Medical students' feedback regarding their clinical learning environment in primary healthcare: a qualitative study

Integrating Learners Into the Pediatric Primary Care Workflow: Strategies for Optimizing Teaching and Learning

Primary care pediatric providers play an important role in the education of future medical professionals. However, it may feel challenging to integrate a learner into out-patient practice given both time constraints and varying levels of experience among learners. Here we discuss how learners at various stages of training from different medical professions can be integrated into the outpatient pediatric clinical environment. We review eight teaching strategies and provide examples of their use in practice. The goal is to introduce tools to support teachers working with learners in the clinical environment to optimize educational experiences for both teachers and learners. [Pediatr Ann. 2024;53(10):e386-e391.].

Clinical students' perception of educational environment in a Nigerian university: a mixed method study

BACKGROUND

Learning environment (LE) research has been given priority in higher education institutions globally because of its influence on learning processes and outcomes. Although studies reporting the perceptions of health science students about LE in Nigeria are available, none have compared the perceptions of students from different health professions. Therefore, this study aimed to assess final-year clinical students' perceptions of their LE from four programs (dentistry, medicine, nursing, and physiotherapy) and compared their LE perceptions.

METHODS

This study adopted a cross-sectional study design using a mixed method approach. The quantitative survey involved all the final-year clinical students at the University of Ibadan, and they completed the Dundee Ready Education Environment Measure (DREEM) questionnaire. The qualitative aspect involved 24 consenting students in four focus group discussions.

RESULTS

A total of 214 out of 223 copies of the DREEM questionnaire were duly completed and returned, yielding 96.0% response rate. The participants' mean age was 24 ± 2.3 years (ranged between 22 and 25 years, p = 0.001). The mean DREEM scores of the students from the four programs ranged between 119.68 ± 18.02 and 147.65 ± 15.89 out of a maximum of 200, interpreted as more positive than negative perceptions of LE. Physiotherapy students' DREEM score was significantly higher than those of medical, dental, and nursing students (p < 0.001). The DREEM scores of other students did not differ significantly (p > 0.05). Dental and medical students had similar positive perceptions. The qualitative aspect revealed that the students had positive perceptions of their teachers' knowledge base and self-acquisition of knowledge but negative perceptions of their teachers' communication skills, infrastructural facilities, lecturer-student relationships, and hostel accommodations.

CONCLUSION

Although the survey indicated that these clinical students had more positive than negative perceptions of their learning environment, the qualitative aspect of the study revealed many challenges that the students were confronted with. The clinical students' perception of their learning environment could be improved if the university authorities would address these challenges.

Mapping interaction quality for nursing and medical students in primary care placement in municipal emergency care units: a systematic observational study

Introduction

Primary care placement for nursing and medical students is vital for developing the competence to accommodate the increasing number of patients with multimorbid and complex conditions. Prior studies have suggested that interaction quality in primary care placement empowers learning. However, research mapping interaction quality in primary care placements in municipal emergency care units is lacking. This study aimed to systematically map interaction quality for nursing and medical students in primary care placement in two municipal emergency care units.

Materials and methods

This study adopted a systematic descriptive observational design. Systematic observations (n = 201 cycles) of eight nursing students (n = 103 cycles) and six medical students (n = 98 cycles) were used to map interaction quality across six learning situations between March and May 2019. Observations were coded using the Classroom Assessment Scoring System-Secondary (CLASS-S). Data were analyzed using descriptive statistics and Spearman correlations.

Results

Interaction quality is described in three domains: (I) emotional support, (II) framework for learning, and (III) instructional support, and the overall measure, student engagement. The results indicated middle-quality interactions in the emotional and instructional support domains and high quality in the framework for learning domain and student engagement. Correlations exhibited similar patterns and ranged from non-significant to strong correlations.

Conclusion

The interaction qualities indicated a generally positive and supportive learning environment contributing to nursing and medical students' learning and active participation in work tasks related to their professional roles. Thus, this new form for primary care placement for nursing and medical students in the municipal emergency care units was found to be a positive learning arena. These results may enhance nursing and medical education programs in countries with similar health services and education. Health education, supervisors, peers, and others contributing to students' learning should recognize which interaction qualities may affect learning and how to improve quality, thus affecting supervisors' approach to training students. While the CLASS-S showed potential for mapping interaction qualities for nursing and medical students in primary care placement in municipal emergency care units, further studies are needed to validate the CLASS-S for use in clinical placement settings.

Medical students' perception of learning from patient encounters in primary health care; a qualitative interview study

BACKGROUND

Clinical practice gives medical students opportunities to develop clinical skills and to gain insight into their future profession as a physician. Students in the medical programme at Karolinska Institutet in Sweden had clinical practice in primary health care in nine of their 11 semesters. The aim of this study was to explore medical students' perceptions of learning from patient encounters in a primary health care context.

METHODS

The study was a qualitative inductive interview study. The 21 participating medical students were from their 3rd, 4th and 5th (final year) year of the study programme. A semi-structured interview guide was used. The data analysis was performed with qualitative content analysis.

RESULTS

The overarching theme of the study was: The individual patient encounters are the key to learning in primary health care. The patient encounters presented both useful opportunities and challenges that could contribute to the students' professional development. The following four categories were found: 1. Patient encounters in are instructive, rewarding and challenging. Practising in primary health care provided experience in meeting and communicating with a wide variety of patients. Students described it being challenging to trust in their own clinical competence and feeling a responsibility towards the patients. 2. Encounters with patients in primary health care provide opportunities for gradual professional development. Students had the opportunity of increasing independence based on their level of clinical competence. They experienced a progression in their professional development after each period in primary health care. 3. A committed supervisor plays a significant role in learning. Committed supervisors who set aside time for supervision, offered support, and encouraged the student, played an important role in the student's learning. 4. Learning in primary health care and learning in hospitals complement one another. It could be difficult for the students to sort out exactly where they learnt different things as they perceived that learning in primary health care and in hospitals complemented one another.

CONCLUSIONS

The students' encounters with authentic patients in primary health care gave them recurring opportunities to develop communication skills and to be trusted to work on their own under supervision, giving them guidance on their way to becoming future physicians.

'They never mentioned this in medical school!' A qualitative analysis of medical students' reflective writings from general practice

OBJECTIVE

The aim of the study was to identify final-year medical students' experiences with thought-provoking and challenging situations in general practice.

DESIGN SETTING AND SUBJECTS

We conducted a qualitative analysis of 90 reflective essays written by one cohort of Norwegian final-year medical students during their internship in general practice in 2017. The students were asked to reflect upon a clinical encounter in general practice that had made a strong impression on them. A primary thematic content analysis was performed, followed by a secondary analysis of encounters that stood out as particularly challenging.

MAIN OUTCOME MEASURES

Clinical scenarios in general practice that make students feel professionally 'caught off guard'.

RESULTS

The analysis identified several themes of challenging student experiences. One of these was 'disorienting encounters' for which the students felt totally unprepared in the sense that they did not know how to think and act. Five different scenarios were identified: (1) patients with highly distracting appearances, (2) 'ordinary consultations' that suddenly took a dramatic turn, (3) patients who appeared unexpectedly confrontational or devaluating, (4) scornful rejection of the young doctor's advice, and finally, (5) confusion related to massive contextual complexity.

CONCLUSIONS

Disorienting encounters stood out as particularly challenging clinical experiences for medical students in general practice. These scenarios evoked an acute feeling of incapacitation: not knowing what to think and do. Further curriculum development will focus on preparing the students to 'know what to do when they don't know what to do'.

Evaluation of learning environment of different family medicine programs, Jeddah-KSA, 2021

Background

A supportive educational climate in which learners are educated and monitored is a significant determinant of the medical trainees' performance and progress and eventually contributes to better patient care. Therefore, residents' training programs need to be assessed and incorporated according to the views and expectations of the candidates. The objectives of this research are to compare and evaluate the learning environment of Family Medicine (FM) programs in Jeddah and make practical recommendations for improvement of the learning environment.

Methods

A descriptive causal-comparative study was designed at FM programs in Jeddah, Saudi Arabia during January, and February 2021, including all residents from R1 to R4. A Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire was used in this study. The overall score and the three domains were calculated.

Results

Two hundred and eighty-three questionnaires were distributed, and 262 were completed and collected, making a response rate of 92.6%. Females represented were 150 (57.3%), and males were 112 (42.7%). The study shows that 78 (29.8%) of the residents reported that the learning environment was excellent, and 154 (58.8%) described it as a more positive than the negative environment, whereas 29 (11.1%) described it as having a lot of problems. Out of 160 maximum scores, the highest total score (127) was observed among residents at the National Guard program, whereas the lowest score (108) was in the FM joint program, P < 0.001.

Conclusion

Evaluation of the training programs is an essential component of quality assurance procedures. The satisfaction of the FM residents at different programs in Jeddah, Saudi Arabia, is better than reported previously, but however, further improvement is warranted. Juniors and residents of the National Guard program were more satisfied than their peers. We recommend low score items should have special consideration from high authorities and ongoing evaluation of the FM training program for further improvement of the learning environment.

Resources for clinical learning environment orientation

INTRODUCTION

Each clinical learning environment (CLE) requires learners to navigate a different set of complex interactions to engage in safe patient care while learning from real patients. Orientation forms the foundation for learning, yet CLE models in the literature are primarily written for an educator audience and practical advice for orienting learners to a new CLE is limited. To address this gap, we designed resources to support both supervisors and learners in the orientation process.

MATERIALS/METHODS

We reviewed the CLE literature to select critical content for orientation and interviewed high performing residents to identify their best practices. We synthesized the literature and resident interviews into a visually appealing and easy to digest infographic designed to simultaneously remind teachers of the critical areas to cover in orientation and empower learners to ask about them. We integrated these principles into an online module for Graduate Medical Education onboarding and surveyed users about how well they could meet the module learning objectives.

RESULTS

We organized the literature review and resident advice regarding questions learners should ask about a new CLE into the typical question categories (why, who, what, when, where, and how) and described strategies for orientation to each category. Our infographic has been incorporated into CLE orientation for multiple types of learners at our institution. After completing the orientation module, 112/124(90%) residents indicated that they could, 'Orient yourself or a learner to a clinical learning environment using orientation questions' moderately to extremely well.

DISCUSSION

We developed resources that can be used by educators to create orientation materials and by learners to ensure they understand important features, resources, and expectations in a new CLE. Because the foundational principles of CLE apply to a variety of clinical settings and learner types, the resources may be broadly applicable.

Medical students' learning experience and participation in communities of practice at municipal emergency care units in the primary health care system: a qualitative study

BACKGROUND

Medical education has been criticised for not adapting to changes in society, health care and technology. Internationally, it is necessary to strengthen primary health care services to accommodate the growing number of patients. In Norway, emergency care patients are increasingly treated in municipal emergency care units in the primary health care system. This study explores medical students' learning experience and how they participated in communities of practice at two municipal emergency care units in the primary health care system.

METHODS

In this qualitative study, we collected data from March to May 2019 using semi-structured individual interviews and systematic observations of six ninth-semester medical students undergoing two-week clerkships at municipal emergency care units. The interview transcripts were thematically analysed with a social constructivist approach. A total of 102 systematic observations were used to triangulate the findings from the thematic analysis.

RESULTS

Three themes illuminated what the medical students learned and how they participated in communities of practice: (i) They took responsibility for emergency care patients while participating in the physicians' community of practice and thus received intensive training in the role of a physician. (ii) They learned the physician's role in interprofessional collaboration. Collaborating with nursing students and nurses led to training in clinical procedures and insight into the nurses' role, work tasks, and community of practice. (iii) They gained in-depth knowledge through shared reflections when time was allocated for that purpose. Ethical and medical topics were elucidated from an interprofessional perspective when nursing students, nurses, and physicians participated.

CONCLUSIONS

Our findings suggest that this was a form of clerkship in which medical students learned the physician's role by taking responsibility for emergency care patients and participating in multiple work tasks and clinical procedures associated with physicians' and nurses' communities of practice. Participating in an interprofessional community of practice for professional reflections contributed to in-depth knowledge of ethical and medical topics from the medical and nursing perspectives.

How Do Clinical Supervisors and Managers in Swedish Primary Care Perceive Their Opportunities to Meet the Learning Needs of Medical Students?

INTRODUCTION

Primary health care centers (PHCCs) in Sweden are struggling to maintain a balance between increasing demands of service and supervision and learning activities for a growing number of students. We sought a deeper understanding of primary care physicians and managers behavioral intention towards supervising, and their perceptions of the structural preconditions and support needed.

METHODS

The study combines two theoretical approaches, the Theory of Planned Behavior (TPB) and Social Practice Theory. A questionnaire with 22 items including an open-ended question was designed to collect quantitative and qualitative data and sent to clinical supervisors and managers at PHCCs in Southern Sweden. The aim was to map a) participants' behavioral intention and perceived capacity to act to improve supervision and b) their perceptions of structural prerequisites and support needed to sustain and develop clinical supervision practice.

RESULTS

A total of 181 questionnaires were returned, with a total response rate of 60.7%. Behavior predictors (attitudes, subjective norms, and perceived behavioral control) were positively correlated to behavioral intention towards supervising and building supervising competence. Three themes emerged from the content analysis of the qualitative data: "Time and distribution", "Improved communication and support systems" and "Elimination of structural barriers.".

DISCUSSION

The manager and supervisor reports suggest that the intentions and capacity of individuals (individuals' agency) is not a strong barrier to high-quality supervising and teaching in PHCC. Organizational preconditions for sustaining and developing supervision practice exist, and structural barriers for exercising agency could be eliminated according to PHCC managers and supervisors. However, a conclusion of our study from a practice theory perspective is that how and to what degree primary care physicians engage in supervision and competence building is determined by how the workplace - and the medical school - afford participation in supervision-related workplace activities. Improved communication between medical school, managers and supervising physicians and on-site faculty development integrated in daily clinical work were described as important facilitators of a favorable supervision and learning environment.

Healthcare student-patient relationship and the quality of the clinical learning environment - a cross-sectional study

BACKGROUND

Relationships with patients are seen as the core component of establishing the quality of patient-centred care and promoting patients' autonomy and relevant use of services. A clinical learning environment that emphasizes relationship-based healthcare is essential for encouraging future healthcare professionals to work in partnership with patients. There is also broad agreement that the insight of patients should be used actively in healthcare students' clinical learning. The aim of this study was to describe healthcare students' perceptions of their relationship with patients and the quality of the clinical learning environment and to identify factors associated with both of these.

METHODS

A cross-sectional survey using an electronic questionnaire was applied to collect data from 1644 Finnish healthcare students, mostly nursing students, between January 2018 and May 2018. The data were analysed statistically using descriptive statistics, Spearman's correlation coefficients, and multifactor analysis of variance.

RESULTS

Students perceived the level of the student-patient relationship and the role of the teacher as good while pedagogical atmosphere, premises of care, premises of learning, and supervisory relationship were perceived to be at very good level. The correlations between the student-patient relationship and all clinical learning environment dimensions were perceived as moderate. Furthermore, a number of student-related factors associated with the student-patient relationship and the quality of the clinical learning environment were detected.

CONCLUSIONS

In this study, the rarely explored perspective of the student-patient relationship within the context of the clinical learning environment was included. The student-patient relationship and the quality of the clinical learning environment were perceived as good by the students, with a number of determining factors affecting these perceptions. Giving the student-patient relationship a role in clinical education may be conducive to students' learning with the patient in focus, and may thus promote the competence needed in the rapidly evolving healthcare environment and the changing scope of clinical practice.

Development and sustainment of professional relationships within longitudinal integrated clerkships in general practice (LICs): a narrative review

BACKGROUND

Longitudinal integrated clerkships (LICs) are a relatively new model of clinical medical education, whereby students participate in patient care over time and develop relationships with those patients', their clinicians, and other health care staff involved in the care of those patients. It has been called 'relationship-based education' but, to date, no review has investigated the development and impact of these central relationships within this curricula model.

AIMS

The aim of this study is to review the literature pertaining to relationships in LICs, specifically to understand how they come about and how they affect learning.

METHODS

The search strategy systematically explored PubMed, ERIC (EBSCO) and Academic Search Complete, using key words and MESH terms. Original research published in peer-reviewed journals between January 2007 and August 2020 that were written in the English language were included in the review.

RESULTS

After applying set inclusion and exclusion criteria, 43 studies were included in this review. A qualitative thematic analysis was undertaken, and results were synthesised narratively. Four distinct categories were identified: defining relationships in LICs, developing relationships in LICs, relationship maintenance and multi-stakeholder impact.

CONCLUSIONS

The longitudinal integrated clerkship model of clinical education facilitates the development of meaningful triangular relationships between student, clinical teacher and patient, which are the central drivers of successful learning within the context of an LIC. These relationships are nested in a set of important supporting relationships involving other supervisors, the medical school and university, the practice clinical and administrative team and peers.

Learning from a situation of discomfort - a qualitative study of physiotherapy student practice in mental health

Purpose: This qualitative study aimed to explore how physiotherapy students learn during practice as physical activity mentors for mentally ill individuals. The practice took place in an everyday environment without the presence of a supervisor.Methods: Information was collected through three focus group interviews with 16 students in their second year of study. The data were analyzed using thematic analysis, based on a sociocultural learning perspective.Results: Three main categories summarize the students' experiences. 1) Experimenting and adapting the activities. The students were challenged through communication and relationship-building, and they had to adapt the activities to the clients' state of mind; 2) Experiencing clients breaking social and cultural codes. The students felt responsible for ensuring the clients did not draw unwanted attention to themselves, which forced them to explore creative solutions; and 3) Learning from situations of discomfort. The students learned from having to cope with unpredictable and embarrassing situations without a supervisor present.Conclusions: Practice as physical activity mentors for mentally ill individuals can stimulate students' learning through reflection in and on action. To avoid stigmatizing behaviors, process experiences and enhance learning, we suggest a frequent and standardized access to supervision.

Students' engagement and perceptions of small group tutorial classes among undergraduate medical students

INTRODUCTION

Small group teaching is an educational strategy that may be used to facilitate learning. Tutorials enable an adult approach toward learning where students take responsibility for their own learning. We aimed to investigate the students' engagement and perceptions of small group tutorial classes among undergraduate medical students.

METHODS

A cross‑sectional, descriptive survey was conducted at the Subbaiah Institute of Medical Sciences, where we collected the data from 300 undergraduate students using convenience sampling method. A self‑administered questionnaire consisting of 22 items which was piloted on 20 students, and six experienced medical educators were consulted for face validation. The internal consistency of the questionnaire measured by Cronbach's alpha reliability test was 0.80. It was used to measure the students' perception on the effectiveness of tutorials with regard to learning experience, teamwork, confidence, communication skills, and role of the teacher. Statistical analyses included mean and standard deviation for the description of each item, t-test to compare the mean scores for gender and class year, and one‑way analysis of variance between groups for age group comparisons using SPSS version 24 software.

RESULTS

Students' overall perceptions of small group teaching effectiveness showed that tutorials were beneficial to their learning process (mean: 3.61±0.50). The majority of the students have positive perceptions toward small group effectiveness, particularly in learning experience (mean: 3.72±0.68) and teamwork (mean: 3.36±0.59). A significant difference was found between year 1 and year 2 students with regards to learning experience (p<0.001), teamwork (p<0.05), communication skills (p<0.05), and the role of the tutor (p<0.001). Additionally, the mean scores, measuring overall effectiveness of tutorials, for the 2nd year students were significantly higher than that for the 1^st year students (3.70± .41 and 3.50 ±0.57, (p<0.001).

CONCLUSIONS

The data of this study show that tutorial is an effective small group teaching method for medical students compared to large group teaching.

'Challenges in experiential learning during transition to clinical practice: A comparative analysis of reflective writing assignments during general practice, paediatrics and psychiatry clerkships'

INTRODUCTION

This study explored the reflective writing (RW) of senior medical students across a co-ordinated reflection education programme in General Practice, Paediatrics and Psychiatry clerkships during their transition to clinical clerkships. The study compared RW themes from within and across three clerkships in order to understand the influence clerkships had on experiential learning and developing professional identity.

METHODS

All medical students in their penultimate year were invited to participate in the study. 135 reflection assignments were analysed. A qualitative thematic analysis of students' RW was performed. An inductive approach was used and data saturation was achieved.

RESULTS

Clerkship specific themes were the intimacy of the experience in General Practice, the powerlessness students felt and the challenge of delivering family centred care in Paediatrics and the sense of perceived risk in Psychiatry. Common themes across the three clerkships were of emotional struggles in developing a professional identity.

CONCLUSION

There is an educational need for developmental space for students during General Practice, greater focus on preparing students for relationship building during Paediatrics and addressing stigma and personal safety issues in students during the Psychiatry clerkships. Across clerkships there is a need for better use of evidence based pedagogies to support emotional development.

Evaluation of the undergraduate family medicine programme of Faculty of Medicine, University of Kelaniya: quantitative and qualitative student feedback

BACKGROUND

Worldwide there is an increasing emphasis on the importance of primary care. The ministry of health Sri Lanka issued a directive in 2016 that training of doctors in primary care should be strengthened. Medical students of the Faculty of Medicine, University of Kelaniya follow a 1 month long clinical appointment in family medicine in their fourth year of study.

METHODS

Feedback is taken from students on completion of the appointment. Half the students from each group complete a pre tested structured feedback questionnaire that consists of answers to questions based on a likert scale with a space for free comments. The other half provide qualitative feedback. In this evaluation data were gathered from 185 (98%) students from all eight clinical groups throughout the year 2016. Quantitative data were analysed using SPSS version 22. Inductive thematic analysis was used to analyse the qualitative data from the Round Robin activity and free comments from the questionnaire.

RESULTS

The qualitative feedback provided a richer indepth overview of student ideas on the appointment compared to the quantitative data. In reflection of a desire for learning to be of relevance students wanted clinically oriented teaching focused on management. They preferred active teaching learning methods such as the opportunity to conduct consultations and receive immediate feedback. Students had a high regard for the teaching sessions by general practitioners at their clinics. The appointment had created an interest in the discipline of family medicine which could have an impact on future choice of career. There were indications to suggest that student attitudes towards patients may have evolved to be more patient centred. Students appreciated the inclusive and low stress ambience of the learning environment.

CONCLUSIONS AND RECOMMENDATIONS

Regular evaluation of teaching programmes helps maintain accountability of faculty and paves the way for more student centred teaching through the incorporation of students' views in devising teaching methods. This evaluation found that qualitative feedback provided more descriptive material to reflect on and therefore improve teaching on the programme. It is recommended that more use should be made of qualitative methodologies in programme evaluations.

Exploring undergraduate medical students' perception of learning procedural skills and its outcomes in clinical settings

INTRODUCTION

Learning procedural skills is one of the essential aspects of undergraduate medical education. However, learning procedural skills in clinical settings is less widely considered. This study aimed to explore the Iranian undergraduate medical students' perception of learning procedural skills and its outcomes in three universities of medical sciences in Iran.

METHODS

A descriptive exploratory qualitative methodology with an in-depth unstructured, face-to-face interview, and content analysis was used in this study. Sixteen students in clinical phases of general medical education programs from educational hospitals were selected using purposive sampling. According to the preferences of the participants, the interviews were conducted in medical schools or in hospitals.

RESULTS

The students participating in this study included 7 females and 9 males (totally 16 people) with a mean age of 23.7 years old with a range of 21-27 years. The three main themes of this study were "the gap of transferring formal teaching from skill lab to clinical placement", "learning self-leading procedural skills in clinical settings", and "students' dissatisfaction with patients' vulnerability" with 8 subthemes which were extracted and explained based on the students' perception.

CONCLUSION

Unsupervised and self-learning by medical students and weakness in controlling the learning process have undesirable results for patients and students.

Medical students' reflection on the family planning services at primary health clinics in Malaysia

CONTEXT

Family planning is crucial for everyone within the reproductive age to promote the health and welfare of every member of the family. For the medical students, it is essential to have core knowledge, understanding of family planning concept, and competency in communication skills with the patients. The final-year medical students are posted in Maternal and Child Health Clinics for 3 weeks to gain the knowledge and practical experiences on the primary healthcare in the community.

AIMS

The aim of this study was to explore the experiences of final-year medical students on family planning services offered at community clinics in Malaysia.

SETTINGS AND DESIGN

This was qualitative study.

SUBJECTS AND METHODS

This qualitative study used the data of the students' reflection written in the case reports on family planning. Coding, identification of subthemes, and themes were done by two researchers independently using RQDA software.

STATISTICAL ANALYSIS USED

Thematic analysis.

RESULTS

Final-year medical students who had exposure to the clinical services at primary care clinic, regarding Malay word (Klinik Kesihatan) gained the learning opportunities during family planning session such as learning by observation, clerking, and counseling the patients, understanding the barriers to utilizing services and learning for their self-improvement. These learning opportunities lead to developing the positive attitudes on their learning experiences and the positive attitudes toward the concept and services of family planning.

CONCLUSIONS

To have the better understanding of family planning services and provide the better care to the community in the future, the clinical exposure at the primary care clinics should be promoted for medical students in Malaysia.

Medical students' perceptions of small group teaching effectiveness in hybrid curriculum

OBJECTIVES

The objective of this study was designed to investigate medical students' perceptions of small group teaching effectiveness in a hybrid curriculum.

MATERIALS AND METHODS

A cross-sectional, descriptive survey was conducted at the School of Medicine, The University of the West Indies, St. Augustine where we collected the data from 195 undergraduate students. A self-administered questionnaire consisting of 25 items was used to measure students' perception on the effectiveness of problem-based learning (PBL) with regard to learning experience, teamwork, confidence, communication skills, and role of the tutor. Statistical analyses included mean and standard deviation for the description of each item; t-test to compare the mean scores for gender and class year, and one-way analysis of variance between groups for age group comparisons.

RESULTS

The students overall perceptions of small group teaching effectiveness showed that the PBL sessions were beneficial to their learning process (mean: 3.63 ± 0.46). Students have positive perceptions toward small group effectiveness, particularly in learning experience (mean: 3.98 ± 0.63) and teamwork (mean: 3.67 ± 0.58). The mean scores, measuring teamwork, for 2^nd year students was significantly higher than that for 1^st year students (3.76 ± 0.55 and 3.55 ± 0.60 respectively, P = 013). A similar significant trend was observed between 2^nd year and 1^st year students on communication skills (3.48 ± 0.67 and 3.29 ± 0.55, respectively, P = 0.046).

CONCLUSIONS

PBL is an effective small group teaching method for medical students. Faculty development and students' training programs are required before implementing PBL.

Medical students' perceptions of their learning environment during a mandatory research project

OBJECTIVES

To explore medical students´ perceptions of their learning environment during a mandatory 20-week scientific research project.

METHODS

This cross-sectional study was conducted between 2011 and 2013. A total of 651 medical students were asked to fill in the Clinical Learning Environment, Supervision, and Nurse Teacher (CLES+T) questionnaire, and 439 (mean age 26 years, range 21-40, 60% females) returned the questionnaire, which corresponds to a response rate of 67%. The Mann-Whitney U test or the Kruskal-Wallis test were used to compare the research environments.

RESULTS

The item My workplace can be regarded as a good learning environment correlated strongly with the item There were sufficient meaningful learning situations (r= 0.71, p<0.001). Overall satisfaction with supervision correlated strongly with the items interaction (r=0.78, p < 0.001), feedback (r=0.76, p<0.001), and a sense of trust (r=0.71, p < 0.001).  Supervisors´ failures to bridge the gap between theory and practice or to explain intended learning outcomes were important negative factors.  Students with basic science or epidemiological projects rated their learning environments higher than did students with clinical projects (χ²_{(3, N=437)}=20.29, p<0.001).

CONCLUSIONS

A good research environment for medical students comprises multiple meaningful learning activities, individual supervision with continuous feedback, and a trustful atmosphere including interactions with the whole staff.  Students should be advised that clinical projects might require a higher degree of student independence than basic science projects, which are usually performed in research groups where members work in close collaboration.