Comparative study of medical education as perceived by students at three Dutch universities

Problem-based learning (PBL): getting the most out of your students - their roles and responsibilities: AMEE Guide No. 84

This Guide discusses the considerable literature on the merits or shortcomings of Problem-based learning (PBL), and the factors that promote or inhibit it, when seen through the eyes of the student. It seems to be the case that PBL works best when students and faculty understand the various factors that influence learning and are aware of their roles; this Guide deals with each of the main issues in turn. One of the most important concepts to recognise is that students and Faculty share the responsibility for learning and there are several factors that can influence its success. They include student motivation for PBL and the various ways in which they respond to being immersed in the process. As faculty, we also need to consider the way in which the learning environment supports the students develop the habit of life-long learning, and the skills and attitudes that will help them become competent reflective practitioners. Each of these elements place responsibilities upon the student, but also upon the Faculty and learning community they are joining. Although all of the authors work in a European setting, where PBL is used extensively as a learning strategy in many medical schools, the lessons learned we suggest, apply more widely, and several of the important factors apply to any form of curriculum. This Guide follows on from a previous review in the AMEE Guides in Medical education series, which provided an overview of PBL and attempts to emphasise the key role that students have in mastering their subject through PBL. This should render the business of being a student a little less mystifying, and help faculty to see how they can help their students acquire the independence and mastery that they will need.

Problem based learning approaches to the technology education of physical therapy students

BACKGROUND

Problem-Based Learning (PBL) is a whole-curriculum concept.

AIM

This study aimed to compare learning preferences and strategies between physical therapy students taught by PBL and those receiving conventional lectures on massage therapy, trauma physical therapy, and electrotherapy, hydrotherapy, and thermotherapy.

METHODS

This quasi-experimental study included 182 male and female students on physical therapy diploma courses at three universities in Andalusia (Spain). The Canfield Learning Skills Inventory (CLSI) was used to assess learning strategies and the Approaches to Study Skills Inventory for Students (ASSIST) to analyze study preferences.

RESULTS

At the end of the academic year 2009/10, physical therapy students taught by PBL considered the most important learning strategies to be group work, study organization, relationship of ideas, and academic results. In comparison to conventionally taught counterparts, they considered that PBL reduced lack of purpose, memorizing without relating, the law of minimum effort, and fear of failure. Among these PBL students, the most highly rated study preferences were: organization of course tasks, cordial interaction with the teacher, learning by reading and images, and direct hands-on experience.

CONCLUSION

For these physical therapy students, PBL facilitates learning strategies and study preferences in comparison to conventional teaching.

Preparation for practice by veterinary school: a comparison of the perceptions of alumni from a traditional and an innovative veterinary curriculum

Alumni survey research can tap users' perspectives on an educational product and thereby provide valuable information for outcomes assessment aimed at improving the quality of educational programs. The study documented here compared the perceptions of two groups of alumni from two curricula offered by the same veterinary school, where the traditional lecture-based curriculum had been gradually replaced by a reformed, more student-centered curriculum. Year 1 of the new curriculum started in 1995, while the old curriculum continued to be delivered to the entering class of 1994. The aim of our study was to determine whether the new program received more positive evaluations from the alumni and whether it was perceived as offering better preparation for veterinary practice. A questionnaire was sent to all alumni who had graduated in the period 2001--2003. Compared to alumni of the traditional program, alumni of the new curriculum reported higher perceived competence levels for clinical knowledge and skills (specific competencies) and for communication skills and academic skills (generic competencies). Alumni of both programs attributed difficulties in the transition from university to work to lack of experience with practical or technical skills and with primary-care cases. They suggested that more attention be paid to these aspects of practice and to practice/business management and communication with clients. The concrete changes in the curriculum appear to have had a noticeable positive effect, without the feared detrimental effect on knowledge acquisition. The results point to further program improvements, particularly for practice-oriented specific and generic skills.

Students' opinions about their preparation for clinical practice

INTRODUCTION

There are data that suggest that medical students do not feel sufficiently prepared for clinical practice in the clerkships. The transition from pre-clinical to clinical training causes problems.

OBJECTIVES

To seek quantitative verification of qualitative findings from an earlier focus group study on problems medical students encounter when entering the clinical phase of undergraduate training.

METHODS

At the start of the clinical phase, all Year 4 students at Maastricht Medical School were surveyed on the transition from pre-clinical to clinical training and its effects on workload, knowledge, skills and learning.

RESULTS

The response rate was 67%. Students were uncertain as to how to behave and act, mainly because they did not know what was expected of them. They experienced a drastic increase in workload and a lack of time for studying. They considered themselves to be moderately prepared with regard to knowledge and they regarded their physical examination skills as satisfactory. Students reported having difficulty applying theoretical knowledge in clinical practice and perceived shortcomings in basic science knowledge. In addition, they felt compelled to change their learning strategies.

DISCUSSION

The results of this study confirm the findings of the focus group study. The students experienced problems related to professional socialisation and workload and deficiencies in knowledge and the organisation of knowledge. A good starting point for improvement may involve exploring students' suggestions of an extensive introduction into the clerkships, a more gradual transition with regard to workload and closer integration of pre-clinical and clinical education.

General competencies of problem-based learning (PBL) and non-PBL graduates

INTRODUCTION

Junior doctors have reported shortcomings in their general competencies, such as organisational skills and teamwork. We explored graduates' perceptions of how well their training had prepared them for medical practice and in general competencies in particular. We compared the opinions of graduates from problem-based learning (PBL) and non-PBL schools, because PBL is supposed to enhance general competencies.

METHOD

We analysed the responses of 1159 graduates from 1 PBL and 4 non-PBL schools to a questionnaire survey administered 18 months after graduation.

RESULTS

Compared with their non-PBL colleagues, the PBL graduates gave higher ratings for the connection between school and work, their medical training and preparation for practice. According to the graduates, the most frequently used competencies with sufficient coverage during medical training were expert knowledge, profession-specific skills and communication skills. The majority of the PBL graduates, but less than half of the non-PBL graduates, indicated that communication skills had been covered sufficiently. All the graduates called for more curriculum attention on working with computers, planning and organisation, and leadership skills. More PBL graduates than non-PBL graduates indicated that they had learned profession-specific methods, communication skills and teamwork in medical school.

DISCUSSION

Overall, the graduates appeared to be satisfied with their knowledge and skills. The results suggest that the PBL school provided better preparation with respect to several of the competencies. However, both PBL and non-PBL graduates identified deficits in their general competencies, such as working with computers and planning and organising work. These competencies should feature more prominently in undergraduate medical education.

Assessing the development of communication skills in undergraduate medical students

CONTEXT

The teaching of clinical communication skills' teaching has become an important part of medical school curricula. Many undergraduate medical courses include communication skills training at various points in their curriculum. Very few reports have been published on the development of communication skills over the duration of a medical undergraduate training.

AIMS

To determine the change in communication skills between early and mid-stages of the students' 5-year curriculum, and to investigate the predictive and theoretical significance of knowledge and understanding of communication skills in relation to observed performance.

PARTICIPANTS

Students entering as the first cohort to the new medical curriculum at Liverpool Medical School (n=207). Nine students withdrew leaving 198 students who completed two summative assessments in June 1997 (level 1) and November 1998 (level 2).

STATISTICAL ANALYSIS

Repeated measures multivariate ANOVAS were applied to the main study data to detect any change in performance between levels 1 and 2.

RESULTS AND CONCLUSIONS

An improvement in communication skills was found in medical students over 17 months of their undergraduate teaching: that is from the level 1 to the level 2 assessment. Knowledge and understanding of communication skills at initial assessment did not show the predicted association with performance at level 2.

Assessing the development of communication skills in undergraduate medical students

CONTEXT

The teaching of clinical communication skills' teaching has become an important part of medical school curricula. Many undergraduate medical courses include communication skills training at various points in their curriculum. Very few reports have been published on the development of communication skills over the duration of a medical undergraduate training.

AIMS

To determine the change in communication skills between early and mid-stages of the students' 5-year curriculum, and to investigate the predictive and theoretical significance of knowledge and understanding of communication skills in relation to observed performance.

PARTICIPANTS

Students entering as the first cohort to the new medical curriculum at Liverpool Medical School (n=207). Nine students withdrew leaving 198 students who completed two summative assessments in June 1997 (level 1) and November 1998 (level 2).

STATISTICAL ANALYSIS

Repeated measures multivariate ANOVAS were applied to the main study data to detect any change in performance between levels 1 and 2.

RESULTS AND CONCLUSIONS

An improvement in communication skills was found in medical students over 17 months of their undergraduate teaching: that is from the level 1 to the level 2 assessment. Knowledge and understanding of communication skills at initial assessment did not show the predicted association with performance at level 2.

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.