Implementation and evaluation of a self-directed learning activity for first-year medical students

Applying team-based learning combined with empathy map to improve self-directed learning skills

BACKGROUND

Lifelong learning is essential for cultivating conscientious nurses. Because self-directed learning is significantly correlated with lifelong learning, it is necessary to enhance nursing students' self-directed learning skills after graduation. This study examined the effectiveness of an integrated team-based learning and empathy mapping teaching strategy in a Psychiatric Nursing course for enhancing students' self-directed learning skills and academic performance.

METHODS

A quasi-experimental design was used. The subjects of the study were 89 third-year nursing students who enrolled in a course on Psychiatric Nursing. Data were collected from September 22, 2021 to January 31, 2022. The participants were recruited using purposive sampling and divided into experimental group and control group. The pre- and post-test learning outcomes of nursing students were evaluated with the Self-Directed Learning Instrument (SDLI).

RESULTS

The experimental group performed significantly better than the control group on the dimensions of "identifying learning resources," "monitoring learning progress," and "interpersonal communication," (p < .05) as revealed by the results. Additionally, the students enhanced their self-directed learning skills (p = .038) and academic performance (p < .001).

CONCLUSIONS

The integrated team-based learning and empathy mapping teaching strategy significantly enhanced the self-directed learning skills and academic performance of nursing students.

Effectiveness of the small private online course-based flipped teaching program for enhancing nursing students' self-directed learning ability in the Surgical Nursing course: A practical study

Small private online course-based flipped teaching is an innovative hybrid instructional approach that merges online and offline activities, fostering autonomous learning among students prior to class and facilitating the assimilation of knowledge within the confines of the classroom. To determine the effectiveness of the small private online course-based flipped teaching model on undergraduate nursing students' self-directed learning abilities, we performed a practice version of the small private online course-based flipped teaching program as a quasi-experiment, specifically designed for the Surgical Nursing course and assessed its effectiveness in students' self-directed learning abilities. To this end, a total of 264 students from the 2019 nursing major cohort were selected. Three classes comprising 131 students were randomly selected as the experimental group, and three other classes, comprising 133 students, were set as the control group. The results revealed no significant differences in the scores of self-directed learning abilities between the experimental and control groups before the experiment. After the experiment, the average scores on each dimension of the self-directed learning abilities improved significantly, and the final score of the experimental group was higher than that of the control group. The small private online course-based flipped teaching model can promote undergraduate nursing students' self-directed learning abilities, owing to its practicality and feasibility for the selected course.

Studying the effectiveness of self-directed education in learning and teaching the otolaryngology module in an integrated-based curriculum

Introduction

Self-learning is a learning process in which students harvest the enterprise, to express their learning goals, choose assets for learning, practice learning strategies, and assess the outcomes achieved. Many forms of self-learning were introduced in integrative medical curricula such as Team-based learning (TBL) and Problem-based learning (PBL). This study aims to evaluate self-learning in the otolaryngology module and determine the type of self-learning that students prefer and which of these types has a stronger impact on achieving the educational objectives of the module.

Material and methods

A cross-sectional study was done on the 270 students of studied the otolaryngology module in three consecutive years representing the whole class of the fifth-year medical students along three consecutive years. A Likert scale questionnaire was distributed to measure the students' satisfaction with the current teaching and learning.

Results

The obtained results revealed higher students 'satisfaction with TBL than other modalities supported by high achievement in TBL-related questions. In addition, there is a significant difference between TBL and PBL (p = .00044). No significant differences were obtained either between TBL and CBL (p = .16570) or between TBL and Seminar presentation (p = .16570). In addition, no significant correlations were obtained between PBL and CBL (p = .34677), between PBL and seminar presentation (p = .46496), and between CBL and seminar (p = .99967).

Conclusion

The results showed that the highest students' satisfaction was towards TBL compared to other educational methods. These results encourage clinical educators to insert and implement TBL in most of the integrative curriculum modules, especially that of the clinical years.

Exploring the determinants of self-directed learning among medical undergraduates: A qualitative study

BACKGROUND

The National Medical Council has recognized the importance of self-directed learning (SDL) for medical graduates and it has been included as one of the competencies for Indian Medical Graduates. The present study was conducted to explore different determinants, and the factors facilitating and deterring of SDL among medical undergraduates.

MATERIALS AND METHODS

This cross-sectional qualitative study was conducted with 40 phase 2 MBBS students and data were collected through focused group discussions over a period of four weeks. A content analysis approach was used in the analysis.

RESULTS

The participants included 23 women (58%) and 17 men (42%). The study revealed three main themes and six sub-themes as factors deterring SDL. The majority of participants (84%) favored individual learning, while a smaller number preferred team-based learning.

DISCUSSION

Cognitive factors emerged as the most common barriers, including problems with initiation and engagement in SDL and the enormous amount of data available. Educational environmental factors, such as heavy workloads and time constraints, as well as frequent assessments, were also identified as barriers. Attitudinal and mental barriers encompassed issues like lack of practical experience, difficulties in adapting to new learning environments, and challenges in concentration and focus.

CONCLUSION

Overall, this study fills gaps in our understanding of factors deterring students' engagement in SDL and provides valuable insights for educators and institutions in implementing effective SDL activities. By addressing these barriers, medical education can equip students better to become lifelong learners and meet the evolving demands of the medical profession.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Pre- and post-examination reflections of first-year medical students in an integrated medical anatomy course

Due to the rigor and pace of undergraduate medical anatomy courses, it is not uncommon for students to struggle and fail initially. However, repetition of coursework places an additional burden on the student, instructor, and institution. The purpose of this study was to compare the exam preparation strategies of repeating and non-repeating students to identify areas where struggling students can be supported prior to course failure. As part of their integrated anatomy course, first-year medical students at Indiana University completed a metacognitive Practice-Based Learning and Improvement (PBLI) assignment prior to and after their first exam. In the PBLIs, students were asked to reflect on their exam preparation strategies, confidence, and satisfaction, as well as their predicted and actual exam performance. PBLI responses from non-repeating and repeating students were then analyzed quantitatively and qualitatively. A total of 1802 medical students were included in this study, including 1751 non-repeating and 51 repeating students. Based on their PBLI responses, non-repeating students were appropriately confident, somewhat satisfied, and more accurate when predicting their exam performance. Repeating students were overconfident, dissatisfied, and inaccurate when predicting their first exam performance on their initial, unsuccessful attempt but were more successful on their second, repeat attempt. Qualitative analysis revealed that repeating students aimed to improve their studying by modifying their existing study strategies and managing their time more effectively. In conjunction with other known risk factors, these insights into repeater and non-repeater exam preparation practices can help anatomy educators better identify and support potential struggling students.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Initial efforts to improve medical student information-seeking behavior with embedded library instruction

Background

Medical students must develop self-directed information-seeking skills while they are learning vast amounts of foundational and clinical skills. Students will use different resources for different phases of their training. Information literacy training provided to students will be more impactful when it is embedded into courses or assignments that mimic real-world scenarios. The retention of these skills is also improved by early and frequent instruction sessions, paired with formative feedback from librarian-educators.

Case Presentation

Librarians received student responses to an information literacy question during two cycles of a Grand Rounds activity. Data were analyzed as follows: sources were grouped according to resource type and assessed for quality, and search terms were aggregated and analyzed to determine frequency of use. A librarian-educator presented the compiled data, making suggestions for improving searching and clarifying expectations for how to improve their resource choices for a second Grand Rounds session. Comparing the M2 Grand Rounds case to the M1 case of the same cohort, the frequency of evidence summary and diagnostic tool use increased and the frequency of search engine, textbook/lecture material, and journal article/database use decreased.

Discussion

In the real-world application of back-to-back Georgetown University's Medical Center Grand Rounds exercises, librarian-led instruction on clinical-specific resources appears to be correlated with an improvement in medical students' searching behavior. This trend supports the argument that introducing students early to librarian-led education on clinical-specific resources, and providing feedback on their searches, improves students' information-seeking behavior.

Barriers and Facilitators to the Learning and Acquisition of Research Competencies among Nursing Students through Active Methodologies: A Qualitative Study Using Reflective Writing

BACKGROUND

The development of educational research, critical thinking skills, and evidence-based practice requires proposals for educational innovation. The purpose of this study was to explore the perspectives of undergraduate nursing students on the barriers and facilitators after the implementation of a novel activity within the course of research methodology, composed of three active learning strategies: (a) project-based learning; (b) small-group learning; and (c) self-directed learning.

METHODS

A qualitative exploratory study using reflective writing was conducted at the Nursing Department of the Red Cross School (Spain). Seventy-four nursing students participated in the study, enrolled in the research methodology course. Purposive sampling was used. Online reflective notes were collected from a script of open-ended questions. An inductive thematic analysis was performed.

RESULTS

The new proposals facilitated learning of the subject matter and its contents. They were useful and enabled the students to put the contents into practice. In addition, they improved the students' organization, planning, and involvement. The barriers identified were a lack of time, ambiguity, inadequate tutoring or novelty of the work, and inequity in the distribution of tasks and workloads.

CONCLUSIONS

Our findings shed light on the barriers and facilitators identified by nursing students when implementing an educational innovation proposal, using three active learning methodologies as learning tools for the subject of nursing research.

The #Tweetorial: an Underutilized Teaching Tool in Undergraduate Medical Education?

Tweetorials are short, self-contained Twitter threads that provide a concise overview of a topic. Recently, they have gained prominence in the Twitter medical community (#MedTwitter) as a medium for teaching and reviewing topics from foundational medical physiological concepts through to complex clinical case presentations. With medical schools increasingly utilizing case-based learning in their curricula, the Tweetorial may have a role in bridging the foundational and clinical sciences while challenging the clinical decision-making acumen of learners. We outline how Tweetorials may be utilized to support self-directed, asynchronous learning amidst increasingly brimming medical curricula and provide undergraduate medical students real-time access to educators, and discuss limitations that may hamper their implementation.

Impact of Virtual Seminars on Hepatitis B Knowledge and Attitudes Among Preclinical-Year Medical Students

Background A limited understanding of hepatitis B virus (HBV) disease transmission contributes to fear of routine contact and can stigmatize affected individuals. To reduce potential HBV-related discrimination, there is a need to increase awareness among medical students on HBV knowledge and transmission. We aimed to assess the impact of virtual education seminars on first- and second-year medical students' understanding of HBV and their attitudes toward HBV infection. Methods Pre- and post-seminar surveys were designed and administered to first- and second-year medical students in the February and August 2021 virtual HBV seminars to assess basic knowledge and attitudes toward HBV infection. The seminars consisted of a lecture on HBV followed by case study discussions. Paired samples t-test and McNemar's test for paired proportional differences were used for analysis. Results This study included 24 first-year and 16 second-year medical students who completed both pre- and post-seminar surveys. After attending the seminar, participants demonstrated an increase in correct responses to transmission modes including vertical transmission (p≤0.001) and sharing razors or toothbrushes (p=0.031) rather than sharing utensils or shaking hands (p<0.01). Using 5-point Likert means, improved attitudes were observed in concerns of shaking hands or hugging (pre=2.4, post=1.3, p<0.001) and caring for someone with infection (pre=1.55, post=1.18, p=0.009), and acceptance of an HBV-infected coworker in the same workplace (pre = 4.13, post= 4.78, p<0.001). Conclusion The virtual education seminars clarify misconceptions about transmission and bias towards individuals with HBV infection. Implementation of educational seminars in medical students' training is important to improve overall knowledge of HBV infection.

Student Leadership Development Initiative for Medical Students: Lessons Learned From Transitioning to Virtual Modalities

Leadership training is a necessary component of undergraduate medical education. Our group successfully implemented a student-led organization starting from 2016 (Student Leadership Development Initiative; SLDI) that aimed to provide medical students with exposure to physician-leader career paths in an informal, organic, interactive setting. The COVID-19 pandemic necessitated a shift to online programming, and given the high prevalence of ZOOMTM fatigue, we incorporated monthly, freely available, self-directed modules as an additional leadership training opportunity. The goals of this study are to assess the (1) feasibility of and participation in a virtual student organization focused on leadership training, (2) whether students' perceptions of the importance of leadership were associated with participation in SLDI, and (3) lessons learned from transitioning to virtual modalities. An anonymous, retrospective cross-sectional survey with 13-items was distributed through an email listserv and a 6-question survey was sent to attendees following each virtual group-discussion. A Fisher's exact test was conducted to assess whether the number of modules completed was associated with students' perception of leadership importance. Survey results showed that 85% strongly agreed or agreed that SLDI helped them develop professional goals and career paths, and 74% reported benefits in becoming more compassionate physician leaders and valuing wellness. All respondents completed ≥1 self-directed module, and the students' perception of leadership importance did not influence the number of self-directed modules completed (p > .05). Most participants (63%) attended ≥67% of virtual events, and postevent feedback was positive; however, only 46% of respondents reported meeting someone new at events and 32% reported that they intended on connecting with new contacts. Our results suggest that virtual leadership student-organization, involving small-group discussions and self-directed modules, is feasible and beneficial for medical students. However, the inability to promote meaningful networking opportunities is a major limitation of a virtual training model.

Inserting an Erroneous Element in the Answer Key of Grouped Team Readiness Assurance Test in Team-Based Learning: A Randomized Controlled Trial in Clinical Toxicology

Purpose

Team-based learning (TBL) is an interactive instructional strategy designed to enhance student engagement. Few studies reported that TBL needs to be more interactive, concerns were raised regarding the insufficient instructor feedback, and students feel that TBL gets less attractive with time. One method of boosting students' interaction and performance is adding an element of challenge or positive stress. Therefore, we hypothesized that inserting an erroneous answer in the answer key would generate an observable improvement in the selected outcomes in terms of better satisfaction, interaction, interest in learning, better academic performance, and better development of competencies compared to traditional TBL.

Methods

This randomized controlled trial aimed to determine if inserting an erroneous element in the answer key of a grouped team readiness assurance test (GRAT) would update TBL and whether this intervention would enhance students' performance and satisfaction.

Results

A total of 55 medical students were recruited (88.7% response rate). Erroneous elements were inserted in the answer key of the experimental group and students enrolled in traditional TBL were considered as controls. Compared to the control group (p < 0.001), the experimental group revealed significantly higher academic performances in GRAT and team evaluation test (TET). Analysis of students' perception of the implemented TBL revealed better perception among the experimental group (33.7 ± 6.4) than the control group (30.1 ± 7.0). Moreover, significantly higher team dynamics were reported among the experimental group than the control group (33.0 ± 6.3 and 27.8 ± 7.6 for both groups, respectively; p = 0.005). The reported advantages were in-depth understanding, easier information retrieval, and development of problem-solving skills. Students considered time and effort as their main limitations.

Conclusion

Adding a few erroneous answers in the GRAT is well perceived by students, enhances their learning competencies and overcomes some TBL challenges.

Implementation of Self-Directed Learning in Physiology for Phase 1 Undergraduate Medical Students

BACKGROUND

One of the primary roles played by Indian medical graduates is that of a lifelong learner. To this end, students must acquire the habit of self-directed learning (SDL). Lack of SDL skills among undergraduate medical students is a concern; hence, this study was designed to introduce SDL in physiology to phase 1 undergraduate medical students and assess its effectiveness through student and faculty perceptions.

METHODS

The project commenced after obtaining clearance from the institutional ethics committee. The faculty members and students were sensitized on SDL. A feedback questionnaire was framed and the topics for SDL were selected. SDL was implemented for six topics. The effectiveness of the sessions was evaluated by administering the feedback questionnaire to the students and recording perceptions of the students and faculty on SDL. The data were subjected to quantitative and qualitative analysis.

RESULTS

A total of 96 phase 1 students participated in the study. A majority of the students felt that after SDL sessions, they were more prepared and aware of their learning strengths and had started taking ownership of their learning. However, some students felt that the activity was not useful in improving their analytical skills. Both the students and the faculty were fairly satisfied with this teaching learning innovation.

CONCLUSIONS

SDL was successfully implemented for phase 1 medical students. Both the students and faculty were satisfied with the SDL strategy. SDL has been shown to make students independent learners who are aware of their learning goals and capable of evaluating their learning.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Nursing students' self-directed learning abilities and related factors at graduation: A multi-country cross-sectional study

AIM

To describe nursing students' level of self-directed learning abilities and identify possible factors related to it at graduation in six European countries.

DESIGN

A cross-sectional comparative design across the countries.

METHODS

The study was conducted from February 2018 to September 2019. Nursing students (N = 4,135) from the Czech Republic, Finland, Italy, Portugal, Slovakia and Spain were invited to respond to the research instruments (the Self-Rating Scale of Self-Directed Learning and the Nurse Competence Scale) at graduation. The data were analysed using the chi-square test, Pearson correlation coefficient and the linear model.

RESULTS

The nursing students' (N = 1,746) overall self-directed learning abilities were at high level in all countries. Statistically significant differences occurred between countries. Spanish nursing students reported the highest level of self-directed learning abilities while students from the Czech Republic reported the lowest. Higher level of self-directed learning abilities was related to several factors, particularly with the self-assessed level of competence and country.

Does ultrasound education improve anatomy learning? Effects of the Parallel Ultrasound Hands-on (PUSH) undergraduate medicine course

BACKGROUND

As ultrasound has become increasingly prominent in medicine, portable ultrasound is perceived as the visual stethoscope of the twenty-first century. Many studies have shown that exposing preclinical students to ultrasound training can increase their motivation and ultrasound competency. However, few studies have discussed the effect of ultrasound training on anatomy learning.

METHOD

The Parallel Ultrasound Hands-on (PUSH) course was designed to investigate whether or not ultrasonography training affects anatomy knowledge acquisition. The PUSH course included anatomical structures located in the chest and abdomen (target anatomy) and was conducted in parallel to the compulsory gross anatomy course. Learners (n = 140) voluntarily participated in this elective course (learners in the course before the midterm examination (Group 1, n = 69), or after the midterm examination (Group 2, n = 71)). Anatomy examination scores (written and laboratory tests) were utilized to compare the effects of the PUSH course.

RESULT

Group 1 obtained significantly higher written test scores on the midterm examination (mean difference [MD] = 1.5(7.6%), P = 0.014, Cohen's d = 0.43). There was no significant difference in the final examination scores between the two groups (Written Test: MD = 0.3(1.6%), P = 0.472). In Laboratory test, both mid-term (MD:0.7(2.8%), P = 0.308) and final examination (MD:0.3(1.5%), P = 0.592) showed no significant difference between two groups. Students provided positive feedback in overall learning self-efficacy after the PUSH course (Mean = 3.68, SD = ±0.56 on a 5-point Likert scale). Learning self-efficacy in the cognitive domain was significantly higher than that in the affective domain (MD = 0.58; P < 0.001) and psychomotor domain (MD = 0.12; P = 0.011).

CONCLUSION

The PUSH course featured a hands-on learning design that empowered medical students to improve their anatomy learning.

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

PURPOSE

One of the aims of medical education is to generate lifelong learners, leading to the identification of self-directed learning (SDL) as an essential component of medical education. While SDL is focused on an individual learner, collaboration is critically important in medicine. We developed an online course using the collaborative SDL (CSDL) framework. A goal for the course was for students to gain a better appreciation for the SDL process by exploring the COVID-19 pandemic.

METHODS

We utilized CSDL to implement a 2-week elective attended by fifteen M3 and M4 medical students. Students submitted short videos reflecting on their course experience and the relevance of the material to their future training. Qualitative analysis of reflections was conducted to determine the effectiveness of the CSDL framework, and an assessment of the course evaluations was performed to explore student perceptions of the course and its effectiveness at preparing them for practice. A survey regarding student perceptions of SDL was offered to M3 and M4 students in order to explore their experiences with SDL and perceptions of its importance in the context of the school curriculum.

RESULTS

The CSDL framework was effective in making students aware of the importance of SDL in medical practice. Students gained basic and clinical knowledge about the subject, experienced increased confidence, and appreciated collaborating with their peers. The survey offered to the general student body reflected that all students perceived that they employed SDL in their time as medical students. However, many students indicated that they had not utilized components of SDL beyond synthesizing and assessing their learning needs.

CONCLUSION

CSDL is an effective method for promoting self-directed learning. Undergraduate medical course constructs utilizing CSDL will benefit students as they continue their career development.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01493-7.

Medical Students' Technology Use for Self-Directed Learning: Contributing and Constraining Factors

BACKGROUND

With medical education shifting towards competency-based models, medical students are expected to be self-directed lifelong learners. There is an urgent need to understand what technology students adopt for self-directed learning and what factors contributed to students' self-initiated technology use.

METHOD

This study took place in a midwestern university medical school, which implements a flipped classroom model where students are required to learn all the course materials independently before class. Twenty-six first- and second-year medical students participated in a semi-structured interview about their self-directed learning with technology, and contributing factors towards technology use. A qualitative description methodology using thematic analysis was used to identify key themes from the interview data.

RESULTS

Medical students reported using four types of technologies for learning video resources, self-assessment tools, management tools, and social media. Three key determinants of students' self-directed technology use were identified, including perceived usefulness, subjective norms, and educational compatibility.

CONCLUSIONS

By probing medical students' self-initiated technology use and its determinants, this study suggested that in a self-directed learning environment, medical students used a variety of third-party resources to facilitate learning and develop self-directed learning skills. This study also provided important practical implications to better support students' productive use of technologies for self-directed learning.

Academic motivation and self-directed learning readiness of nursing students during the COVID-19 pandemic in three countries: A cross-sectional study

BACKGROUND

It is crucial to evaluate student academic motivation and self-directed learning (SDL) readiness while teaching online or flexibly. During the coronavirus disease 2019 epidemic, there were few investigations on the link between academic motivation and SDL readiness.

AIM

This study investigated the connection between academic motivation and SDL readiness and the three academic motivation domains' predictive features.

METHODS

This cross-sectional study used convenience sampling to recruit 1187 nursing students from four nursing colleges in three countries. We utilized the Academic Motivation Scale College Version and Self-directed Learning Readiness Scale for Nurse Education to collect data. Descriptive and inferential statistics were employed to analyze the data.

RESULTS

Extrinsic motivation received the highest mean. Most nursing students exhibited SDL readiness, whereas "desire for learning" was rated the highest dimension of SDL readiness. We found significant differences in nursing students' intrinsic and extrinsic motivation and amotivation between the three countries. Finally, country, gender, and intrinsic motivation were significant predictors of the nursing students' SDL readiness.

CONCLUSION

Among Filipino, Saudi, and Thai nursing students, their SDL readiness is influenced by the intrinsic motivation domain. Therefore, nursing students with higher levels of intrinsic motivation are proactive learners for SDL.

Validation of Internal structure of Self-Directed Learning Readiness Scale among Indian Medical Students using factor analysis and the Structural equation Modelling Approach

BACKGROUND

The Self-Directed Learning Readiness Scale (SDLRS) is a tool that helps in the assessment of the readiness of the students to pursue Self-Directed Learning (SDL). There are no documented studies on the validation of internal structure of the SDLRS among Indian medical students. Hence, the objective of this study is to validate the internal structure of SDLRS among Indian medical students using factor analysis and the Structural Equation Modelling (SEM) approach.

METHODS

We administered Fisher's 40-item SDLRS to 750 students after receiving the ethics clearance and the author's permission and taking written informed consent from all the study participants (response rate: 92%). The exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Cronbach's alpha were performed using SPSS version 25 and the Lavaan package of R version 3.1.2.

RESULTS

The values of the comparative fit index (CFI), standardised root-mean-square residual (SRMR), and root mean square error of approximation (RMSEA) were ≥ 0.9, ≤ 0.08, and ≤ 0.08, respectively, for a model fit to be acceptable. EFA showed that except for Q2 (loading score: 0.210), Q12 (loading score: 0.384), Q13 (loading score: 0.362), and Q25 (loading score: -0.219), all the items loaded well. After the exclusion of the aforementioned items, the factor loading scores for the items in the self-management, desire for learning, and self-control factors ranged from 0.405 to 0.753 (Cronbach α: 0.775), 0.396 to 0.616 (Cronbach α: 0.730), and 0.427 to 0.556 (Cronbach α: 0.799), respectively. The updated model was used for CFA, which displayed a good model fit.

CONCLUSIONS

The resultant model consisting of 36 items is shown to have internal structure validity for Indian version of SDLRS, which can be used to assess medical students.

Influencing factors of self-directed learning abilities of medical students of mainland China: a cross-sectional study

OBJECTIVES

This study aimed to evaluate the level of medical students' self-directed learning (SDL) ability in mainland China and to identify its modifiable influencing factors for medical educators to take measures to improve medical professionals' ability in SDL.

DESIGN

This was a cross-sectional study conducted between January and June 2019.

SETTING

This study involved students from five medical colleges located in the cities of Shenyang, Binzhou, Xuzhou, Shanghai and Guangzhou of mainland China.

PARTICIPANTS

Participants included 365 medical students and residents sampled by the stratified clustered random method from five medical colleges.

METHODS

The t-test, F-test and multiple linear regression analyses were performed to test the association between personal and contextual factors of medical students and SDL.

RESULTS

The mean total SDL score was 76.12 (SD=10.96), implying that Chinese mainland medical students had moderate SDL ability. A univariate analysis found that the personal characteristics of confidence, students' enjoyment of their specialty, utilisation of library resources, learning goals and habits and academic performance as well as the contextual factors of age, gender, learning resources, family income and group discussion were significantly associated with the total SDL score (p<0.05). Multiple linear regression analyses showed that academic performance, learning goals, confidence, learning resources, utilisation of library resources, family income and age were significantly associated with the total SDL score (p<0.05).

CONCLUSION

Our study indicated that the contextual factors of learning resources, family income and age as well as the personal factors of academic performance, learning goals, confidence and utilisation of library resources were associated with medical students' SDL ability in mainland China. It may be advisable to implement appropriate teaching strategies to improve students' confidence and assist them establish learning goals, as well as to amplify school learning resources and encourage students to use them fully.

A story half told: a qualitative study of medical students' self-directed learning in the clinical setting

BACKGROUND

Medical educators have promoted self-directed learning (SDL) as an important means of enabling students to take responsibility for their own learning throughout their training and practice. While SDL has been well-studied in classroom settings, it remains a story half told: barriers to and facilitators of SDL in the clinical setting are not yet well described. The goals of this study were to explicate student experiences of SDL in their clinical training and to identify the roles that local social and cultural contexts play in shaping their experiences of SDL.

METHODS

To understand students' conceptualization and experiences of SDL in the clinical setting, we carried out a qualitative study with 15 medical students at Harvard Medical School. The semi-structured interviews were recorded and transcribed. Using an interpretivist approach, data were analyzed both deductively and inductively using the Framework method of content analysis.

RESULTS

Participants described patient care activities as primary motivators for engagement in SDL in the clinical setting. Participants' descriptions of SDL aligned with Knowles' steps in SDL, with an additional step of consolidation of learning related to their patients' diagnosis and management. Participants described using a range of cognitive, social-emotional, and peer learning strategies to enhance their SDL. Participants who described a growth mindset appeared to engage in SDL more easily. Learning environments that fostered SDL were those in which faculty and residents demonstrated an educational orientation, promoted psychological safety, and invited student engagement. Teams with perceived excessive work demands were perceived to be less supportive of SDL.

CONCLUSIONS

Our study enhances previous classroom-based models of SDL by providing specific, practical implications for both students and faculty in the clinical training setting. Participants described SDL in the clinical setting as patient-centered, and when effectively implemented, SDL appears to support a mastery rather than performance orientation. Our study paves the way for improving medical students' clinical SDL and helping them become lifelong learners in the field of medicine.

Some Learning Theories for Medical Educators

Perspectives on the nature of learning influence decisions about curriculum design, teaching and learning strategies, and assessment of students. Current literature on medical education suggests that medical teachers have much interest in using theories to inform their practice. This article describes the following learning theories that have been discussed to various degrees in previous literature on medical education: cognitivism, constructivism, experiential learning, adult learning, self-directed learning, community of practice and situated learning, cognitive apprenticeship, and reflective learning. Each theory is explained in sufficient detail to help readers grasp its essence. Then, medical education literature is cited to show how the theory has been used or can be used to guide practice in medical education. Finally, this article analyzes the problem-based learning approach as an example to illustrate how the theories may be reflected in practice. Throughout the introduction of the various theories, this article aims at their application in medical education and attempts to draw connections among the theories rather than represent them as unrelated or competing ideas.

Attitudes and experience of urology trainees in interpreting prostate magnetic resonance imaging

INTRODUCTION

Multiparametric magnetic resonance imaging (mpMRI) has resulted in accurate prostate cancer localization and image-guided targeted sampling for biopsy. Despite its more recent uptake, knowledge gaps in interpretation and reporting exist. Our objective was to determine the need for an educational intervention among urology residents working with mpMRIs.

METHODS

We administered an anonymous, cross-sectional, self-report questionnaire to a convenience sample of urology residents in U.S. and Canadian training programs. The survey included both open- and closed-ended questions employing a five-point Likert scale. It was designed to assess familiarity, exposure, experience, and comfort with interpretation of mpMRI.

RESULTS

Fifty-three surveys were completed by residents in postgraduate years (PGY) 1-5 and of these, only 12 (23%) reported any formal training in mpMRI interpretation. Most residents' responses demonstrated significant experience with prostate biopsies, as well as familiarity with reviewing mpMRI for these patients. However, mean (± standard deviation [SD]) Likert responses suggested a relatively poor understanding of the components of Prostate Imaging-Reporting and Data System (PI-RADS) v2 scoring for T2-weighted films (2.45±1.01), diffusion-weighted imaging (DWI) films (2.26±0.90), and dynamic contrast-enhanced (DCE) films (2.21±0.99). Similar disagreement scores were observed for questions around interpretation of the different functional techniques of MRI images. Residents reported strong interest (4.21±0.91) in learning opportunities to enhance their ability to interpret mpMRI.

CONCLUSIONS

While mpMRI of the prostate is a tool frequently used by care teams in teaching centers to identify suspicious prostate cancer lesions, there remain knowledge gaps in the ability of trainees to interpret images and understand PI-RADS v2 scoring. Online modules were suggested to balance the needs of trainee education with the residency workflow.