Exploration of Dietetics Graduate Students’ Experience in a Flipped Course Using Learning Reflections

ObjectiveEvaluate graduate students’ experience in a flipped metabolism course using periodic learning reflections.MethodsTwo cohorts of graduate students (n = 17, total) were recruited from an advanced metabolism course using a flipped learning approach during the fall 2016 and 2017 semesters. After course completion, 2 investigators used content analysis to develop themes from 8 structured learning reflections.ResultsFour themes were developed from the reflections: responsibility for learning, metacognition, team-based learning, and transfer of skills. Resistance to flipped learning peaked at week 4 of the semester. By the end of the semester, students seemed to embrace the flipped approach and self-directed learning.Conclusions and ImplicationsDespite reporting being better self-directed learners by the end of the semester, students may struggle with the flipped learning format early in the semester. Thus, instructors may need to adopt supportive techniques with students initially.     

Effects of an experiential learning program on the clinical reasoning and critical thinking skills of occupational therapy students

This study examined the effects of participation in a 1-week, experiential, hands-on learning program on the critical thinking and clinical reasoning skills of occupational therapy students. A quasi-experimental, nonrandomized pre- and post-test design was used with a sample of 25 students. The students had completed three semesters of didactic lecture coursework in a master's level OT educational program prior to participation in a hands-on therapy program for children with hemiplegic cerebral palsy. Changes in critical thinking and clinical reasoning skills were evaluated using the following dependent measures: Self-Assessment of Clinical Reflection and Reasoning (SACRR) and the California Critical Thinking Skills Test (CCTST). Changes in pretest and posttest scores on the SACRR and the CCTST were statistically significant (p>0.05) following completion of the experiential learning program. This study supports the use of hands-on learning to develop clinical reasoning and critical thinking skills in healthcare students, who face ever more diverse patient populations upon entry-level practice. Further qualitative and quantitative investigations are needed to support the results of this study and determine which components of experiential learning programs are essential for developing clinical reasoning and critical thinking skills in future allied health professionals.     

Comparison of directed and self-directed learning in evidence-based medicine: a randomised controlled trial

OBJECTIVES: To compare 2 educational programmes for teaching evidence-based medicine (EBM). DESIGN: Prospective randomised controlled trial accompanied by a qualitative evaluation. SETTING: University of Oslo, Norway, 2002-03. PARTICIPANTS: A total of 175 students entered the study. All tenth semester medical students from 3 semesters were eligible for inclusion if they completed baseline assessment and consent forms and either attended teaching on the first day of the semester or gave reasons for their absence on the first day in advance. Interventions One intervention was based on computer-assisted, self-directed learning (self-directed intervention), whilst the other was organised as workshops based on social learning theory (directed intervention). Both educational interventions consisted of 5 half-day sessions. MAIN OUTCOME MEASURES: The primary outcomes were knowledge about EBM and skills in critical appraisal. A secondary outcome measured attitudes to EBM. Outcomes were compared on an intention-to-treat basis using a stratified Wilcoxon rank-sum test. RESULTS: There were no differences in outcomes for the 2 study groups in terms of EBM knowledge (mean deviation 0.0 [95% confidence interval - 1.0, 1.0], P = 0.8), critical appraisal skills (MD 0.1 [95% CI - 0.9, 1.1], P = 0.5), or attitudes to EBM (MD - 0.3 [95% CI - 1.4, 0.8], P = 0.5). Follow-up rates were 96%, 97% and 63%, respectively. CONCLUSIONS: This trial and its accompanying qualitative evaluation suggest that self-directed, computer-assisted learning may be an alternative format for teaching EBM. However, further research is needed to confirm this and investigate alternative educational models.     

Does PBL Matter? Relations Between Instructional Context,Learning Strategies,and Learning Outcomes

Purpose:To compare learning strategies used in Problem based learning (PBL) and lectures, and the relations between learning strategies and learning outcomes to determine how different learning strategies associated with PBL and lectures contribute to aspects of clinical competence. Design:The 52-item learning strategies questionnaire was given to preclinical medical students during lecture and PBL sessions in first and third year from 1994 to1998. Response patterns were compared across the two contexts and factor structures investigated. Regression analyses examined relations between learning strategies and outcomes.Main Outcome Measures/Results:Comparison of responses on the 326 complete pairs of lecture and PBL questionnaires indicated differences at the 0.05 level on 44 of the 52 items. The mean differences were greater than 0.5 (on a 5 point scale)at the 0.001 level for 20 items. Of these, five strategies were used more often in PBL and 15 in lectures. Comparisons of learning strategy use across years showed significant changes with time in both instructional contexts. Principal component analysis revealed a stable factor structure with 4 factors distinctly associated with PBL and 4 factors with the lecture learning context. The remaining 6 factors were mixed and independent of context. Exploratory regression analysis revealed that learning outcomes in examinations were influenced by learning strategies. Multiple choice performance was positively predicted by learning associated with lecture class notes and negatively by group work, whereas the OSCE (objective structured clinical exam) performance was positively predicted by class participation in PBL, self-directed note making and lecture class notes.Conclusion:We have developed a learning strategies questionnaire that shows that students' learning strategies are influenced by instructional context, and patterns of learning strategy use change over time. There is tentative evidence that the students' learning strategies influence learning outcomes. This revised version was published online in June 2006 with corrections to the Cover Date.     

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.     

Introducing a problem-based unit into a lifespan nutrition class using a randomized design produces equivocal outcomes

Problem-based learning (PBL) is a tutorial, student-centered, problem-driven educational strategy adopted by medical and allied health educators to positively influence self-directed learning, critical thinking, and learning behavior. PBL was examined in dietetics education through random assignment of 32 undergraduate dietetics students for two weeks to either a problem-based or a lecture-based case format for the infant and elderly units of a 16-week lifespan nutrition course. Random assignment followed stratification for gender and earlier course examination performance. Expert validation of PBL curricular components and noted differences in discussion structure and information resources verified curriculum distinctiveness. Main outcome measures were pre- and post-Cognitive Behavior Survey scores for memorization, reflection, and positive learning experience scales, unit and course evaluations and unit examination scores. Students in problem-based modules demonstrated greater gains in reflective thinking with stable memorization, suggesting improved critical thinking skills. Tenets that problem-based learning promotes knowledge retention and provides a more positive learning experience were not upheld. Knowledge acquisition was not hindered by a problem-based approach. We conclude that gains in reflective thinking and evidence of increased self-directed learning argue for inclusion of PBL in dietetics curricula and that a problem-based education will help dietitians successfully respond to professional development needs.     

Mapping as a learning strategy in health professions education: a critical analysis

Medical Education 2012: 46 : 1215–1225 Context Mapping is a means of representing knowledge in a visual network and is becoming more commonly used as a learning strategy in medical education. The assumption driving the development and use of concept mapping is that it supports and furthers meaningful learning. Objectives The goal of this paper was to examine the effectiveness of concept mapping as a learning strategy in health professions education. Methods The authors conducted a critical analysis of recent literature on the use of concept mapping as a learning strategy in the area of health professions education. Results Among the 65 studies identified, 63% were classified as empirical work, the majority (76%) of which used pre‐experimental designs. Only 24% of empirical studies assessed the impact of mapping on meaningful learning. Results of the analysis do not support the hypothesis that mapping per se furthers and supports meaningful learning, memorisation or factual recall. When documented improvements in learning were found, they often occurred when mapping was used in concert with other strategies, such as collaborative learning or instructor modelling, scaffolding and feedback. Conclusions Current empirical research on mapping as a learning strategy presents methodological shortcomings that limit its internal and external validity. The results of our analysis indicate that mapping strategies that make use of feedback and scaffolding have beneficial effects on learning. Accordingly, we see a need to expand the process of reflection on the characteristics of representational guidance as it is provided by mapping techniques and tools based on field of knowledge, instructional objectives, and the characteristics of learners in health professions education.     

Brief or New: The Benefits of On-Line Learning in Occupational Therapy

SUMMARY

This paper discusses the benefits of incorporating an on-line program, such as Blackboard, into occupational therapy education to enhance the learning experience. An occupational therapy department at a midwestern university piloted the use of Blackboard in two classes in the spring semester of the junior year. Students (n = 16) ranging in age from 20–28 years participated in the pilot study, which lasted a period of 12 weeks. The students were given various assignments on Blackboard involving discussions, answering questions related to the lecture topic, and sharing evidence-based practice. Overall, the student perceptions of incorporating Blackboard into a traditional classroom were positive. Eighty-one percent of the students felt that Blackboard was easy to access, 75% felt that they could share thoughts and stories that they would not necessarily have shared in a classroom setting, and 81% felt that Blackboard expanded on lecture topics and relevant practice information. Data suggest that on-line learning can enhance the educational experience by building upon student fieldwork experiences, evidence-based practice, discussion of key concepts in the profession, and clinical reasoning.     

Concept maps in medical education: an analytical literature review

Medical Education 2010: 44 : 440–448 Objectives As the medical profession continues to change, so do the educational methods by which medical students are taught. Various authors have acknowledged the need for alternative teaching and learning strategies that will enable medical students to retain vast amounts of information, integrate critical thinking skills and solve a range of complex clinical problems. Previous research has indicated that concept maps may be one such teaching and learning strategy. This article aims to: (i) review the current research on concept maps as a potential pedagogical approach to medical student learning, and (ii) discuss implications for medical student teaching and learning, as well as directions for future research. Methods The literature included in this review was obtained by searching library databases including ACADEMIC SEARCH, ERIC, EBSCOHost, PsychINFO, PsychARTICLES, PubMed/MEDLINE, CINAHL and EMBASE. This literature review is a summary of both conceptual and empirically published literature on the uses of concept mapping in medical education. Results The 35 studies reviewed here indicate that concept maps function in four main ways: (i) by promoting meaningful learning; (ii) by providing an additional resource for learning; (iii) by enabling instructors to provide feedback to students, and (iv) by conducting assessment of learning and performance. Conclusions This review provides ideas for medical school faculty staff on the use of concept maps in teaching and learning. Strategies such as fostering critical thinking and clinical reasoning, incorporating concept mapping within problem‐based learning, and using concept mapping in group and collaborative learning are identified. New developments in medical education include the use of serial concept maps, concept maps as a methodology to assist learners with lower cognitive competence, and the combination of group concept maps with structured feedback.     

Students Teaching Students: Learning Through Doing,Being, and Becoming

This paper describes a creative teaching strategy that may be used by occupational therapy educators. The strategy is illustrated through the learning experience of five occupational therapy students in Pi Theta Epsilon (PTE) who participated in a project which involved teaching first year occupational therapy students. With guidance from their faculty advisor, the students developed a lecture on Occupational Science and designed a pre and posttest instrument to measure the first year student's learning as well as their own performance and learning. Qualitative data from the five PTE students provided insight into their teaching experience. This project afforded an opportunity for the five students to apply and strengthen their problem-solving, interpersonal, and leadership skills, and teamwork. The doing aspect of preparing a lecture required various skills and knowledge that will benefit the students as future practitioners. The actual teaching of others allowed the students to experience being in the role of an educator. Such learning activities help to prepare students for their journey to becoming occupational therapists.     

Advancements in nutrition and dietetics teaching and learning: Evaluation of the student portfolio

Aim: To describe the use and evaluation of a clinical teaching and learning portfolio in undergraduate nutrition and dietetics education. Method: The results of a quantitative and qualitative questionnaire evaluation of the portfolio by students and supervisors conducted during 2008 are described. Results: A portfolio is a valuable tool for use in clinical teaching and learning as our results show it assists in goal setting for the students, clearly identifies course requirements, facilitates regular opportunities for effective feedback and provides structured self-directed learning activities to help students improve their knowledge of dietetic processes in the workplace setting. Conclusion: Nutrition and dietetics educators should consider the use of a portfolio as a tool for assessing critical thinking, communication and problem-solving skills.     

自主导向学习法与传统教学法在临床护理带教中的效果分析

目的探讨自主导向学习法与传统教学法在临床护理带教中的效果。方法选取该院2017年1-12月40名胸部内科实习护生为参照组,选取2018年1-12月40名胸部内科实习护生为观察组,参照组实施传统教学模式,观察组接受自主导向学习模式。比较两组实习护生出科考试成绩、自主导向学习及核心能力情况。结果观察组理论成绩、实际操作成绩评分高于参照组(P<0.05),观察组学习行为、学习意识、学习策略、沟通能力、自我评价等自主导向学习评定评分高于参照组(P<0.05),观察组评判思维能力、临床护理能力、人际关系、领导能力、专业发展能力等核心能力评定评分高于参照组(P<0.05)。结论自主导向学习法用于临床护理带教中效果显著,可提升实习护生出科考试成绩、自主导向学习能力及核心能力。     

Integrating diet therapy and dietary counseling: an alternative education technique

The purpose of this study was to examine the effects of a change in education methods on learning among students enrolled in a coordinated undergraduate program (CUP). An experimental process applying the principles of diet therapy and counseling in a situation involving volunteer clients was initiated, and the effects were measured. A pretest-post-test design was used for this investigation. Two psychometric instruments, the Myers-Briggs Type Indicator and the Affective Sensitivity Scale, were used to measure changes in attitudes, values, and aptitude. The curriculum of the treatment group (19 juniors in the CUP) was reorganized so that diet therapy and dietary counseling would be taught during the same semester. The laboratory sessions were combined the last 6 weeks of the semester to provide an opportunity for students to counsel clients recruited from the university campus. The comparison group (11 seniors in the CUP) had enrolled in diet therapy the first semester of the junior year and dietetic counseling the second semester; those students were tested during their senior year. The research indicated that the students in the treatment group learned effectively. They significantly increased their awareness, listening, and understanding during the treatment period. The post-test of the treatment group indicated that they had increased perception and more acute affective sensitivity in comparison with the control group.     

Promoting professional knowledge, experiential learning and critical thinking for medical students

It has been recognized internationally that undergraduate medical education must adapt to changing needs, as illustrated by the Tomorrow's Doctors recommendations from the General Medical Council. This paper aims to relate contemporary educational theory to under-graduate medical educational requirements, specifically highlighting conditions (e.g. experiential learning) for: professional knowledge acquisition; critical thinking, problem-solving and clinical problem-solving; and lifelong professional learning. Furthermore, problem-based learning (PBL) is highlighted as potentially providing such conditions. There are lessons from contemporary educational theory for the reform of undergraduate medical education. These include valuing prior knowledge and experience; promoting learner responsibility through facilitating rather than directing learning; encouraging learners to test out and apply new knowledge, and using small-group work to foster explicitly the elusive skills of critical thinking and reflection. Contemporary educational theory contributes valuable insights, but cannot dictate the ultimate 'mix'; at best it provides some principles for reflective analysis of the learning experiences created for tomorrow's doctors.     

An investigation into problem solving in education: a problem-solving curricular framework

The purpose of this study was to examine how two aspects of teaching, mastery of content and problem solving, could be linked in a curricular framework. A professional educational program in physical therapy which had been developed to teach both content and problem solving was evaluated. The subjects for the study were 81 students in a baccalaureate program in a Midwestern medical school who participated in this problem-solving curriculum. The primary assessment instrument used was the Watson-Glaser Critical Thinking Appraisal. Findings indicated that performance on a test of critical thinking was affected by the curriculum. Regression analysis indicated that one course designed as an introduction to problem solving was significantly related to changes in problem-solving skill scores. Although significant change in the test scores did occur, these changes were not evident until the completion of the year-long program. Differing effects for lecture and field experience (or patient care) courses were not observed, and traditional measures such as grade point averages had no statistical relationship to problem-solving skill scores.     

Self-Weighing and Visual Feedback Facilitates Self-Directed Learning in Adults Who Are Overweight and Obese

ObjectiveUnderstanding how and why self-weighing works for some individuals but not others in weight management is vital. This study investigated how self-weighing and tracking of weight using a Web site facilitated a self-directed learning process in overweight or obese adults interested in losing weight.DesignSemistructured interviews with study completers (n = 47) and voluntary withdrawals (n = 10) about their experience after 6 and 12 months of using the program or when they withdrew.AnalysisQualitative, guided by self-directed learning theory.ResultsAlthough both completers and those who withdrew engaged in self-directed learning, often exemplifying the same concepts (eg, instrumental learning), experiences described a positive sense of control over weight in completers and a lack of sense of control in those who withdrew.Conclusions and ImplicationsOverall, it seemed that frequent self-weighing and visual feedback of body weight over time facilitated a self-directed learning process in both completers and those who withdrew. This research provides a rich understanding of how adults use self-weighing to facilitate self-directed learning for weight loss. Future studies assessing how self-weighing and visual displays of weight facilitate a self-directed learning process in diverse populations and age groups are necessary to better understand how self-weighing works and for whom self-weighing is beneficial.     

Evaluation of a motivational education program for cardiovascular risk reduction: Effects on knowledge and behavior

The purposes of this study were 1) to compare the effectiveness of an interactive/reflective lifestyle education program with an instrumental program in changing nutrition behavior for the reduction of cardiovascular risk, and 2) to evaluate the effects of interactive/reflective nutrition education practice on patients' development of critical/creative thinking and problem-solving skills. Patients were stratified according to risk, and randomly assigned to the experimental (interactive/reflective) or control (instrumental) group. Measures of knowledge and nutrition behavior were administered prior to and immediately following the intervention, six weeks after program completion, and three months later to assess maintenance effects. Of 32 relatively well-educated patients completing the study, participants in interactive/reflective sessions demonstrated improvements in nutrition behavior relative to the control group that could not be attributed to gains in knowledge scores. Qualitative evaluation of the learning process suggested that the development of critical/creative thinking and problem-solving skills among experimental group participants may have contributed to behavior change.     

Inquiry-based learning: An instructional alternative for occupational therapy education

An inquiry-based learning (IBL) approach was used as the model of instruction in one of three sections offered annually to large introductory occupational therapy classes in a Canadian university during 1994/5, 1995/6, 1996/7. Students' final grades in this pre-entry course form part of the grade point average on which admission to the BSc OT programme is based. The IBL model was employed to (1) increase the amount of student-directed learning, (2) increase the amount of independent problem-solving, (3) increase student-instructor interaction within the learning situation, and (4) reduce the number of in-class hours for students. This study is an evaluation of whether students from the IBL sections would subsequently do as well as those from other sections in selected junior professional courses. Students from the three IBL sections (n=47) were peer matched to students who had completed other sections of the introductory course, but were part of the same admission cohort (n=68). Their grades in three junior professional courses were compared at the end of their first year in the BSc OT programme. Results indicated that students from the IBL sections did at least as well as those from other sections where a different instructional approach was used, and those from the IBL sections in 1994/5 and 1996/7 each did significantly better on two of the junior professional courses used as the outcome measure: therapeutic occupation and assessment and evaluation techniques. Students reported that the IBL experience stimulated them to learn more about the field, helped them develop problem-solving skills in relation to occupational therapy, and enabled them to learn more about career opportunities in occupational therapy. Mature students were more positive about the IBL approach than students in their first year of university.     

Learning outcomes in two different teaching approach in nursing education in Iran: e-learning versus lecture

Traditional teaching methods used in medical education couldn't meet the need for keeping pace with up to date information. Present study has conducted in order to compare the effect of lecture and e-learning methods on nursing students' learning outcomes in the context of Iran. A cross-over design was applied. Study sample was consisted of 32 students which were in third semester of nursing bachelor program and were passing Maternal Child nursing course. The first part of the course was taught using lecture method during first four weeks; an e-learning method was the technique used to educate the remained part of the course during the second four weeks. Students' learning outcomes in each method, opinion toward and participation with both educational methods was assessed. No significant difference was found between students exam scores in both methods. Considering students' opinion toward educational methods, no significant difference was found between two methods in general but students reported better "capability" and "independency" in e-learning method while lecture was obtained higher scores in "effectiveness on learning" and "motivation" characteristics. E-learning can be used in teaching some nursing courses. It is recommended to use e-learning method with appropriate interactive strategies and attractive virtual environments to motivate students.     

Process-Oriented Guided-Inquiry Learning: A Natural Fit for Occupational Therapy Education

ABSTRACT

After a brief review of the major group cooperative learning strategies, this article presents the format and use of Process-Oriented Guided-Inquiry Learning (POGIL) as a recommended teaching strategy for occupational therapy classes. This recommendation is based upon evidence of effectiveness of this strategy for enhancing critical thinking, content retention, and teamwork. Strategies for learning the process and suggestions for its use are based upon literature evidence and the authors’ experiences with this strategy over 4 years in a class on evidence-based practice.