Medical faculty as humanistic physicians and teachers: the perceptions of students at innovative and traditional medical schools

BACKGROUND AND OBJECTIVES: The training of caring physicians represents an important goal of medical education. Little is known however, on whether medical faculty constitute good role models for teaching humanistic skills to medical students. In this study, we examined to what extent medical students at innovative and traditional schools perceived their teachers as humanistic physicians and teachers. We also explored whether pre-clinical and clinical students shared the same perceptions. METHODS: A mail survey was conducted in Canada of all second-year students and senior clerks at one innovative medical school (problem-based learning (PBL), patient-centred, community-oriented) and three traditional medical schools. Students were asked to what extent they agreed or disagreed that the majority of their teachers behaved as humanistic physicians and teachers; 10 statements were used. Overall, 65% of the 1039 students returned the questionnaire. RESULTS: Over 25% of second-year students and 40% of senior clerks did not agree that their teachers behaved as humanistic caregivers with patients or were good role models in teaching the doctor-patient relationship. More than half of second-year students and senior clerks did not agree that their teachers valued human contact with them or were supportive of students who had difficulties. There were few differences in the way medical students at innovative and traditional schools perceived their teachers' humanistic qualities. At the pre-clinical level however, there were more students from the innovative school than from the traditional schools (around 60% vs. 40%, P < 0.005) who agreed that their teachers valued human contact with them and were supportive of students. CONCLUSION: Our results indicate that the PBL curriculum fosters better teacher-student relationships during the pre-clinical years. They also suggest that an unacceptably large number of medical students are taught by physicians who seem to lack compassion and caring in their interactions with patients. This study questions the adequacy of medical faculty as role models for the acquisition of caring competence by medical students.     

Implementation of problem-based learning in Asian medical schools and students' perceptions of their experience

BACKGROUND: Since the introduction of problem-based learning (PBL) at McMaster University in 1969, many medical schools in the USA, Canada and Europe have included PBL in their curricula. In the past decade, many medical schools in Asia have also done so. However, so far no one has questioned whether the outcomes expected of the learner in a PBL setting are applicable to students from different cultural upbringings. AIM: The aim of this study was to investigate the implementation of PBL in Asian medical schools, their students' perceptions of this new mode of teaching/learning and how the problems that have arisen may be overcome. METHOD: Published reports and conference presentations were gathered on the implementation of PBL in some Asian medical schools and comparisons of the experiences in PBL of Asian and students of other ethnic backgrounds. RESULTS: Most Asian medical schools and their students appear to be positive about adapting to PBL in their curriculum. The positive and negative observations appear to be similar to those experienced in non-Asian medical schools. The problems that arose for students in Asian medical schools in the early stages of implementing PBL appear to have been overcome after a period of adjustment with the help of supportive and open-minded tutors. The reports also suggested that trigger problems should be carefully designed to make them relevant and interesting for the students. CONCLUSION: Strong support from the academic administrators (dean and other staff responsible for implementation of the curriculum) in the introduction of PBL into the curriculum and careful training of both faculty and students appear to be key factors to ensure the successful implementation of PBL in Asian medical schools.     

Faculty attitudes towards medical communication and their perceptions of students' communication skills training at Dalhousie University

SETTING: Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. OBJECTIVES: (1) To assess the attitudes of full-time clinical faculty members towards medical communication using the newly developed Attitudes Towards Medical Communication Scale; (2) to determine faculty members' perceptions of communications training for students and residents. METHODS: An anonymous self-completion survey was sent to 233 full-time clinical faculty members. The questionnaire asked about faculty attitudes towards medical communication, and assessed faculty members' views of student and resident training in communication. RESULTS: Faculty scored highly in the Attitudes Towards Medical Communication Scale, with a mean score of 51.5 (SD 4.1) out of a possible 60. In univariate analysis, rating of personal enjoyment of teaching, rating of the importance of teaching, and having attended at least one faculty communications workshop in the previous 5 years were significantly associated with higher scale scores. When these factors were assessed using linear regression, only having attended a workshop and higher rating of the importance of teaching remained significant. Faculty assessed student training in communications skills poorly overall. When assessing seven specific communications areas, more than 20% rated this training as poor for six of the areas for third- and fourth-year students and for five of the areas for residents. CONCLUSIONS: Clinical faculty at Dalhousie have very positive attitudes towards medical communication, and more highly positive attitudes are found in those who have attended a communications workshop. Despite this evidence that faculty appreciate the importance of medical communication skills, many assessed students' training in this curriculum area as poor.     

A Formative Evaluation of the American Cancer Society Changing the Course Nutrition Education Curriculum

A formative evaluation was conducted of Changing the Course, a behaviorally oriented, activity-based nutrition education curriculum for elementary students from the American Cancer Society, to assess feasibility of program implementation. Sixteen teachers in six schools in the Northeast taught the 15-16 session lower and upper elementary curricula to 702 students. Teacher satisfaction with the curriculum was high. Fidelity of implementation of the curriculum also was high and relatively few modifications to learning activities were made. Teachers reported the one day of training they received was adequate. They also reported a positive influence of the curriculum on themselves and their students. Student achievement results showed most children achieved most of the learning objectives at posttest--80% giving the correct answers on more than 75% of the test items. An examination of children's item-by-item answers on the posttest and of teachers' logs provided information useful for the final stages of development of the curricula and teacher training procedures, before national dissemination.     

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

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

Evaluation of an Interactive Case-based Online Network (ICON) in a Problem Based Learning Environment

Purpose: This study sought to assess the introduction of a web-based innovation in medical education that complements traditional problem-based learning curricula. Utilizing the case method as its fundamental educational approach, the Interactive Case-based Online Network (ICON) allows students to interact with each other, faculty and a virtual patient in difficult neurological cases. Given the paucity of available metrics to benchmark online systems, we complement user perceptions with data on system utilization. Methods: We describe a case study of distinct, small group tutorials over 2 years as part of the Human Nervous System and Behavior (HNSB) course at the Harvard Medical School. Participating students and faculty were interviewed following completion of the course and their utilization of the system was recorded and examined. Results: Students each spent 3.2±1.3 h (mean±SD) through 8.6±2.8 accessions per week using ICON outside of required tutorial time. Faculty each spent 4.8±3.4 h through 16.6±8.9 accessions per week on ICON. Students identified real-time engagement, stronger relationships with faculty, increased accountability to the tutorial group and self-selected pace as the most beneficial characteristics of the ICON-based tutorial in comparison to traditional problem based learning (PBL) tutorials. Faculty identified enhanced collaboration with students and more realistic student experiences as the most beneficial characteristics. Both students and faculty reported that limitations of ICON included increased time investment for faculty and increased reliance on good faculty mentorship. Conclusion: This is the first study of the ICON learning system in undergraduate medical education, a platform designed to facilitate collaboration outside of the classroom. Data on user perceptions and system utilization suggest that both faculty and students chose to adopt this online learning system as a means for collaboration. The study also outlines future avenues for research in assessing novel online technologies.     

Student perceptions of tutor skills in problem-based learning tutorials

OBJECTIVE: The problem-based learning (PBL) tutor plays a role that is different from the role of a teacher in a conventional teaching format. In the Faculty of Medicine and Health Sciences, United Arab Emirates, all students are Arab nationals and tutors are expatriates with different sociocultural backgrounds from the students. This study was designed to investigate how students evaluate tutors in PBL tutorials and whether student evaluations of tutors change with the progress of students in PBL tutorials. METHODS: Differences in tutor performance evaluation by male and female students were also analysed. The students evaluated 12 tutor skills in a scale of 1-3, 1 being 'below average' and 3, 'outstanding'. Student responses from a total of 314 (98.1%) completed forms collected over 2 academic years were analysed statistically. A total of 14 tutors participated in the PBL programme. RESULTS: The analysis revealed that tutors as a group were rated as having average to outstanding tutor skills in 10 items of the evaluation form. Students and faculty perceptions were different for the tutor skills of guiding students for information management. The students expected more support from tutors, whereas the tutors tried to emphasize self-learning in the PBL curriculum. Lower scores to the tutors in the 'problem' bringing sociocultural and religious issues for discussion showed that a gap in sociocultural/religious understanding between students and tutors might influence tutor skills. CONCLUSIONS: Differences in tutor evaluation by male and female students indicate necessity of adopting different strategies by tutors in a different sociocultural background. The results of the study have direct implications for faculty development.     

Providing early clinical experience in primary care

Undergraduate courses in British medical schools are changing following recommendations from the General Medical Council. Increasing emphasis has been placed on teaching in the community. Nottingham Medical School has pioneered the teaching of basic clinical skills in primary care during the pre-clinical course to help produce an integrated curriculum. This qualitative study evaluated the first two years of the new early clinical experience course at Nottingham by using interviews with 19 students and their GP tutors. Students claimed to have gained confidence in talking to patients, their understanding of the role of the doctor and the importance of the doctor-patient relationship. Students were less confident about examining patients and some reported having had little opportunity to practice examination skills. Half the students thought that the early clinical visits had helped them to understand and be more motivated to learn their basic medical sciences course. The newly recruited GP teachers were highly motivated, very positive about the early clinical teaching and all wanted to continue to teach the pre-clinical students. Difficulties in providing the course included communication with students and staff, organization of student travel and variation in the quality of teaching. However, the Nottingham early clinical experience course has shown that basic clinical skills can be successfully taught to pre-clinical students in primary care.     

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.     

Influence of PBL with open-book tests on knowledge retention measured with progress tests

The influence of problem-based learning (PBL) and open-book tests on long-term knowledge retention is unclear and subject of discussion. Hypotheses were that PBL as well as open-book tests positively affect long-term knowledge retention. Four progress test results of fifth and sixth-year medical students (n = 1,648) of three medical schools were analyzed. Two schools had PBL driven curricula, and the third one had a traditional curriculum (TC). One of the PBL schools (PBLob) used a combination of open-book (assessing backup knowledge) and closed-book tests (assessing core knowledge); the other two schools (TC and PBLcb) only used closed-book tests. The items of the progress tests were divided into core and backup knowledge. T tests (with Bonferroni correction) were used to analyze differences between curricula. PBL students performed significantly better than TC students on core knowledge (average effect size (av ES) = 0.37–0.74) and PBL students tested with open-book tests scored somewhat higher than PBL students tested without such tests (av ES = 0.23–0.30). Concerning backup knowledge, no differences were found between the scores of the three curricula. Students of the two PBL curricula showed a substantially better long-term knowledge retention than TC students. PBLob students performed somewhat better on core knowledge than PBLcb students. These outcomes suggest that a problem-based instructional approach in particular can stimulate long-term knowledge retention. Distinguishing knowledge into core and backup knowledge and using open-book tests alongside closed-book tests could enhance long-term core knowledge retention.     

Tutoring in problem-based learning: perceptions of teachers and students

This study examined teacher and student perceptions during the first 2 years of a complete transition from a conventional to a problem-based learning (PBL) curriculum at Dalhousie University. Teaching staff who had tutored in the two pre-clinical years (   n = 88  ) completed a questionnaire at the end of the 1993–94 academic year, and student assessments of their tutors were collated for all nine units (   n = 597  ).
Seven research questions were addressed in the study which examined the faculty, student and administrative aspects of tutoring. The results showed that faculty tutors rated PBL more highly than traditional medical school methods on eight of the nine items. Teaching staff were very satisfied with their tutoring experience, but expressed a need for further training in group facilitation, questioning, handling 'difficult' situations and evaluating students. They reported that their workload outside tutorials was cut almost in half in their second year of tutoring. Students expected a tutor to be a skilled group facilitator who would guide them in their learning, while helping to maintain a positive group climate. They did not want the tutor to teach the content as they perceived the task of learning to be their responsibility.
Several major administrative factors affected tutors' and students' perceptions of tutorials, including: changing tutorial group composition and tutor every 8–10 weeks; team tutoring; end-of-unit exam; conflicting demands of basic science 'vertical' units and ongoing 'horizontal' units; departmental budgetary requirements for basic medical education; recognition of tutoring in promotion and tenure decisions; and recruitment of tutors.     

A comparison of interprofessional perceptions and working relationships among health and social care students: the results of a 3-year intervention

A longitudinal quantitative study in an English faculty of health and social care explored the effects of a pre-qualifying interprofessional curriculum for students from 10 professional programmes. Students on the interprofessional curriculum completed questionnaires containing four attitude scales on entry to the faculty, during their second year and at the end of their final year. At qualification, 581 students (76.9% of those qualifying) completed scales concerning their communication and teamwork skills, their attitudes towards interprofessional learning, their perceptions of interaction between health and social care professionals, and their opinions about their own (inter)professional relationships. Questionnaires were completed at both entry and qualification by 526 students (69.8% of those qualifying), and at all three points by 468 students (61.9% of those qualifying). A comparison group of 250 students (67.6% of those qualifying) on the previous uniprofessional curricula also completed questionnaires at qualification. Students on the interprofessional curriculum showed no significant change in their self-assessment of their communication and teamwork skills between entering the faculty and qualification. However, there was a negative shift in their attitudes to interprofessional learning and interprofessional interaction. Nevertheless, most students were positive about their own professional relationships at qualification. Students with previous experience of higher education were comparatively positive about their communication and teamwork skills, as were female students about interprofessional learning. However, the strongest influence on students' attitudes at qualification appeared to be professional programme. This suggests that interprofessional education does not inhibit the development of profession-specific attitudes. Students who qualified on the interprofessional curriculum were more positive about their own professional relationships than those who qualified on the previous uniprofessional curricula. These data suggest that experiencing an interprofessional curriculum has an effect on students' attitudes at qualification, particularly with regard to their positive perception of their own professional relationships.     

What drives students’ self-directed learning in a hybrid PBL curriculum

Evidence supporting Problem-based learning (PBL) fostering students’ self-directed learning (SDL) in hybrid PBL curricula is inconsistent. To explore the influence of PBL in a hybrid curriculum on students’ SDL, the authors investigated the following: (1) students’ self-assessed SDL ability, (2) students’ perceptions of the influence of curricular components on SDL, and (3) the relationships between curricular elements and SDL. The research questions were explored both quantitatively and qualitatively. All year 1 (n = 93) and year 2 (n = 93) students in 2004 were invited to participate. Participants completed a 53-item questionnaire addressing (a) self-assessment of their SDL ability, and (b) perceived influence of individual curriculum elements on individual study and SDL. Student and faculty focus group interviews (FGIs) were conducted. Students rated their SDL skills highly, particularly identifying knowledge deficits, learning skills and strategies, and managing study time. Students thought lectures helped in selecting study topics and learning for the tutorial case. Other components including tutors, unit/case objectives, tests, and tutorial discussions, were seen as influencing what to study and the learning process. No significant difference was observed in the responses between year 1 and 2 students. Among the six curriculum components, tutorial discussion and objectives were weakly correlated with with SDL ability. Findings from students and faculty focus group supported the perceived positive influence of the curriculum on SDL. This study found that students’ perceived SDL ability was positively influenced by several components of the hybrid PBL curriculum. However, further investigations are needed for a clearer understanding of the specific effects of the hybrid PBL curriculum on students’ SDL.     

A comparison of learning outcomes and attitudes in student- versus faculty-led problem-based learning: an experimental study

OBJECTIVES: To compare learning outcomes and perceptions of facilitator behaviours and small-group process in problem-based learning (PBL) groups led by students and those led by faculty. DESIGN: A prospective, Latin-square cross-over design was employed. Second-year medical students participated in 11 PBL cases over the course of the academic year. For each case, half the student groups were led by faculty and the other half by a student group member selected randomly to serve in the facilitator role. Learning outcomes were assessed by performance on objective examinations covering factual materials pertinent to the case. Perceptions of facilitator behaviours and of group functioning were assessed with a questionnaire completed at the end of each individual case. Focus-group discussions were held to gain more in-depth information about student perceptions and experience. Student-led sessions were observed at random by the investigators. SETTING: A state-supported, US medical school with a hybrid lecture-based and problem-based curriculum. SUBJECTS: One hundred and twenty-seven second-year medical students and 30 basic science and clinical faculty. RESULTS: No differences were detected in student performance on the objective evaluation based on whether the facilitator was a faculty member or peer group member, nor were there any differences in the perceptions of group process. Students gave peer facilitators slightly higher ratings in the second semester of the experiment. In the focus-group discussions, students voiced a general preference for student-led groups because they felt they were more efficient. Observation and focus-group reports suggest that groups led by students sometimes took short cuts in the PBL process. CONCLUSION: In a hybrid lecture- and PBL-based curriculum, student performance on objective examinations covering PBL materials is unaffected by the status of the facilitator (student vs. faculty). However, in peer-facilitated groups, students sometimes took short cuts in the PBL process that may undermine some of the intended goals of PBL.     

Paired basic science and clinical problem-based learning faculty teaching side by side: do students evaluate them differently?

INTRODUCTION: Many studies have evaluated the desirability of expert versus non-expert facilitators in problem-based learning (PBL), but performance differences between basic science and clinical facilitators has been less studied. In a PBL course at our university, pairs of faculty facilitators (1 clinician, 1 basic scientist) were assigned to student groups to maximise integration of basic science with clinical science. AIMS: This study set out to establish whether students evaluate basic science and clinical faculty members differently when they teach side by side. METHODS: Online questionnaires were used to survey 188 students about their faculty facilitators immediately after they completed each of 3 serial PBL cases. Overall satisfaction was measured using a scale of 1-7 and yes/no responses were gathered from closed questions describing faculty performance. results: Year 1 students rated basic science and clinical facilitators the same, but Year 2 students rated the clinicians higher overall. Year 1 students rated basic scientists higher in their ability to understand the limits of their own knowledge. Year 2 students rated the clinicians higher in several content expertise-linked areas: preparedness, promotion of in-depth understanding, and ability to focus the group, and down-rated the basic scientists for demonstrating overspecialised knowledge. Students' overall ratings of individual faculty best correlated with the qualities of stimulation, focus and preparedness, but not with overspecialisation, excessive interjection of the faculty member's own opinions, and encouragement of psychosocial issue discussion. CONCLUSION: When taught by paired basic science and clinical PBL facilitators, students in Year 1 rated basic science and clinical PBL faculty equally, while Year 2 students rated clinicians more highly overall. The Year 2 difference may be explained by perceived differences in content expertise.     

Development of knowledge in basic sciences: a comparison of two medical curricula

Medical Education 2012: 46 : 1206–1214 Context Basic medical sciences education differs among medicine courses, especially as traditional and integrated problem‐based learning (PBL) curricula teach basic sciences in very different ways. The literature shows no clear differences in the performance of students of these different educational philosophies. The Charité Medical University of Berlin (Charité Universitätsmedizin Berlin) teaches both a traditional medical curriculum (TMC) and a PBL reformed medical curriculum (RMC). Both curricula conduct the Progress Test in Medicine (PTM), which examines competence in the basic and clinical sciences from the first to the last semester. Objectives The aim of this study was to compare the development and retention of knowledge in the basic medical sciences between students on the traditional and reformed undergraduate medical curricula, respectively. Methods For each student and single PTM, relative frequencies of correct answers were computed for basic sciences items only and for the whole curriculum. Frequencies were averaged and grouped by semester and curriculum. Analyses of variance (anova s) were performed at all measurement points with a Bonferroni‐corrected p‐value at the level of p < 0.005. Eta‐squared (η²) was used to classify effect size. Results In the first three semesters, RMC students slightly outperform TMC students in the basic sciences, although TMC students receive more systematic teaching. After this, TMC students develop a peak of knowledge in basic sciences and overtake RMC students. The knowledge of TMC students then decreases over time, but despite this, they perform better in the final semester. Students on the RMC show constant progress throughout their undergraduate studies. Overall, the development of medical knowledge is consistent in both curricula. There is no significant difference in this outcome between the traditional and PBL courses. Conclusions Progress testing as a longitudinal method allows us to better understand the development of knowledge during formal undergraduate education. The main difference between traditional and problem‐based medical education seems to be provoked by the high‐stakes national examination undertaken in the traditional course (the Physikum).     

Analysis and prospects for curricular reform of medical schools in Southeast Europe

AIM: To analyse the curricula of 16 medical schools in 6 countries in Southeast Europe in order to establish a prevailing standard curriculum against which a prospective curriculum reform could formulate its objectives. METHODS: Curricular information was gathered from a questionnaire sent via e-mail to the respective medical schools. The data collected ranged from the numbers of enrolled students to a breakdown of courses with distribution of instruction hours for certain teaching formats. For easier comparison the courses were clustered into 5 groups: pre-clinical, clinical, public health, liberal arts and electives. RESULTS: Belgrade has the highest number of undergraduate students, while Mostar has the lowest. Novi Sad, Foca/Srbinje, Zagreb, Split, Sofia, Ljubljana and Mostar have more than 5000 instruction hours, but Sarajevo lags behind with 4005 hours. Anatomy dominates the course load in Year 1, ranging from a share of 18.4% in Sofia to 11.3% in Novi Sad. Physiology dominates Year 2, ranging from 16.8% in Rijeka to 8.9% in Split, whereas in Year 3 the dominating course is pathology, reaching a peak of 13.7% in Sarajevo. Sofia has the highest number of class hours of clinical courses. The predominant public health courses are social medicine, family medicine and medical ecology. Medical English is taught at all medical schools (as electives in Ljubljana and Rijeka). CONCLUSION: There is considerable potential for curriculum improvement in the region. Teacher training, student participation, the definition of core competencies and the introduction of new methodologies should all be implemented in the process.     

The development of self-regulated learning during the pre-clinical stage of medical school: a comparison between a lecture-based and a problem-based curriculum

Society expects physicians to always improve their competencies and to be up to date with developments in their field. Therefore, an important aim of medical schools is to educate future medical doctors to become self-regulated, lifelong learners. However, it is unclear if medical students become better self-regulated learners during the pre-clinical stage of medical school, and whether students develop self-regulated learning skills differently, dependent on the educational approach of their medical school. In a cross-sectional design, we investigated the development of 384 medical students’ self-regulated learning skills with the use of the Self-Regulation of Learning Self-Report Scale. Next, we compared this development in students who enrolled in two distinct medical curricula: a problem-based curriculum and a lectured-based curriculum. Analysis showed that more skills decreased than increased during the pre-clinical stage of medical school, and that the difference between the curricula was mainly caused by a decrease in the skill evaluation in the lecture-based curriculum. These findings seem to suggest that, irrespective of the curriculum, self-regulated learning skills do not develop during medical school.