Exploration of a Collaborative Self-Directed Learning Model in Medical Education

Assessment of first-year medical student perceptions in the development of self-directed learning skills in a single medical school course

Self-directed learning (SDL) is a form of education in which learners take charge of their own learning process, with an active role in knowledge, skill and attitude acquisition. Developing SDL skills is essential to becoming a lifelong learner, which is necessary in the current climate of rapidly expanding medical knowledge. Students must also develop the ability to reflect on their own strengths and weaknesses in SDL-related skills, allowing them to set appropriate learning goals and identify areas that require further improvement. Critical Reasoning Exercises (CREs), a student-driven, problem-based learning course, was introduced for first year medical students at New York Medical College School of Medicine to ensure all steps of the SDL cycle were covered in a comprehensive and standardized way. As part of the formative assessment process for CREs, we developed and validated a five-item self-reporting rubric of SDL competency to aid students' self-assessment of their acquisition of SDL skills. The increase in student self-assessed total score from midpoint to endpoint of CREs was statistically significant (p < .001), indicating students' perceived increase in SDL competency by the end of the CRE course. In addition to the total score, there was a significant perceived increase in competency for four of the five component skills of SDL (p < .05). Interestingly, there was also a statistically significant difference in student self-assessment total scores among facilitator groups at the midpoint of the CRE course. Integration of CREs into the curriculum demonstrated potential as an effective educational intervention for medical student development of competency in SDL.

Exploring influencing factors and facilitating strategies for self-directed learning from the perspective of medical trainees: a multicentre qualitative study in China

OBJECTIVES

Exploration of influencing factors and promotion strategies for self-directed learning (SDL) is a current research hotspot. However, there is a dearth of relevant research among medical trainees. The objective of the present study was to explore the perceptions of SDL among medical trainees, while also identifying the multidimensional factors associated with SDL and potential facilitating strategies from the perspective of medical trainees.

DESIGN

This multicentre qualitative study used focus group discussions to gather insights into SDL, analysed through thematic analysis. NVivo V.12 was used for efficient data management and processing.

SETTING

Four focus group discussions were held at three large tertiary hospitals in mainland China from December 2022 to July 2023.

PARTICIPANTS

This study used purposive sampling to recruit eligible participants from the selected hospitals, primarily through instructor recommendations. Recruitment was further supported by snowball sampling, where trainees who completed the interviews referred additional participants. Medical trainees from three major tertiary hospitals in mainland China were ultimately invited to participate in the study.

RESULTS

A total of four focus group discussions were conducted involving 17 medical trainees. Thirteen themes were summarised and assigned into three categories: (1) perceptions of SDL among medical trainees, (2) multidimensional factors affecting SDL among medical trainees and (3) potential improvement strategies.

CONCLUSION

This qualitative study investigated the perspectives of medical trainees regarding SDL across various grades and hospitals in mainland China. The participants universally acknowledged the significance of SDL and expressed a strong aspiration to enhance their competence in this area. The study identified that the factors influencing SDL abilities are multifaceted, highlighting the need for tailored intervention strategies to address these challenges effectively.

It takes a village: an ethnographic study on how undergraduate medical students use each other to learn clinical reasoning in the workplace

When students learn with-and from-other students, it is called peer-assisted learning (PAL). How undergraduate medical students use their peers for their clinical-reasoning learning process remains unclear, although literature suggests that it is a promising learning strategy at this stage. This research therefore explores the question: 'How is PAL manifested in the clinical learning environment of undergraduate medical students with regard to developing clinical-reasoning skills?'. A constructivist paradigm with a sociocultural theoretical framework was adopted for this research, using PAL and workplace learning as theoretical background. Focused ethnography and a combination of template and open coding was used to gather and analyze qualitative data. Twenty semi-structured interviews were conducted with nine students, four residents, and seven clinical supervisors. A total number of 31.5 h were used for five clinical observations. Following categories were used to describe the data: (1) the role of PAL in the clinical-reasoning learning practice, in which PAL-theory was placed alongside clinical practice, (2) the role of different actors during PAL and (3) the PAL environment, in which contextual factors have been scrutinized. Students deploy various categories of PAL to advance their clinical-reasoning skills, although they were largely unaware of these processes, and facilitation of PAL is not consistently provided. Three topics of discussion are identified that need to be acknowledged: (1) the design of a PAL environment that is conducive to collaborative learning, (2) the shifting roles of peers when they enter clinical practice, and (3) the individualistic tendencies of students that can hamper PAL. Future research could focus on stimulating and facilitating PAL among the next generation of students and integrating PAL into the clinical practice workflow.

Autonomous learning and creative cognition: the mediating effect of gifted students' self-efficacy

Introduction

In today's world, it is of great importance to raise qualified learners whose creative thinking skills and self-efficacy are developed and who can make various choices and take responsibility for their choices as well as implementing them by making their own decisions. In this regard, the study examined the role of gifted students' self-efficacy (SE) as a mediator on the relationship between autonomous learning (AL) and creative cognition (CC).

Methods

A proposed conceptual model was tested using a cross-sectional survey design. Based on "convenience sampling," the study group consisted of 528 gifted secondary school students enrolled in three Science and Arts Centers in Ankara, Türkiye in the 2022-2023 academic year. A two-step Structural equation modelling (SEM) analysis was conducted for data analysis.

Results and discussion

The findings revealed that AL positively and significantly predicted CC, SE was positively correlated with CC, and both dimensions of AL (Independence of Learning- IoL and Study habits- SH) had a significant direct and indirect influence on CC via SE, confirming that the dimensions of AL (IoL and SH) had distinct indirect influences on CC via SE. The study improves our understanding of the role that SE beliefs play in the interaction between AL and CC, which helps to expand and improve models that represent these processes. In order to create conditions that encourage AL, foster SE beliefs, and eventually improve CC among gifted students, educators, policymakers, and parents can create a learning environment that not only promotes AL and strong SH but also fosters SE and CC, ultimately leading to more innovative and self-reliant students.

Exploration of the integration of microbiology and immunology emerging topics into undergraduate medical education

PURPOSE

Medical school educators face challenges determining which new and emerging topics to incorporate into medical school curricula, and how to do so. A study was conducted to gain a better understanding of the integration of emerging topics related to microbiology and immunology in the undergraduate medical curriculum (UME).

METHODS

An anonymous survey with 17 questions was emailed to medical school faculty who teach immunology and/or microbiology through the DR-Ed listserv, the American Society for Microbiology (ASM) Connect listserv, and attendees of the Association of Medical School Microbiology and Immunology Chairs (AMSMIC) Educational Strategies Workshop. Participants were asked about experiences, perceptions, and the decision-making process regarding integrating emerging topics into UME.

RESULTS

The top emerging topics that were added to the curriculum or considered for addition in the last 10 years included COVID-19, Zika virus, mRNA vaccines, and Mpox (formerly known as monkeypox). Most respondents reported lectures and active learning as the major methods for topic delivery, with most faculty indicating that formative assessment was the best way to assess emerging topics. Content experts and course directors were the most cited individuals making these decisions. Top reasons for incorporating emerging topics into curricula included preparing students for clinical treatment of cases, followed by demonstrating the importance of basic science, and opportunities to integrate basic science into other disciplines. Challenges for incorporating these topics included making room in an already crowded curriculum, followed by content overload for students.

CONCLUSIONS

This study describes the rationale for integrating emerging topics related to microbiology and immunology into UME, and identifies the current new and emerging topics, as well as the main methods of integration and assessment. These results may be used by medical educators to inform curricular decisions at their institutions. Future studies will include developing innovative learning modules that overcome barriers to integration.

Exploring the Potential of a Serious Game Framework in Developing Systems-Thinking Skills

Effective decision-making within veterinary practice demands a comprehensive understanding of interconnected animal, public, and environmental health systems. To foster systems thinking, participatory modeling and serious games are gaining prominence. Serious games combine play, instruction, and problem-based learning to facilitate skill acquisition. This study investigates the potential of a multiplayer serious game framework as a participatory method to cultivate systems thinking skills in a Master of Veterinary Medicine program. The research focuses on the Territory Game, designed to encourage engagement and creativity, assessing its role in fostering systems thinking among veterinary students. Integrated into a master's course, the game immerses students in complex decision-making scenarios, aiding their navigation of real-world intricacies. Qualitative analysis of discussions and responses provides insights. Results indicate that serious game-based learning within a participatory structure enhances participants' grasp of decision-making complexities. The game's simulated environment promotes a broader perspective and consideration of diverse factors in choices. Additionally, the game framework exhibits potential to enhance group participation, autonomy, time management, and inclusivity for reserved individuals. However, the study acknowledges that teaching methods like participatory modeling might not universally fit all contexts and could require instructor support. The framework's effectiveness is influenced by educational constraints, engagement levels, learning styles, and expertise. Nonetheless, the Territory Game framework shows promise in deepening understanding of complex veterinary decisions and fostering critical systems thinking skills essential for effective decision-making. Future research should explore its adaptability, scalability, and long-term impact across diverse educational settings.

Promotion of self-directed learning abilities among Chinese medical students through preparing for career calling and enhancing teaching competencies in medical education: a cross-sectional study

BACKGROUND

Medical students face a heavy burden as they are tasked with acquiring a vast amount of medical knowledge within a limited time frame. Self-directed learning (SDL) has become crucial for efficient and ongoing learning among medical students. However, effective ways to foster SDL ability among Chinese medical students are lacking, and limited studies have identified factors that impact the SDL ability of medical students. This makes it challenging for educators to develop targeted strategies to improve students' SDL ability. This study aims to assess SDL ability among Chinese medical students and examine the effects of career calling and teaching competencies on SDL ability, as well as the possible mechanisms linking them.

METHODS

Data were collected from 3614 respondents (effective response rate = 60.11%) using cross-sectional online questionnaires and analyzed using IBM SPSS Statistics 22.0. The questionnaire comprised a Demographic Characteristics Questionnaire, Self-directed Learning Ability Scale (Cronbach's alpha = 0.962), Teaching Competencies Scale, and Career Calling Scale.

RESULTS

The average SDL ability score of Chinese medical students was 3.68 ± 0.56, indicating a moderate level of SDL ability. The six factors of the Self-directed Learning Ability Scale-self-reflection, ability to use learning methods, ability to set study plans, ability to set studying objectives, ability to adjust psychological state, and willpower in studying-accounted for 12.90%, 12.89%, 12.39%, 11.94%, 11.34%, and 8.67% of the variance, respectively. Furthermore, career calling was positively associated with SDL learning ability (β = 0.295, p < 0.001), and SDL learning ability was positively associated with teaching competencies (β = 0.191, p < 0.01). Simple slope analysis showed that when the level of teaching competencies was higher, the influence of career calling on SDL ability was stronger.

CONCLUSIONS

Chinese medical students' SDL ability has room for improvement. Medical students could strengthen their willpower in studying by setting milestones goals with rewards, which could inspire their motivation for the next goals. Teachers should guide students to learn experience to improve students' reflective ability. Educators play a crucial role in bridging the gap between career calling education and SDL ability enhancement, highlighting the significance of optimal teaching competencies. Colleges should focus on strengthening teachers' sense of career calling and teaching competencies.

Innovative Self-directed, Problem-oriented, Lifelong learning, Integrated Clinical case Exercise (SPLICE) modules promote critical thinking skills, early clinical exposure, and contextual learning among first professional-year medical students

Medical education is undergoing various transformations to promote a more personalized and contextual way of learning. In light of this, the innovative "Self-directed, Problem-oriented, Lifelong learning, Integrated Clinical case Exercise" (SPLICE) modules were designed, implemented, and evaluated for medical students in the first professional year as a strategy for early clinical exposure in a collaborative and self-directed way of learning. This is a mixed methods study involving first-year medical students. Students were divided randomly into the control and the intervention groups. Six SPLICE modules were administered to the intervention while the control group followed the traditional curricula. The educational outcome was compared using an end-of-module assessment. In addition, 13-item and 8-item questionnaires were administered to students to evaluate the SPLICE and plenary sessions on a 5-point Likert scale. Furthermore, students' feedback was obtained on a 10-point rating scale and in in-depth small-group interviews. The majority of students perceived that the SPLICE module improved their communication and encouraged meaningful, active learning. Students found the plenary sessions to be well organized, with sufficient interaction with professionals. Students also gave excellent scores for feedback on SPLICE modules, demonstrating the effectiveness of the innovation. In terms of test scores used in assessing learning outcomes, the intervention group outperformed the control group (P < 0.0001). The innovative SPLICE curriculum facilitated early clinical exposure and active self-directed learning. Students perceived SPLICE modules to be highly helpful in terms of promoting meaningful learning and the future application of knowledge.NEW & NOTEWORTHY The very essence of this innovative "Self-directed, Problem-oriented, Lifelong learning, Integrated Clinical case Exercise" (SPLICE) curriculum is the team-based learning of integrated pre-, para-, and clinical learning objectives right from the first professional year of study serving as an early clinical exposure. This unique way of learning creates a holistic educational environment by combining both academic and professional development thereby empowering the next generation of physician leaders to take autonomy of their own learning strategies and emerge as competent lifelong learners.

Self-directed learning assessment practices in undergraduate health professions education: a systematic review

PURPOSE

The goal of this systematic review was to examine self-directed learning (SDL) assessment practices in undergraduate health professions education.

METHODS

Seven electronic databases were searched (PubMed, Embase, PsycINFO, ERIC, CINAHL, Scopus, and Web of Science) to retrieve English-language articles published between 2015 and July of 2022, investigating assessment of SDL learning outcomes. Extracted data included the sample size, field of study, study design, SDL activity type, SDL assessment method, number of SDL assessments used, study quality, number of SDL components present utilising the framework the authors developed, and SDL activity outcomes. We also assessed relationships between SDL assessment method and number of SDL components, study quality, field of study, and study outcomes.

RESULTS

Of the 141 studies included, the majority of study participants were medical (51.8%) or nursing (34.8%) students. The most common SDL assessment method used was internally-developed perception surveys (49.6%). When evaluating outcomes for SDL activities, most studies reported a positive or mixed/neutral outcome (58.2% and 34.8%, respectively). There was a statistically significant relationship between both number and type of assessments used, and study quality, with knowledge assessments (median-IQR 11.5) being associated with higher study quality (p < 0.001). Less than half (48.9%) of the studies used more than one assessment method to evaluate the effectiveness of SDL activities. Having more than one assessment (mean 9.49) was associated with higher quality study (p < 0.001).

CONCLUSIONS

The results of our systematic review suggest that SDL assessment practices within undergraduate health professions education vary greatly, as different aspects of SDL were leveraged and implemented by diverse groups of learners to meet different learning needs and professional accreditation requirements. Evidence-based best practices for the assessment of SDL across undergraduate healthcare professions education should include the use of multiple assessments, with direct and indirect measures, to more accurately assess student performance.

The positive impact of introducing modified directed self-learning using pre-small group discussion worksheets as an active learning strategy in undergraduate medical education

BACKGROUND

Directed self-learning (DSL) is an active learning approach where the learners are provided with predefined learning objectives and some facilitation through the learning process in the form of guidance and supervision. It can help establish a strong foundation for autonomous and deep learning.

OBJECTIVE

The aim of this study was to introduce a modified form of DSL to second-year undergraduate medical students using pre-small group discussion (pre-SGD) worksheets. The authors intended to evaluate its effectiveness through theme assessment and investigate students' perceptions using a feedback questionnaire.

METHODS

This was an analytical cross-sectional study. Modified DSL (MDSL) was introduced to 96 second-year undergraduate medical students in two themes. Students were divided randomly into two groups. One group was exposed to traditional DSL (TDSL), and the other was introduced to MDSL using pre-SGD worksheets for the first theme. Groups were reversed for the second theme. The activity was followed by a theme assessment, which was scored for research purpose only. The scores of this assessment were compared, and perceptions of the students were gathered using a validated questionnaire. Data were analyzed using IBM's statistical package of social sciences (SPSS) version 22.

RESULTS

The comparison of theme assessment scores revealed statistically significant difference (P = 0.002) in median scores between control TDSL and experimental MDSL groups. The percentage of students scoring ≥80% in theme assessment was significantly higher in the experimental group compared to the control group (P = 0.029). This strategy was well perceived by the students in terms of acceptability and effectiveness as depicted by a high degree of agreement on the Likert-scale.

CONCLUSION

Modified DSL resulted in significant improvement in academic performance of undergraduate medical students. MDSL was also well perceived as an active learning strategy in terms of acceptability, effectiveness, and comparison with TDSL. [Figure: see text].

Transition From Observational to Collaborative Learning to Augment Practical Skill Training in First-Year Medical Students

Introduction Students exhibit less interest in hematology demonstration experiments as they are not expected to do it during their examination. Adopting a different strategy, like collaborative learning, might spark interest, motivate them to work together towards a shared objective, and help further learning and understanding. The current study aimed to assess the effectiveness of collaborative learning in comparison with traditional practical demonstration. Methodology First MBBS students were divided into two groups of 50 each (1 - collaborative learning, 2 - traditional demonstration). In the traditional demonstration, the experiment was demonstrated by faculty using the required materials. In the collaborative learning method, 50 students were divided into groups (seven of seven each) and each group was provided with procedural details of the experiment and requisite materials. At the end of the experiment, assessment was done. In collaborative learning groups, the team cohesion scale (TCS) was employed to analyze group dynamics. Students' perceptions, and feedback regarding collaborative learning as a tool in practical experiments were collected using a five-point Likert scale. Results Post-experiment assessment scores in collaborative learning (8.65±1.54) were significantly higher than the traditional demonstration group (7.06±1.46). High scorers in TCS consistently belonged to groups that completed the experiment on time (positive outcome), whereas students with low scores often belonged to groups that did not complete the experiment (negative outcome). Conclusion Collaborative learning may be used for practical teaching in medical education as it fosters good communication, enables problem-solving, aiding the Indian medical graduate in fulfilling the role of a team member.

Direct and indirect effects of self-directed learning on creativity in healthcare undergraduates: a chain mediation model of openness to challenge and diversity and creative self-efficacy

Background

Creativity and self-directed learning (SDL) are prominent for undergraduate healthcare students to provide quality patient care in an increasingly complex healthcare environment. Research suggested that SDL is linked with creativity, yet the mechanism underlying the relationship between SDL and creativity has not been fully understood.

Objective

This study examined the relationship between SDL and creativity and constructed a chain mediation model to identify the mediating effect of openness to diversity and challenge (ODC) and creative self-efficacy (CSE).

Methods

Through convenience sampling, 575 healthcare undergraduates (average age = 19.28 years, SD = 1.124 years) were surveyed from Shandong Province in China. Creativity, SDL, ODC, and CSE were assessed using corresponding scales. Pearson's correlation analysis, hierarchical multiple linear regression analysis, a serial multiple mediation analysis, and bias-corrected percentile Bootstrap method were conducted by using structural equation modeling by AMOS 26.0.

Results

The direct path between SDL and creativity was significant. SDL can positively predict both ODC and CSE, and the latter two variables can significantly and positively predict creativity. ODC and CSE played a significant partial mediating role in the relationship between SDL and creativity. The mediating effect consists of three indirect effects: SDL → ODC → creativity (the mediating effect value is 0.193, p = 0.012), SDL → CSE → creativity (the mediating effect value is 0.096，p = 0.001), and SDL → ODC → CSE → creativity (the mediating effect value is 0.035, p = 0.031).

Conclusion

SDL can positively predict creativity. ODC and CSE had significant mediating effects between SDL and creativity, including single partial mediating effects of ODC and CSE and chain mediating effects of ODC-CSE.

Medical students' self-directed learning skills during online learning amid the COVID-19 pandemic in a Korean medical school

PURPOSE

This study examined medical students' self-directed learning skills in online learning contexts, and whether there were any differences among the student groups (from pre-medical program year 1 to medical program year 2) amid the coronavirus disease 2019 (COVID-19) pandemic. It also explored the components of self-directed learning skills influencing their perceived learnring performance and satisfaction in online learning contexts.

METHODS

This study used a cross-sectional survey design and convenience sampling. It was conducted in a Korean medical school, which delivered all courses online because of the COVID-19 pandemic. The self-directed learning skill survey, which included student satisfaction and perceived learning performance items, was disseminated over two weeks through email to the participants. The collected data were analyzed through descriptive statistics, analysis of variance, and multiple regressions.

RESULTS

The survey response rate was 70% (140/200). The overall mean of self-directed learning skills was 3.85. Students in medical year 2 showed the highest score (4.15), while students in medical year 1 showed the lowest score (3.69). The learning plan category score (3.74) was the lowest among the three categories. The pre-medical program year 1 students showed the lowest score in the perceived learning performance (3.16), and only the learning plan category impacted student satisfaction (t=2.605, p=0.041) and perceived learning performance (t=3.022, p=0.003).

CONCLUSION

When designing online learning environments, it is imperative to provide features to help students set learning goals and search diverse online learning resources. In addition, it is an effective strategy to provide the students in medical program year 1 with self-directed learning skills training or support for successful online learning.