Does problem‐based learning lead to deficiencies in basic science knowledge? An empirical case on anatomy

INTRODUCTION: Problem-based learning (PBL) is supposed to enhance the integration of basic and clinical sciences. In a non-integrative curriculum, these disciplines are generally taught in separate courses. Problem-based learning students perceive deficiencies in their knowledge of basic sciences, particularly in important areas such as anatomy. Outcome studies on PBL show controversial results, sometimes indicating that medical students at PBL schools have less knowledge of basic sciences than do their colleagues at more traditional medical schools. We aimed to identify differences between PBL and non-PBL students in perceived and actual levels of knowledge of anatomy. METHODS: Samples of Year 4 students in all eight medical schools in the Netherlands completed a questionnaire on perceived knowledge and took part in a computerised anatomy test consisting of both clinically contextualised items and items without context. RESULTS: Problem-based learning students were found to have the same perceived level of anatomy knowledge as students at other medical schools. Differences in actual levels of knowledge were found between schools. No significant effects on knowledge levels were found for PBL schools versus non-PBL schools. CONCLUSION: The results of this study show that PBL does not result in a lower level of anatomy knowledge than more traditional educational approaches. It remains to be ascertained whether the levels students attain are adequate. Subjects for further study are the desired level of anatomy knowledge at the end of undergraduate medical education and the effectiveness of basic science learning within a clinical context and with repetition over the course of the curriculum.     

Shared goals, shared learning: evaluation of a multiprofessional course for undergraduate students

Twenty-eight undergraduate degree students from seven health care professions attended a two-day pilot course. Using small multiprofessional groups, final-year students from occupational therapy, orthoptics, therapy radiography, nursing, physiotherapy, medicine and dentistry explored professional roles and clinical problem-solving using a theme-based approach. A balance of didactic and interactive small-group learning enabled them to identify issues surrounding multiprofessional teamworking and collaboration in the National Health Service. Evaluation results showed that the course increased knowledge and understanding of other health care professions, developed more positive attitudes and demonstrated the importance of multiprofessional teamwork and communication. Participating students believed that both early and regular opportunities for shared learning should be essential aspects of undergraduate courses.     

The impact of curricular change on medical students' knowledge of anatomy

BACKGROUND: In recent years, following the publication of Tomorrow's Doctors, the undergraduate medical curriculum in most UK medical schools has undergone major revision. This has resulted in a significant reduction in the time allocated to the teaching of the basic medical sciences, including anatomy. However, it is not clear what impact these changes have had on medical students' knowledge of surface anatomy. AIM: This study aimed to assess the impact of these curricular changes on medical students' knowledge of surface anatomy. SETTING: Medical student intakes for 1995-98 at the Queen's University of Belfast, UK. METHODS: The students were invited to complete a simple examination paper testing their knowledge of surface anatomy. Results from the student intake of 1995, which undertook a traditional, 'old' curriculum, were compared with those from the student intakes of 1996-98, which undertook a new, 'systems-based' curriculum. To enhance linear response and enable the use of linear models for analysis, all data were adjusted using probit transformations of the proportion (percentage) of correct answers for each item and each year group. RESULTS: The student intake of 1995 (old curriculum) were more likely to score higher than the students who undertook the new, systems-based curriculum. CONCLUSION: The introduction of the new, systems-based course has had a negative impact on medical students' knowledge of surface anatomy.     

Anatomy and embryology in medical education at Cambridge University, 1866-1900

Introduction The teaching of anatomy remains controversial to the present day. This paper explores the arguments over its merits in medical and scientific education at one of the ancient universities. History Medical professors at Cambridge University relied upon the science departments to provide basic scientific instruction, whilst science professors relied upon medical students to make up numbers for their courses. Discussion Human anatomy became a source of contention: did it really educate the mind, or was it simply a dry subject that medical students had to learn by rote? Could the university even cater for professional education?     

Ultrasound anatomy: a practical teaching system in human gross anatomy

Cross-sectional imaging such as CT and ultrasound have rapidly developed a central role in diagnostic medicine. However, cross-sectional anatomy has lagged behind in its incorporation into medical school education, often leaving students without even a basic understanding of these images. At Hannover Medical School, we have successfully combined hands-on ultrasound workshops performed by medical students on other students with our anatomy course. This interactive component of our anatomy courses improves our students' understanding of clinical anatomy and introduces them to ultrasound imaging.     

Professionalism and the basic sciences: an untapped resource

CONTEXT: Medical, technological and societal developments influence doctors' professional responsibilities and present challenges to educating medical students about professionalism. Medical education about professionalism generally focuses on behaviours and competencies which are taught primarily by clinicians in clinical courses and settings. DISCUSSION: Many professional competencies in medicine parallel those in science. We consider here whether medical professionalism can also be taught through the basic science courses which often initiate medical education, and which are typically taught by scientists. CONCLUSIONS: Like doctors, basic science faculty staff can teach professional competencies to medical students. Science faculty are well situated to teach professional competencies and should do so. They can model how to pursue evidence and manage conflicting information. They can also provide explicit messages to students about professional competencies and their value, and create learning objectives that reinforce those messages.     

Medical students' learning of anatomy: memorisation, understanding and visualisation

INTRODUCTION: There is much subjective discussion, but few empirical data that explore how students approach the learning of anatomy. AIMS: Students' perceptions of successful approaches to learning anatomy were correlated with their own approaches to learning, quality of learning and grades. METHODS: First-year medical students (n = 97) studying anatomy at an Australian university completed an online survey including a version of the Study Process Questionnaire (SPQ) that measures approaches to learning. The quality of students' written assessment was rated using the Structure of Observed Learning Outcomes (SOLO) taxonomy. Final examination data were used for correlation with approaches and quality of learning. RESULTS: Students perceived successful learning of anatomy as hard work, involving various combinations of memorisation, understanding and visualisation. Students' surface approach (SA) scores (mean 30 +/- 3.4) and deep approach (DA) scores (mean 31 +/- 4.2) reflected the use of both memorisation and understanding as key learning strategies in anatomy. There were significant correlations between SOLO ratings and DA scores (r = 0.24, P < 0.01), between SA scores and final grades (r = - 0.30, P < 0.01) and between SOLO ratings and final grades (r = 0.61, P < 0.01) in the subject. CONCLUSIONS: Approaches to learning correlate positively with the quality of learning. Successful learning of anatomy requires a balance between memorisation with understanding and visualisation. Interrelationships between these three strategies for learning anatomy in medicine and other disciplines require further investigation.     

The relationship between medical students' attitudes towards communication skills learning and their demographic and education-related characteristics

INTRODUCTION: The General Medical Council (GMC) has stressed the importance of medical students' attitudes towards learning. However, few studies have explored medical students' attitudes towards communication skills learning. This study explores the relationship between the attitudes of medical students at two different schools and their demographic and education-related characteristics. METHODS: A total of 490 medical students from the Universities of Nottingham (Years 1 and 2) and Leicester (Year 1) completed the 26-item Communication Skills Attitude Scale (CSAS) and a personal details questionnaire satisfactorily. The relationships between students' attitudes and their demographic and education-related characteristics were analysed separately for Nottingham and Leicester students using both univariate and multivariate statistics. RESULTS: The attitudes of Nottingham and Leicester medical students towards communication skills learning were significantly associated with a number of demographic and education-related characteristics. Both Nottingham and Leicester students with more positive attitudes towards communication skills learning tended to be female, tended to think their communication skills needed improving and tended not to have parents who were doctors. Both Nottingham and Leicester students with more negative attitudes towards communication skills learning tended to think their communication skills did not need improving. DISCUSSION: The results indicate that medical students' attitudes towards communication skills learning are associated with their demographic and education-related characteristics. These findings have a number of implications for educational practice and further research and these are discussed in this paper.     

Evaluation of a surgical simulator for learning clinical anatomy

BACKGROUND: New techniques in imaging and surgery have made 3-dimensional anatomical knowledge an increasingly important goal of medical education. This study compared the efficacy of 2 supplemental, self-study methods for learning shoulder joint anatomy to determine which method provides for greater transfer of learning to the clinical setting. METHODS: Two groups of medical students studied shoulder joint anatomy using either a second-generation virtual reality surgical simulator or images from a textbook. They were then asked to identify anatomical structures of the shoulder joint as they appeared in a videotape of a live arthroscopic procedure. RESULTS: The mean identification scores, out of a possible score of 7, were 3.1 +/- 1.3 for the simulator group and 2.9 +/- 1.5 for the textbook group (P = 0.70). Student ratings of the 2 methods on a 5-point Likert scale were significantly different. The simulator group rated the simulator more highly as an effective learning tool than the textbook group rated the textbook (means of 3.2 +/- 0.7 and 2.6 +/- 0.5, respectively, P = 0.02). Furthermore, the simulator group indicated that they were more likely to use the simulator as a learning tool if it were available to them than the textbook group was willing to use the textbook (means of 4.0 +/- 1.2 and 3.0 +/- 0.9, respectively, P = 0.02). CONCLUSION: Our results show that this surgical simulator is at least as effective as textbook images for learning anatomy and could enhance student learning through increased motivation. These findings provide insight into simulator development and strategies for learning anatomy. Possible explanations and future research directions are discussed.     

Teaching research methodology in medical schools: students' attitudes towards and knowledge about science

OBJECTIVE: To explore the relationship between teaching scientific methodology in Year 2 of the medical curriculum and student attitudes towards and knowledge about science and scientific methodology. DESIGN: Anonymous questionnaire survey developed for this purpose. SETTING: Zagreb University School of Medicine, Croatia. PARTICIPANTS: A total of 932 students (response rate 58%) from all 6 years were invited to participate. MAIN OUTCOME MEASURES: Score on attitude scale with 45 Likert-type statements and score on knowledge test consisting of 8 multiple choice questions. RESULTS: The average attitude score for all students was 166 +/- 22 out of a maximum of 225, indicating a positive attitude towards science and scientific research. The students' average score on the knowledge test was 3.2 +/- 1.7 on 8 questions. Students who had finished Year 2 had the highest mean attitude (173 +/- 24) and knowledge (4.7 +/- 1.7) scores compared with other year groups (P < 0.001, anova and Tukey posthoc test). For students who had attended a mandatory Year 2 course on the principles of scientific research in medicine (Years 3 to 6), multiple linear regression analysis showed that knowledge test score (B = 3.4; SE = 0.4; 95% confidence interval 2.5-4.2; P < 0.001) and average grades (B = 7.6; SE = 1.5; 95% CI 4.6-10.6; P < 0.001) were significant predictors of attitude towards science, but not sex or failure to pass a year (B = - 0.6; SE = 1.7; 95% CI - 3.9-2.6; P = 0.707; and B = - 3.1; SE = 1.9; 95% CI - 6.8-5.7; P = 0.097, respectively). CONCLUSION: Medical students have generally positive attitudes towards science and scientific research in medicine. Attendance of a course on research methodology is related to a positive attitude towards science.     

Interprofessional training in the context of clinical practice: goals and students' perceptions on clinical education wards

AIMS: This paper describes the context of interprofessional training on clinical education wards (CEWs) and reports students' perceptions of this type of interprofessional and professional training. CONTEXT: A 2-week interprofessional clinical course was designed for medical students in their surgical eighth term, and nursing, occupational therapy and physiotherapy students, all in their sixth term. Clinical tutors were responsible for the patients and also supervised the students. The goals for the students included: to provide the patients with good medical care, nursing and rehabilitation; to develop their own professional roles; to enhance their level of understanding of the other professions; to stress the importance of good communication for teamwork and for patient care; to enhance understanding of the role of the patient, and to become more aware of ethical aspects of health care. MATERIAL AND METHODS: A questionnaire developed by teachers from the 4 educational departments was used. A total of 962 students responded (78%). RESULTS: The CEWs provided the students with good clinical practice in terms of training in their own professions as well in learning more about the other professions. The importance of good communication for teamwork and for patient care was recognised. The quality of supervision and students' perception of their own professional roles were important factors regarding satisfaction with the CEW course. CONCLUSIONS: The CEW course seemed to provide the students with an opportunity to develop their own professional roles and their functions as team members.     

Learning together: clinical skills teaching for medical and nursing students

OBJECTIVE: To evaluate the feasibility and effectiveness of shared learning of clinical skills for medical and nursing students at the University of Manchester. DESIGN: Medical and nursing students learned clinical skills in either uniprofessional or multiprofessional groups. These groups rotated through skills stations taught by multiprofessional facilitators. The groups stayed together for a series of 3 sessions held at weekly intervals (an induction meeting followed by 2 3-hour teaching sessions). Both quantitative and qualitative methods were used to evaluate the project. CONTEXT: A total of 113 Year 3 students registered on the Medical (n = 41), Bachelor of Nursing (Honours) (n = 43) or the Diploma for Professional Studies in Nursing (n = 29) courses participated in the project which was set in the clinical skills unit of a teaching hospital. RESULTS: Pre- and post self-evaluation of confidence levels for the taught skills revealed a statistically significant increase for all skills. The primary reason students gave for participation in the project was to learn or consolidate skills. An additional inducement for participation was the opportunity to share knowledge and observations between professional groups. Tutors also evaluated the experience favourably, particularly with regard to small group discussions. They indicated that the programme provided an opportunity to standardise clinical skills teaching. CONCLUSION: Collaborative learning opportunities for nursing and medical students are feasible and add value to the learning experience. Data indicate positive outcomes of learning in multiprofessional groups, comprising increased confidence levels, increased understanding of others' professional roles and personal development.     

Cross-year peer tutoring experience in a medical school: conditions and outcomes for student tutors

AIMS: To examine the features of cross-year peer tutoring and to explore their relationships to learners' characteristics and educational outcomes from the student-tutor perspective. METHOD: The records of 447 final year medical students were examined to provide data on the starting terms, frequency and course targets of peer tutoring activity of student tutors. The relationships of these features with their learners' characteristics, academic achievements and selective clerkship pathways were analysed. SETTING: The medical education programme at the University of Brasilia, Brazil. RESULTS: Analysis showed that about 96% of all graduates had acted as student tutors at some time during the programme, with great variation in starting terms, numbers and types of courses tutored. The average number of tutored courses per tutor was four. Frequency and variety of tutored courses were significantly related to achievement, learning style and gender. Higher achievers acted as student tutors for many terms and explored different subjects, and there is evidence that the experience expanded their academic expertise. Specific tutoring in a clinical course also related to strength of early career preference. Furthermore, there was a significant correlation between the number of terms of tutoring undertaken in a clinical course and the proportion of students choosing selective clerkship training in the same area by the end of programme. CONCLUSIONS: The findings suggest that acting as a peer tutor can be an appealing and constructive educational opportunity to further students' academic development. Enhanced expertise seems to relate to the accumulation and breadth of tutoring experience. Moreover, clinical tutoring may help students in making decisions regarding choice of career.     

Social issues in medicine: a follow-up comparison of senior-year medical students'' attitudes with contemporaries in non-medical faculties

A comparison of first-year medical students' attitudes to social issues in medicine with attitudes of non-medical first-year students in 1983 found that the medical group was less conservative towards general social issues but more conservative in relation to those areas which closely affect the doctor's role, particularly the place of allied health professions and government intervention in health care. This paper reports a follow-up study of the same groups of students when they had reached senior years in their respective courses. While medical student conservatism on general social issues continues to be no greater than other student groups there is a marked increase in conservatism of attitudes towards government involvement in health care and regulation of costs. Attitudes to allied health professions and preventive care remain unchanged but senior medical students are significantly less likely to recognize social factors as determinants of illness than they were when they commenced the study of medicine. Specific curricular attention to social and behavioural medicine does not appear to counteract the predominantly biomedical perspective students experience in teaching hospitals, the major venue for their clinical education.     

The influence of tutoring competencies on problems, group functioning and student achievement in problem-based learning

CONTEXT: Prominent factors in problem-based learning (PBL) are the problems to be solved, tutorial group functioning and tutors' competencies. These factors mutually affect one another and largely determine whether a powerful learning environment will be created. It is a tutor's task to stimulate active, self-directed, contextual and collaborative learning and display interpersonal behaviour that is conducive to students' learning. We investigated the effects of tutors' competencies on students' learning and on other variables, such as group functioning and student achievement. OBJECTIVES: We investigated whether tutors who stimulate active, self-directed, contextual and collaborative learning make better use of problems and meaningful contexts in PBL and also enhance group functioning. We also investigated whether the quality of problems has a positive impact on group functioning and whether group functioning advanced student achievements. METHODS: Questionnaires were used to collect data from students at the end of 11 modules in Years 1 and 2 of a PBL undergraduate medical curriculum. We used structural equation modelling to test the fit of a theoretical model representing the factors of interest and their relationships. RESULTS: Stimulation of active and constructive learning, self-directed learning and collaborative learning by tutors enhanced the quality of the problems and group functioning. The quality of the problems promoted group functioning, which was found to have a positive effect on student achievement. CONCLUSIONS: Tutors' competencies had a positive effect on the learning of students. This suggests that it would be worthwhile including these competencies in staff development.     

Assessing personal process learning in a health promotion module for medical students

This paper describes the development and evaluation of an assessment method for personal process learning in a student-centred health promotion module. Personal process learning refers to students' awareness and understanding of their learning about personal values and attitudes, their skills for planning change, and their communication skills. The assessment forms part of the professional examination in public health. The paper documents and critically reviews the assessment method in the light of student feedback. The problem of student acceptability is highlighted and we describe the adjustments that have been made in response to this and how they have been received. It is concluded that medical students are open to innovative forms of assessment as long as they perceive them to be valid, fair and equitable.     

Teaching and learning about human sexuality in undergraduate medical education

BACKGROUND: Effective management of the doctor's role in relation to human sexuality requires sensitivity and tact, an ability to put patients at ease, use of appropriate language, and therapeutic, non-discriminatory attitudes. However, previous research suggests that medical students and doctors may hold negative attitudes towards homosexuality and some forms of sexual behaviour. Some educational programmes have started to help students develop communication skills for sexual health consultations, but little work has addressed the broader issue of attitudes and values which may underlie behaviour. It is vital that medical students begin early the process of reflection and recognition of how their attitudes and values might influence their care of patients. In this paper we report on a course designed to initiate this process at Leicester-Warwick Medical School (LWMS). COURSE DESCRIPTION: The course utilizes techniques of desensitization, problem-solving and reflection to enable the students to achieve the learning outcomes, which are primarily oriented towards reflection and self-development. It uses a variety of teaching and learning strategies, combining peer learning with self-directed learning, and small-group learning with whole class learning. COURSE EVALUATION: We report observations and a before-and-after questionnaire study of students' views and attitudes. This evaluation suggests that the course is successful in reducing students' anxieties about human sexuality and improving their confidence in developing appropriate skills. CONCLUSIONS: The LWMS course is one model which might be used to begin the process of encouraging medical students to develop ways of appropriately managing their responsibilities in relation to human sexuality.     

Performance of medical students in case-based and essay components of written anatomy examinations

This paper reports on second-year medical students' performance in the case-based and traditional essay components of the gross anatomy written examinations at the University of Otago held at the end of 1988 and 1989. The mean marks for these two components of the examinations are presented for the three main categories of student entry. Differential performance on the case-based component relative to the essay component has been determined for each student in the class and ranked in order. The proportions of students in the three entry categories falling in the various quartiles for the class are given. The data show that when an intensive programme of case-based learning was followed, as in 1988, all three categories performed similarly on the case-based component relative to the essay component. When a less intensive programme of case-based learning was used, as in 1989, the differential performance of the preferential undergraduate and graduate categories was different to each other. The findings suggest that the achievement of students in the case-based projects is dependent upon the organization of the programme and the extent to which students and staff become involved in the projects. The writing of reports on the cases by students for assessment in 1988 may have had an important influence on the outcome for this year.     

Measuring the effect of interprofessional problem-based learning on the attitudes of undergraduate health care students

OBJECTIVES: This study aimed to measure the improvement in attitudes towards interprofessional collaboration of undergraduate health care students who have a single module of interprofessional problem-based learning (PBL) using real patients as triggers integrated into their curricula. DESIGN: A dedicated module, consisting of 5 PBL seminars, was integrated into the undergraduate medical, nursing and physiotherapy curricula at the participating institutions. Seminar groups consisted of students from a single profession in the control group, and of evenly distributed students from the participating professions in the intervention group. The Interdisciplinary Education Perception Scale was used to measure improvements in attitudes towards interprofessional co-operation. Patients, faculty members and students were included in the evaluation of the interprofessional module and their comments examined for indications of adverse effects of the use of patients in this setting. RESULTS: A total of 177 students were recruited into the study and assigned to 1 of 16 seminar groups, all of which attended the complete module, 8 in control mode and 8 in intervention mode. Statistically significant improvements could be identified in the overall attitudes of male students in the intervention group, and in attitudes pertaining to the competence and autonomy of individuals in one's own profession in the intervention group as a whole. No significant improvements were detected in the control group. No adverse effects of the use of real patients came to light. CONCLUSIONS: The integration of an interprofessional educational module that requires limited student and faculty time in undergraduate health care curricula may be proven to have an effect. The Interdisciplinary Education Perception Scale may be suitable for measuring such effect. Real patients may continue to contribute to education in this setting.     

Multiprofessional learning: the attitudes of medical, nursing and pharmacy students to shared learning

OBJECTIVES: The belief that the effectiveness of patient care will improve through collaboration and teamwork within and between health care teams is providing a focus internationally for 'shared learning' in health professional education. While it may be hard to overcome structural and organizational obstacles to implementing interprofessional learning, negative student attitudes may be most difficult to change. This study has sought to quantify the attitudes of first-year medical, nursing and pharmacy students' towards interprofessional learning, at course commencement. DESIGN: The Readiness for Interprofessional Learning Scale (RIPLS) (University of Liverpool, Department of Health Care Education), was administered to first-year medical, nursing and pharmacy students at the University of Auckland. Differences between the three groups were analysed. SETTING: The Faculty of Medical and Health Sciences, University of Auckland. RESULTS: The majority of students reported positive attitudes towards shared learning. The benefits of shared learning, including the acquisition of teamworking skills, were seen to be beneficial to patient care and likely to enhance professional working relationships. However professional groups differed: nursing and pharmacy students indicated more strongly that an outcome of learning together would be more effective teamworking. Medical students were the least sure of their professional role, and considered that they required the acquisition of more knowledge and skills than nursing or pharmacy students. CONCLUSION: Developing effective teamworking skills is an appropriate focus for first-year health professional students. The timing of learning about the roles of different professionals is yet to be resolved.