Brazilian medical students' perceptions of expert versus non-expert facilitators in a (non) problem-based learning environment

The Use of Peer Teaching in the Online Clinical PBL: The Medical Students' Perspectives

Purpose

To evaluate medical students' perceptions about using peer teaching (PT) in the online Clinical PBL (C-PBL).

Materials and Methods

The C-PBL used in the Primary care Unit (PCU) of the medical course of the Ribeirao Preto University was adapted to the virtual environment. A PT session was included to enhance students' intrinsic motivation. This cross-sectional study applied a 14-item survey to evaluate the perceptions of 378 medical students from the first to the seventh semester about the use of PT in this context.

Results

According to participants' perceptions, the use of PT in the online C-PBL allowed the interactive participation of students and produced satisfactory knowledge acquisition. Preparing and presenting a slideshow and being taught by peers contributed significantly to their learning. The survey used to collect information presented a high internal consistency measured by Cronbach's alpha.

Conclusion

From the students' perspectives, the use of PT in the online C-PBL was satisfactory and improved learning for peer teachers and learners. This study contributes additional evidence suggesting that PT is an effective teaching strategy in online learning and can be associated with PBL. This finding has implications for curriculum development and the health system.

A Comparison of the Academic Achievement at the End of the Medicine Undergraduate Degree Program Between Students Who Only Used the University Admission Test and Those Who Used the University Admission Test Plus Marks from the High School National Exam (ENEM) at a Single Brazilian Center

Purpose

The role of marks in the University Admission Test (UAT) plus the marks from pre-university academic records in predicting academic achievement at the end of the Medicine undergraduate degree program is not completely known. This study was undertaken to compare the performance of marks in the UAT alone with those of the UAT plus marks from the National High School Exam (ENEM in Brazil) regarding students' outcomes at the end of the Medicine undergraduate degree program.

Methods

Fifty-one (51) students from the last semester (12th) of our Medicine undergraduate degree program were included in the study. They were divided into a group of those who used the marks obtained in the UAT plus the marks obtained in the ENEM (ENEM group, n=9), and those who only used the marks in the UAT (non-ENEM group, n=42). We compared the academic achievement of the non-ENEM group with that of the ENEM group regarding the mean marks obtained in the clerkship, in the Progress Test (PT), and in the Objective Structured Clinical Examination (OSCE).

Results

The mean scores obtained in the disciplines of the clerkship were higher in the non-ENEM group compared to the ENEM group (7.32 ± 0.41 vs 6.98 ± 0.31, p= 0.01). Both groups obtained similar mean marks in the OSCE and in the PT. A moderate correlation was observed between the marks in the clerkship with those of the UAT from the non-ENEM group (p=0.00006; r=0.45).

Conclusion

Marks of the UAT alone appear to be associated with a higher academic achievement in the clerkship than marks of the UAT plus scores obtained from the ENEM at the end of the Medicine undergraduate degree program.

Factors Affecting Knowledge and Attitude Towards Hybrid Problem-Based Learning Curriculum Among Academicians of the University of Gondar, Northwest Ethiopia

BACKGROUND

Adapting a tutor role in a hybrid problem-based learning (h-PBL) model is a challenge to novices. Therefore, this study aimed to assess the factors associated with the academicians' knowledge and attitude toward the h-PBL curriculum.

METHODS

An institution-based cross-sectional study was conducted from August 1st to 30th, 2021. A Simple random sampling was employed. Data were entered and analyzed with EpiData 4.6 and SPSS® version 25. Multivariable logistic regression analysis was fitted and adjusted odds ratio at a p-value of ≤0.05 and 95% confidence interval were used to declare significant association.

RESULTS

The study included 415 academicians with a response rate of 97.8%. Four-sixths (66.3%) of them have good knowledge (95% CI = 61.7-70.8). Being age 30-34 (AOR = 2.97; 95% = CI: 1.69-5.23), being age over 34 (AOR = 3.36; 95% CI = 1.6-6.66), currently teaching (AOR=1.84; 95 CI = 1.1-3.07) and having received PBL training (AOR = 1.9; 95% CI = 1.01-2.7) were significantly associated with good knowledge. More than half (51.1%) had a favorable attitude (95% CI = 46.3-55.9). Being age over 34 (AOR = 3.69; 95% CI: 1.98-6.89), having 5-9 (AOR = 2.21; 95% CI: 1.85-2.34) and above 9 years of experience (AOR = 1.53; 95% CI = 1.03-2.11), having received PBL training (AOR = 1.93; 95% CI = 1.17-2.8), ever-constructing PBL cases (AOR = 1.7; 95% CI = 1.08-2.68), and presence of rooms set aside for PBL sessions (AOR = 2.26; 95% CI = 1.2-4.16) were significantly associated with academicians' favorable attitude.

CONCLUSION

Academicians' knowledge and attitude towards the h-PBL curriculum can be improved with training, participation in PBL case construction, and setting rooms aside for PBL sessions.

Enhanced learning strategies of undergraduate medical students with a structured case presentation format

BACKGROUND

Improvement of the learning in undergraduate bedside teaching needs to be promoted through innovative interventions. Changes in the structured format (SF) for bedside case discussion may help students improve their learning experience and gain insights into collaborative self-directed learning. The aim of the present study was to encourage collaborative and self-directed learning strategies by MBBS undergraduate students through a new case presentation format structured for this purpose.

MATERIALS AND METHODS

This was an interventional study carried out in the year 2010-2011. A new SF for bedside cases presentation was developed. A comparison with the traditional format was done by holding one session in each format. Uniformity of topic and teaching style was ensured by having the sessions on pulmonary medicine cases with the same teacher. The student perspective of the educational process was analyzed using evaluation pro forma, Likert scale, and narratives.

RESULTS

Ninety final year and prefinal year MBBS students participated in this study. There was significantly higher participation in history taking (50.7%) and clinical examination (60%) in the SF. A higher statistically significant number of clinical possibilities were considered in the SF (85.3% vs. 66.6%). Similarly, significantly higher number of students indulged in self-directed learning and referred to learning resources in the SF. The SF provided students an active role (96.9%), encouraged access to resources (93.9%), and control of learning (75.7%). The additional interactive session was productive (90.9%), discussions were streamlined (66.6%), and the role of a teacher was considered important (75.7%).

CONCLUSION

The SF generated higher participation in the aspects of history taking, clinical examination, and consideration of differential diagnoses. It led to a perceived improvement in self-directed and collaborative learning among students.

The barriers and facilitators to implementing dementia education and training in health and social care services: a mixed-methods study

BACKGROUND

The health and social care workforce requires access to appropriate education and training to provide quality care for people with dementia. Success of a training programme depends on staff ability to put their learning into practice through behaviour change. This study aimed to investigate the barriers and facilitators to implementation of dementia education and training in health and social care services using the Theoretical Domains Framework (TDF) and COM-B model of behaviour change.

METHODS

A mixed-methods design. Participants were dementia training leads, training facilitators, managers and staff who had attended training who worked in UK care homes, acute hospitals, mental health services and primary care settings. Methods were an online audit of care and training providers, online survey of trained staff and individual/group interviews with organisational training leads, training facilitators, staff who had attended dementia training and managers. Data were analysed using descriptive statistics and thematic template analysis.

RESULTS

Barriers and facilitators were analysed according the COM-B domains. "Capability" factors were not perceived as a significant barrier to training implementation. Factors which supported staff capability included the use of interactive face-to-face training, and training that was relevant to their role. Factors that increased staff "motivation" included skilled facilitation of training, trainees' desire to learn and the provision of incentives (e.g. attendance during paid working hours, badges/certifications). "Opportunity" factors were most prevalent with lack of resources (time, financial, staffing and environmental) being the biggest perceived barrier to training implementation. The presence or not of external support from families and internal factors such as the organisational culture and its supportiveness of good dementia care and training implementation were also influential.

CONCLUSIONS

A wide range of factors may present as barriers to or facilitators of dementia training implementation and behaviour change for staff. These should be considered by health and social care providers in the context of dementia training design and delivery in order to maximise potential for implementation.

"Sage on the stage or guide on the side"-Undergraduate nursing students' experiences and expectations of bioscience tutors in a blended learning curriculum: A qualitative study

AIMS AND OBJECTIVES

This study sought to explore undergraduate nursing students' perceptions of the role and value of their bioscience tutors in a blended learning curriculum.

BACKGROUND

Blended learning approaches typically have reduced face-to-face contact with tutors-particularly in bioscience subjects which nursing students have traditionally found difficult, and the move to more web-based learning resources may compound this difficulty.

DESIGN

Qualitative descriptive study.

METHODS

This qualitative study was conducted with 19 undergraduate nursing students enrolled in bioscience subjects, at a large university in outer metropolitan Sydney, Australia in 2016. Semi-structured interviews were conducted over the telephone or face-to-face. Duration of interviews ranged from 13 to 71 min. Results were thematically analysed. EQUATOR guidelines for qualitative research (COREQ) applied.

RESULTS

Two main themes with accompanying sub-themes were identified. The first theme identified the importance of the tutor in bioscience, including their qualities, expertise and contextualisation of learning. The second theme provided insights into students' perceptions of what they considered good and poor approaches to learning.

CONCLUSIONS

This study has clearly shown that while nursing students appreciated the flexibility offered by the online component of a blended learning curriculum, they still wanted an experienced bioscience tutor with clinical experience for their face-to-face classes. While the tutor was seen as crucial to providing clarification and context for content that was often challenging, they also played a key role in engaging and motivating students and creating a learning environment where students felt empowered to ask questions and debate issues with their peers. Given the increased use of online learning, further research could determine if the current study findings are also applicable in nonscience areas of study.

RELEVANCE TO CLINICAL PRACTICE

The importance of students having a sound understanding of the biosciences for safe, effective clinical practice cannot be underestimated.

Students' perception of animal or virtual laboratory in physiology practical classes in PBL medical hybrid curriculum

Over the years, much criticism against animal use for physiology teaching has been made. Hence, replacement by suitable alternatives has increased in several pedagogical approaches. This study examined students' perceptions of animal versus virtual (video/computer) laboratory classes in physiological sciences associated with the effectiveness of the problem-based learning (PBL) hybrid curriculum. Three cohorts of medical students from the University of Ribeirão Preto, who participated in animal or virtual physiology classes or both, were asked to fill out a 5-point Likert questionnaire about knowledge acquisition/motivation, importance to PBL learning goals, skills acquired, need for animal use, academic formation, learning impairment, and alternative methods. We also assessed their grades in the final exam. A total of 350 students were included, in which 108 participated only in virtual classes, 120 only in practical animal laboratory classes, and 122 in both approaches. The majority agreed that the two methods improved their knowledge acquisition/motivation and helped to reinforce tutorial goals and to acquire skills. However, the cohort who experienced both approaches favored animal laboratory. Students believe animal use is needed and did not impair their learning. Conversely, their opinion about academic formation without animal laboratory classes was divided, as was whether this approach inspired them to seek alternative methods. Despite the different perceptions, there was no difference among the groups' final grades (7.3 ± 1 vs. 7.2 ± 1 vs. 7.2 ± 2 for virtual or practical animal laboratory classes or both, respectively). Therefore, virtual activities are not as effective as animal use in the opinions of the students, but they are successful strategies in physiology learning that can be used in practical classes in a hybrid PBL curriculum.

Formative assessment scores in tutorial sessions correlates with OSCE and progress testing scores in a PBL medical curriculum

BACKGROUND

Effective assessments programs are a challenge in problem-based learning (PBL). One of the main principles of this educational setting is the Formative Assessment (FA). We hypothesized that students' performance assessed by FA in tutorial sessions in a PBL curriculum is related to other summative assessments.

OBJECTIVE

To investigate the correlation among FA in tutorial sessions with grades obtained in Objective Structured Clinical Evaluation (OSCE) and Progress Testing (PT) to better understand the assessment process in PBL medical teaching approach and to predict student's future performance.

DESIGN

An observational cross-sectional study was conducted comparing FA, OSCE and PT scores from 4th to 8th semester medical students. Correlation analyses were performed using pooled and separate data from the 4th and 8th semesters.

RESULTS

From the 5th to 8th semester, OSCE scores were smaller compared to the FA, while PT scores were lower in all stages. In the pooled data, the correlation analysis showed a significant positive relationship between grades on FA and OSCE, FA and PT and OSCE and PT. A significant correlation among the three assessments strategies was also detected in the 8^th semester, but not in the 4th semester.

CONCLUSIONS

Assessment strategies in PBL approach, including FA, OSCE and PT, have positive correlations, which increases as the medical course becomes more complex.

Assessment test before the reporting phase of tutorial session in problem-based learning

PURPOSE

In our context, problem-based learning is not used in the preuniversity environment. Consequently, students have a great deal of difficulty adapting to this method, particularly regarding self-study before the reporting phase of a tutorial session. Accordingly, the aim of this study was to assess if the application of an assessment test (multiple choice questions) before the reporting phase of a tutorial session would improve the academic achievement of students at the preclinical stage of our medical course.

METHODS

A test consisting of five multiple choice questions, prepared by tutors of the module at hand and related to the problem-solving process of each tutorial session, was applied following the self-study phase and immediately before the reporting phase of all tutorial sessions. The questions were based on the previously established student learning goals. The assessment was applied to all modules from the fifth to the eighth semesters. The final scores achieved by students in the end-of-module tests were compared.

RESULTS

Overall, the mean test score was 65.2±0.7% before and 68.0±0.7% after the introduction of an assessment test before the reporting phase (P<0.05). Students in the sixth semester scored 67.6±1.6% compared to 63.9±2.2% when they were in the fifth semester (P<0.05). Students in the seventh semester achieved a similar score to their sixth semester score (64.6±2.6% vs 63.3±2%, respectively, P>0.05). Students in the eighth semester scored 71.8±2.3% compared to 70±2% when they were in the seventh semester (P>0.05).

CONCLUSION

In our medical course, the application of an assessment test (a multiple choice test) before the reporting phase of the problem-based learning tutorial process increases the overall academic achievement of students, especially of those in the sixth semester in comparison with when they were in the fifth semester.

Lecturing skills as predictors of tutoring skills in a problem-based medical curriculum

PURPOSE

Recruitment of tutors to work in problem-based learning (PBL) programs is challenging, especially in that most of them are graduated from discipline-based programs. Therefore, this study aims at examining whether lecturing skills of faculty could predict their PBL tutoring skills.

METHODS

This study included evaluation of faculty (n=69) who participated in both tutoring and lecturing within particular PBL units at the College of Medicine and Medical Sciences (CMMS), Arabian Gulf University, Bahrain. Each faculty was evaluated by medical students (n=45±8 for lecturing and 8±2 for PBL tutoring) using structured evaluation forms based on a Likert-type scale (poor to excellent). The prediction of tutoring skills using lecturing skills was statistically analyzed using stepwise linear regression.

RESULTS

Among the parameters used to judge lecturing skills, the most important predictor for tutoring skills was subject matter mastery in the lecture by explaining difficult concepts and responding effectively to students' questions. Subject matter mastery in the lecture positively predicted five tutoring skills and accounted for 25% of the variance in overall effectiveness of the PBL tutors (F=22.39, P=0.000). Other important predictors for tutoring skills were providing a relaxed class atmosphere and effective use of audiovisual aids in the lecture.

CONCLUSION

Predicting the tutoring skills based on lecturing skills could have implications for recruiting tutors in PBL medical programs and for tutor training initiatives.