Using a filter to improve the chatroom experience in interactive medical education

A computer chatroom exercise between faculty and students was used in a Human Behavior course for first-year medical students to provide an interactive exam review learning exercise. Two conditions were compared--one that filtered out all irrelevant student comments, and one without the filter that permitted all student comments. Four one-hour chatroom sessions, each with eight groups of five students, were conducted with all comments recorded. Comments were rated as on- or off-task by a blinded external faculty member. The filtered condition resulted in increased on-task and decreased off-task student comments compared with the non-filtered condition. However, students made fewer total comments in the filtered situation. Results suggested that a trade-off occurred between focused and uninhibited faculty-student communication; the implications are discussed.     

Acquiring and demonstrating attitudes in medical education: attitudes to homosexuality as a case study

The main features of a learning programme for medical students that addresses attitudinal issues, using as an example attitudes to homosexuality, are described. Essential and useful features and strategies of the exercise are outlined, together with potential problems.     

LectureKeepr: A novel approach to studying in the adaptive curriculum

Abstract

As medical students search for ways to squeeze more hours of learning into their day, many have turned to technology for quick and efficient ways to study. Most commonly this includes based apps for purchase that involve visual tasks, mental review and repetition. Tasks involve flashcard creation, answering multiple choice questions (MCQs) and schedule planning. They typically require students to visually interact with a computer or smartphone screen. Alternatively, auditory apps may not only offer the benefit of enhanced learning through review and repetition, but also address convenience, portability, and metacognitive development without physical and temporal requirements of visual presentation. Auditory learning is eyes and “hands-free” allowing the learner to contiguously engage in other activities such as physical exercise, traveling, eating, etc. In this randomized, case-comparison study, half of the students were exposed to audio lecture content before class using a mobile application called LectureKeepr (LK) and half were exposed to lecture content before class via written material prepared by the professor. Pre- and post-MCQ quizzes were used to measure differences between groups in knowledge improvement. In addition, student perceptions of the auditory learning experience were assessed by an on-line survey. ANOVA with repeated measures revealed that students in the LK intervention group performed better on the postquiz than the students in the written materials group.     

Evaluation of the role of incentive structure on student participation and performance in active learning strategies: A comparison of case-based and team-based learning

Background: Student participation is important for the success of active learning strategies, but participation is often linked to the level of preparation. At our institution, we use two types of active learning activities, a modified case-based learning exercise called active learning groups (ALG) and team-based learning (TBL). These strategies have different assessment and incentive structures for participation. Non-cognitive skills are assessed in ALG using a subjective five-point Likert scale. In TBL, assessment of individual student preparation is based on a multiple choice quiz conducted at the beginning of each session.

Methods: We studied first-year medical student participation and performance in ALG and TBL as well as performance on course final examinations.

Results: Student performance in TBL, but not in ALG, was strongly correlated with final examination scores. Additionally, in students who performed in the upper 33rd percentile on the final examination, there was a positive correlation between final examination performance and participation in TBL and ALG. This correlation was not seen in students who performed in the lower 33rd percentile on the final examinations.

Conclusions: Our results suggest that assessments of medical knowledge during active learning exercises could supplement non-cognitive assessments and could be good predictors of performance on summative examinations.     

Ward round simulation in final year medical students: Does it promote students learning?

Introduction: Ward round skills are essential for doctors in hospital settings. Literature shows medical students’ deficiencies in these skills. Simulation has been used to train these skills. However, exposing learners to simulation at an early stage may be associated with a high cognitive load and limited learning. This study aims to determine how students experience this load and its interplay with performance and which factors promote and impair learning.

Methods: Fifty-six final year medical students participated in a simulated ward round training exercise. Both students’ performance and cognitive load were measured to determine if there was any correlation and interviews were carried out to understand which factors support and impair learning.

Results: Performance scores revealed deficiencies in ward round skills. Students experienced a cognitive load that weakly correlated with performance. Qualitative findings provided important insights into simulated ward-based learning. It is clear that well-designed clinical scenarios, prioritization tasks, teamwork and feedback support students’ learning process whereas distractions impair learning.

Conclusions: WRS proved to be a good teaching method to improve clinical skills at this stage as the cognitive load is not too high to impair learning. Hence, including tasks in the simulation design can enhance the learning process.     

To what extent do students generate learning issues that correspond to pre-set faculty objectives?

The aim of this study was to investigate whether the content of the problems in a problem-based learning programme directs the students to the faculty's educational objectives. Sixteen students in two study groups in a three-year programme for training in psychotherapy generated 228 learning issues. The tutors reported the issues and the discussion themes. The learning issues and themes were compared with the faculty objectives. The correspondence between faculty objectives and learning issues/themes was 79% in the study groups, which showed that the problems presented direct the students to the faculty goals. The result also shows that it is important to study not only the learning issues but also what students talk about while preparing the reports in their group.     

Experiential learning in an anaesthesia simulation centre: analysis of students' comments

The anesthesia computer-controlled patient simulator offers a valuable experiential learning experience for undergraduate medical students. The purpose of this study was to gather students' opinions of the simulator learning experiences and to study and analyze their comments regarding the nature of the learning. All fourth-year medical students were invited to participate in a simulator session during their anesthesia rotation. A satisfaction survey was administered and the qualitative data were analyzed. A total of 145 students completed the questionnaire (100% return rate). Most students (88%) reported the session to be a positive learning experience that provided opportunities for applying their knowledge in a realistic environment. Some students indicated a lack of comfort in the environment but this did not appear to inhibit performance. Student comments highlighted the value of the learning experience and provided insights into the nature of the learning. The computer-controlled patient simulator offers new and challenging opportunities for medical students to apply their knowledge and practice working through an Anesthesia case without endangering patient safety.     

What do medical students actually do on clinical rotations?

As medical schools make use of an increasing variety of clinical teaching settings, it is of interest to find that that there is very little published research that explores the actual learning activities undertaken by students in different environments. This study was designed to describe and analyse a typical week for students learning the same curricular material in one of three Australian settings: an urban tertiary teaching hospital, a remote secondary referral hospital and a rural community-based programme. Twenty-eight students completed week-long learning logs in weeks 9 and 35 of a 40-week academic year. Each student recorded his or her activity in 15-minute intervals for each week. Analysis of these data revealed that, compared with the hospital-based students, the community-based students reported greater patient contact, more time spent in clinical settings and increased time supervised by experienced clinicians. Whilst the community-based students valued their learning in clinical settings more highly than the learning they undertook at their home, the opposite was found for the tertiary hospital-based students. This study, the first to compare student activity in these three prototypical settings in the medical education literature, provides empirical evidence supporting community-based programmes as credible alternatives to traditional teaching hospital-based environments.     

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.     

Self-assessed learning style correlates to use of supplemental learning materials in an online course management system

Background: The benefit of online learning materials in medical education is not well defined. Aim: The study correlated certain self-identified learning styles with the use of self-selected online learning materials. Methods: First-year osteopathic medical students were given access to review and/or summary materials via an online course management system (CMS) while enrolled in a pre-clinical course. At the end of the course, students completed a self-assessment of learning style based on the Index of Learning Styles and a brief survey regarding their usage and perceived advantage of the online learning materials. Results: Students who accessed the online materials earned equivalent grades to those who did not. However, the study found that students who described their learning styles as active, intuitive, global, and/or visual were more likely to use online educational resources than those who identified their learning style as reflective, sensing, sequential, and/or verbal. Conclusions: Identification of a student's learning style can help medical educators direct students to learning resources that best suit their individual needs.     

Innovative curriculum: Integrating the bio-behavioral and social science principles across the LifeStages in basic science years

Behavioral and social science integration in clinical practice improves health outcomes across the life stages. The medical school curriculum requires an integration of the behavioral and social science principles in early medical education. We developed and delivered a four-week course entitled “LifeStages” to the first year medical students. The learning objectives of the bio-behavioral and social science principles along with the cultural, economic, political, and ethical parameters were integrated across the lifespan in the curriculum matrix. We focused on the following major domains: Growth and Brain Development; Sexuality, Hormones and Gender; Sleep; Cognitive and Emotional Development; Mobility, Exercise, Injury and Safety; Nutrition, Diet and Lifestyle; Stress and coping skills, Domestic Violence; Substance Use Disorders; Pain, Illness and Suffering; End of Life, Ethics and Death along with Intergenerational issues and Family Dynamics. Collaboration from the clinical and biomedical science departments led to the dynamic delivery of the course learning objectives and content. The faculty developed and led a scholarly discussion, using the case of a multi-racial, multi-generational family during Active Learning Group (ALG) sessions. The assessment in the LifeStages course involved multiple assessment tools: including the holistic assessment by the faculty facilitator inside ALGs, a Team-Based Learning (TBL) exercise, multiple choice questions and Team Work Assessment during which the students had to create a clinical case on a LifeStages domain along with the facilitators guide and learning objectives.     

Influence of community experiences on first-year medical students' reflective writing

The purpose of this research was to investigate the usefulness of providing students with community-located experiences as a basis for reflection by observing the degree to which community-located experiences influenced the quality of a reflective writing exercise. Students were prepared for reflection by means of a lecture and a handout on the meaning, function and process of reflection. One hundred and twenty-eight students (66 Afrikaans-speaking, and 62 English-speaking) took part in the study. Initially, most students (71%) who revealed affect prior to the visit reported negative emotional states. For 54% of the students who revealed emotions upon arrival, positive emotional states replaced the negative and this increased to 67% as the visit continued. This represented the most important stage of the personal growth continuum, signifying awareness of perspective 'distortions'. The majority (94.3%) regarded the visit as being important prior to immersing themselves in the theory of primary healthcare. In the questionnaire survey, students were asked for their opinions on the value of reflective writing as a tool for promoting deep learning, as students' attitudes were considered an important determinant of increased uptake of this kind of activity. Reflective writing can be promoted through using a real-world experience as stimulus, and a framework for guiding students' thoughts.     

One-on-one tutorials in private practices and clinics: four years of experience in Basel, Switzerland

The one-on-one tutorial is a new form of learning that is practice oriented. It is based on a teacher-student relationship continuing over two years. Since 1997, third- and fourth-year students have worked for one half day per week under the supervision of their tutor, be it in a private practice or in a hospital. This programme facilitates direct patient contact at an early stage of medical school. In addition, it allows students to apply their knowledge in everyday life. The interactive form of learning is of paramount importance in this module. The ARIVA learning model was developed specially for third-year students and the logbook for fourth-year students. After each tutorial third-year students completed the ARI VA worksheet and fourth-year students completed the logbook. They were handed in together with the structured learning report. Between 85 and 109 students per year participated in these tutorials, totalling 733 students. Each student was taught an average of 3.1 patients in the presence of the tutor. In addition students examined an average of 2.4 patients independently and fulfilled an average of 1.2 practical tasks. For the fourth-year students the number of contacts with patients and the spectrum of diseases examined are impressive. All learning goals were fulfilled The one-on-one tutorial is a practice-oriented, interactive learning method. It uses a variety of didactic methods based on the principals of problem-oriented learning. In a relatively early stage of their medical education one-on-one tutorials give students the opportunity to learn independently how to interview and examine patients. They also give students the possibility to acquaint themselves with a multitude of diseases with the aid of instructions and demonstrations. They are conducive to work with patients above all because students learn how to perform certain techniques.     

Twelve tips for potential distance learners

Distance learning courses are becoming popular among medical professionals due to their flexibility, allowing minimal disruption to personal and professional commitments. The ability to continue professional duties, allied to the reduced cost of distance learning courses, also makes them attractive to institutions looking to develop the skills of their staff. However the nature of distance learning courses means that they are often of long duration and many students fail to maintain motivation while working in isolation. This is reflected by high non-completion rates. This article outlines issues that all students planning a distance learning course should consider, relating to choice of course, time management, funding and adjusting to the different nature of distance learning. The authors advise developing a support network for distance learning students, either in person or electronically, to increase motivation and completion.     

The conceptions of the nature of learning of first-year physiotherapy students and their relationship to students' learning outcomes

Research shows that students' conceptions of what 'learning' is influences both their approaches to learning and their learning outcomes. Lower level conceptions of learning are associated with surface approaches to learning, encouraging poor quality learning outcomes. However, more advanced conceptions are associated with deep learning approaches and high-quality learning outcomes. The Structure of Observed Learning Outcomes (SOLO) taxonomy was used to analyse the conceptions of learning of a new intake of physiotherapy students. The presence of a relationship between these and assessment outcomes was also investigated. As in other studies, a majority of students had lower level conceptions of learning than desired in higher education. However, a larger proportion of students had higher levels of conception than has been found in other research. A direct relationship between conceptions of learning and learning outcomes was also identified. The implications of these findings for achievement of high-quality learning are discussed.     

Uncover it,students would learn leadership from Team-Based Learning (TBL): The effect of guided reflection and feedback

Context: Little is known about best practices for teaching and learning leadership through Team-Based learning? (TBL?) with medical students. We hypothesized that guided reflection and feedback would improve shared leadership and shared leadership capacity, and enhance team decision quality in TBL teams. We used the Kolb experiential learning theory as the theoretical framework.

Method: The study was conducted at Tehran University of Medical Sciences. Three TBL sessions with 206 students (39 teams) participated in the study. Using a quasi-experimental design, one batch received guided reflection and feedback on their team leadership processes (n?=?20 teams) and the other received only TBL (n?=?19 teams). Observers measured shared leadership using a checklist. Shared leadership capacity was measured using a questionnaire. Scores on a team application exercise were used to assess quality of team decisions.

Results: Evidence did not support our first hypothesis that reflection and feedback enhance shared leadership in TBL teams. Percentages of teams displaying shared leadership did not differ between intervention and control groups in sessions 1 (p?=?0.6), 2 (p?=?1) or 3 (p?=?1). The results did not support the second hypothesis. We found no difference in quality of decision making between the intervention and control groups for sessions 1 (p?=?0.77), 2 (p?=?0.23), or 3 (p?=?0.07). The third hypothesis that the reflection and feedback would have an effect on shared leadership capacity was supported (T?=??8.55, p?>?0.001 adjusted on baseline; T?=??8.55, p?>?0.001 adjusted on gender).

Discussion and conclusion: We found that reflection and feedback improved shared leadership capacity but not shared leadership behaviors or team decision quality. We propose medical educators who apply TBL, should provide guided exercise in reflection and feedback so that students may better understand the benefits of working in teams as preparation for their future roles as leaders and members of health care teams.     

Student access and use of IT during general practice attachments

As universities change the delivery of their medical undergraduate courses, many have started to develop the community as a learning resource. In Manchester, part of the rationale behind problem-based learning is that students become familiar with the tools for finding information. Within the medical school and its main teaching hospitals, students have access to varied information resources using IT. These are often less available from off-campus sites and particularly within general practice. Even where available, students may not use them. Initial evaluation suggests that IT facilities are particularly useful for students who have longer placements. However, students prioritize their use of time in the community and furnishing general practices with a computer and other IT equipment does not, in itself, promote use by the students unless there is a perceived need. Training and support within the practice needs to be undertaken to enhance the learning environment for the undergraduates.     

Community-based or tertiary-based medical education: so what is the question?

This edition of Medical Teacher brings to our attention another insightful article from the Flinders University Rural Clinical School, led by Professor Paul Worley (Worley et al., 2004), enquiring as to what students actually do on their clinical rotations. Beginning with the premise that there is little published material exploring the learning activities undertaken by students in different learning environments, Worley and colleagues conducted a study that was able to compare three groups of students. These students were exposed to the same curricula material in three different environments, namely an urban teaching hospital, a remote secondary referral hospital and a rural community-based programme. Although Worley et al. admit to the small numbers of students within the study, and the generalisability of their results, the community students reported greater and more valuable patient contact, more effective time spent in clinical settings and an increased time being supervised by experienced clinicians, compared to the secondary and tertiary based students. The secondary hospital based students reported more time spent in lectures and tutorials than the tertiary or community-based students and the time spent in their clinical settings was valued less than the time spent learning at home. The impact is that this is yet another paper that demonstrates the value of communities as a credible alternative to the traditional teaching hospital. However it does raise other questions regarding medical education and community learning.     

Reflective learning and the Net Generation

Net Generation undergraduate medical students often have low engagement with reflective learning because it does not match their learning preferences. In our survey of all first-year students, the main learning preferences were bodily-kinaesthetic and interpersonal. Those students with the highest scores in their written reflective learning assessment generally had linguistic and interpersonal learning preferences. We suggest that all educators consider how reflective learning is implemented in the curriculum and recommend further research to determine if our findings are generalizable.