclinical learners often begin initial clinical experiences with sophisticated definitions of professional expertise, and hold specific expectations for professionalism. These are based on previous coursework and personal experience. These expectations influence their perceptions of effective preceptors and learning experiences. Early clinical experiences can also influence perceptions about career and specialty choice. Improving our understanding of preclinical learners’ perceptions of preceptor quality will improve the efficacy of faculty development efforts and learning experiences.     

Medical faculty as humanistic physicians and teachers: the perceptions of students at innovative and traditional medical schools

BACKGROUND AND OBJECTIVES: The training of caring physicians represents an important goal of medical education. Little is known however, on whether medical faculty constitute good role models for teaching humanistic skills to medical students. In this study, we examined to what extent medical students at innovative and traditional schools perceived their teachers as humanistic physicians and teachers. We also explored whether pre-clinical and clinical students shared the same perceptions. METHODS: A mail survey was conducted in Canada of all second-year students and senior clerks at one innovative medical school (problem-based learning (PBL), patient-centred, community-oriented) and three traditional medical schools. Students were asked to what extent they agreed or disagreed that the majority of their teachers behaved as humanistic physicians and teachers; 10 statements were used. Overall, 65% of the 1039 students returned the questionnaire. RESULTS: Over 25% of second-year students and 40% of senior clerks did not agree that their teachers behaved as humanistic caregivers with patients or were good role models in teaching the doctor-patient relationship. More than half of second-year students and senior clerks did not agree that their teachers valued human contact with them or were supportive of students who had difficulties. There were few differences in the way medical students at innovative and traditional schools perceived their teachers' humanistic qualities. At the pre-clinical level however, there were more students from the innovative school than from the traditional schools (around 60% vs. 40%, P < 0.005) who agreed that their teachers valued human contact with them and were supportive of students. CONCLUSION: Our results indicate that the PBL curriculum fosters better teacher-student relationships during the pre-clinical years. They also suggest that an unacceptably large number of medical students are taught by physicians who seem to lack compassion and caring in their interactions with patients. This study questions the adequacy of medical faculty as role models for the acquisition of caring competence by medical students.     

Cognitive apprenticeship in clinical practice: can it stimulate learning in the opinion of students?

Learning in clinical practice can be characterised as situated learning because students learn by performing tasks and solving problems in an environment that reflects the multiple ways in which their knowledge will be put to use in their future professional practice. Collins et al. introduced cognitive apprenticeship as an instructional model for situated learning comprising six teaching methods to support learning: modelling, coaching, scaffolding, articulation, reflection and exploration. Another factor that is looked upon as conducive to learning in clinical practice is a positive learning climate. We explored students’ experiences regarding the learning climate and whether the cognitive apprenticeship model fits students’ experiences during clinical training. In focus group interviews, three groups of 6th-year medical students (N = 21) discussed vignettes representing the six teaching methods and the learning climate to explore the perceived occurrence of the teaching methods, related problems and possibilities for improvement. The students had experienced all six teaching methods during their clerkships. Modelling, coaching, and articulation were predominant, while scaffolding, reflection, and exploration were mainly experienced during longer clerkships and with one clinical teacher. The main problem was variability in usage of the methods, which was attributed to teachers’ lack of time and formal training. The students proposed several ways to improve the application of the teaching methods. The results suggest that the cognitive apprenticeship model is a useful model for teaching strategies in undergraduate clinical training and a valuable basis for evaluation, feedback, self-assessment and faculty development of clinical teachers.     

Significant increase in factual knowledge with web-assisted problem-based learning as part of an undergraduate cardio-respiratory curriculum

In recent years, increasing attention has been paid to web-based learning although the advantages of computer-aided instruction over traditional teaching formats still need to be confirmed. This study examined whether participation in an online module on the differential diagnosis of dyspnoea impacts on student performance in a multiple choice examination of factual knowledge in cardiology and pneumology. A virtual problem-based learning environment for medical students supervised by postgraduate teachers was created. Seventy-four out of 183 fourth-year medical students volunteered to use the online module while attending a 6-week cardio-respiratory curriculum in summer 2007. Of these, 40 were randomly selected to be included (intervention group); the remaining 34 served as an internal control group. Analysis of all written exams taken during the preceding term showed that both groups were comparable (86.4 ± 1.1 vs. 85.9 ± 1.1%; p = 0.751). Students in the intervention group scored significantly higher in the final course assessment than students allocated to the control group (84.8 ± 1.3 vs. 79.5 ± 1.4%; p = 0.006; effect size 0.67). Thus, additional problem-based learning with an online module as part of an undergraduate cardio-respiratory curriculum lead to higher students’ scores in an exam testing factual knowledge. Whether using this teaching format increases overall student motivation to engage in the learning process needs to be further investigated.     

Blended learning positively affects students’ satisfaction and the role of the tutor in the problem-based learning process: results of a mixed-method evaluation

Problem-based learning (PBL) is an established didactic approach in medical education worldwide. The impact of PBL depends on the tutors’ quality and the students’ motivation. To enhance students’ motivation and satisfaction and to overcome the problems with the changing quality of tutors, online learning and face-to-face classes were systematically combined resulting in a blended learning scenario (blended problem-based learning—bPBL). The study aims at determining whether bPBL increases the students’ motivation and supports the learning process with respect to the students’ cooperation, their orientation, and more reliable tutoring. The blended PBL was developed in a cooperation of students and teachers. The well-established Seven Jump-scheme of PBL was carefully complemented by eLearning modules. On the first training day of bPBL the students start to work together with the online program, but without a tutor, on the final training day the tutor participates in the meeting for additional help and feedback. The program was evaluated by a mixed-method study. The traditional PBL course was compared with the blended PBL by means of qualitative and quantitative questionnaires, standardized group interviews, and students’ test results. In addition log-files were analyzed. A total of 185 third-year students and 14 tutors took part in the study. Motivation, subjective learning gains and satisfaction achieved significantly higher ratings by the bPBL students compared with the students learning by traditional PBL. The tutors’ opinion and the test results showed no differences between the groups. Working with the web-based learning environment was assessed as very good by the students. According to the log-file analysis, the web-based learning module was frequently used and improved the cooperation during the self-directed learning.     

Psychosocial Mediators of a School-Based Tobacco Prevention Program in India: Results from the First Year of Project MYTRI

Each day in India, an estimated 5,500 youth initiate tobacco use, contributing to predictions that by 2020, tobacco will account for 13% of all deaths in India. Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) is a multi-component school-based intervention designed to prevent and reduce tobacco use among adolescents in Delhi and Chennai, India. The intervention was implemented over the 2004–2006 school years and involved 6th and 8th grade students in 32 classrooms. Students participated in peer-led classroom activities involving games, competitions, and other activities intended to target a number of psychosocial risk factors believed to prevent tobacco use among urban Indian youth. To more fully understand how Project MYTRI influenced students’ intentions to smoke or chew tobacco, the current study used mediation analysis to investigate whether Project MYTRI altered the psychosocial risk factors as intended, and whether the changes in psychosocial risk factors were, in turn, responsible for altering students’ tobacco-use intentions. Multi-level mediation models were estimated using student data from baseline and 1-year follow-up surveys. Results indicated that the psychosocial risk factors Knowledge of Health Effects, Normative Beliefs, Reasons to Use Tobacco, and Perceived Prevalence were significant mediators between the intervention activities and students’ tobacco use intentions. Evidence of inconsistent mediation was observed for the Perceived Prevalence factor. These findings, combined with those from qualitative research and the second-year student data, will help to illuminate the impact of Project MYTRI on participating youth.     

Occupational therapy students' perspectives regarding international cross-cultural experiences

Background: The purpose of this study was to investigate the perspectives of occupational therapy students who have engaged in international, cross‐cultural learning and service experiences. Methods: This study utilized a qualitative, phenomenological design. Nine semi‐structured interviews were conducted with students who engaged in international learning opportunities. The interviews were coded and analyzed using a constant comparative analysis approach. Results: Three central themes emerged from the data anlysis. Connectedness is the process of forming relationships with others while engaging in cross‐cultural experiences. Students formed relationships with faculty, other students, and people within the community. Cultural awareness is the recognition and understanding of a different culture and responding to those differences. Students attempted to understand the new culture in comparison to their own lived experiences. Complexity portrays cross‐cultural opportunities as dynamic, multi‐faceted and intricate. This was demonstrated as the students raised additional questions about the conflict between their own culture and the new culture they entered. Students also identified limited orientation, support and structure with such experiences and the conflicting roles between volunteer, student, and team member. Conclusions: The ability to connect with others when building relationships in diverse cultural contexts held meaning for the students; however, the students also expressed conflict in trying to make sense of the new culture as it often challenged personal beliefs and constructs. The complexity and challenges of engaging in these opportunities needs to be recognized and further explored to assess how curricula and faculty best supports culturally responsive care.     

Medical Students’ Mindset for Reflective Learning: A Revalidation Study of the Reflection-In-Learning Scale

The aims of this paper are to examine the measurement properties of the Reflection-in-Learning Scale (RLS) and to identify whether there are relationships between RLS scores early in the medical program and outcomes of the students’ academic activity later on. The 14-item RLS was administered to second-year students (N=275) at start and at end of the third semester, after the students had reviewed their previous learning experience with the Course Valuing Inventory. The internal consistency, temporal stability and dimensionality of the RLS scores were investigated in relation to the start-end perspectives. Furthermore, a 2-year follow-up allowed the assessment of the relationships of third-term RLS scores with sixth-term measures of both academic achievement and diagnostic reasoning as appraised by the Diagnostic Thinking Inventory (DTI). Findings indicate that RLS data have acceptable unidimensionality and consistency of measurement, notwithstanding a significant individual–context interaction. Repeated measures revealed distinct patterns of RLS scores relating to perceived self-efficacy on the ability to reflect. Third-term RLS scores were significant, albeit weak, predictors of sixth-term cognitive achievement and DTI-related diagnostic reasoning ability. In conclusion, the results do not support a major explanatory role for RLS on knowledge representation. Nevertheless, the findings appear to substantiate the construct validity of this tool as an index of the students’ frame of mind as regards reflective learning. They suggest that the RLS captures a self-regulation or cognitive housekeeping dimension of the students’ reflective learning. The individual pattern of such (reflective) activity is likely to vary with specific learning conditions.     

Tutor Training,Evaluation Criteria and Teaching Environment Influence Students’ Ratings of Tutor Feedback in Problem-Based Learning

Aim In a problem-based learning (PBL) curriculum, tutor’s feedback skills are important. However, evaluation studies often show that students rate many tutors as ineffective in providing feedback. We explored whether this is related: (a) to tutors’ skills, and hence a teaching intervention might improve their performance; (b) to the formulation of the evaluation item, hence a more specific wording might help students better recognize a feedback when received; (c) to PBL teaching environment, and hence the tutors’ teaching unit might influence students’ ratings. Methods Students rated 126 tutors of 13 one-month teaching units over three consecutive years on their ability of providing feedback. We assessed how (a) a teaching intervention given between years 1 and 2, (b) a rewording of the evaluation item which took place in year 3, and (c) the tutors’ teaching unit, influenced students’ ratings. Results The ratings of tutors considered as effective by students at year 1 improved after the teaching intervention, while those of unsatisfactory tutors did not progress. However the ratings of the latter increased after reformulation of the evaluation item. This increase varied across teaching units. Discussion Students’ ratings of tutors’ ability to give feedback seem to vary in function of the tutors’␣training, of the formulation of the evaluation item, and of the tutors’ teaching environment. These variables should be considered for setting up effective strategies in faculty development.     

Students’ opinions about the effects of preclinical patient contacts on their learning

Several reasons have been given why students should have contacts with real patients early in the undergraduate medical curriculum, i.e., in the preclinical phase. However, it is not clear exactly what effects early patient contacts have with regard to knowledge construction and the development of clinical reasoning skills. We sought students’ views of the effects of preclinical real patient contacts on their learning, knowledge construction and development of clinical reasoning. Twenty-four students in the third and last preclinical year of a 6-year undergraduate medical programme were divided into three focus groups which met twice, after which saturation was reached. The discussions were recorded and transcribed. Summaries of the discussions were approved by the students after some modifications. Atlas-ti software was used to create a coding framework resulting in identification of main themes and sub themes. Early patient contacts motivate students to study, help them understand the impact of illness on patients’ lives, and enhance professional socialisation and memory processes. Students distinguish between analytic and non-analytic clinical reasoning in connection with real patients. Analytic reasoning involves clinical and basic science knowledge. Non-analytic reasoning involves pattern recognition and is made possible by experiential learning from different patient contacts. The students indicate that seeing real patients early in their training has several positive effects on their learning. The contacts enhance knowledge construction and clinical reasoning. Although our results will have to be validated by quantitative, observational and experimental research, they imply that educational benefits are to be gained from real patient contacts in the preclinical phase of medical education.     

Exploring factors affecting undergraduate medical students’ study strategies in the clinical years: a qualitative study

The aim of this study is to explore the effects of clinical supervision, and assessment characteristics on the study strategies used by undergraduate medical students during their clinical rotations. We conducted a qualitative phenomenological study at King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia during the period from November 2007 to December 2008. We conducted semi-structured focus groups interviews with students and conducted individual interviews with teachers and students to explore students’ and clinical teachers’ perceptions and interpretations of factors influencing students’ study strategies. Data collection was continued until saturation was reached. We used Atlas-ti Computer Software (Version 5.2) to analyse the data, apply the obtained themes to the whole dataset and rearrange the data according to the themes and sub-themes. Analysis of data from interviews with twenty-eight students and thirteen clinical supervisors yielded three major themes relating to factors affecting students’ study strategies: “clinical supervisors and supervision”, “stress and anxiety” and “assessment”. The three themes we identified played a role in students’ adoption of different study strategies in the “community of clinical practice”. It appeared that teachers played a key role, particularly as assessors, clinical supervisors and as a source of stress to students.     

Effect of worksheet scaffolds on student learning in problem-based learning

The purpose of this study was to investigate the effect of worksheets as a scaffolding tool on students’ learning achievement in a problem-based learning (PBL) environment. Seventeen PBL classes (N = 241) were randomly assigned to two experimental groups—one with a worksheet provided and the other without. Students’ learning of the topic at hand was evaluated by comparing results from pre- and post-lesson concept recall tests. We also obtained information about students’ perceptions of factors impacting their learning using a Learning Impact Questionnaire. The data was analyzed by means of analyses of variance. Results of the study indicated that there was no statistically significant difference between the levels of understanding for both groups of students. In addition, survey results revealed that the strongest factor perceived by students to impact their learning in a PBL context is the tutor followed by team and class dynamics, while the influence of the worksheet was rated lowest. These findings suggest that scaffolds such as worksheets may not play a significant role in enhancing students’ learning within the social constructivist framework of problem-based learning. On the other hand, the importance of the role of tutor and collaborative small group learning which are key features of PBL is reinforced.     

Problem-Based Learning Online: Perceptions of Health Science Students

This qualitative study explored health sciences students' perceptions of their experiences in online problem based learning (PBL) and focused on their views about learning and group process in the online environment. Participants were novices to online learning and highly experienced in PBL, therefore, they could reflect on past face-to-face PBL experiences. Three groups of learners were involved, including undergraduate nursing and midwifery students and graduate students in a neonatal nurse practitioner program. Findings are presented using the six steps of the PBL process (Rideout & Carpio, 2001). Results indicated that it is feasible to conduct PBL online. Students felt that it increased their flexibility for learning, enhanced their ability to deeply process content, and provided access to valuable learning resources. Students experienced a period of adaptation to the online environment, perceived a heavy workload, and had difficulties making group decisions online. In addition to using asynchronous communication, chats (synchronous communication) were valued to support group decision-making online. Students appreciated validation of their online contributions from their peers and wanted clear expectations of what constituted successful tutorial participation from their tutors. Although online PBL can work effectively, tutors and students need to develop online literacy skills to smooth their transition to an online PBL environment.     

International medical school faculty development: the results of a needs assessment survey among medical educators in China

To explore the need for faculty development among Chinese medical educators. Leaders at each medical school in China were asked to complete a 123-item survey to identify interest in various topics and barriers and perceived benefits of participating in faculty development programs. Interest levels were high for all topics. Experience with Hospital Management and Research positively correlated with interest in learning more (p < 0.001). Ninety-two percent believe that international experiences are very or extremely important to medical educators’ career advancement. Chinese medical education faculty members have a strong interest in faculty development programs.     

Peer Assessment in Problem-Based Learning: A Qualitative Study

Peer assessment provides a powerful avenue for students to receive feedback on their learning. Although student perceptions of peer assessment have been studied extensively in higher education, little qualitative research has been undertaken with medical students in problem-based learning (PBL) curricula. A qualitative study of students’ attitudes to, and perceptions of, peer assessment was undertaken within the framework of a larger study of metacognition with first-year medical students at the University of Queensland. A highly structured format for provision of feedback was utilised in the study design. Many recommendations from the higher education literature on optimal implementation of peer-assessment procedures were put into practice. Results indicated the existence of six main themes: (1) increased responsibility for others, (2) improved learning, (3) lack of relevancy, (4) challenges, (5) discomfort, and (6) effects on the PBL process. Five of these themes have previously been described in the literature. However, the final theme represents a unique, although not unexpected, finding. Students expressed serious concerns about the negative impact of peer assessment on the cooperative, non-judgmental atmosphere of PBL tutorial groups. The practical implications of these findings are considered.