Aligning physical learning spaces with the curriculum: AMEE Guide No. 107

This Guide explores emerging issues on the alignment of learning spaces with the changing curriculum in medical education. As technology and new teaching methods have altered the nature of learning in medical education, it is necessary to re-think how physical learning spaces are aligned with the curriculum. The better alignment of learning spaces with the curriculum depends on more directly engaged leadership from faculty and the community of medical education for briefing the requirements for the design of all kinds of learning spaces. However, there is a lack of precedent and well-established processes as to how new kinds of learning spaces should be programmed. Such programmes are essential aspects of optimizing the intended experience of the curriculum. Faculty and the learning community need better tools and instruments to support their leadership role in briefing and programming. A Guide to critical concepts for exploring the alignment of curriculum and learning spaces is provided. The idea of a networked learning landscape is introduced as a way of assessing and evaluating the alignment of physical spaces to the emerging curriculum. The concept is used to explore how technology has widened the range of spaces and places in which learning happens as well as enabling new styles of learning. The networked learning landscaped is explored through four different scales within which learning is accommodated: the classroom, the building, the campus, and the city. High-level guidance on the process of briefing for the networked learning landscape is provided, to take into account the wider scale of learning spaces and the impact of technology. Key to a successful measurement process is argued to be the involvement of relevant academic stakeholders who can identify the strategic direction and purpose for the design of the learning environments in relation to the emerging demands of the curriculum.     

AMEE Medical Education Guide No. 15: Problem-based learning: a practical guide

This practical guide for health professions teachers provides a perspective of one of the most important educational developments in the past 30 years.Problem-based learning (PBL) is a continuum of approaches rather than one immutable process. It is a teaching method that can be included in the teacher's tool-kit along with other teaching methods rather than used as the sole educational strategy.PBL reverses the traditional approach to teaching and learning. It starts with individual examples or problem scenarios which stimulate student learning. In so doing, students arrive at general principles and concepts which they then generalize to other situations. PBL has many advantages. It facilitates the acquisition of generic competences, encourages a deep approach to learning and prepares students for the adult learning approach they need for a lifetime of learning in the health care professions. It is also fun. PBL helps in curriculum planning by defining core, ensuring relevance of content, integrating student learning and providing prototype cases. There are also drawbacks associated with PBL. Students may fail to develop an organized framework for their knowledge. The PBL process may inhibit good teachers sharing their enthusiasm for their topic with students and student identification with good teachers.Teachers may not have the skills to facilitate PBL.The problem scenario is of crucial significance. It should engage the students' interest and be skilfully written. While the medium selected for presentation of the scenario is usually print, other media may be used.The clinical tasks carried out by the student may replace the problem scenario as the focus for learning.Students are supported during the PBL process by tutors and/or study guides.The amount of support required is inversely related to the students' prior learning and understanding of the PBL process. A range of additional learning resources and opportunities may be made available to the students, including textbooks, videotapes, computer-based material, lectures and clinical sessions. Tutors require group facilitation skills, an understanding of the PBL process and knowledge of the course and of the curriculum in general.They need special personal qualities and it is preferable if they have expertise in the content area.While special assessment processes have been developed to assess students learning by the PBL method, the general principles of assessment apply to PBL courses and a mixed menu of assessment methods needs to be employed. Curriculum design involves a skilful blend of educational strategies designed to help students achieve the curriculum outcomes. PBL may make a valuable contribution to this blend but attention needs to be paid to how it is implemented.     

Attitudes to concept maps as a teaching/learning activity in undergraduate health professional education: influence of preferred learning style

Concept maps that integrate and relate concepts in a nonlinear fashion are widely accepted as an educational tool that can underpin meaningful learning in medical education. However, student take-up may be affected by a number of cognitive and non-cognitive influences. In the present study, student attitudes to pre-prepared concept maps introduced in Stage 2 conjoint MPharm and BSc Pharmacology lectures were examined in relation to preferred learning styles according to the Felder-Silverman model. There was no statistically significant influence of dichotomous learning style dimension (sensing/intuitive; visual/verbal; active/reflector; sequential/global) on the self-reported utility of such concept maps to learning. However, when strength of preference was analysed within each dimension, moderate/strong verbal learners were found to be significantly less likely to self-report concept maps as useful relative to mild verbal learners. With this important exception, these data now suggest that student attitudes to concept maps are broadly not influenced by preferred learning styles and furthermore highlight the potential of concept maps to address a variety of different learning styles and thereby facilitate 'teaching to all types'. Concept maps could therefore potentially assist motivation, engagement and deep learning in medical and biomedical science education when used as a supplement to more traditional teaching/learning activities.     

Reflections on integrating theories of adult education into a medical school faculty development course

The purpose of this study was to test a three-day course model for medical school faculty designed to promote self-directed learning, teaching skills, personal awareness and interdisciplinary collegiality. The training program described was conducted three times in our medical school. Fifty-eight faculty from 11 clinical departments have participated in this intensive experience of learning how to teach, based on principles of learner-centered learning and adult education theory. Participants defined their own learning objectives and worked collaboratively in facilitated small groups to develop teaching skills. Reflection groups engaged in discussion on critical incidents of experience as teachers and learners, and promoted awareness regarding personal approaches to teaching. Qualitative and quantitative data showed that the course was effective in: (1) providing an academically and emotionally safe environment for learning; (2) enabling participants to recognize and value learner-centered learning; (3) increasing participant personal awareness, and (4) promoting interdisciplinary collegiality. End-of-course data assessing the following course attributes, using a five-point scale, where 1 was 'not effective' and 5 was 'very effective', showed: (a) exploration of needs: mean 4.20 +/- SD 0.91; (b) interactive sharing of ideas; mean 4.60 +/- SD 0.58; (c) opportunity to receive feedback: mean 4.26 +/- SD 0.80; (d) opportunity to practice new skills; mean 4.11 +/- SD 0.72. In terms of participation in further faculty development, 92% of participants committed themselves to continue the work begun at the course. It was concluded that the faculty development program created a safe, learner-centered environment for participants that promoted both awareness of and commitment to self-directed learning, and facilitated teaching skill development and interdisciplinary collegiality. Our three-day course appears to be highly effective in initiating a long-term faculty development process. Additionally, we conclude that there is a need for longitudinal follow-up to support and expand mastery of these teaching skills.     

Learning methods and strategies of anatomy among medical students in two different Institutions in Riyadh,Saudi Arabia

Abstract

Background: Anatomy instructors adopt individual teaching methods and strategies to convey anatomical information to medical students for learning. Students also exhibit their own individual learning preferences. Instructional methods preferences vary between both instructors and students across different institutions.

Aims: In attempt to bridge the gap between teaching methods and the students’ learning preferences, this study aimed to identify students’ learning methods and different strategies of studying anatomy in two different Saudi medical schools in Riyadh.

Materials and Methods: A cross-sectional study, conducted in Saudi Arabia in April 2015, utilized a three-section questionnaire, which was distributed to a consecutive sample of 883 medical students to explore their methods and strategies in learning and teaching anatomy in two separate institutions in Riyadh, Saudi Arabia.

Results: Medical students’ learning styles and preferences were found to be predominantly affected by different cultural backgrounds, gender, and level of study. Many students found it easier to understand and remember anatomy components using study aids. In addition, almost half of the students felt confident to ask their teachers questions after class. The study also showed that more than half of the students found it easier to study by concentrating on a particular part of the body rather than systems. Students’ methods of learning were distributed equally between memorizing facts and learning by hands-on dissection. In addition, the study showed that two thirds of the students felt satisfied with their learning method and believed it was well suited for anatomy.

Conclusions: There is no single teaching method which proves beneficial; instructors should be flexible in their teaching in order to optimize students’ academic achievements.     

Small groups and problem-based learning: are we singing from the same hymn sheet?

Recently, commented that there is a need for better ways of looking at how teaching and learning work in the PBL approach before it is banished to the wilderness of other educational innovations. The premise of this paper is that better ways of looking at how PBL works are dependent on better ways of understanding PBL. The recent exchange of views in the literature about the value of the small-group learning environment in PBL suggests that there is a variety of perspectives on the role and purpose of the small group. The debaters will have difficulty settling their differences or even understanding each other's point of view if they are not 'singing from the same hymn sheet'. In pursuit of clarifying the issue and contributing to an enhanced understanding of PBL, this paper critiques published views of the small-group learning environment against a way of looking at PBL as a whole approach to learning medicine.     

The Swiss catalogue of learning objectives

PBL philosophy may challenge the need for explicit and specific educational objectives in medical education. From a practical point of view, however, such objectives are essential to achieve a close overlap between learning, teaching and assessment. Since the 1970s medical licensing in Switzerland has been based, among other things, on passing a uniform, centrally prepared MCQ exam for the graduates of all five Swiss medical schools. The need for a set of jointly developed learning, teaching and assessment objectives has become apparent. The Joint Conference of Swiss Medical Schools has therefore charged a small taskforce with the development of such a catalogue. This paper describes the background, process and results of this work.     

Applying adult learning principles to medical education in the United States

An extensive literature on adult learning principles has been developed over the last 40 years. Simultaneously, undergraduate medical educational programs have undergone varying degrees of curricular reform. The present paper discusses the educational and societal factors that have functioned as a catalyst for innovations in medical education, and reviews the major initiatives which have been undertaken. Data are analyzed to assess the extent to which some of these changes have been incorporated into medical curricula. A comprehensive review of adult learning principles is than presented, in order to provide a framework for the incorporation of principles of adult learning into the next wave of medical education reform. The review of adult learning principles reveals that undergraduate medical educational reform has underutilized the robust literature on adult learning. The present paper concludes with suggestions for medical education reform that incorporates the principles of adult learning and discusses the major impediment to curricular reform.     

Twelve tips for the development of electronic study guides

With recent advances in technology, electronic study guides are becoming extraordinary management, learning and assessment tools in the teaching-learning process, replacing printed study guides. The educational advantages they offer are listed here. During the elaboration of an electronic study guide, there are important issues to consider, such as the student's capabilities in the use of electronic media, the type of software to be used, proper authorizations and accessibility, the inclusion of all information and links needed, as well as a clear explanation on the use of the software. This paper offers twelve useful tips for the development of electronic study guides.     

E-learning in sexuality education

The use of computers in learning and communication is not new to health professional education. However, the rapid developments in technology and the increasing competence of students in computer- and web-based learning make the need for health professional education to take the next step to e-learning a necessity rather than a choice. This paper describes an e-learning unit in sexuality developed in response to a felt need for a flexible online unit in the topic. The use of online tools for e-learning in sexuality are discussed and course evaluation presented. The need for a strong pedagogic model and the careful development of learning activities to utilize the facilities available for assessment, feedback and especially synchronous and asynchronous communication are discussed as they apply to the sexuality unit.     

Current trends and future implications in the developing role of clinical skills centres

Clinical skills centres (CSCs) have contributed significantly to undergraduate medical education. Using alternative venues for training in communication skills, clinical examination and practical procedures they avoid jeopardising patient-care in traditional clinical settings. Using simulation they enable tutors to structure learning opportunities, provide standardized and reproducible experiences and create learner-centred environments where mistakes are permissible. However, recent changes in patients' attitudes and expectations and in students' and doctors' needs indicate that further changes in the delivery and learning of clinical skills are required. Four current trends in teaching and learning are emerging in CSCs. The range of delivery methods available is expanding; educational strategies are being adopted; a variety of assessment opportunities are being identified and the need for support mechanisms for students and tutors is being recognized. The implementation of these trends gives rise to a number of resource implications that must be met. Appropriate planning is required to ensure that the future contribution of CSCs will be successful in training healthcare professionals for practice in contemporary society.     

Data and metadata: development of a digital curriculum

The teaching potential of a problem-based learning (PBL-)oriented curriculum sparks a lot of enthusiasm, but the matrix-type organization of the curriculum elements calls for more powerful organizational tools than the block-oriented structure of previous curricula. Also, the multitude of digital elements available for teaching purposes present a fascinating development, but again the task of putting this offering into order is considerable. The aim of the present project was to set up a database-driven curriculum, organizing the administrative information in a way that allows the multiaxial access required by the new curriculum. Also, we wished to catalogue existing and upcoming digital teaching resources in a way that allowed a logical connection to the curricular activities. The database has a relational structure containing all the administrative information on lessons, as well as topic keywords and abstracts. An index table of the teaching resources forms a link to the curriculum database, and allows the resources to be searched based on curriculum information (topic, term, lecturer etc). Upcoming challenges include acquisition and quality assurance of teaching resources and teaching, as well as motivating the teachers and students. Automated data acquisition mechanisms and curricular activities available only online may be valuable elements in this ongoing process.     

Developing and evaluating ambulatory care: problem-based learning cases

Medical educators have raised concerns about the quality of teaching and learning in busy ambulatory care settings. Problem-based learning (PBL), which allows students to learn to diagnose and manage common ambulatory care problems as they discuss patients away from the clinical setting, is one possible solution for addressing these concerns. This article describes a process for developing realistic and well-written PBL cases for an ambulatory care clerkship. The process details specific steps for writing and evaluating cases to ensure they contain relevant learning issues students often encounter in outpatient training sites. Faculty at other institutions can adapt this process to develop and evaluate PBL cases reflecting the common presenting problems and patient issues at their sites.     

The process of developing a research questionnaire to measure attitudes to shared learning

This article discusses the process by which a questionnaire was developed specifically to measure attitude to shared learning. Over a three-year period the attitude questionnaire was developed and tested using pre-registration students who were engaged in a shared learning programme. These pre-registration students were from three professional groups, namely occupational therapy (OT), diagnostic radiography (DR), and therapeutic radiography (TR). While the study hypothesis was that shared learning would improve attitudes over the three-year period, the focus of this article is to discuss the process by which the research instrument was developed. The rationale for focusing on the process is a simple one. After a diligent literature search it was clear that there were no attitude questionnaires specific to attitude measurement in relation to shared learning. Thus without an already validated attitude to a shared learning questionnaire, it became imperative to create systematically a credible attitude measure of shared learning. The process centred on understanding how monadic scales are constructed and used to measure attitudes and perceptions of participants. Amongst a number of processes to be followed was the need also to check the reliability of the developed questionnaire. This was done using the Cronbach alpha coefficient. A Cronbach alpha coefficient of 0.7 was set as a minimum reliability requirement, which was duly satisfied. The outcome of this process was that it very useful to learn how to produce a suitable instrument to measure attitude to shared learning and to add in a small way to the range of attitude questionnaires available.     

Team-based learning: a practical guide: AMEE guide no. 65

Team-based learning? (TBL) is an instructional strategy developed in the business school environment in the early 1990s by Dr Michaelsen who wanted the benefits of small group learning within large classes. In 2001, a US federal granting agency awarded funds for educators in the health sciences to learn about and implement the strategy in their educational programs; TBL was put forward as one such strategy and as a result it is used in over 60 US and international health science professional schools. TBL is very different from problem-based learning (PBL) and other small group approaches in that there is no need for multiple faculty or rooms, students must come prepared to sessions, and individual and small groups of students (teams) are highly accountable for their contributions to team productivity. The instructor must be a content-expert, but need not have any experience or expertise in group process to conduct a successful TBL session. Students do not need any specific instruction in teamwork since they learn how to be collaborative and productive in the process. TBL can replace or complement a lecture-based course or curriculum.     

Common strategies in clinical data collection displayed by experienced clinician-teachers in internal medicine

The role model displayed by clinician-teachers influences learning experiences but learners may face various reasoning styles. Our goal was to describe common strategies in clinical data collection displayed by experienced clinician-teachers in internal medicine. We studied six internists heavily involved in teaching while they were working up the same seven cases portrayed by a standardized patient. Each encounter was audio-recorded and replayed to allow the subjects commenting on the purpose and diagnostic hypotheses considered for each piece of information collected. Information and hypotheses elicited by all physicians were considered key items. Although the subjects reached the same final diagnoses, they differed on several characteristics of their data collection process. They also displayed common behaviours, such as: early acquisition of key data (half of them acquired within the first 19 questions asked) through clarification of the patients' complaints and focused data collection; early generation of the final diagnosis (within the first 10 questions asked) and use of diagnostic hypotheses to frame data collection; and summarization of the information at hand during the encounter (at least twice). Whether making teachers explicitly conscious about their own reasoning processes may help them better model and explain their diagnostic approach to specific cases should be assessed in follow-up studies.     

Programmatic assessment: From assessment of learning to assessment for learning

In assessment a considerable shift in thinking has occurred from assessment of learning to assessment for learning. This has important implications for the conceptual framework from which to approach the issue of assessment, but also with respect to the research agenda. The main conceptual changes pertain to programmes of assessment. This has led to a broadened perspective on the types of construct assessment tries to capture, the way information from various sources is collected and collated, the role of human judgement and the variety of psychometric methods to determine the quality of the assessment. Research into the quality of assessment programmes, how assessment influences learning and teaching, new psychometric models and the role of human judgement is much needed.     

Teaching styles of tutors in a problem-based curriculum: students' and tutors' perception

This study compared the self-rated with student-rated teaching styles of PBL tutors. We also examined the relationship between teaching styles of tutors' and students' evaluation of tutor effectiveness in tutorials. The study included 48 tutors and 276 medical students. Tutors, and students' were given a teaching style inventory with a 5-point scale consisting of 21 items that comprise four domains of teaching styles (facilitative, collaborative, suggestive and assertive). In addition, quantitative and qualitative evaluations of tutor effectiveness by students were analyzed. Tutors perceived themselves in the facilitative-collaborative end of the spectrum of styles In contrast, students perceived tutors as less 'facilitative-collaborative' and more 'suggestive-assertive' than tutors self-ratings (p < 0.001). In addition, the difference in perception between students and tutors ratings in the facilitative-collaborative domains was more evident as students progressed in the PBL curriculum. The students' ratings of the effectiveness of tutors correlated more strongly with facilitative-collaborative than with suggestive-assertive domains of teaching styles. However, other tutor attributes such as establishing rapport with students, providing academic help for them and having content expertise were considered important criteria of an effective tutor. We conclude that there is a mismatch between students' and tutors' perceptions about teaching styles of tutor. Tutor attributes other than teaching styles are important determinants of an effective tutor.     

A qualitative evaluation of senior house officers' teaching and learning: towards sharing good practice

The evaluation explored junior doctors'/senior house officers' (SHOs') teaching and learning experiences and identified examples of consultants' good teaching practices. The qualitative study is based on semi-structured interviews conducted towards the end of a six-month rotation. Data analysis revealed that in spite of the heavy workloads of both consultants and SHOs there were many positive examples of consultants' creative approaches to teaching and learning, as well as provision of personal and professional support and, for some, ongoing feedback from both consultants and the healthcare team. There was room for improvement, particularly concerning learning experiences in some clinical settings, the development of clinical skills and a need for two-way feedback. However, all the participants would recommend their experience to future SHOs and colleagues.     

Theoretical insights into interprofessional education: AMEE Guide No. 62

In this Guide, we support the need for theory in the practice of interprofessional education and highlight a range of theories that can be applied to interprofessional education. We specifically discuss the application of theories that support the social dimensions of interprofessional learning and teaching, choosing by way of illustration the theory of social capital, adult learning theory and a sociological perspective of interprofessional education. We introduce some of the key ideas behind each theory and then apply these to a case study about the development and delivery of interprofessional education for pre-registration healthcare sciences students. We suggest a model that assists with the management of the numerous theories potentially available to the interprofessional educator. In this model, context is central and a range of dimensions are presented for the reader to decide which, when, why and how to use a theory. We also present some practical guidelines of how theories may be translated into tangible curriculum opportunities. Using social capital theory, we show how theory can be used to defend and present the benefits of learning in an interprofessional group. We also show how this theory can guide thinking as to how interprofessional learning networks can best be constructed to achieve these benefits. Using adult learning theories, we explore the rationale and importance of problem solving, facilitation and scaffolding in the design of interprofessional curricula. Finally, from a sociological perspective, using Bernstein's concepts of regions and terrains, we explore the concepts of socialisation as a means of understanding the resistance to interprofessional education sometimes experienced by curriculum developers. We advocate for new, parallel ways of viewing professional knowledge and the development of an interprofessional knowledge terrain that is understood and is contributed to by all practitioners and, importantly, is centred on the needs of the patient or client. Through practical application of theory, we anticipate that our readers will be able to reflect and inform their current habitual practices and develop new and innovative ways of perceiving and developing their interprofessional education practice.