Context matters when striving to promote active and lifelong learning in medical education

Medical students' orientation toward lifelong learning in an outcome-based curriculum and the lessons learnt

BACKGROUND

Lifelong learning (LL) is an important outcome of medical training. The objective of this study is to measure the orientation of medical students toward LL and to determine the types of self-directed learning (SDL) activities that contribute toward LL skills.

METHODS

The Jefferson Scale of Physician Lifelong Learning for medical student (JeffSPLL-MS) questionnaire was used. Factor analysis was performed, Cronbach's alpha and effect size were calculated. The types of learning activities that contribute to LL skills were identified.

RESULTS

Three-factor structure emerged from the factor analysis and were identified as learning beliefs and motivation, skills in seeking information and attention to learning opportunities. A significant increase (p < .05; ES = 0.27) in orientation toward LL with academic progression was observed. Clinical students improved significantly in the domains of 'skills in seeking information' (p < .001; ES = 0.48) and 'attention to learning opportunities' (p < .001; ES = 0.55). Problem-based learning, flipped classroom, guided reading, projects and experiential learning activities are perceived to be effective for promoting LL.

CONCLUSIONS

Medical students' LL skills develop progressively from preclinical to clinical years. Self-directed learning activities are perceived to be effective in promoting LL skills.

Understanding the lived experiences of medical learners in a narrative medicine course: a phenomenological study

BACKGROUND

Reflection and various approaches to foster reflection have been regarded as an indispensable element in enhancing professional practice across different disciplines. With its inherent potential to engage learners in reflection and improvement, narrative medicine has been adopted in various settings. However, the relevance and effectiveness of reflection remains underexplored in the context of narrative medicine, specifically in regard to the concern about variability of learner acceptance and the way learners really make sense of these reflective activities. This study aimed to explore what medical learners experience through narrative medicine and the meanings they ascribe to the phenomenon of this narrative-based learning.

METHODS

Using a transcendental phenomenology approach, twenty medical learners were interviewed about their lived experiences of taking a narrative medicine course during their internal medicine clerkship rotation. Moustakas' phenomenological analysis procedures were applied to review the interview data.

RESULTS

Six themes were identified: feeling hesitation, seeking guidance, shifting roles in narratives, questioning relationships, experiencing transformation, and requesting a safe learning environment. These themes shaped the essence of the phenomenon and illustrated what and how medical learners set out on a reflective journey in narrative medicine. These findings elucidate fundamental elements for educators to consider how narrative approaches can be effectively used to engage learners in reflective learning and practice.

CONCLUSION

Adopting Moustakas' transcendental phenomenology approach, a better understanding about the lived experiences of medical learners regarding learning in narrative medicine was identified. Learner hesitancy should be tackled with care by educators so as to support learners with strategies that address guidance, relationship, and learning environment. In so doing, medical learners can be facilitated to develop reflective capabilities for professional and personal growth.

Interest in technology among medical students early in their clinical experience

BACKGROUND

The world is in the midst of the "digital" revolution characterized by the ascendency of computerization, information systems and artificial intelligence with an emphasis on innovation and creativity. This revolution has affected current medical practice and promises to significantly impact it in the future. This requires physician's understanding and participation in adopting such technology. This study aimed to explore the role technology plays in the future career plans of medical students.

METHODS

A questionnaire examining selection criteria for medical specialty choice, criteria for choosing a post-residency job and demographic data was completed by a convenience sample of 5th-year Israeli medical students.

RESULTS

Two-hundred forty-two students (51 % men) completed the questionnaire, an 84 % response rate. Only a third (35 %) rated the specialty selection criterion "provides mechanical/ technological challenges" as important, while only 7% considered as important that a specialty requires skills in computer science. Few students were interested in post-residency positions requiring much technological knowledge (25 %) and requiring much skill with computerized information systems (13 %). Male students were significantly more interested than females in such positions and these students more often reported that they were considering careers in surgery and its subspecialties. This surgical bent was confirmed by the 42 % of students interested in post-residency positions that include time in the operating room having more interest in positions requiring much technological knowledge than the students not interested in operating room time.

CONCLUSIONS

This preliminary study demonstrated that as a group the students' expressed relatively little interest in medical specialties and post-residency positions involving technological challenges and knowledge of information (computer) science. Yet, the sub-group interested in the surgical specialties had such interests. These findings were perplexing since the students belong to Generations Y and Z who are steeped in the use of smartphones and social media. Therefore, we failed to support our hypothesis that Generation Y and Z students would be attracted to specialties and positions that provide them with technological challenges. Furthermore, medical educators need to explore this apparent lack of interest in technology in order to insure that the future physician workforce is ready to face future "digital" challenges.

Health management students' self-regulation and digital concept mapping in online learning environments

BACKGROUND

Self-regulation of learning is considered one of the key capabilities deemed essential for the healthcare system and its workers to cope successfully with the current challenges they are facing. Therefore, healthcare curricula are increasingly called upon to support self-regulation as a central learning outcome. With scant relevant publications describing how students of medicine and other healthcare professions regulate their learning, this study set out to design and assess a problem-based learning using digital concept mapping in an online course and to evaluate the set of connections between this intervention and Health Management students' self-regulation of learning.

METHOD

Students of a Management of Health Service Organizations program (100) were presented with an ill-structured problem, relevant to their course content (accreditation process within hospitals) and were asked to argue for or against the implementation of the accreditation process. The participants were asked to detail five arguments to establish their decision by using Mindomo, a popular digital platform for designing concept maps. The students were given predefined criteria that allowed them to self-assess their maps. Data for the analysis were gathered by two measurements: Concept mapping for problem-based learning scale and the Online self-regulated learning scale and were analyzed by using Partial Least Squares - Structural Equation Modeling.

RESULTS

The analyses showed that at the beginning of the process, students' online self-regulation was found lower than at the end of the intervention, and only two self-regulation sub-factors: Goal setting and Task strategies, were positively linked to students' perceptions of the intervention. After the intervention, the analyses showed that it increased the levels of four Online self-regulation sub-factors: Goal setting, Task strategies, Environment structuring, and Time management.

CONCLUSIONS

Teachers need to recognize and account for different types of learners and encourage and scaffold students' effective use of self-regulation strategies. Low self-regulated learners might fail to see the advantages of concept mapping in problem-solving activities. Combining these teaching and learning tools together with the use of advanced technology in an online course that encourages active learning enables the development and acquisition of abilities of self-directed learning among students in the medical and health management professions.

Limited effects from professional identity formation-oriented intervention on self-regulated learning in a preclinical setting: a randomized-controlled study in Japan

BACKGROUND

Developing self-regulated learning in preclinical settings is important for future lifelong learning. Previous studies indicate professional identity formation, i.e., formation of self-identity with internalized values and norms of professionalism, might promote self-regulated learning. We designed a professional identity formation-oriented reflection and learning plan format, then tested effectiveness on raising self-regulated learning in a preclinical year curriculum.

METHODS

A randomized controlled crossover trial was conducted using 112 students at Jichi Medical University. In six one-day problem-based learning sessions in a 7-month pre-clinical year curriculum, Groups A (n = 56, female 18, mean age 21.5y ± 0.7) and B (n = 56, female 11, mean age 21.7y ± 1.0) experienced professional identity formation-oriented format: Group A had three sessions with the intervention format in the first half, B in the second half. Between-group identity stages and self-regulated learning levels were compared using professional identity essays and the Motivated Strategies for Learning Questionnaire.

RESULTS

Two-level regression analyses showed no improvement in questionnaire categories but moderate improvement of professional identity stages over time (R2 = 0.069), regardless of timing of intervention.

CONCLUSIONS

Professional identity moderately forms during the pre-clinical year curriculum. However, neither identity nor self-regulated learning is raised significantly by limited intervention.

Active learning of medical students in Taiwan: a realist evaluation

BACKGROUND

Active learning is defined as any instructional method that engages students in the learning process. Cultural differences in learning patterns can play an important role in engagement with active learning. We aimed to examine process models of active learning to understand what works, for whom and why.

METHODS

Forty-eight sixth- and seventh-year medical students with experience of active learning methods were purposively selected to participate in ten group interviews. Interactions around active learning were analysed using a realist evaluation framework to unpack the 'context-mechanism-outcome' (CMO) configurations.

RESULTS

Three core CMO configurations, including cultural, training and individual domains, were identified. In the cultural context of a strong hierarchical culture, the mechanisms of fear prompted students to be silent (outcome) and dare not give their opinions. In the training context of teacher-student familiarity alongside teachers' guidance, the mechanisms of learning motivation, self-regulation and enthusiasm were triggered, prompting positive learning outcomes and competencies (outcome). In the individual context of learning how to learn actively at an early stage within the medical learning environment, the mechanisms of internalisation, professional identity and stress resulted in recognising active learning and advanced preparation (outcomes).

CONCLUSIONS

We identified three CMO configurations of Taiwanese medical students' active learning. The connections among hierarchical culture, fear, teachers' guidance, motivation, the medical environment and professional identity have been shown to affect the complex interactions of learning outcomes. Fear derived from a hierarchical culture is a concern as it is a significant and specific contextual factor, often sparking fear with negative outcomes.

IUPS Physiology Education Workshop series in India: organizational mechanics, outcomes, and lessons

Active learning promotes the capacity of problem solving and decision making among learners. Teachers who apply instructional processes toward active participation of learners help their students develop higher order thinking skills. Due to the recent paradigm shift toward adopting competency-based curricula in the education of healthcare professionals in India, there is an emergent need for physiology instructors to be trained in active-learning methodologies and to acquire abilities to promote these curriculum changes. To address these issues, a series of International Union of Physiological Sciences (IUPS) workshops on physiology education techniques in four apex centers in India was organized in November 2018 and November 2019. The "hands-on" workshops presented the methodologies of case-based learning, problem-based learning, and flipped classroom; the participants were teachers of basic sciences and human and veterinary medicine. The workshop series facilitated capacity building and creation of a national network of physiology instructors interested in promoting active-learning techniques. The workshops were followed by a brainstorming meeting held to assess the outcomes. The aim of this report is to provide a model for implementing a coordinated series of workshops to support national curriculum change and to identify the organizational elements essential for conducting an effective Physiology Education workshop. The essential elements include a highly motivated core organizing team, constant dialogue between core organizing and local organizing committees, a sufficient time frame for planning and execution of the event, and opportunities to engage students at host institutions in workshop activities.

The role of data science and machine learning in Health Professions Education: practical applications, theoretical contributions, and epistemic beliefs

Data science is an inter-disciplinary field that uses computer-based algorithms and methods to gain insights from large and often complex datasets. Data science, which includes Artificial Intelligence techniques such as Machine Learning (ML), has been credited with the promise to transform Health Professions Education (HPE) by offering approaches to handle big (and often messy) data. To examine this promise, we conducted a critical review to explore: (1) published applications of data science and ML in HPE literature and (2) the potential role of data science and ML in shifting theoretical and epistemological perspectives in HPE research and practice. Existing data science studies in HPE are often not informed by theory, but rather oriented towards developing applications for specific problems, uses, and contexts. The most common areas currently being studied are procedural (e.g., computer-based tutoring or adaptive systems and assessment of technical skills). We found that epistemic beliefs informing the use of data science and ML in HPE poses a challenge for existing views on what constitutes objective knowledge and the role of human subjectivity for instruction and assessment. As a result, criticisms have emerged that the integration of data science in the field of HPE is in danger of becoming technically driven and narrowly focused in its approach to teaching, learning and assessment. Our findings suggest that researchers tend to formalize around the epistemological stance driven largely by traditions of a research paradigm. Future data science studies in HPE need to involve both education scientists and data scientists to ensure mutual advancements in the development of educational theory and practical applications. This may be one of the most important tasks in the integration of data science and ML in HPE research in the years to come.

Resident learning trajectories in the workplace: A self-regulated learning analysis

CONTEXT

Research in workplace learning has emphasised trainees' active role in their education. By focusing on how trainees fine-tune their strategic learning, theories of self-regulated learning (SRL) offer a unique lens to study workplace learning. To date, studies of SRL in the workplace tend to focus on listing the factors affecting learning, rather than on the specific mechanisms trainees use to regulate their goal-directed activities. To inform the design of workplace learning interventions that better support SRL, we asked: How do residents navigate their exposure to and experience performing invasive procedures in intensive care units?

METHODS

In two academic hospitals, we conducted post-call debriefs with residents coming off shift and later sought their elaborated perspectives via semi-structured interviews. We used a constant comparative methodology to analyse the data, to iteratively refine data collection, and to inform abductive coding of the data, using SRL principles as sensitising concepts.

RESULTS

We completed 29 debriefs and nine interviews with 24 trainees. Participants described specific mechanisms: identifying, creating, avoiding, missing and competing for opportunities to perform invasive procedures. While using these mechanisms to engage with procedures (or not), participants reported: distinguishing trajectories (i.e. becoming attuned to task-relevant factors), navigating trajectories (i.e. creating and interacting with opportunities to perform procedures), and co-constructing trajectories with their peers, supervisors and interprofessional team members.

CONCLUSIONS

We identified specific SRL mechanisms trainees used to distinguish and navigate possible learning trajectories. We also confirmed previous findings, including that trainees become attuned to interactions between personal, behavioural and environmental factors (SRL theory), and that their resulting learning behaviours are constrained and guided by interactions with peers, supervisors and colleagues (workplace learning theory). Making learning trajectories explicit for clinician teachers may help them support trainees in prioritising certain trajectories, in progressing along each trajectory, and in co-constructing their plans for navigating them.

Experiential learning without prior vicarious learning: an insight from the primary dental care setting

The vicarious learning method (by observation) is used to help learners emulate their teachers' behaviours. The experiential learning method (by experience) is traditionally used thereafter, so that learners can apply these behaviours to a given situation. Both methods are widely utilised within clinical skills training. A clinical teacher may well face the question of whether a learner can complete a certain clinical task without having seen it performed before. Therefore, clinical teachers will need to determine which method, vicarious or experiential, is most effective for their learners. To help explore this, the author reflects on two examples from dental teaching practice, followed by discussion of the need to also observe soft skills; provide meaningful feedback; be a good role model; facilitate deep learning; know our learners, and implement learner-centred learning. Collectively, this reveals that although experiential learning may be possible and beneficial by itself, further research is required to fully support this.

Learning in the workplace: Use of informal feedback cues in doctor-patient communication

OBJECTIVES

We expect physicians to be lifelong learners. Participation in clinical practice is an important potential source of that learning. To support physicians in this process, a better understanding of how they learn in clinical practice is necessary. This study investigates how physicians recognise and use informal feedback from interactions with patients in outpatient settings as learning cues to adjust their communication behaviours in daily practice.

METHODS

To understand physicians' use of informal feedback, we combined non-participant observations with semi-structured interviews. We enrolled 10 respiratory physicians and observed 100 physician-patient interactions at two teaching hospitals in the Netherlands. Data collection and analysis were performed iteratively according to the principles of constructivist grounded theory.

RESULTS

Following stages of open, axial and selective coding, we were able to conceptualise how physicians use cues to reflect on and adjust their communication. In addition to vast variations within and across patient encounters, we observed recurring adjustments in physicians' communication behaviours in response to specific informal feedback cues. Physicians recognised and used these cues to self-monitor communication performance. They had established 'communication repertoires' based on multiple patient interactions, which many saw as learning opportunities contributing to the development of expertise. Our findings, however, show differences in physicians' individual levels of sensitivity in recognising and using learning opportunities in daily practice, which were further influenced by contextual, personal and interpersonal factors. Whereas some described themselves as having little inclination to change, others used critical incidents to fine-tune their communication repertoires, and yet others constantly reshaped them, seeking learning opportunities in their daily work.

CONCLUSIONS

There is large variation in how physicians use learning cues from daily practice. To enhance learning in and from daily practice, we propose turning workplace learning into a collaborative effort with the aim of increasing awareness and the use of informal performance-relevant feedback.

PowerPoint to the People: The Four Secrets to Delivering a Great Medical Talk

Medical talks are a staple of post-medical school education, but the effectiveness of these lectures can be quite variable. One significant reason for this is that while physicians and trainees are well trained at presenting information to one another, they have little to no formal training on giving hour-long medical didactics. Focusing on four specific categories including creating a strong first impression, effective use of PowerPoint, impactful delivery of information, and thorough preparation a physician at any stage in training can become a strong presenter.

How is self-regulated learning documented in e-portfolios of trainees? A content analysis

BACKGROUND

It is assumed that portfolios contribute to self-regulated learning (SRL). Presence of these SRL processes within the documentation kept in portfolios is presupposed in common educational practices, such as the assessment of reflective entries. However, questions can be asked considering the presence of SRL within portfolios. The aim of this study was to gain insight into the documentation of SRL processes within the electronic (e)-portfolio content of medical trainees. SRL consists of numerous processes, for this study the focus was on self-assessment via reflection and feedback, goal-setting and planning, and monitoring, as these are the processes that health professions education research mentions to be supported by portfolios.

METHODS

A database containing 1022 anonymous e-portfolios from General Practitioner trainees was used to provide descriptive statistics of the various available e-portfolio forms. This was followed by a quantitative content analysis of 90 e-portfolios, for which, a codebook was constructed to rate the documentation of the included SRL processes.

RESULTS

The numbers of forms in the e-portfolios varied to a great extent. Content analysis showed a limited documentation of reflective entries, and available entries mainly described events and experiences without explanations and context. Feedback was generally limited to comments on what went well and lacked specificity, context and suggestions for future action. Learning goals and plans were short of specificity, but did contain challenging topics and different goals were compatible with each other. 75% of the e-portfolios showed (limited) signs of monitoring.

CONCLUSIONS

The e-portfolio content showed limited documentation of SRL processes. As documentation of SRL requires time and asks for a high level of introspection and writing skills, one cannot expect documentation of SRL processes to appear in e-portfolio content without efforts.

Comparison of the evaluation of formative assessment at two medical faculties with different conditions of undergraduate training, assessment and feedback

Introduction: Both formative and summative assessments have their place in medical curricula: formative assessment to accompany the learning process and summative assessment to ensure that minimum standards are achieved. Depending on the conditions of undergraduate training, assessment and feedback, students place more or less importance on formative assessment, and thus the fulfilment of its function may be questionable. This study describes how the low-stakes formative Berlin Progress Test (BPT) is embedded at two medical faculties with partially different framework conditions and what effects these have on the students' testing efforts and the evaluation of the test, especially the perception of its benefits and (intangible) costs, such as non-participation in contemporaneous activities and emotional impairments. Methods: In this study, the proportion of non-serious BPT participants at two medical faculties (total sample: N_F1=1,410, N_F2=1,176) in winter term 2015/16 was determined both by the number of unanswered questions on the test itself and in a survey using a standardized instrument (N_F1=415, N_F2=234). Furthermore, open questions were asked in this survey about perceived benefits and perceived costs, which were analyzed with qualitative and quantitative methods. Results: The BPT is generally better accepted at Faculty 2. This can be seen in the higher proportion of serious test takers, the lower perceived costs and the higher reported benefit, as well as the higher proportion of constructive comments. Faculty 2 students better understood the principle of formative testing and used the results of the BPT as feedback on their own knowledge progress, motivation to learn and reduction of exam fear. Discussion: When medical faculties integrate formative assessments into the curriculum, they have to provide a framework in which these assessments are perceived as an important part of the curriculum. Otherwise, it is questionable whether they can fulfil their function of accompanying the learning process.

Provoking a Conversation Around Students' and Supervisors' Expectations Regarding Workplace Learning

Construct: This study presents a tool that can facilitate a conversation about students' and supervisors' expectations concerning responsibilities during workplace learning. Background: It is often unclear who is responsible for facilitating learning opportunities in the workplace. In order to increase learning opportunities, it is important that expectations are discussed and alignment is reached between the student's and supervisor's expectations. This study collected and interpreted validity evidence for a tool that aims to provoke such a conversation. Approach: Three types of validity evidence were collected: response process, content, and consequences evidence. Educational leaders, medical teachers, and students of four medical schools were involved. The data collection consisted of cognitive interviews, a modified Delphi approach (with three rounds of inquiry), completed tools, and narrative comments. Findings: This study showed that the expectations of most students and supervisors were not initially aligned. The conversation, for which the tool aims to be a catalyst, facilitated better alignment of expectations about responsibilities during workplace learning. Moreover, the students' perceived degree of consensus and satisfaction after the conversation were very high. Conclusions: This study underlined the relevance and usefulness of a tool that facilitates conversation about expectations regarding responsibilities, potentially enhancing learning opportunities at the workplace.

Trainee-environment interactions that stimulate motivation: A rich pictures study

CONTEXT

Staying motivated when working and learning in complex workplaces can be challenging. When complex environments exceed trainees' aptitude, this may reduce feelings of competence, which can hamper motivation. Motivation theories explain how intrapersonal and interpersonal aspects influence motivation. Clinical environments include additional aspects that may not fit into these theories. We used a systems approach to explore how the clinical environment influences trainees' motivation and how they are intertwined.

METHODS

We employed the rich pictures drawing method as a visual tool to capture the complexities of the clinical environment. A total of 15 trainees drew a rich picture representing a motivating situation in the workplace and were interviewed afterwards. Data collection and analysis were performed iteratively, following a constructivist grounded theory approach, using open, focused and selective coding strategies as well as memo writing. Both drawings and the interviews were used to reach our results.

RESULTS

Trainees drew situations pertaining to tasks they enjoyed doing and that mattered for their learning or patient care. Four dimensions of the environment were identified that supported trainees' motivation. First, social interactions, including interpersonal relationships, supported motivation through close collaboration between health care professionals and trainees. Second, organisational features, including processes and procedures, supported motivation when learning opportunities were provided or trainees were able to influence their work schedule. Third, technical possibilities, including tools and artefacts, supported motivation when tools were used to provide trainees with feedback or trainees used specific instruments in their training. Finally, physical space supported motivation when the actual setting improved the atmosphere or trainees were able to modify the environment to help them focus.

CONCLUSIONS

Different clinical environment dimensions can support motivation and be modified to create optimal motivating situations. To understand motivational dynamics and support trainees to navigate through postgraduate medical education, we need to take all clinical environment dimensions into account.

Beyond the self: The role of co-regulation in medical students' self-regulated learning

CONTEXT

Medical students are expected to self-regulate their learning within complex and unpredictable clinical learning environments. Research increasingly focuses on the effects of social interactions on the development of self-regulation in workplace settings, a notion embodied within the concept of co-regulated learning (CRL). Creating workplace learning environments that effectively foster lifelong self-regulated learning (SRL) requires a deeper understanding of the relationship between CRL and SRL. The aim of this study was therefore to explore medical students' perceptions of CRL in clinical clerkships and its perceived impact on the development of their SRL.

METHODS

We conducted semi-structured interviews with 11 purposively sampled medical students enrolled in clinical clerkships at one undergraduate competency-based medical school. Data collection and analysis were conducted iteratively, informed by principles of constructivist grounded theory. Data analysis followed stages of open, axial and selective coding, which enabled us to conceptualise how co-regulation influences the development of students' self-regulation.

RESULTS

Data revealed three interrelated shifts in CRL and SRL as students progressed through clerkships. First, students' CRL shifted from a focus on peers to co-regulation with clinician role models. Second, self-regulated behaviour shifted from being externally driven to being internally driven. Last, self-regulation shifted from a task-oriented approach towards a more comprehensive approach focusing on professional competence and identity formation. Students indicated that if they felt able to confidently and proactively self-regulate their learning, the threshold for engaging others in meaningful CRL seemed to be lowered, enhancing further development of SRL skills.

CONCLUSIONS

Findings from the current study emphasise the notion that SRL and its development are grounded in CRL in clinical settings. To optimally support the development of students' SRL, we need to focus on facilitating and organising learners' engagement in CRL from the start of the medical curriculum.

Professionals' perspectives on factors affecting GP trainees' patient mix: results from an interview and focus group study among professionals working in Dutch general practice

INTRODUCTION

Seeing and treating patients in daily practice forms the basis of general practitioner (GP) training. However, the types of patients seen by GP trainees do not always match trainees' educational needs. Knowledge about factors that shape the mix of patient types is limited, especially with regard to the role of the professionals who work in the GP practice.

AIM

We investigated factors affecting the mix of patients seen by GP trainees from the perspective of professionals.

DESIGN AND SETTING

This qualitative study involved GP trainees, GP supervisors, medical receptionists and nurse practitioners affiliated with a GP Specialty Training Institute in the Netherlands.

METHODS

Twelve focus groups and seven interviews with 73 participants were held. Data collection and analysis were iterative, using thematic analysis with a constant comparison methodology.

RESULTS

The characteristics of patients' health problems and the bond between the doctor and patient are important determinants of GP trainees' patient mix. Because trainees have not yet developed bonds with patients, they are less likely to see patients with complex health problems. However, trainees can deliberately influence their patient mix by paying purposeful attention to bonding with patients and by gaining professional trust through focused engagement with their colleagues.

CONCLUSION

Trainees' patient mix is affected by various factors. Trainees and team members can take steps to ensure that this mix matches trainees' educational needs, but their success depends on the interaction between trainees' behaviour, the attitudes of team members and the context. The findings show how the mix of patients seen by trainees can be influenced to become more trainee centred and learning oriented.

Problem-based projects in medical education: extending PBL practices and broadening learning perspectives

Medical education strives to foster effective education of medical students despite an ever-changing landscape in medicine. This article explores the utility of projects in problem-based learning-project-PBL-as a way to supplement traditional case-PBL. First, project-PBL may enhance student engagement and motivation by allowing them to direct their own learning. Second, project-PBL may help students develop metacognitive competencies by forcing them to collaborate and regulate learning in settings without a facilitator. Finally, project-PBL may foster skills and competencies related to medical research. As illustrated through a brief example from Aalborg University, Denmark, students learn differently from project-PBL and case-PBL, and so one implementation cannot simply replace the other. I conclude by suggesting future directions for research on project-PBL to explore its benefits in medical education.

Self-Directed and Lifelong Learning: A Framework for Improving Nursing Students’ Learning Skills in the Clinical Context

Self-directed lifelong learning is an important competency for nursing students to meet their professional development, yet it can be challenging for some students to acquire self-directed learning skills in a clinical context. A framework based on Hiemstra and Brockett’s “Person, Process, Context” model was developed to promote nurses' self-directed lifelong learning. The implication stems from our expectation that the framework can accelerate the development of interpersonal and intellectual skills valuable to a nursing student’s lifelong learning process.

Does changing from a teacher-centered to a learner-centered context promote self-regulated learning: a qualitative study in a Japanese undergraduate setting

BACKGROUND

Previous studies indicate that a teacher-centered context could hinder undergraduates from self-regulated learning (SRL), whereas a learner-centered context could promote SRL. However, SRL development between a teacher-centered and a learner-centered context has not directly compared in undergraduate settings. Also, it is still unclear how a contextual change toward learner-centered learning could influence SRL in students, who are strongly accustomed to teacher-centered learning.

METHODS

We conducted three focus groups that examined 13 Japanese medical students who left a traditional curriculum composed of didactic lectures and frequent summative tests and entered a seven-month elective course (Free Course Student Doctor or FCSD). The FCSD emphasizes student-designed individualized learning with support and formative feedback from mentors chosen by students' preference. We also conducted two focus groups that examined 7 students who remained in the teacher-centered curriculum during the same period. Students were asked to discuss their 1) motivation, 2) learning strategies, and 3) self-reflection on self-study before and during the period. Data were analyzed using thematic analysis and code comparison between the two cohorts.

RESULTS

The non-FCSD participants described their motivational status as being one among a crowd set by the teacher's yardstick. Their reflection focused on minimizing the gap between themselves and the teacher-set yardstick with strategies considered monotonous and homogeneous (e.g. memorization). FCSD participants described losing the teacher-set yardstick and constructing their future self-image as an alternative yardstick. They compared gaps between their present status and future self-image by self-reflection. To fill these gaps, they actively employed learning strategies used by doctors or mentors, leading to diversification of their learning strategies.

CONCLUSIONS

A contextual change toward learner-centered learning could promote SRL even in students strongly accustomed to teacher-centered learning. In the learner-centered context, students began to construct their self-image, conduct self-reflection, and seek diverse learning strategies by referring to future 'self' models.

Medical student psychological distress and academic performance

INTRODUCTION

The impact of medical student psychological distress on academic performance has not been systematically examined. This study provided an opportunity to closely examine the potential impacts of workplace and study related stress factors on student's psychological distress and their academic performance during their first clinical year.

METHODS

This one-year prospective cohort study was performed at a tertiary hospital based medical school in Melbourne, Australia. Students completed a questionnaire at three time points during the year. The questionnaire included the validated Kessler psychological distress scale (K10) and the General Health Questionnaire-28 (GHQ-28), as well as items about sources of workplace stress. Academic outcome scores were aggregated and correlated with questionnaire results.

RESULTS

One hundred and twenty six students participated; 126 (94.7%), 102 (76.7%), and 99 (74.4%) at time points one, two, and three, respectively. 33.1% reported psychological distress at time point one, increasing to 47.4% at time point three. There was no correlation between the K10 scores and academic performance. There was weak negative correlation between the GHQ-28 at time point three and academic performance. Keeping up to date with knowledge, need to do well and fear of negative feedback were the most common workplace stress factors.

CONCLUSIONS

Poor correlation was noted between psychological distress and academic performance.