Validity of index of learning styles scores: multitrait-multimethod comparison with three cognitive/learning style instruments

Cognitive and learning styles research is limited by the lack of evidence supporting valid interpretations of style assessment scores. We sought evidence to support the validity of scores from 4 instruments: the Index of Learning Styles (ILS); the Learning Style Inventory (LSI); the Cognitive Styles Analysis (CSA), and the Learning Style Type Indicator (LSTI). The ILS assesses 4 domains: sensing-intuitive (SensInt), active-reflective (ActRefl), sequential-global (SeqGlob) and visual-verbal (VisVerb), each of which parallel a similar domain in at least 1 of the other instruments. We administered the ILS, LSI and CSA to family medicine and internal medicine residents and Year 1 and 3 medical students and applied the multitrait-multimethod matrix to evaluate convergence and discrimination. After 3 months participants repeated the ILS and completed the LSTI. A total of 89 residents and medical students participated. Multitrait-multimethod analysis showed evidence of both convergence and discrimination for ActRefl (ILS, LSI and LSTI) and SensInt (ILS and LSTI) scores. ILS SeqGlob and SensInt scores showed unanticipated correlation. No other domains met the criteria for convergence or discrimination. Test-retest reliabilities for ILS scores were 0.856 for SensInt, 0.809 for ActRefl, 0.703 for SeqGlob and 0.684 for VisVerb. Cronbach's alpha values were > or = 0.810 for LSI and 0.237-0.758 for LSTI. At least 9 participants misinterpreted the LSI instructions. These data support the validity of ILS active-reflective and sensing-intuitive scores, LSI active-reflective scores and LSTI sensing-intuitive scores for determining learning styles in this population. Cognitive style and learning style scores may not be interchangeable, even for constructs with similar definitions.     

A comparison of the effects of problem-based learning and lecturing on the development of students' critical thinking

BACKGROUND: Educational approaches are thought to have facilitative or hindering effects on students' critical thinking development. The aim of this study was to compare the effects of problem-based learning (PBL) and lecturing approaches on the development of students' critical thinking. METHODS: All 79 Year 1 undergraduate nursing students at a university in Hong Kong were randomly assigned to 1 of 2 parallel courses delivered by either PBL (n = 40) or lecturing (n = 39) over 1 academic year. The primary outcome measure was students' critical thinking disposition as measured by the California Critical Thinking Disposition Inventory (CCTDI). Individual interviews were also conducted to elicit the students' perceptions of their learning experience. Data were collected at 4 timepoints spanning 3 years. RESULTS: The overall CCTDI and subscale scores for the PBL group were not significantly different from those of the lecture group at the first timepoint (pretest). Compared with lecture students, PBL students showed significantly greater improvement in overall CCTDI (P = 0.0048), Truthseeking (P = 0.0008), Analyticity (P = 0.0368) and Critical Thinking Self-confidence (P = 0.0342) subscale scores from the first to the second timepoints; in overall CCTDI (P = 0.0083), Truthseeking (P = 0.0090) and Analyticity (P = 0.0354) subscale scores from the first to the third timepoints; and in Truthseeking (P = 0.0173) and Systematicity (P = 0.0440) subscale scores from the first to the fourth timepoints. CONCLUSIONS: There were significant differences in the development of students' critical thinking dispositions between those who undertook the PBL and lecture courses, respectively.     

The effect of testing on skills learning

Objectives  In addition to the extrinsic effects of assessment and examinations on students' study habits, testing can have an intrinsic effect on the memory of studied material. Whether this testing effect also applies to skills learning is not known. However, this is especially interesting in view of the need to maximise learning outcomes from costly simulation-based courses. This study was conducted to determine whether testing as the final activity in a skills course increases learning outcome compared with an equal amount of time spent practising the skill.
Methods  We carried out a prospective, controlled, randomised, single-blind, post-test-only intervention study, preceded by a similar pre- and post-test pilot study in order to make a power calculation. A total of 140 medical students participating in a mandatory 4-hour in-hospital resuscitation course in the seventh semester were randomised to either the intervention or control group and were invited to participate in an assessment of learning outcome. The intervention course included 3.5 hours of instruction and training followed by 30 minutes of testing. The control course included 4 hours of instruction and training. Participant learning outcomes were assessed 2 weeks after the course in a simulated scenario using a checklist. Total assessment scores were compared between the two groups.
Results  Overall, 81 of the 140 students volunteered to participate. Learning outcomes were significantly higher in the intervention group ( n  = 41; mean score 82.8%, 95% confidence interval [CI] 79.4–86.2) compared with the control group ( n  = 40; mean score 73.3%, 95% CI 70.5–76.1) ( P  < 0.001). Effect size was 0.93.
Conclusions  Testing as a final activity in a resuscitation skills course for medical students increases learning outcome compared with spending an equal amount of time practising the skills.     

Pre-test and post-test in a medicine clerkship

Offered the opportunity to take the previous quarter's post-test as a pre-test at the beginning of their 3-month medicine clerkship with the understanding it would have no effect on their final grades, 132 of 148 students (89%) took this opportunity. Post-test means for each quarter's group were significantly greater than pre-test means ( P = 0.0001). Pre-test means did not increase over the four quarters of the year of this study despite increasing student experience in other clinical disciplines. For this entire year correlations were as follows: Pre-test vs post-test r =0.591 ( P =0.0001), pre-test vs clinical r =0.306 ( P =0.0004), and post-test vs clinical r =0.329 ( P =0.0001). By quarter these correlations were generally consistent. An interesting and unexpected finding was that students in the autumn quarter had significantly lower pre-test and clinical scores than students in the winter quarter. This may indicate that students highly motivated to medicine take this as their first clinical clerkship and those least motivated as their last first clinical-year clerkship.     

Surgical e-learning: validation of multimedia web-based lectures

BACKGROUND: Distance learning has been advocated increasingly as a modern efficient method of teaching surgery. Efficiency of knowledge transfer and validity of web-based courses have not been subjected to rigorous study to date. METHODS: An entirely web-based surgical 5-week lecture course was designed. Fifty per cent of the lectures were prepared as HTML slides with voice-over while the other group was presented in the text-only form. Only written material presented was examined. The lectures were presented via an educational web module. The lecture series was balanced specifically to reduce the pre-existent knowledge bias. Web usage was estimated utilising surrogates, including the number of hits as well as log-on timing. Face validity was assessed by a standardised questionnaire. RESULTS: Eighty-eight students took part in the lecture series and subsequent examination and questionnaire. Median multiple choice questionnaire (MCQ) marks were significantly higher in the aural lecture-derived stems versus the non-aural (P = 0.012, Mann-Whitney U-test). There was widespread approval of web-based learning as an adjunct to conventional teaching. Usage rates were augmented significantly in the final week when compared to the previous 4 weeks (mean total hits weeks 1-4 +/- SEM: 100.9 +/- 9.7 and mean total hits week 5: 152.1 +/- 13.1; P < 0.001, Kruskal-Wallis). However, total hits did not correlate with overall examination results (r(2) = 0.16). The aural lectures demonstrated higher face validity than the non-aural for content and presentation (P < 0.05, Kruskal-Wallis). CONCLUSIONS: The addition of aural files to the novel web-based lecture series is face valid and results in significantly increased examination performance.     

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.     

Introducing resident doctors to complexity in ambulatory medicine

Objectives Medical education instructional methods typically imply one ‘best’ management approach. Our objectives were to develop and evaluate an intervention to enhance residents’ appreciation for the diversity of acceptable approaches when managing complex patients. Methods A total of 124 internal medicine residents enrolled in a randomised, crossover trial. Residents completed four web‐based modules in ambulatory medicine during continuity clinic. For each module we developed three ‘complex cases’. Cases were intended to be complex (numerous variables, including psychosocial and economic barriers) and to suggest multiple acceptable management strategies. Several experienced faculty members described how they would manage each case. Residents reviewed each case, answered the same questions, and compared their responses with expert responses. Participants were randomly assigned to complete two modules with, and two modules without complex cases. Results A total of 76 residents completed 279 complex cases. Residents agreed that complex cases enhanced their appreciation for the diversity of ‘correct’ options (mean ± standard error of the mean 4.6 ± 0.2 [1 = strongly disagree, 6 = strongly agree]; P < 0.001). Mean preference score was neutral (3.4 ± 0.2 [1 = strongly favour no cases, 6 = strongly favour cases]; P = 0.72). Knowledge post‐test scores were similar between modules with (76.0 ± 0.9) and without (77.8 ± 0.9) complex cases (95% confidence interval for difference ? 4.0 to 0.3; P = 0.09). Resident comments suggested that lack of time and cognitive overload impeded learning. Conclusions Residents felt complex cases made a valuable contribution to their learning, although preference was neutral and knowledge scores were not affected. Methods to facilitate trainee comfort in managing medically complex patients should be further explored.     

Learning human anatomy: does learning occur during a lecture?

Information uptake during a formal lecture was evaluated using a sample of 43 second-year medical students to whom a topic on human developmental anatomy was presented. The sample was divided into two groups: Blue (group B) (21 students) and Red (group R) (22 students). Prior to the lecture, a pre-test of 20 multiple choice questions was administered to each group. The lecture was then delivered over 50 minutes. Both in its preparation and presentation, the lecture conformed to the principles of programmed instruction. After a 10-minute students' question-and-answer session, a post-test was served. For group B, this was group R's pretest while group R, in turn, received group B's pretest. No question in the pre-test was repeated in the post-test. Intergroup comparisons of pre-test scores and of post-test scores revealed non-significant differences (P greater than 0.05), thus confirming that the pre- and the post-tests were of comparable difficulty. In each group, the mean post-test score was significantly higher than the pre-test score (P less than 0.001). The pooled scores indicated that the percentage mastery of material presented during the lecture increased from -1.8% to 58.4%. These results demonstrate that significant learning can occur during a lecture prepared and delivered in accordance with sound pedagogical principles.     

Attitude towards computer-based learning: determinants as revealed by a controlled interventional study

BACKGROUND: Curriculum-wide implementation of computer-based learning (CBL) in undergraduate medical education remains elusive. Unlike many pilot tests of singular learning programmes, dropout rates are high and acceptance seems low in the long run. We studied the effect of a new CBL programme, suitable for curriculum-wide implementation, on Year 3 medical students' attitudes towards CBL. METHODS: Students from 2 universities participating in a mandatory pharmacology course were given access to a CBL programme covering cardiovascular drug therapy in a controlled randomised study (n = 167). Learner properties and attitude towards CBL were measured using psychometric scales, and knowledge by multiple-choice questions (pre- and post-test). RESULTS: Attitude towards CBL worsened in the CBL group (n = 70). Individual learners' properties did not explain this effect. The perceived programme quality was rated only 'average', which may contribute to the lower post-test values of attitude towards CBL. Learning outcomes were similar between the control group (n = 97) and students using CBL (n = 44). Learning efforts were shifted from self-study towards CBL. CONCLUSION: The initial enthusiasm of students was not maintained when using a programme designed to complement or even replace traditional teaching. Curriculum-wide implementation of CBL might be hampered by the discouragement of users.     

Teaching junior doctors to manage patients who somatise: is it possible in an afternoon?

CONTEXT: Many patients in primary care somatise psychological distress. Training general practitioners (GPs) to manage somatisation has been shown to lead to improvements in their management of these patients. However, the training has been intensive and conducted by psychiatrists, making it impractical for widespread use. The aim of this research was to determine the effectiveness of a teaching package in improving the ability of GP registrars to manage patients who somatise, when taught by GP vocational course tutors within the constraints of a general practice vocational training scheme. METHODS: This was a before-and-after training evaluation of GP registrars' skills. A total of 22 GP registrars and 6 GP course organisers were recruited from 3 GP vocational training schemes. The GP trainees had 2 videotaped consultations with trained actors role-playing patients with somatised depression, before and 1 month after training. RESULTS: There was a significant overall improvement in the ability of GP registrars to manage patients who somatise (mean scores on a 4-point Likert scale: pre-training 1.4 [standard deviation, SD, 0.6]; post-training 2.2 [SD 0.9]; P = 0.002). General practice registrars improved their ability to use a negotiating style of consultation (skill present in 8/22 pre-training, 16/22 post-training; P = 0.02) and also demonstrated more empathy during the 'consultation' after training (mean scores on a 5-point Likert scale: pre-training 2.3 [SD 1.0]; post-training 3.0 [SD 0.8]; P = 0.03). CONCLUSIONS: Using a structured training package, it is possible for GP vocational course tutors to successfully teach GP registrars to manage patients who somatise psychological distress. Given limited resources for teaching in terms of cost and time, this training package could have important implications for training medical staff.     

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.     

The effectiveness and reliability of peer-marking in first-year medical students

BACKGROUND: Peer-marking has been suggested as a method to enhance self-directed learning and reflection, although whether this improves performance is unclear. This study evaluated the impact of peer-marking on examination performance and investigated its reliability and acceptability to students. METHODS: First-year medical students were randomised to peer-marking using a model answer or no intervention (control arm). Student scores were compared with tutor-marked scores. Two months later, students completed a summative assessment and performance was compared between students randomised to peer-marking and the control arm. A focus group was held with students in the intervention arm to capture their experiences and attitudes. RESULTS: A total of 289 of 568 students consented to participate and 147 were randomised to peer-marking (142 controls). Students randomised to peer-marking achieved marginally higher examination marks (1.5% difference, 95% CI -0.8% to 3.9%, P = 0.19) than controls (adjusting for year and in-course assessment), although this may have been due to chance. Students were harsher markers than the tutors. Focus group analysis suggested that students valued peer-marking, although concerns about passing judgement on a colleague's work were expressed. CONCLUSIONS: Peer-marking did not have a substantial effect on examination performance, although a modest effect cannot be excluded. Students gained insight into examination technique but may not have gained deeper knowledge. Given its potential positive educational value, further work is required to understand how peer-marking can be used more effectively to enhance the learning experience.     

Factors predictive of successful learning in postgraduate medical education

PURPOSE: To establish which personal and contextual factors are predictive of successful outcomes in postgraduate medical education. METHOD: We performed a follow-up study of 118 doctors on a postgraduate occupational health training programme on the management of mental health problems. The following personal and contextual variables were measured as potential predictors of outcome: gender; age; years of experience as a doctor; university of graduation; learning style (Kolb); present employer (occupational health service), and educational format (problem-based or lecture-based). The main outcome measures were: scores on knowledge tests consisting of true/false and open answer questions, and performance in practice based on self-report and performance indicators. To determine the effect of potential predictive factors univariate analyses of variance and repeated measurement analysis of variance was applied. RESULTS: The mean scores of knowledge (P < 0.001) and performance (P = 0.001) of the participants increased after the educational programme. After multivariate analysis female gender was positively related to accruements in both knowledge and performance (both P < 0.05), independently of the influence of other factors. Accommodator learning style showed a relation with knowledge increase (P = 0.05), but had no influence on performance (P = 0.79). The problem-based educational format yielded a better performance outcome (P = 0.05), but had no influence on knowledge tests (P = 0.31). CONCLUSION: Gender and learning style were found to be related to an increase in knowledge. Gender was also found to be related to improvement in performance after a postgraduate medical education programme. We found no interactions with course design (i.e. problem-based or non problem-based learning formats), but further research could reveal other cues, suggesting practical consequences of student characteristics for course design in postgraduate training.     

Optimal sequencing of bedside teaching and computer-based learning: a randomised trial

Objectives  We aimed to establish the most effective order in which to deliver teaching to medical students when using both bedside teaching (BT) and computer-based learning (CBL) and to ascertain the students' preferred method and order of delivery.
Methods  A sample of 28 medical students were randomly divided into two equal groups during their orthopaedic knee examination teaching session. Group 1 received standard BT and group 2 undertook a CBL package. Each group then undertook an objective structured clinical examination (OSCE). The groups then received the other method of teaching followed by another OSCE. A questionnaire was administered to all students to assess their views on, and preferences for, the various teaching methods.
Results  Mean scores on the first OSCE were 12.19 for group 1 (BT then CBL) and 11.96 for group 2 (CBL then BT) ( P  = 0.692). Mean scores on the second OSCE were 11.81 for group 1 compared with 12.79 for group 2 ( P  = 0.038). Statistical analysis showed a significantly better score improvement for group 2 (CBL then BT) over group 1 (BT then CBL). Of the 26 students who returned questionnaires, 24 (92%) expressed their preference for traditional BT over CBL only, and 23 (88%) were in favour of undertaking CBL prior to traditional BT.
Conclusions  The CBL package is a useful tool and is most effective if used before BT. Students prefer BT alone over CBL alone, but, if offered both, prefer to undertake CBL first.     

Effects of reflective practice on the accuracy of medical diagnoses

Context  Reflective practice has been suggested to be an important instrument in improving clinical judgement and developing medical expertise. Empirical evidence supporting this suggestion, however, is absent. This paper reports on an experiment conducted to study the effects of reflective practice on diagnostic accuracy.
Methods  Participants were 42 internal medicine residents in hospitals in 2 states in the northeast of Brazil. They diagnosed 16 clinical cases. The experiment employed a repeated measures design, with 2 independent variables: the complexity of clinical cases (simple or complex), and the reasoning approach induced to diagnose the case (participants were instructed to diagnose each case either through pattern recognition or reflective reasoning). The dependent variable was the accuracy of the diagnosis provided for each case. All participants participated in each of the 2 levels of both independent variables.
Results  A main effect of case complexity emerged. There was no statistically significant main effect of reflective practice. However, a significant interaction effect was found between case complexity and mode of processing (F[1,41] = 4.48, P  < 0.05), indicating that although reflective practice did not make a difference to accuracy of diagnosis in simple cases, it had a positive effect when diagnosing complex cases.
Conclusions  Reflective practice had a positive effect on diagnosis of complex, unusual cases. Non-analytical reasoning was shown to be as effective as reflective reasoning for diagnosing routine clinical cases. Findings support the idea that reflective practice may particularly improve diagnoses in situations of uncertainty and uniqueness, reducing diagnostic errors.     

Origin bias of test items compromises the validity and fairness of curriculum comparisons

OBJECTIVE: To determine whether items of progress tests used for inter-curriculum comparison favour students from the medical school where the items were produced (i.e. whether the origin bias of test items is a potential confounder in comparisons between curricula). METHODS: We investigated scores of students from different schools on subtests consisting of progress test items constructed by authors from the different schools. In a cross-institutional collaboration between 3 medical schools, progress tests are jointly constructed and simultaneously administered to all students at the 3 schools. Test score data for 6 consecutive progress tests were investigated. Participants consisted of approximately 5000 undergraduate medical students from 3 medical schools. The main outcome measure was the difference between the scores on subtests of items constructed by authors from 2 of the collaborating schools (subtest difference score). RESULTS: The subtest difference scores showed that students obtained better results on items produced at their own schools. This effect was more pronounced in Years 2-5 of the curriculum than in Year 1, and diminished in Year 6. CONCLUSIONS: Progress test items were subject to origin bias. As a consequence, all participating schools should contribute equal numbers of test items if tests are to be used for valid and fair inter-curriculum comparisons.     

A conceptual framework for developing teaching cases: a review and synthesis of the literature across disciplines

Case-based teaching is regarded as a superior instructional method compared with lectures in promoting a learner's critical thinking skills. While much is known about the role a discussion facilitator plays in case-based teaching, the debate on the influence of the format and structure of cases on learning is controversial. We sought to identify strategies for constructing cases based on studies from multiple disciplines, which report the development and use of cases in teaching and learning. The purpose was to offer the medical and other educational communities a conceptual framework that can be examined in future research. Based on a review of 100 studies, we synthesised 17 strategies around 5 core attributes of cases: relevant (level of learner, goals and objectives, setting of case narrative); realistic (authenticity, distractors, gradual disclosure of content); engaging (rich content, multiple perspectives, branching of content); challenging (difficulty, unusual cases, case structure, multiple cases), and instructional (build upon prior knowledge, assessment, feedback, and teaching aids). Despite the wide use of cases in disparate disciplines, there has been no overarching study that synthesises strategies of case development or tests these strategies in research settings. The framework we developed can serve as a menu of case development options that educators and researchers can pilot and evaluate in their local settings.     

Web‐ or paper‐based portfolios: is there a difference?

OBJECTIVE: To determine the differential effects of a paper-based versus a web-based portfolio in terms of portfolio quality, user-friendliness and student motivation. METHODS: An experimental design was used to compare Year 1 medical students' reflective portfolios. The portfolios differed in presentation medium only (i.e. web-based versus paper-based). Content analysis, a student questionnaire and mentor interviews were used to evaluate portfolio quality, user-friendliness and student motivation. A total of 92 portfolios were scored independently by 2 raters using a portfolio quality-rating instrument. RESULTS: Portfolio structure, quality of reflection and quality of evidence showed no significant effects of presentation medium. Multi-level analysis showed a significant effect for student motivation: web-based portfolios scored 0.39 more than paper-based portfolios (P < 0.05; effect size 0.76). The mentors reported no differences in portfolio quality, except that there were more visuals in web-based portfolios. Students spent significantly more time preparing the web-based than the paper-based portfolios (15.4 hours versus 12.2 hours; t = 2.1, P < 0.05; effect size 0.46). The 2 student groups did not differ significantly in terms of their satisfaction with the portfolio. The mentors perceived the web-based portfolios as more user-friendly. CONCLUSIONS: The web-based portfolios were found to enhance students' motivation, were more user-friendly for mentors, and delivered the same content quality compared with paper-based portfolios. This suggests that web-based presentation may promote acceptance of portfolios by students and teachers alike.     

Prospective randomised comparison of traditional, personal bedside and problem-oriented practical dermatology courses

PURPOSE: This paper reports a prospective, randomised study comparing a problem-oriented practical (POP) course based on paper cases to a personal bedside teaching (PBT) practical course and a standard practical course. METHODS: During 2 consecutive terms, students were randomly allocated to either 2 POP groups/term (n = 10/group), 2 PBT groups/term (n = 10/group) or the standard practical course, which consisted of a rotating system of lectures and bedside teaching with randomly appointed tutors. Each course was evaluated with the same 12-item questionnaire and multiple-choice test administered at the beginning and end of the course. RESULTS: The numbers of students evaluated were 36 for the POP groups, 37 for the PBT groups, and 155 for the standard course. The PBT and POP courses were rated significantly better (P < 0.001) than the standard course for all items. Aggregate marks (mean +/- SD) were: 1.59 +/- 0.8 for the POP course; 1.69 +/- 0.68 for the PBT course, and 2.71 +/- 0.98 for the standard course. There were no significant differences between the POP and PBT courses. Significantly better learning rates as indicated by an increase in the number of correctly answered questions were observed in students attending the POP and PBT courses. CONCLUSION: This prospective study demonstrated that there was no difference in the rating of a POP course and a bedside teaching course by students randomly assigned to 1 of 3 different pedagogical approaches. Furthermore, both alternative options achieved better ratings than the standard course, which is current teaching practice in our medical school. The PBT and POP approaches provided superior learning success and POP helped solve the problems of standardisation and patient recruitment.     

Problem-based learning versus lecture-based learning in a course of basic pharmacology: a controlled, randomized study

Since its first implementation in a medical programme at McMaster University, Canada, problem-based learning (PBL) has become a well-established means of teaching and learning medicine. Extensive research has been conducted and a number of strengths of the method are well supported. Several items, however, remain unclear although there is evidence that no relevant difference exists in factual knowledge among students from PBL and traditional curricula, a controlled, randomized study has not been conducted to address this issue. The Medical Faculty of the University of Cologne is in the process of integrating elements of PBL into its curriculum. In the spring term of 1997, after seven semesters of experience with PBL supplementing the traditional course of basic pharmacology, we did for the first time use PBL instead of the lecture-based course (LBL) and conducted a controlled prospective study to determine the effects of this intervention. One-hundred and twenty-three students were randomly assigned to either PBL (n = 63), with tutorial groups of up to nine students, or to the traditional, lecture-based course (n = 60). Analysis of the results of both groups in the examination of basic pharmacology, consisting of multiple-choice and short-essay questions, revealed similar scores with a tendency favouring PBL students in the category of short-essay questions. Hence, it seems clear that PBL does not imply a disadvantage in terms of factual knowledge. Students considered PBL to be an effective learning method and favoured it over the lecture format. Furthermore, students reported positive effects of PBL in terms of use of additional learning resources, interdisciplinarity, team work and learning fun.