Problem-based learning: a review of literature on its outcomes and implementation issues

Medical education research study quality instrument: an objective instrument susceptible to subjectivity

BACKGROUND

The medical education research study quality instrument (MERSQI) was designed to appraise medical education research quality based on study design criteria. As with many such tools, application of the results may have unintended consequences. This study applied the MERSQI to published medical education research identified in a bibliometric analysis.

METHODS

A bibliometric analysis identified highly cited articles in medical education that two authors independently evaluated using the MERSQI. After screening duplicate or non-research articles, the authors reviewed 21 articles with the quality instrument. Initially, five articles were reviewed independently and results were compared to ensure agreed upon understanding of the instrument items. The remainder of the articles were independently reviewed. Overall scores for the articles were analyzed with a paired samples t-test and individual item ratings were analyzed for inter-rater reliability.

RESULTS

There was a significant difference in mean MERSQI score between reviewers. Inter-rater reliability for MERSQI items labeled response rate, validity and outcomes were considered unacceptable.

CONCLUSIONS

Based on these results there is evidence that MERSQI items can be significantly influenced by interpretation, which lead to a difference in scoring. The MERSQI is a useful guide for identifying research methodologies. However, it should not be used to make judgments on the overall quality of medical education research methodology in its current format. The authors make specific recommendations for how the instrument could be revised for greater clarity and accuracy.

Implementing mind mapping in small-group learning to promote student engagement in the medical diagnostic curriculum: a pilot study

BACKGROUND

Medical diagnostics is a pivotal bridge curriculum that receives much less attention from undergraduates in non-clinical medicine health profession programs with less student engagement and poor performance. Mind mapping is an active learning strategy for graphically presenting radiant thinking to culture clinical reasoning. The purpose of this study was to explore whether students' comprehensive diagnostic skills are enhanced through increased student engagement by employing mind mapping.

METHODS

We implemented mind mapping in small-grouped workshops with 86 junior undergraduates from preventive medicine program, for physical diagnostic sessions including physical examination (PE) maneuver, electrocardiogram (ECG) interpretation and medical history collection. We also conducted assessments of the above skills, as well as online surveys regarding their expectation on this course, self-evaluation of mind mapping in teaching and the learning process of all the modules.

RESULTS

Group members employing mind mapping in all PE sessions obtained higher scores in the heart and lung systems during the PE maneuver exam. Similarly, groups that made more in-depth mind maps achieved higher scores on the ECG quiz. In addition, groups displaying mind maps for history taking from normal classes and reformed class exhibited greater completeness of medical history with both standardized patients and real patients, which was consistent with increased collection of accompanying symptoms. Mind mapping was valued by the majority of students for its benefits in terms of acquiring PE maneuver, theoretical knowledge, medical history collection and medical records writing, clinical reasoning, communication skills, sense of teamwork and cooperation, professionalism and humanistic literacy.

DISCUSSION

The visual feature of mind mapping evoked extensive behavioral engagement in all groups, as did cognitive and emotional engagement, as the majority of students expressed their willingness and affective reactions. In the short term, the positive feedbacks encourage growing engagement. The continuous benefits of mind mapping require long-term observation.

Use of problem-based learning in orthopaedics education: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Currently, problem-based learning (PBL) has been widely used in many disciplines, but no systematic review has explored the advantages and disadvantages of PBL in orthopaedics education.

METHODS

We searched the PubMed, Cochrane Library, Embase, Web of Science, Scopus, Chongqing VIP Database (VIP), Chinese National Knowledge Infrastructure (CNKI), and Wanfang databases up to April 2023 to identify for relevant studies. Relevant studies were identified by using specific eligibility criteria, and data were extracted.

RESULTS

A total of 51 randomized controlled trials with 4268 patients were included. Compared with traditional education, PBL teaching yielded significantly higher knowledge scores (SMD=1.10, 95% CI: 0.78~1.41, P<0.00001), procedural skill scores and clinical skill scores than traditional teaching (SMD=2.07, 95% CI: 1.61~2.53, P<0.00001; SMD=1.20, 95% CI: 0.88~1.52, P<0.00001). Moreover, the total scores were higher in the PBL teaching group than in the traditional teaching group (MD=5.69, 95% CI: 5.11~6.26, P<0.00001). Students also expressed higher levels of interest and satisfaction in the PBL teaching group than in the traditional teaching group (OR=4.70, 95% CI: 3.20~6.93, P<0.00001; OR=5.43, 95% CI: 3.83~7.69, P<0.00001). However, there was less learning time and higher levels of learning pressure in the PBL teaching group (OR=0.12, 95% CI: 0.06~0.24, P<0.00001; OR=5.95, 95% CI: 3.16~11.23, P<0.00001).

CONCLUSION

Current evidence indicates that PBL teaching can increase knowledge scores, procedural skill scores, and clinical skill scores. Students have higher levels of interest in teaching and higher levels of teaching satisfaction in the PBL group. However, students can feel higher levels of study pressure and experience less study time. The findings of the current study need to be further verified in multicentre, double-blind and large-sample RCTs.

Problem Based Learning in Medical Education: Handling Objections and Sustainable Implementation

The introduction of problem-based learning (PBL) in 1969 is considered the greatest innovation in medical education of the past 50 years. Since then, PBL has been implemented in different educational settings across virtually all health professions. However, some PBL schools gradually faced resistance from academic staff who were more familiar with traditional teacher-centred curricula. At times this has resulted in reversion to tradition or compromise whereby PBL is implemented within a lecture-based curriculum. Resistance can also emerge in a traditional school when a PBL curriculum is being considered for implementation. One of the first signs of this erosion is doubts about PBL raised in the form of objections or criticisms. This perspective review describes eight objections raised to assert why PBL is inferior or untenable. The background to each objection is provided together with evidence-informed rebuttals derived from professional practice and the published literature. Best practices are discussed for sustainable management of a PBL-based curriculum. A well-implemented PBL curriculum with appropriate and cost-effective infrastructure, training, teaching-learning activities, and assessment will position schools to harness the full benefit of PBL in training medical and health professionals.

Digital PBL-CBL teaching method improves students' performance in learning complex implant cases in atrophic anterior maxilla

Background

The clinical teaching of esthetic implant-supported restoration of the atrophic maxilla is challenging due to the complexity and unpredictability of bone and soft tissue augmentation. The traditional problem-based learning and case-based learning method (PBL-CBL method) with a full digital workflow (digital PBL-CBL method) provides the students a chance to view clinical cases in a more accurate and measurable way. The aim is to evaluate the effectiveness of the new digital PBL-CBL method in teaching complex implant cases in esthetic area.

Materials & Methods

A full digital workflow of dental implant therapy was established for patients with severely atrophic anterior maxilla. The digital data of cases done in the new workflow was used as teaching materials in digital PBL-CBL teaching. Fifty-four postgraduate students were randomly selected and divided into three groups, including traditional PBL-CBL group (students taught in a PBL-CBL method with no digital cases), digital PBL-CBL group (students taught in a PBL-CBL method with full digital cases) and control group (students taught in didactic teacher-centered method). After training for three months, a study of the students' opinions on the corresponding teaching method was carried out through a feedback questionnaire. A theory test was used to evaluate students' mastery of knowledge about tissue augmentation and esthetic implant restoration. A case analysis was used to determine whether students could apply the knowledge to problem solving.

Results

The digital PBL-CBL method resulted in a higher rate of satisfaction than the traditional PBL-CBL method and the didactic teacher-centered method in all items except for "This approach decreases extracurricular work". Case analysis scores of the digital PBL-CBL group were significantly higher than that of the traditional PBL-CBL group and the control group. For the theory test, the digital PBL-CBL group (61.00 ± 6.80) but not traditional PBL-CBL group (55.22 ± 9.86) obtained a significant higher score than the control group (45.11 ± 12.76), although no significant difference was found between the digital PBL-CBL group and the traditional PBL-CBL group.

Conclusion

Compared with other methods, students taught with the digital PBL-CBL method showed higher satisfaction and better performance in acquisition of academic knowledge and ability in solving practical clinical problems. The digital PBL-CBL method provided a promising alternative for teaching complex implant cases at the anterior maxilla.

Learning journeys - student learning development in the first years of a medical degree: an analysis of student conversations

Introduction

Students starting medical school generally come from a learning background that expects them to learn content, which is reproduced to pass an exam. As a part of their learning development, they must adapt and become self-motivated learners who can determine the underlying principles or concepts and use these to problem solve in the uncertainty of real-life clinical practice. Whilst much has been written about designing curricula to promote learning development, there is no one-size fits all approach to facilitating this type of learning, thus an analysis of what helps and hinders learning development is indicated.

Methods

Student pairs in Y2 and Y3 of an undergraduate Bachelor of Medicine, Bachelor of Surgery (BMBS) programme of a South-West UK medical school, were asked to audio record a conversation about their learning through a facilitated problem-based learning approach during the BMBS course so far. They were provided with a brief to aid them in their discussion in the style of the outside broadcast method of BBC Radio 4s listening project. Using this method, the conversation was unfacilitated and allowed to take its natural course. Conversations were transcribed and coded to determine emerging themes with respect to the developing understanding of the students about what and how they were learning.

Results

Four student pairs volunteered for the project one from Y2 and three from Y3. Five key themes were identified including: from 'learning it all, to structured learning'; 'developing understanding and the spiral curriculum'; 'working alone versus working with others'; 'integrated learning and understanding context' and 'assessment and resources.' Narrative analysis within these themes suggested that over the course of the first two to three years of study, participants developed a better understanding of how best to learn, although there were differences in both time and order that participants reached a point where learning felt more natural to them.

Discussion

Analysis of the data suggested that students develop independently towards being self-motivated lifelong learners. There were several key aspects of curriculum design that could be used to facilitate this development, which could easily be incorporated into developing or creating problem- / enquiry-based curricula.

A Bibliometric Analysis of the 100 Most Cited Articles on Problem-Based Learning in Medical Education

Problem-based learning (PBL) is an instructional approach used in medical education that is characterized by solving problems in small groups with tutor guidance. More than 50 years since PBL's inception, many questions remain to be addressed about its processes and learning outcomes. The purpose of the study was to examine the bibliometric characteristics of the 100 most cited articles on PBL in medical education and to identify landmark papers that have made significant contributions to PBL research. Results were systematically reviewed for citation frequency, publication year, journal, article type, article focus, authors, author collaboration, and country collaboration. The number of citations ranged from 81 to 3531 times cited with 31,041 total citations. The articles were contributed by 211 authors in 23 journals and most articles (68%) were published in Medical Education, Academic Medicine, and Medical Teacher. The majority of the articles (71%) originated from Netherlands, Canada, and the United States and six prolific authors were identified. Almost half of the articles are classified as empirical research. Article foci included theoretical foundations of PBL, curriculum design, learning outcomes and processes, tutors, assessment, guides to PBL implementation, commentaries, and student well-being. The strong author and country collaborations indicate continued global interest in the PBL instructional method, which is likely to remain an active topic of research as the evidence of its effectiveness over traditional instructional methods as well as its most impactful components is inconclusive.

Performance and preference of problem-based learning (PBL) and lecture-based classes among medical students of Nepal

Background: PBL (problem based learning) is new active learning educational strategy that has been extensively tested and used in recent years. Patan Academy of Health Sciences (PAHS) is one of medical schools from Nepal, a Low Income Country (LIC) implementing PBL for undergraduate medical education. This study aims to compare PAHS students' understanding and knowledge retention when taught through PBL and lecture-based classes and compare students' perceptions of PBL and lectures in medical education. Methods: This is a cross-sectional study of medical students of a PBL based medical school in Nepal, a non-Western low-income country. Ethical approval was given by the institutional research committee of the Patan Academy of Health Sciences. Understanding and knowledge retention was assessed with 50 vignette-based multiple-choice questions, half of which were taught through PBL sessions, and the remaining half were taught in didactic lectures during basic science years of medical school. A separate pre-validated perception questionnaire was used to assess students' preferences regarding PBL and lectures. Results: Out of 107 students, 99 participated in the understanding and knowledge retention questionnaires and 107 completed perception questionnaires. Understanding and knowledge retention of students was found to be the same for topics taught by PBL and lectures, with median scores of 17 and s16, respectively. PBL were mostly preferred for the physiology (59.81%), pathology (51.40%) and pharmacology (53.27%) concepts, and lectures were mostly preferred for the anatomy (78.50%), biochemistry (45.79%), and microbiology (42.99%) topics. Students wanted the same concepts to be taught through both PBL and lectures, especially for anatomy. Conclusions: Understanding and knowledge retention is the same for topics taught by either PBL or lectures during the basic science years of undergraduate medical education. Students prefer PBL for physiology, pathology, and pharmacology-related concepts, conventional didactic lecture for physiology and microbiology, and a combination of lecture and PBL sessions for anatomy.

The Role of Problem-Based Learning in Preparing Medical Students to Work As Community Service-Oriented Primary Care Physicians: A Systematic Literature Review

The number of primary care physicians in the United States is dwindling rapidly, and osteopathic medical schools are embracing the challenge of leading students toward a career in primary care to meet this need. In recent years, the Problem-Based Learning (PBL) curriculum in medical education has emerged as a patient-centered, social-justice-focused methodology. The unique format of PBL centered around patient cases allows learning through community-based medicine, promoting medical graduates' entry into primary care. Through exploring the literature on this topic, the research question posed for this review is as follows: How have the skills gained in PBL been effectively preparing medical students to become community service-oriented primary care physicians, and how can we qualitatively and quantitatively assess a learner's preparedness to engage in primary care work? The variables studied were board licensing examination scores, clinical competence, and interpersonal skills, all of which emerged as common ways to assess learners' preparedness to work in primary care. The methodology of this literature review was organized using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart to describe how articles were selected and synthesized to evaluate the variables. The results revealed the variables to be consistent strengths of PBL students, particularly clinical competence, and interpersonal skills, both of which are key in working in primary care and any clinical specialty. Since early in its implementation, literature has demonstrated the tendencies of PBL students to be interested in and later work in primary care, though little follow-up has been done recently. The question of why this phenomenon exists was largely answered by our literature review. In conclusion, through our analysis of the existing literature, the authors demonstrated that the PBL curriculum helps foster students' desire to serve patients. Limitations of the literature included small sample sizes, heterogeneous analysis methods, limited inclusion of qualitative assessment of student progress, and limited existing data on the prevalence of PBL in medical schools, as well as the entrance of PBL graduates into primary care careers.

Flipped Classroom Case Learning vs Traditional Lecture-Based Learning in Medical School Ophthalmology Education: A Randomized Trial

PURPOSE

To address the problem of teaching noncore specialties, for which there is often limited teaching time and low student engagement, a flipped classroom case learning (FCCL) module was designed and implemented in a compulsory 5-day ophthalmology rotation for undergraduate medical students. The module consisted of a flipped classroom, online gamified clinical cases, and case-based learning.

METHOD

Final-year medical students in a 5-day ophthalmology rotation were randomized to the FCCL or a traditional lecture-based (TLB) module. The outcomes of subjective assessments (student-rated anonymous Likert scale questionnaire, scale 1 to 5, and course and teaching evaluation, scale 1 to 6) and objective assessments (end-of-rotation and post-MBChB multiple-choice questions, scale 0 to 60) were compared between the 2 groups.

RESULTS

Between May 2021 and June 2022, 216 students (108 in each group) completed the study. Compared with the TLB students, the students in the FCCL group rated various aspects of the course statistically significantly higher, including feeling more enthusiastic and engaged by the course and more encouraged to ask questions and participate in discussions (all P < .001). They also gave higher ratings for the instructional methods, course assignments, course outcomes, and course workload ( P < .001). They gave higher course and teaching evaluation scores to the tutors (5.7 ± 0.6 vs 5.0 ± 1.0, P < .001). The FCCL group scored higher than the TLB group on the end-of-rotation multiple-choice questions (53.6 ± 3.1 vs 51.8 ± 2.8, P < .001). When 32 FCCL students and 36 TLB students were reassessed approximately 20 weeks after the rotation, the FCCL group scored higher (40.3 ± 9.1) than the TLB group (34.3 ± 10.9, P = .018).

CONCLUSIONS

Applying the FCCL module in ophthalmology teaching enhanced medical students' satisfaction, examination performance, and knowledge retention. A similar model may be suitable for other specialties.

Online case-based learning in medical education: a scoping review

BACKGROUND

Case-Based Learning (CBL) in medical education is a teaching approach that engages students as learners through active learning in small, collaborative groups to solve cases from clinical patients. Due to the challenges afforded by the COVID-19 pandemic, small group learning such as CBL, transitioned quickly to include technology-enhanced learning to enable distance delivery, with little information on how to apply pedagogical frameworks and use learning theories to design and deliver online content.

METHODS

To extend understanding of online CBL a scoping review protocol following the PRISMA-ScR framework explored the literature that describes the use of online CBL application in medical education and the outcomes, perceptions, and learning theories. A literature search was conducted in January 2022 followed by a subsequent review in October 2022. After peer review using the PRESS guidelines, the CASP appraisal tool was used to assess the rigor of each study design.

RESULTS

The scoping review identified literature published between 2010 and 2022 (n = 13 articles), on online CBL in the field of medical education with 11 observational studies describing student and facilitator perceptions and two randomized controlled studies. Positive perceptions of online learning included a flexible work-life balance, connection with learners, and improved accessibility. Negative experiences of online CBL included poor internet access, a distracting learning environment, and loss of communication. In the studies that collected student performance data, results showed equivalent or improved outcomes compared to the control. The CASP appraisal tool highlighted the deficiencies in most study designs, lack of framework or learning theory, and poor reproducibility of the methods to answer the research questions.

CONCLUSION

This scoping review identified literature to describe the academic outcomes, and student and facilitator perceptions of online CBL in medical education. However, the CASP tool uncovered deficiencies in study descriptions and design leading to poor quality evidence in this area. The authors provide recommendations for frameworks and learning theories for the future implementation of online CBL.

Investigating problem-posing during math walks in informal learning spaces

Informal mathematics learning has been far less studied than informal science learning - but youth can experience and learn about mathematics in their homes and communities. "Math walks" where students learn about how mathematics appears in the world around them, and have the opportunity to create their own math walk stops in their communities, can be a particularly powerful approach to informal mathematics learning. This study implemented an explanatory sequential mixed-method research design to investigate the impact of problem-posing activities in the math walks program on high school students' mathematical outcomes. The program was implemented during the pandemic and was modified to an online program where students met with instructors via online meetings. The researchers analyzed students' problem-posing work, surveyed students' interest in mathematics before and after the program, and compared the complexity of self-generated problems in pre- and post-assessments and different learning activities in the program. The results of the study suggest that students posed more complex problems in free problem-posing activities than in semi-structured problem-posing. Students also posed more complex problems in the post-survey than in the pre-survey. Students' mathematical dispositions did not significantly change from the pre-survey to post-survey, but the qualitative analysis showed that they began thinking more deeply, asking questions, and connecting school content to real-world scenarios. This study provides evidence that the math walks program is an effective approach to informal mathematics learning. The program was successful in helping students develop problem-posing skills and connect mathematical concepts to the world around them. Overall, "math walks" provide a powerful opportunity for informal mathematics learning.

Students’ Perception of Quality of Learning Experience (Structure, Process and Outcome): Discipline Versus Problem Based Medical Curriculum and the Mediation Role of Process Quality

Problem-based learning (PBL) is now incorporated into the curricula of most medical schools around the world. In comparison to the traditional curriculum, less is known about the influence of the adoption and implementation of a problem-based curriculum on the perceived structures, processes, and outcomes of learning experiences reported by students. The purpose of this study was twofold: (1) to compare the quality of learning experience of students enrolled in traditional discipline-based and problem-based medical curricula and (2) to explore the mediation effect of the process quality between the relationship of the structural quality and students’ perception of learning experience outcomes. Through the distribution of an electronic survey, all 3rd and 4th year medical students enrolled in the discipline-based curriculum and the problem-based curriculum were invited to participate in the study. The students from both curricula completed the Student Experience Survey (SES), which was developed by the National Center for Academic Accreditation and Evaluation. Descriptive statistics, independent sample t-test and Hayes Macro regression analysis were used. Students enrolled in the problem-based curriculum had higher perceived support and sufficient advice with higher perceived quality of learning experiences compared with students enrolled in the traditional curriculum, however they reported less enjoyment of their university life. The structural factors (t = 19.83, p ≤ 0.001) and process factors (t = 9.21, p ≤ 0.001) were associated with an increase in students’ reported outcomes by 0.67 and 0.49, respectively. These findings explain the mechanism by which the structural factors, such as maintaining adequate facilities and support, may help in enhancing the process quality (e.g., learner-centered learning), which in turn can enhance learning experience outcomes.

An international study on the implementation of programmatic assessment: Understanding challenges and exploring solutions

INTRODUCTION

Programmatic assessment is an approach to assessment aimed at optimizing the learning and decision function of assessment. It involves a set of key principles and ground rules that are important for its design and implementation. However, despite its intuitive appeal, its implementation remains a challenge. The purpose of this paper is to gain a better understanding of the factors that affect the implementation process of programmatic assessment and how specific implementation challenges are managed across different programs.

METHODS

An explanatory multiple case (collective) approach was used for this study. We identified 6 medical programs that had implemented programmatic assessment with variation regarding health profession disciplines, level of education and geographic location. We conducted interviews with a key faculty member from each of the programs and analyzed the data using inductive thematic analysis.

RESULTS

We identified two major factors in managing the challenges and complexity of the implementation process: knowledge brokers and a strategic opportunistic approach. Knowledge brokers were the people who drove and designed the implementation process acting by translating evidence into practice allowing for real-time management of the complex processes of implementation. These knowledge brokers used a 'strategic opportunistic' or agile approach to recognize new opportunities, secure leadership support, adapt to the context and take advantage of the unexpected. Engaging in an overall curriculum reform process was a critical factor for a successful implementation of programmatic assessment.

DISCUSSION

The study contributes to the understanding of the intricacies of implementation processes of programmatic assessment across different institutions. Managing opportunities, adaptive planning, awareness of context, were all critical aspects of thinking strategically and opportunistically in the implementation of programmatic assessment. Future research is needed to provide a more in-depth understanding of values and beliefs that underpin the assessment culture of an organization, and how such values may affect implementation.

Quality Assurance of Undergraduate Medical Education in Israel by Continuous Monitoring and Prioritization of the Accreditation Standards

External accreditation reviews of undergraduate medical curricula play an important role in their quality assurance. However, these reviews occur only at 4-10-year intervals and are not optimal for the immediate identification of problems related to teaching. Therefore, the Standards of Medical Education in Israel require medical schools to engage in continuous, ongoing monitoring of their teaching programs for compliance with accreditation standards. In this paper, we propose the following: (1) this monitoring be assigned to independent medical education units (MEUs), rather than to an infrastructure of the dean's office, and such MEUs to be part of the school governance and draw their authority from university institutions; and (2) the differences in the importance of the accreditation standards be addressed by discerning between the "most important" standards that have been shown to improve student well-being and/or patient health outcomes; "important" standards associated with student learning and/or performance; "possibly important" standards with face validity or conflicting evidence for validity; and "least important" standards that may lead to undesirable consequences. According to this proposal, MEUs will evolve into entities dedicated to ongoing monitoring of the education program for compliance with accreditation standards, with an authority to implement interventions. Hopefully, this will provide MEUs and faculty with the common purpose of meeting accreditation requirements, and an agreed-upon prioritization of accreditation standards will improve their communication and recommendations to faculty.

Qualitative study of the learning and studying process of resident physicians in China

BACKGROUND

Clinical medical education is essential in physician training. This study developed recommendations for medical residency course design on the basis of the perspectives of learners in China and how they interact with their environment. The central research topic was the professional development and learning process of residents, including the obstacles that hinder and factors that promote their learning, their views on existing teaching methods, interaction between teachers and medical teams, and suggestions for designing future residency training programs.

METHODS

This study had a qualitative research design. Interviews were conducted between July and October 2019 with 17 specialist residents and 12 assistant general practitioner residents from the department of education of the hospital. The participants were recruited from Qingyuan People's Hospital in Guangdong Province, China. The interview outlines focused on the following four themes: clinical learning experiences and reflections on learning, experience of interaction with patients, experience of working with other medical personnel, and future learning directions.

RESULTS

To overcome challenges in clinical learning, the residents mainly learned from their teachers and focused specifically on their own experiences. Regarding teaching methods and designs in clinical medicine, the residents preferred large-group, small-group, and bedside teaching and reported that bedside teaching enables the resolution of clinical problems, initiates self-learning, and improves diagnostic thinking. They disliked teachers with low teaching motivation or who were reluctant to interact with them and favored teachers who had strong teaching skills and respect for their students.

CONCLUSIONS

The residents suggested that clinical and active learning must be the main learning method for developing general medical competencies. Residency training must be conducted in an environment that facilitates residents' learning and meaningful learning activities. The interdependent symbiotic relationships in the education ecosystem can serve as a reference for designing residency courses.

Effect of self-regulated learning and technology-enhanced activities on anatomy learning, engagement, and course outcomes in a problem-based learning program

Problem-based learning (PBL) offers advantages for teaching anatomy and physiology for physical therapy students as clinical cases provide a scaffold for a comprehensive review of body systems. Although the utilization of interactive anatomy software greatly contributes to an active learning environment and efficient use of time, simply providing textbook readings, access to anatomy software, and models is not enough to engage students to become active in reaching their learning goals. Time constraints, meaningful technology implementation, resource abundance, and unfamiliarity are challenges that decrease the effectiveness of both facilitating and learning anatomy. The present study investigated the use of three supplemental learning tools to support anatomy instruction in a self-regulated manner. Friedman test results demonstrated significant differences for perceived engagement [χ²(2) = 15.74, P < 0.001, W = 0.23] but not for perceived learning. Survey responses demonstrated that perceived engagement was greatest with the nondigital supplemental learning tool compared with the two technology-enhanced learning tools (iBooks Author + SoftChalk and SoftChalk alone). Multivariate regression analyses demonstrated statistically significant relationships between the nondigital supplemental learning tool and anatomy practical scores (P < 0.001). The technology-enhanced supplemental learning tools did not further increase learning outcomes as measured by practical scores compared with nondigital learning tools. Incorporation of instructor-created instructional materials independent of technology is an efficient method to drive self-regulated learning, enhance engagement, and improve anatomy course outcomes and may overcome barriers associated with a purely self-directed PBL model.

A Bibliometric Analysis of the Landscape of Problem-Based Learning Research (1981-2021)

Background

Problem-Based Learning (PBL) is an instructional method of hands-on, active learning centered on investigating and resolving messy, real-world problems. This study aims to systematically analyze the current status and hotspots of PBL research and provide insights for research in the field.

Methods

Problem-based learning-related publications were retrieved from the Web of Science Core Collection using "Problem-Based Learning". Annual publications, countries, institutions, authors, journals, references, and keywords in the field were visually analyzed using the R, VOSviewer, and Microsoft Excel 2019 software.

Results

A total of 2,790 articles and reviews were analyzed, with a steady increase in publications in the field of PBL. Overall, the United States was the major contributor to the study of PBL. Van Der Vleuten CPM was the key researcher in this field. Moreover, most of the publications were published in Medical Education. Keyword analysis showed that current research hotspots focus on the extensions of PBL teaching mode, application of PBL teaching method, and reform of PBL.

Conclusion

Research on PBL is flourishing. Cooperation and exchange between countries and institutions should be strengthened in the future. These findings will provide a better understanding of the state of PBL research and inform future research ideas.

Medical student engagement in small-group active learning: A stimulated recall study

BACKGROUND

Active learning relies on students' engagement with teachers, study materials and/or each other. Although medical education has adopted active learning as a core component of medical training, teachers have difficulties recognising when and why their students engage or disengage and how to teach in ways that optimise engagement. With a better understanding of the dynamics of student engagement in small-group active learning settings, teachers could be facilitated in effectively engaging their students.

METHODS

We conducted a video-stimulated recall study to explore medical students' engagement during small-group learning activities. We recorded one teaching session of two different groups and selected critical moments of apparent (dis)engagement. These moments served as prompts for the 15 individual semi-structured interviews we held. Interview data were analysed using Template Analysis style of thematic analysis. To guide the analysis, we used a framework that describes student engagement as a dynamic and multidimensional concept, consisting of behavioural, cognitive and emotional components.

RESULTS

The analysis uncovered three main findings: (1) In-class student engagement followed a spiral-like pattern. Once students were engaged or disengaged on one dimension, other dimensions were likely to follow suit. (2) Students' willingness to engage in class was decided before class, depending on their perception of a number of personal, social and educational antecedents of engagement. (3) Distinguishing engagement from disengagement appeared to be difficult for teachers, because the intention behind student behaviour was not always identifiable.

DISCUSSION

This study adds to the literature by illuminating the dynamic process of student engagement and explaining the difficulty of recognising and influencing this process in practice. Based on the importance of discerning the intentions behind student behaviour, we advise teachers to use their observations of student (dis)engagement to initiate interaction with students with open and inviting prompts. This can help teachers to (re-)engage students in their classrooms.

Able Construction: A Spreadsheet Activity for Teaching Bayes’ Theorem

Using classroom activities to motivate the teaching and learning of Bayes’ theorem is not new. However, many of the textbook exercises and published simulations gloss over how the requisite probabilities are determined. In our case study, Able Construction is a fictional company hoping to exploit historical bidding data to inform its own bidding strategy on a municipal construction project. Unlike most other classroom activities, we challenge students to calculate the necessary probabilities directly from a given dataset. In our experience with implementing this case in introductory business analytics courses at the undergraduate- and graduate-level, we find that this spreadsheet activity gives students the opportunity to exercise their own judgement regarding data manipulation and definition of states of nature. This autonomy in analysis develops in students a deeper appreciation for practical skills required for possible analytics careers after graduation, and leads to engaging discussions of the applicability of Bayes’ theorem in practice.

Does performance at the intercollegiate Membership of the Royal Colleges of Surgeons (MRCS) examination vary according to UK medical school and course type? A retrospective cohort study

OBJECTIVES

The knowledge, skills and behaviours required of new UK medical graduates are the same but how these are achieved differs given medical schools vary in their mission, curricula and pedagogy. Medical school differences seem to influence performance on postgraduate assessments. To date, the relationship between medical schools, course types and performance at the Membership of the Royal Colleges of Surgeons examination (MRCS) has not been investigated. Understanding this relationship is vital to achieving alignment across undergraduate and postgraduate training, learning and assessment values.

DESIGN AND PARTICIPANTS

A retrospective longitudinal cohort study of UK medical graduates who attempted MRCS Part A (n=9730) and MRCS Part B (n=4645) between 2007 and 2017, using individual-level linked sociodemographic and prior academic attainment data from the UK Medical Education Database.

METHODS

We studied MRCS performance across all UK medical schools and examined relationships between potential predictors and MRCS performance using χ2 analysis. Multivariate logistic regression models identified independent predictors of MRCS success at first attempt.

RESULTS

MRCS pass rates differed significantly between individual medical schools (p<0.001) but not after adjusting for prior A-Level performance. Candidates from courses other than those described as problem-based learning (PBL) were 53% more likely to pass MRCS Part A (OR 1.53 (95% CI 1.25 to 1.87) and 54% more likely to pass Part B (OR 1.54 (1.05 to 2.25)) at first attempt after adjusting for prior academic performance. Attending a Standard-Entry 5-year medicine programme, having no prior degree and attending a Russell Group university were independent predictors of MRCS success in regression models (p<0.05).

CONCLUSIONS

There are significant differences in MRCS performance between medical schools. However, this variation is largely due to individual factors such as academic ability, rather than medical school factors. This study also highlights group level attainment differences that warrant further investigation to ensure equity within medical training.

The impact of facilitation in a problem-based pedagogy on self-directed learning readiness among nursing students: a quasi-experimental study in Tanzania

Background

Self-directed learning is important in nursing as it is associated with improved clinical and moral competencies in providing quality and cost-effective care among people. However, unethical professional conduct demonstrated by some graduate nurses is linked with the way they are developed in schools alongside the content and pedagogies prescribed in nursing curricula. Pedagogical transformations appear to be inevitable to develop enthusiastic nursing students who can work independently in delivering quality and cost-effective nursing services to people. This study intended to examine the impact of facilitation in a problem-based pedagogy on self-directed learning readiness among undergraduate nursing students in Tanzania.

Methods

A controlled quasi-experimental design was conducted in Tanzanian higher training institutions from January to April 2019. A 40-item Self-directed learning Readiness scale for nursing education adopted from previous studies measured self-directed learning and the Student A descriptive analysis via a Statistical Package for Social Sciences software program (version 23) was performed to establish nursing students’ socio-demographic characteristics profiles. Independent samples t-test determined mean scores difference of self-directed learning readiness among nursing students between groups while regression analysis was performed to discriminate the effect of an intervention controlled with other co-related factors.

Results

The post-test results of self-directed learning readiness showed that nursing students scored significantly higher [(M = 33.01 ± 13.17; t (399) = 2.335; 95%CI: 0.486,5.668)] in the intervention group than their counterparts in the control. Findings of SDL readiness subscales were significantly higher among students in the intervention including self-management [(M = 10.11 ± 4.09; t (399) = 1.354; 95%CI: 0.173,4.026)], interest learning [(M = 9.21 ± 2.39; t (399) = 1.189; 95%CI: 0.166,4.323)] and self-control [(M = 13.63 ± 5.05; t (399) = 2.335; 95%CI: 0.486,5.668)]. The probability of nursing students to demonstrate self-directed learning readiness was 1.291 more times higher when exposed to the intervention (AOR = 1.291, p < 0.05, 95%CI: 0.767, 2.173) than in the control.

Conclusion

Facilitation in a problem-based pedagogy promises to change the spectrum of nursing learning habits potentially to their academic and professional achievements. Nurse tutors need to be empowered with it to prepare nursing students to meet their academic and professional potentials.

A processual view on the use of problem-based learning in high school physiology teaching

In problem-based learning (PBL), the steps and processes present in the PBL tutorial cycle are essential for constructive, self-directed, collaborative, and contextual student learning. This article presents a procedural study of a PBL tutorial cycle with high school students new to the method regarding human respiration and circulation physiology. We observed group dynamics and the learning process that occurred throughout the PBL tutorial cycle. The results indicate that conceptual changes were close to the planned learning objectives and that students enjoyed studying applying PBL. Moreover, a positive correlation was observed between group dynamics, self-directed learning and learning outcomes. Our results provide grounds for restructuring the tutorial cycle, especially important for novice PBL students, such as problem reformulation and the development and diversification of applied learning scaffolds. We conclude that the qualitative analysis performed herein can yield a deeper understanding of the PBL tutorial cycle and may be used to foster PBL implementation in institutions with little experience with the method and monitor its outcomes in organizations with mature PBL use.

An upgrade of the Malmö model by implementing case-based teaching and learning, in an undergraduate dental education

BACKGROUND

At our dental education, the examination failure rate amongst students has increased, resulting in subsequent involuntary dropouts. One of the main problems seems to be that the students struggle with taking the necessary responsibility for their learning, as required by the problem-based learning (PBL) methodology.

AIM

To describe the background to, and the transition process from, pure PBL to case-based teaching and learning (CBT) with flipped classroom seminars at the dental programme at [anonymised for peer review].

METHODS

In this position paper, we describe our observed problems with the PBL methodology, as implemented at this faculty, and the potential benefits of a change towards CBT. The current implementation of CBT is presented, along with educational research supporting the choice of activities.

RESULTS

Tentative findings are that the flipped classroom seminars and the clearer instructions appear to be successful with higher levels of activity, engagement and attendance amongst the students, and the students have evaluated the seminars as very good learning activities.

CONCLUSION

Tentative findings suggest that the current implementation of CBT may be a fruitful way of teaching in dental education today. Most of the teaching staff have been reawakened to teaching, and as a result, the content of the courses are being reviewed and improved. The students appreciate that what is expected of them has been made clearer and that there is a variety of learning activities.

Participation in the Assessment Processes in Problem-Based Learning: Experiences of the Students of Social Sciences in Lithuania

The article explores the idea of change in the higher educational process that is implemented via the problem-based learning strategy. Problem-based learning (PBL) is widely understood as an epistemological transformation in higher education. It is emphasized that the transformation should take place throughout the educational process, and assessment is an inseparable and very important part thereof. The study was aimed at revealing the experiences of participation in the assessment processes in PBL of students attending social science programmes in Lithuania. The empirical study, employing a semi-structured interview method, has shown that the students feel empowered when they have the opportunity to assess the entire educational process and (self-)assess the efforts related to the possibilities to become actively engaged in improvement of the assessment strategy. The study has also shown students’ critical approach to the previous experience of assessment in the educational process. Difficulties of student participation in the assessment process in PBL were also identified. They were largely due to the change in the assessment system employed by the teacher and the manifestations of student bias when participating in (self-)assessment.

The prognostic validity of the formative for the summative MEQ (Modified Essay Questions)

Objective: The purpose of formative examinations is that students and lecturers receive an early feedback regarding the success of learning behavior and teaching methods. These also serve as practice for later summative exams. The aim of this paper is to investigate to what extent the result of the formative MEQ* at the end of the first semester at Witten/Herdecke University (UW/H) in the study program human medicine can be used as a predictor for the summative MEQ-1 at the end of the second semester which is part of the equivalence examination replacing the state examination. Methodology: The predictive value of the score achieved in the MEQ* on the MEQ-1 score, as well as the potential influence of the variables gender, age, high school graduation grade (German Abiturnote), professional background, and self-efficacy expectancy, was determined for students of human medicine. Results: Data from two cohorts of UW/H with a total of 88 students were included. Scores on the formative MEQ* correlate with those on the summative MEQ-1 in both cohorts. In regression analyses, only the score on the MEQ* proves to be a significant predictor of performance on the MEQ-1 (40.5% variance explanation). Particularly significant predictors are the scores in the subjects anatomy and clinical reasoning. Vocational training or pre-study only appear to contribute to higher scores in the MEQ* after the first semester, but have no further significance in predicting scores in the MEQ-1. Conclusion: The MEQ* was confirmed to be a good predictor of the MEQ-1. Thus, it serves as a formative exam to inform students about their current state of knowledge with regard to the summative exam MEQ-1, so that they can adequately adapt their learning strategies in the course of the second semester.

Effective Learning Behavior in Problem-Based Learning: a Scoping Review

Problem-based learning (PBL) emphasizes learning behavior that leads to critical thinking, problem-solving, communication, and collaborative skills in preparing students for a professional medical career. However, learning behavior that develops these skills has not been systematically described. This review aimed to unearth the elements of effective learning behavior in a PBL context, using the protocol by Arksey and O'Malley. The protocol identified the research question, selected relevant studies, charted and collected data, and collated, summarized, and reported results. We discovered three categories of elements-intrinsic empowerment, entrustment, and functional skills-proven effective in the achievement of learning outcomes in PBL.

A New Hybrid Concept, Combining Lectures and Case-Seminars, Resulted in Superior Ratings from Both Undergraduate Medical Students and Teachers

BACKGROUND

Due to declining student ratings, a new teaching method was applied to a course in gastrointestinal diseases for undergraduate medical students. Problem-based learning was replaced with our new concept, consisting of a theory week with traditional lectures and case seminars.

METHODS

In this retrospective study, we compared student-ratings from the problem-based learning era to a new hybrid concept. The students evaluated the concepts by rating (1-6, 6 = best) nine different subject areas. Additional free text comments were possible. Teachers working with both concepts did likewise. Statistical differences between the two periods were studied by Mann Whitney U-test.

RESULTS

The study group consisted 621 students (57% females, total response rate of 52%). Scores for lectures (4.9 vs.3.8) and teaching stimulation and feedback (4.6 vs 3.6, and 3.7 vs 3.4, respectively), and to what extent the contents reflected learning goals (5.2 vs 4.3, p<0.05 for all) were instantly improved, which also prevailed in the following semesters. At the end of the study period, a significant improvement in case seminars (4.8 vs 4.3) and practical training (4.9 vs 3.8, p<0.05 for both) was seen. Free text answers revealed that the students felt more prepared for their clinical rotation. Teachers rated the new hybrid concept higher (4.7 vs 3.5, p<0.05) and especially praised the new lectures.

CONCLUSION

The new learning concept resulted in both improved student-ratings and more satisfied teachers. We believe that the hybrid concept, combining lectures and case-seminars, facilitated learning and improved the learning climate. The subsequent uninterrupted practical training also received improved scores.

Is project-based learning effective among kindergarten and elementary students? A systematic review

Project-based learning (PjBL) is becoming widespread in many schools. However, the evidence of its effectiveness in the classroom is still limited, especially in basic education. The aim of the present study was to perform a systematic review of the empirical evidence assessing the impact of PjBL on academic achievement of kindergarten and elementary students. We also examined the quality of studies, their compliance with basic prerequisites for a successful result, and their fidelity towards the key elements of PBL intervention. For this objective, we conducted a literature search in January 2020. The inclusion criteria for the review required that studies followed a pre-post design with control group and measured quantitatively the impact of PBL on content knowledge of students. The final sample included eleven articles comprising data from 722 students. The studies yielded inconclusive results, had important methodological flaws, and reported insufficient or no information about important aspects of the materials, procedure and key requirements from students and instructors to guarantee the success of PjBL. Educational implications of these results are discussed.

Teaching Professionalism to Medical Students Using Dissection-Based Anatomy Education: a Practical Guide

Professionalism is a core competency for all healthcare professionals and is a subject of great interest within the academic community due to its vital importance in delivering the highest quality patient care. Despite this, professionalism remains difficult to define, teach and assess. The potential use of anatomy education in teaching professionalism has been increasingly highlighted within the literature, but still remains an underutilised tool in medical education. Therefore, this practical guide offers evidence-based practical points for successfully incorporating professionalism within a dissection-based anatomy course delivered to undergraduate medical students.

Comparative Study of Attitudes towards Communication Skills Learning between Medical and Dental Students in Saudi Arabia

Background: Communication skills (CS) learning is a core skill in medical and dental education. The comparison of attitudes towards CS between dental and medical students based on the taught curriculum (problem-based learning vs. traditional teaching) in Saudi Arabia awaits investigation. Aims: (1) To assess the attitudes of both undergraduate dental and medical students towards communication skills (CS) learning and (2) to compare the attitudes towards CS between Medical and Dental students in relation to sociodemographic and education-related characteristics. Methods and Materials: A cross-sectional study, using an online survey, invited 260 conveniently sampled Taibah university medical and dental undergraduate students. The survey collected data on sociodemographic characteristics, education-related factors, and CS using Communication Skills Attitude Scale (CSAS) that assess positive and negative attitudes (PAS, NAS). Data analysis included descriptive statistics and the Mann–Whitney U test. Results: Of the distributed questionnaire 91% responded (145 dental and 91 medical students). There were, overall, non-significant scores’ differences between medical and dental students on PAS (Medicine Median 51 vs. Dentistry Median 50, p = 0.059) and NAS (Medicine Median 32 vs. Dentistry Median 32, p = 0.596). Older medical students, those at clinical levels and those who reported they need to improve their communication skills and student whose parents were not doctors, tended to score statistically significantly (p = 0.032, 0.017, 0.034, and 0.004, respectively) on PAS compared with dental students; on the other hand, medical students with doctor parents scored significantly high in NAS compared to dental students (p = 0.015). Conclusion: Demographic and education-related characteristics underpinned medical student positive attitude towards CS compared to dental students. Although medical and dental students showed no differences in self-rating their attitudes towards (CS). Different factors influence medical and dental students’ attitudes towards CS learning.

Approaches to Learning: Does Medical School Attract Students with the Motivation to Go Deeper?

Graduate-entry, following a science degree, is the preferred pathway into many medical schools, however little is known about how the learning approaches of medical students compare to those of science students. This study compared the learning approaches and achievement orientations of science students with those aiming to enter graduate-entry medicine programs. The two factor study process questionnaire and the achievement goal orientation survey were used to compare students in; stage one: third year science students (n = 86) to graduate-entry medicine students (n = 158); stage two: applicants to graduate medicine (n = 84); stage three: first year science students (n = 363) to first year pre-medicine students (n = 68). Medical students and applicants to medicine demonstrated a greater preference for deep learning than third year science students (p < 0.0001). Pre-medicine students were similar to medical students. Medical students, applicants to medicine and pre-medicine students also all had a greater preference for a learning goal orientation. The preference for a deeper approach to learning and stronger learning goal orientation in students enrolled in medicine or aiming to gain entry to graduate medicine indicates a motivation towards the acquisition of knowledge. Medical educators need to ensure that students continue to develop positive and beneficial styles of learning to assist them to develop into life-long learners.

The effectiveness of the combined problem-based learning (PBL) and case-based learning (CBL) teaching method in the clinical practical teaching of thyroid disease

Background

This study aimed to evaluate the effectiveness and efficiency of PBL–CBL combined teaching in thyroid surgery and make observations from the students’ perspectives, based on their satisfaction with the learning process.

Methods

We prospectively enrolled 354 fourth-year students majoring in clinical medicine, along with 232 residents, from September 2014 to June 2019. These participants were randomly allocated into either the combined PBL–CBL teaching group or the traditional lecture-based classroom group to attend a course about thyroid nodules. Both pre- and post-class quizzes were conducted. An anonymous questionnaire was also administered to both groups to evaluate the students’ perceptions and experiences. We compared the two teaching methods among all the students as well as with the fourth-year students and residents in subgroups.

Results

The traditional group’s pre-class quiz scores were significantly higher than the PBL–CBL group’s (as determined by a two-tailed t-test at a 95% confidence interval, T = 16.483, P < 0.001). After class, in the PBL–CBL group, the mean total quiz score and the basic knowledge and case analysis scores increased significantly (P < 0.001). The PBL–CBL group’s performance improvement was significantly higher than the traditional group’s (increasing from 52.76 to 70.51 vs. from 67.03 to 71.97). Furthermore, the scores for learning motivation, understanding, student–teacher interaction, the final examination, communication skills, clinical thinking skills, self-learning skills, teamwork skills, and knowledge absorption, as measured by the survey, were significantly higher in the PBL–CBL group than in the traditional group (P < 0.001). Meanwhile, the survey scores representing the amount of students’ free time the course consumed were significantly lower in the PBL–CBL group than in the traditional group (P < 0.001).

Conclusions

PBL combined with CBL may be an effective method for improving medical students’ and residents’ performance and enhancing their clinical skills.

Building an Online Learning Module for Satellite Remote Sensing Applications in Hydrologic Science

This article presents an online teaching tool that introduces students to basic concepts of remote sensing and its applications in hydrology. The learning module is intended for junior/senior undergraduate students or junior graduate students with no (or little) prior experience in remote sensing, but with some basic background of environmental science, hydrology, statistics, and programming. This e-learning environment offers background content on the fundamentals of remote sensing, but also integrates a set of existing online tools for visualization and analysis of satellite observations. Specifically, students are introduced to a variety of satellite products and techniques that can be used to monitor and analyze changes in the hydrological cycle. At completion of the module, students are able to visualize remote sensing data (both in terms of time series and spatial maps), detect temporal trends, interpret satellite images, and assess errors and uncertainties in a remote sensing product. Students are given the opportunity to check their understanding as they progress through the module and also tackle complex real-life problems using remote sensing observations that professionals and scientists commonly use in practice. The learning tool is implemented in HydroLearn, an open-source, online platform for instructors to find and share learning modules and collaborate on developing teaching resources in hydrology and water resources.

Interdisciplinary Teaching Using Satellite Images as a Way to Introduce Remote Sensing in Secondary School

This article aims to meet two needs: (i) the need for skilled workers and students in the area of remote sensing and (ii) the need to make school science interesting for students. This article addresses both needs by proposing a project for high school students entitled “the Colors of Earth”. The main aim for students was to distinguish between different types of land cover via the creation of various false color band compositions from the satellite Sentinel-2. Achieving this goal requires knowledge from various subjects and enables their practical application via work performed using real data. The project was presented to 39 high-school teachers and 184 high-school students (K-9 and K-10) in the summer semester of the 2019/2020 school year, and their opinions about the project were collected. Overall, both students and teachers judged the project to be interesting, worth introducing to the school, and capable of influencing student opinions of science. In addition, introducing remote sensing elements during pre-university education can help meet the demands for students and workers to study Earth observation.

The Challenge of Transdisciplinary Research: A Case Study of Learning by Evaluation for Sustainable Transport Infrastructures

While transdisciplinary (TD) research is desired in order to solve real world sustainability issues, this may be challenging for both academic and non-academic participants. Supporting learning through evaluation, we analyzed a project aiming at sustainable transport infrastructures. After developing a TD research framework as a benchmark, two external independent evaluators interviewed all project researchers, representatives for end-users, and donors. The evaluators compared results with the framework, and evaluators and participants critically reflected on the results together. There were three inconsistencies relative to the framework: (1) limited understanding of TD research among project management, end-users, and most of the researchers; (2) no structured learning process among end-users; instead, they expressed very diverse opinions about what they expected from the project; (3) project leaders had limited understanding of the special challenges of TD research, did not fully understand the status of the project’s social system, and thus did not act as facilitators of the required collaborative learning process. Non-academic participants saw themselves as customers and not as partners in the knowledge production process. We conclude that TD problem-solving research requires much time and needs facilitation and training. A preparatory phase with a lower level of funding would be helpful in preparing for TD processes.

Students perceive skills learned in pre-clerkship PBL valuable in core clinical rotations

Purpose: Problem-based learning (PBL) is an instructional method widely used by medical educators that promotes an environment in which students effectively learn the foundational knowledge and skills that are prerequisites for graduation. This study evaluated medical students' perceptions of the helpfulness of skills acquired in PBL to core clerkship rotations.Methods: A 25-item survey was designed to assess students' perceptions of skills learned in PBL that were helpful on core clerkships and transferable to the clinical setting. A random sample of students with at least 8 months of clerkship experience were invited to complete the survey.Results: Of 68 students, 35 (52%) returned questionnaires. Results suggest a clustering of themes based on their perceived value. Skills learned in PBL that students rated most highly as helpful or very helpful during core clinical rotations include: comfort discussing concepts, identifying key information, presentation skills, interpersonal skills, diagnostic thinking, finding information, self-awareness, and organizing information. Other items rated highly included: forming questions, time management, primary literature (engaging with published original research articles), and leadership. The skills acquired in PBL were associated with multiple competency domains.Conclusions: Although conditions of the pre-clerkship curriculum are substantially different from the learning environment of clerkship rotations, skills learned in PBL are perceived as applicable to authentic clinical training.

Initial evaluation of a virtual reality bomb-defusing simulator for development of undergraduate healthcare student communication and teamwork skills

Communication and teamworking skills are essential healthcare professional skills, yet undergraduates exhibit reluctance to engage with group work, especially in interprofessional groups. The aim of the study was to investigate whether a virtual reality bomb-defusing simulator would enable students to gain these skills through an enjoyable and challenging scenario without profession-specific knowledge. Students took it in turns to play the role of the ‘Defuser’ immersed in a headset, while the rest of the group were ‘Experts’ with a printed manual, but no sight of the bomb. The task challenged students to relay obscure symbols and instructions to each other rapidly and effectively. A subsequent focus group explored the impact of the simulation on students’ perceived learning, engagement and communication skills. The focus group of five multiprofessional healthcare students reported high levels of engagement and satisfaction while highlighting value in developing communication and teamwork. The simulator nurtured initial group dynamics and team bonding. Evaluation data indicated that the intervention facilitated cooperation, team bonding and the development of good communication skills. This method of encouraging communication would fit well into an interprofessional learning session as a useful tool ahead of more technical and clinically based group work.

The focus group of five multiprofessional healthcare students reported high levels of engagement and satisfaction while highlighting value in developing communication and teamwork. The simulator nurtured initial group dynamics and team bonding.

Medical Students' Acquaintance with Core Concepts, Institutions and Guidelines on Good Scientific Practice: A Pre- and Post-questionnaire Survey

German medical students are not sufficiently introduced to the ethical principles and pitfalls of scientific work. Therefore, a compulsory course on good scientific practice (GSP) has been developed and implemented into the curriculum of medical students, with the goal to foster scientific integrity and prevent scientific misconduct. Students' knowledge and attitudes towards GSP were evaluated by a pre-post-teaching questionnaire survey (n = 239). Most participants initially had startling knowledge gaps in the field. Moreover, they were not acquainted with core institutions on GSP, the office of ombudsperson and the nationally binding guidelines on GSP. The pre-post-teaching comparison showed statistically significant improvement in all areas tested; moreover, after the course participants confided more trust in GSP institutions. Applying ethical rules into practice can be challenging; therefore, students need to learn to work independently with guidelines on GSP and should be introduced to institutions providing further guidance. As our study has shown, students are very willing to pursue a scientific career based on integrity and honesty, however, they lack the knowledge how to do so. In light of our results, we therefore recommend to integrate courses on GSP already at an early time into the mandatory curriculum of medical students.

Application of Case-Based Readiness Assurance Process as a Model for Case-Based Pedagogy and Collaborative Learning in Physiology

The preclinical phase of the undergraduate medical curriculum has to embed clinically relevant learning experience to bridge basic sciences with clinical disciplines. Student-centric educational methods like the readiness assurance process of team-based learning promote active learning. In this study, we report our implementation of the case-based readiness assurance process (CBRAP) as a case-based strategy for introducing early clinical exposure in the preclinical phase of the undergraduate medical curriculum in India. Four CBRAPs with individual and group readiness assurance tests (IRAT and GRAT) were conducted in four different systems taught in physiology (hematology, muscle physiology, cardiovascular physiology, and renal physiology). The multiple-choice questions for CBRAP were specifically designed to test application and problem-solving by incorporating clinical vignettes with pathophysiology and lab findings. This study was designed to involve all 250 students from the first professional year. The GRAT scores were significantly more than mean IRAT scores in all four CBRAPs (p value < 0.001). The GRAT scores in the second, third, and fourth CBRAPs were significantly better than the GRAT score of the first CBRAP (p value < 0.001). The GRAT scores correlated significantly with mean IRAT in three out of four CBRAPs and with the highest IRAT in two out of four CBRAPs. Based on the student feedback of CBRAP and other case-based strategies, it was found that students preferred CBRAP and the majority of students reported that discussion of CBRAP questions with team members was useful. In conclusion, innovative case-based teaching methods with active student involvement can be incorporated in the preclinical curriculum for improving learning outcomes.

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning

BACKGROUND

What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL).

METHOD

The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times.

RESULTS

A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content.

DISCUSSION

UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training.

The development and electronic delivery of case-based learning using a fast healthcare interoperability resource system

HL7 International’s Fast Healthcare Interoperability Resources (FHIR) standard provides a common format for sharing health data (eg, FHIR resources) and a RESTful Application Programming Interface (eg, FHIR API) for accessing those resources via a FHIR server connected to an electronic health record system or any other system storing clinical data. Substitutable Medical Applications and Reusable Technologies (SMART) leverages FHIR to create an electronic health record (EHR) agnostic app platform. It utilizes the OAuth standard to provide for authorization and authentication. This paper describes the development and informal evaluation of Case Based Learning on FHIR (CBL on FHIR), a prototype EHR-connected FHIR/SMART platform to provide interactive digital cases for use in medical education. The project goals were to provide a more interactive form of CBL than is possible on paper to more realistically simulate clinical decision making and to expose medical students to modern informatics systems and tools for use in patient care.