Approaches to learning in a problem-based medical programme: a developmental study

In this study we investigate how the introductory phase of the problem-based medical programme in Maastricht affects the study methods of students. On the first day of the academic year, 142 men and women medical students completed the Short Inventory of Study Approaches and again at the end of the introductory period. The study indicates that these study methods are fostered by training in problem-based learning given during the introductory period.     

Active and problem-based learning: two years'' experience in physiology at the Medical School of the University of Barcelona

Traditional educational methods are used in most medical schools. The introduction of new methods including active and problem-solving learning in traditional medical schools is difficult. The aims of this experiment were: (1) to introduce a self-learning system with a problem-solving approach in physiology; (2) to promote active student participation; (3) to introduce early clinical exposure; (4) to evaluate the response of the students to this experiment; and (5) to evaluate the feasibility and usefulness of a self-learning and problem-solving approach in only one discipline. Our experience has shown that it is possible to change the learning system in a traditional medical school, with good acceptance by the students and with a high level of satisfaction on the part of the teachers.     

Medical teaching at a peripheral site by videoconferencing

The departments of Child Health and Mental Health of Aberdeen University's Medical Faculty recently took part in a 3 month trial assessing the potential of video-conferecning as a medium for teaching students on peripheral hospital attachments. The equipment used was British Telecom's VC7000 Videoconferencing System and an ISDN2 (integrated services digital network) connection, which was installed between two sites. The locations used were a teaching room in the Royal Aberdeen Children's Hospital and the Paediatric Unit at Raigmore Hospital in Inverness. This paper describes the resources required to support the trial, the methods used to run it and the results of staff and student evaluation of the trial. Evaluation forms were completed and returned by eight members of staff and by 30 fourth- and fifth-year medical students. The results indicated that, although after this particular trial both staff and students rated the overall usefulness as low, they attributed this to technical problems and limitations specific to the type of equipment used rather than to the method itself. The overall impression was that videoconferencing with ISDN has potential as a teaching tool in the medical undergraduate course but that further improvements in image quality and voice switching are required.     

A learning resources centre: its utilization by medical students

Innovations in medical education have led to the increasing use of problem-based learning techniques, a committee system organization, and more time for independent study in many undergraduate programmes. There has been an increase in availability of alternative methods for presentation of information. To encourage self-directed learning, resources such as computers, videos and models, among others, should be readily available to students. The University of Calgary Faculty of Medicine has provided various resources contained in one area, called the Bacs Learning Resource Centre (BLRC). Since the maintenance and further development of such a centre requires significant resources, it is important to determine student utilization of the various components used in their learning. For those who are about to set up such a learning resource centre this information gives guidance on which materials are most useful.
The utilization of the centre by 69 first year medical students was studied using questionnaires. The utilization during a specific course was determined by analysing the entries in the individual log books given to the students at the beginning of the Integrative Course. With the exception of one student, all those who responded to the questionnaire used the Centre, with 20% or less of their total study time being spent there. The BLRC was most used for the Musculo-skeletal, Cardiovascular and Reticulo-Endothelial courses. All categories of resources were found to be useful, with the tape/slides least utilized. Utilization was most influenced by the quality of resources available and recommendations by peers. The development of a centre such as the BLRC, with a variety of resources concentrated in one area, suitable for individual or group study and accessible 24 hours a day, should be considered by all medical schools to enhance self-directed learning in medical students.     

Active learning in a Year 2 pathology curriculum

PURPOSE: Team-based learning (TBL) has been successfully used in non-medical curricula, but its effectiveness in medical education has not been studied extensively. We evaluated the impact of TBL on the academic performance of Year 2 medical students at Wright State University by comparing this active learning strategy against a traditional method of case-based group discussion (CBGD). METHODS: A prospective crossover design assigned 83 Year 2 medical students to either CBGD or TBL for 8 pathology modules in the systems-based curriculum. The effectiveness of both learning methods was assessed by performance on pathology-based examination questions contained in end-of-course examinations. The highest and lowest academic quartiles of students were evaluated separately. Students' opinions of both methods were surveyed. RESULTS: No significant differences in whole group performance on pathology-based examination questions were observed as a consequence of experiencing TBL versus CBGD. However, students in the lowest academic quartile showed better examination performance after experiencing TBL than CBGD in 4 of 8 modules (P = 0.035). Students perceived that the contributions of peers to learning were more helpful during TBL than CBGD (P = 0.003). CONCLUSION: This study demonstrates that TBL and CBGD are equally effective active learning strategies when employed in a systems-based pre-clinical pathology curriculum, but students with lower academic performance may benefit more from TBL than CBGD.     

Developing a Korean communication skills attitude scale: comparing attitudes between Korea and the West

Objectives  We aimed to develop a Korean version of the Communication Skills Attitude Scale (CSAS) created by Rees et al . in order to elucidate the positive and negative aspects of Korean pre-medical and medical students' attitudes towards communication skills (CS) learning.
Methods  We performed two surveys. In the first of these, 325 pre-medical and medical students completed a translated version of the CSAS. In the second survey, 257 medical students and doctors-in-training answered five open-ended questions to obtain more qualitative data about their attitudes.
Results  Principal component analysis with direct oblimin rotation performed with the data from the first survey produced the following five factors: facilitation of interpersonal skills; doubts about the importance of CS learning in medicine; motivation; negative attitudes towards assessment, and overconfidence. Results from the second survey indicated that facilitation and importance within a medical context were two core attitudinal factors and suggested some modification to the CSAS to improve its fit for Korean pre-medical and medical students.
Conclusions  Using a Korean version of the CSAS (CSAS-K), we determined five factors that revealed a somewhat complex attitude structure among students towards CS learning. The CSAS required some modification, possibly because CS teaching and learning in Korea are in the development stage. Finally, the educational implications of the results are discussed.     

Is new always better? A comparison of an established teaching method with a new teaching method in a surgical course

A comparison has been made between the effective- ness of a problem-solving exercise and a formal lecture on medical Students' learning during their surgical attachment. The format of a clinical trial has been adapted. No difference has been shown in the knowledge conveyed by the two methods, although the students preferred the problem-solving exercise. No assessment has been made in this study of differences in the students ability to solve problems after exposure to different methods of teaching.     

Short-term outcomes and long-term impact of a programme in medical education for medical students

Objectives  There is growing appreciation of the value of early preparation of future medical educators. Staff development programmes, conferences and workshops pertaining to the training of educators may be crucial to the pursuit of a school's larger educational mission to educate students, doctors and scholars and to provide comprehensive knowledge, research, patient care and service. This study examined the efficacy of a 1-week educational intervention aimed at preparing medical students to become effective doctor educators by building skills early in their careers. The study asked whether participation in a 5-day teacher training programme led to increased knowledge of instructional methods, more favourable attitudes towards teaching, and the integration of structured instructional design methods in a student-developed teaching project.
Methods  A mixed methods research design was employed with quantitative data captured through pre- and post-test inventories, qualitative components captured through written comments, and a 2-year post-intervention survey. Quantitative analyses included pre-/post-intervention repeated measures with calculated effect sizes. Qualitative analysis was conducted using constant comparative methods.
Results  Subjects demonstrated improved content knowledge and more positive attitudes towards motivation, teaching confidence, teacher roles, varied pedagogy, and use of assessment, instructional planning, and evaluation. Subjects were able to incorporate the programme's teaching theory and methods into their teaching projects and assessment of peers' and others' teaching in their own institutions 2 years post-training.
Conclusions  This study demonstrates that a well-designed programme for teacher preparation can be pedagogically effective for training medical students to become better educators and that this learning can be incorporated into long-term practice.     

Towards the identification of student learning problems: the development of a diagnostic inventory

An understanding of how students approach their learning has important implications for medical education. Of particular interest is the fact that the approach students use in their study has a significant impact on both the quality of the learning and their academic success. It would clearly be of value to identify students whose approach to learning was predictive of unsatisfactory performance. This paper describes the initial development of two versions of an inventory (questionnaire) which was designed to aid in the diagnosis of student learning problems. Preliminary information is given on the reliability and validity of these instruments. Factor analyses support the underlying design. Correlation of subscales with academic performance has provided encouraging evidence of the potential of these inventories in identifying students with specific learning or study problems.     

Expectation and experience: dissonances between novice and expert perceptions in medical education research

Context  There is both qualitative and quantitative variation in the research methods training provided for Masters and doctoral students on medical education programmes across the UK. Unlike other higher-degree programmes, there are no requirements for higher-degree medical education students to have studied the subject at degree level or for their supervisors to have training in social science research methods. This study explores the ways in which a panel of experts responded to novices' presentations of their research in progress.
Methods  This qualitative, case-based study of a 1-day education research consortium generated data in two phases. The author collected detailed field notes as a non-participant observer and subsequently analysed the data they contained. A second set of data was generated from written reflexive accounts of the day e-mailed to the author by all participants 1 month after the event and was subsequently analysed.
Results  Thematic coding revealed wide degrees of variance between the research experiences and abilities of the novices and the expectations of the experts. These levels of dissonance are ascribed to the limited amounts of research training undertaken by students and the variable guidance provided by research supervisors, some of whom were themselves novices in this area.
Conclusions  If medical education research is to thrive, it requires a properly developed infrastructure with training and support for research supervisors and students alike. Communities of practice need to be fostered to enable researchers to collaborate and disseminate good practice. This will ensure that medical education research practitioners can produce theoretically sound, rigorously designed and executed studies that can contribute to the evidence base for medical education.     

The learning style of medical students

Recent research indicates that students' learning styles and approaches to study may have a significant bearing on their academic success. A study was undertaken on first-, third- and final-year medical students to analyse their preferred learning styles and approaches to study, using the Lancaster Approaches to Learning Inventory. The results showed that students entering the medical school had preferences which were more similar to science students' than arts students'. The medical students had high scores on reproducing orientation (surface approach) in all years tested. The first-year students had low scores on meaning orientation (deep approach) but the scores from students in later years showed a progressive rise. The implications of these results with regard to selection, teaching and assessment are explored. However, this preliminary study does not allow us to differentiate between the effect of student preference and that of the context and the environment in which they study.     

Medical teaching—help or hindrance?

The paper describes an ongoing research study into the learning practices of medical students. Responses from structured interviews of forty-four (20%) first-year students at the University of New South Wales indicate that they work long hours, use few resources, consult little with teaching staff, co-operate a lot with each other and see themselves as responsible for their own learning. It is suggested that teacher training activities should take more notice of the actual learning practices of students if teachers and students are not to become confused and disillusioned.     

The ‘expert’ in problem‐based and case‐based learning: necessary or not?

BACKGROUND: Problem-based learning (PBL) and other small-group teaching methods which incorporate principles of adult learning, are exciting innovations in medical education. In the application of these methods to medical curricula many schools have introduced non-expert tutors. However, research evaluating the effectiveness of non-expert lead teaching has been inconclusive. AIM: The present study aim was to compare the outcome of teaching in small groups facilitated by either an 'expert' or a 'non-expert' tutor, in a single topic area. METHOD: Fourth-year medical students were allocated randomly to teaching of eating disorders either by a non-expert or an expert tutor. Outcomes were evaluated by (i) a knowledge test, and (ii) self-report ratings by tutors and students of their learning methods and other qualities. RESULTS: The study found that while the non-expert tutor was rated more highly for her group management skills, and she also rated her students more highly in the area of oral communication, students who were taught by the expert scored higher in the end-of-course test in the topic area. CONCLUSION: The findings suggest that caution should be exercised, and the need for more research before widespread adoption of teaching by non-expert tutors.     

Peer tutoring and student outcomes in a problem-based course

Summary: Summary. Does peer-tutoring affect students’ educational outcomes in problem-based learning? Students’ characteristics and outcomes were compared along 14 successive classes of a problem-based learning course in the University of Brasilia medical programme. In the first stage of this time series, 26 teacher-tutored groups were formed; in the second stage, 50 groups had both teacher- and peer-tutoring. Both groups had equivalent characteristics in stages one and two as regards membership size and composition (students’ learning style, self-confidence and motivation to learn). Results showed that scores for problem-solving tests and self-evaluation of skills were not significantly different between first and second stage groups. However, scores of meaningfulness of course experience and group work usefulness were significantly higher in the peer-tutoring stage. Significant positive correlations were found between scores of meaningfulness of course experience and both self-evaluation and group work usefulness but not between the first measure and group size or motivation to learn. The findings suggest that peer-tutoring can facilitate group work without sustained loss of cognitive achievement in long range conditions of problem-based learning experience.     

An approach to the question of relevance of medical physiology courses

One of the problems of designing basic science courses is to define objectives relevant to the future needs of the graduates. A simple approach is described whereby a series of clinical problems were identified by physiologists and practising physicians. Priority areas were then identified to provide a basis for defining objectives for the medical physiology courses and for the selection of materials and methods. It is argued that the question of relevance, emotional involvement and effective facilitation of learning will be served by the approach described. Finally, the usefulness of this exercise to the selection and orientation of appropriate evaluation tools is discussed.     

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.     

Videotaped vs traditional lectures for medical students

Closed-circuit television (CCTV) provides medical departments with alternatives in instructional formats. Concern, however, has been voiced about teaching via TV because the medium itself might cause inattention. This study investigated whether TV will lower the test scores of medical students. Sixty-one students were randomly divided into two groups. The lecture (control) group received the information via traditional lectures, including use of 2”× 2” transparencies. The video group received concurrently the same information via CCTV. Multiple-choice examinations were given after each of the six sessions. The cumulative mean scores were similar: lecture group = 87.56%, video group = 87.99%, i.e., no significant difference (P=0.77). To detect attitudinal differences toward the two formats, the students were surveyed at the end of the series and intragroup agreement on specific questions was calculated. The students rated the lecture format more highly. In response to the question ‘Did the audiovisual materials used by the instructor aid your learning?’, the mean rating from the lecture group was 7.37 (scale of 0–9) compared to a mean rating of 5.93 from the video group (P< 0.0003).     

Learning preferences of medical students

Summary. Learning styles and preferred learning approaches are believed to have an influence on student learning. This study investigated the learning preferences of first-, second- and fourth-year medical students as well as explored differences in learning preferences from first- to fourth-year students. In June 1992, 95 students were administered the learning preferences inventory (LPI) designed by Rezler at the United Arab Emirates University. Analysis of variance ( anova ) was used to test the significance of the differences of the six LPI mean scores on Abstract/Concrete, Teacher-structured/Student-structured, and Individual/Interpersonal categories across the academic year and sex. The two predominant preferences were concrete and teacher-centred. Results of this study showed students preferred teacher-structured learning experiences dealing with concrete and applied tasks, rather than abstract tasks.     

A community-based learning experience for medical students

A programme in which medical students are attached to Children's Institutions for one year is described. The students' role embraces a medical and psychosocial component in which students conduct clinics, screening programmes and health education as well as develop relationships with individuals and groups of children. This experiential learning programme enables medical students to obtain an understanding of children's needs and work through their own feelings which are aroused when confronted with children who have been deprived and abused.