Implementation of self-directed learning within clinical clerkships

Learning Plan Use in Undergraduate Medical Education: A Scoping Review

PURPOSE

How to best support self-regulated learning (SRL) skills development and track trainees' progress along their competency-based medical education learning trajectory is unclear. Learning plans (LPs) may be the answer; however, information on their use in undergraduate medical education (UME) is limited. This study summarizes the literature regarding LP use in UME, explores the student's role in LP development and implementation, and identifies additional research areas.

METHOD

MEDLINE, Embase, PsycInfo, Education Source, and Web of Science databases were searched for articles published from database inception to March 6, 2024, and relevant reference lists were manually searched. The review included studies of undergraduate medical students, studies of LP use, and studies of the UME stage in any geographic setting. Data were analyzed using quantitative and qualitative content analyses.

RESULTS

The database search found 7,871 titles and abstracts with an additional 25 found from the manual search for a total of 7,896 articles, of which 39 met inclusion criteria. Many LPs lacked a guiding framework. LPs were associated with self-reported improved SRL skill development, learning structure, and learning outcomes. Barriers to their use for students and faculty were time to create and implement LPs, lack of training on LP development and implementation, and lack of engagement. Facilitators included SRL skill development, LP cocreation, and guidance by a trained mentor. Identified research gaps include objective outcome measures, longitudinal impact beyond UME, standardized framework for LP development and quality assessment, and training on SRL skills and LPs.

CONCLUSIONS

This review demonstrates variability of LP use in UME. LPs appear to have potential to support medical student education and facilitate translation of SRL skills into residency training. Successful use requires training and an experienced mentor. However, more research is required to determine whether benefits of LPs outweigh the resources required for their use.

Principles of oncology taught in a one-week course

BACKGROUND

Growing challenges in oncology require evolving educational methods and content. International efforts to reform oncology education are underway. Hands-on, interdisciplinary, and compact course formats have shown great effectiveness in the education of medical students. Our aim was to establish a new interdisciplinary one-week course on the principles of oncology using state-of-the-art teaching methods.

METHODS

In an initial survey, medical students of LMU Munich were questioned about their current level of knowledge on the principles of oncology. In a second two-stage survey, the increase in knowledge resulting from our recently established interdisciplinary one-week course was determined.

RESULTS

The medical students' knowledge of clinically important oncological topics, such as the diagnostic workup and interdisciplinary treatment options, showed a need for improvement. Knowledge of the major oncological entities was also in an expandable state. By attending the one-week course on the principles of oncology, students improved their expertise in all areas of the clinical workup in oncology and had the opportunity to close previous knowledge gaps. In addition, students were able to gain more in-depth clinical knowledge on the most common oncological entities.

CONCLUSION

The interdisciplinary one-week course on the principles of oncology proved to be an effective teaching method to expand the knowledge of the future physicians to an appropriate level. With its innovative and interdisciplinary approach, the one-week course could be used as a showcase project for the ongoing development of medical education in Germany.

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.

Does prior knowledge affect interaction dynamics and learning achievement in digital problem-based learning? A pilot study

Objective

Previous research on problem-based learning (PBL) describes that videotaped observations develop meaningful insights into cognitive processes in tutorial groups. Analysis regarding the amount of prior knowledge on learning achievement has not been investigated in medical education so far, although both are key factors of PBL success. Thus, we intended to analyse videos of digital problem-based learning (dPBL) sessions, focusing on knowledge acquisition and interaction dynamics among groups with different levels of prior knowledge to reveal any distinctions.

Methods

This study employed a pilot design by dividing 60 dental students into twelve subgroups with less or more prior knowledge, determined by a pre-semester multiple choice test (MCQ). The groups engaged in videotaped dPBL cases, which were examined regarding group interactions and tutor effectiveness. The learning achievement was assessed through a post-semester MCQ, an oral and practical exam.

Results

The video analysis showed that dPBL groups with less prior knowledge achieved significantly higher tutor effectiveness and group interaction utterances, but that the percentage of time in which utterances occurred was similar in both groups. Related to the MCQ results, the students with less prior knowledge learned four times more than those with profound previous abilities, but no significant difference was found in the results of the oral exam and practical exam.

Conclusions

The interaction dynamics in dPBL depend on the group's amount of prior knowledge. Especially groups including participants with less prior knowledge seemed to benefit from dPBL in comparison to groups with more prior knowledge. The dPBL groups acquired knowledge in different ways during the courses but, finally, all students arrived at a similar level of knowledge.

How does quiz activity affect summative assessment outcomes? An analysis of three consecutive years’ data on self-directed learning

Background: We investigated how quiz activities can improve summative assessment outcomes by analyzing the relationship between them.Methods: We used 217 first-year medical students’ medical informatics data from 3 consecutive years. We analyzed summative assessment outcomes between quiz completion and incompletion groups, one-time and multiple-time quiz learning groups, and three combined comparisons between subgroups of quiz learning activity frequencies: 1 versus 2, 3, 4, and 6 (group 1), 1 and 2 versus 3, 4, and 6 (group 2), and 1, 2, and 3 versus 4 and 6 (group 3). We then analyzed correlations between the final quiz scores and summative assessment outcomes.Results: The summative assessment means for students who completed quizzes and those who did not were 87.16±8.73 and 83.22±8.31, respectively (p=0.001). The means for the one-time and multiple-time quiz learning groups were 86.54±8.94 and 88.71±8.10, respectively (p=0.223). The means for combined subgroups were not significantly different between groups (p>0.05), although a statistically significant increasing trend was found from groups 1 to 3 (0.223>0.203>0.075 using the t-test and 0.225>0.150>0.067 using the Mann-Whitney test, respectively). Summative assessment scores were not significantly correlated with quiz scores (r=0.115, p=0.213).Conclusions: Quizzes helped students who used self-directed learning obtain better summative assessment outcomes. Formative quizzes presumably did not provide students with direct knowledge, but showed them their weak points and motivated them to work on areas where their knowledge was insufficient.

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.

Simulated ward round training in the medical curriculum Munich

Conducting a ward round in a structured and goal-oriented manner is one of the central competencies of a physician's work. Despite its relevance, ward round competence was only addressed in an unstructured way in the Medical Curriculum Munich (MeCuM) prior to 2011. Therefore, the project's aim was to implement an evidence-based course on medical ward round competence. This project report provides a guideline for developing such a training course. Project planning and development was guided by the steps of the "Kern cycle", beginning with needs assessment, learning objectives definition, and selection of appropriate teaching methods, and ending with implementation and evaluation.