Educators' consideration of learner motivation in ophthalmology education in medical school: Influences on teaching practice and course design

BACKGROUND

Ophthalmology education in medical school has historically neglected the impact of autonomous motivation on student learning and wellbeing. This study aimed to understand ophthalmology educators' consideration and application of student motivation in ophthalmology medical education.

MATERIAL AND METHODS

Lead ophthalmology educators from Australian and New Zealand medical schools participated in an online semi-structured in-depth interview. Interview transcripts were analysed using thematic analysis. Codes were generated and aligned into overarching themes.

FINDINGS

Six educators participated in the study. Five main themes arose from the transcripts: the lack of explicit consideration of student motivation, implicit consideration of motivation in curriculum design and in teaching practices, the impact of innovation on motivation and the relationship between teacher and student motivation. Participants also commented on trends in ophthalmology education including generalists' confidence in managing ophthalmic disease, the role of fundoscopy in medical education and time pressure on ophthalmology in medical schools.

CONCLUSION

There has only been an implicit instead of explicit consideration of motivation in ophthalmology education in medical school, which leaves an unfulfilled potential for teaching practices to impact the affective along with cognitive and metacognitive aspects of learning. This study highlights the need for motivation to be explicitly incorporated into the development of teaching practices and curriculum reform.

The experiences of social and health care and health sciences educators of implementing hybrid teaching in higher education: A qualitative study

BACKGROUND

Educators in the social and health care and health sciences fields play a key role in developing the competencies of health professionals and experts. The increase in hybrid education in higher education provides flexible education but also causes additional stress for educators. In order to develop educators' competencies in hybrid teaching, it is necessary to understand educators' experiences of that. In this study, hybrid teaching means synchronous face-to-face and distance teaching.

OBJECTIVES

The study aims to describe the experiences of social and health care and health sciences educators of hybrid teaching in higher education.

DESIGN

We employed a qualitative descriptive research design.

PARTICIPANTS

A total of 21 social and health care and health sciences educators were interviewed.

METHODS

The data was collected through semi-structured interviews in seven group interviews and an individual interview from February 2022 to April 2022. The data was analysed using inductive content analysis.

RESULTS

Educators felt that hybrid education brought flexibility to their teaching activities and have implemented it successfully. Moreover, educators shared that implementing hybrid teaching requires them to have pedagogical competence and technology skills, ensuring interaction with students and creating a safe learning environment. Their positive attitude towards digital pedagogy is essential. Educators recognised the need to ensure students' digital skills in hybrid education. Moreover, challenges related to assessment were also identified. Educators experienced increased workload due to pressures, psychological strain and distribution of attention. They felt that they needed support and adequate resources to implement it.

CONCLUSIONS

The results have societal value in enhancing educators' continual professional development, developing high-quality evidence-based teaching and student skills, and assessing and applying different digital solutions to hybrid education.

Ethics education: Nurse educators' main concern and their teaching strategies

BACKGROUND

To practice nursing ethics, students must first understand the ethical concepts and principles of their profession, but despite this knowledge, students face challenges in implementing ethical principles in clinical settings. The educational performance of nurse educators is critical in resolving these challenges. This study focused on the lived experiences of nurse educators.

OBJECTIVE

To address the main concern of educators when teaching ethics to undergraduate nursing students and how they deal with it.

RESEARCH DESIGN

We conducted this qualitative content analysis in Iran in 2020. We used individual semi-structured interviews to collect, record, and transcribe data, as well as Graneheim and Lundman method to analyze them.

PARTICIPANTS

and research context: We used purposive sampling to select 11 nurse educators who either were currently in the position of ethics educators or had taught ethics from Iranian universities of medical sciences.

ETHICAL CONSIDERATIONS

The present study received the code of ethics No. IR.MODARES.REC.1399.036. Participants were aware of the study's purpose and signed a consent form to participate in the study. We considered data confidentiality and the voluntary principle in data collection.

FINDINGS

Nurse educators' main concern was how to sensitize students to ethical principles in clinical settings, so they tried to involve students in the teaching process, to repeat and practice ethical principles and concepts, simplify and simulate ethical principles and concepts, and provide opportunities for students to gain clinical experiences.

DISCUSSION

To sensitize students to ethical nursing care, nurse educators try to institutionalize ethical principles using different teaching methods, including students' involvement in teaching, experiential learning through simulated situations, practice, repetition, and provision of opportunities for practice and experience.

CONCLUSION

Improving students' cognitive ability and objectifying moral concepts and principles for students will institutionalize moral values in them that are fundamental for their moral sensitization.

Why do I teach? Teachers' instrumental and prosocial motivation predict teaching quality across East and West

BACKGROUND

Individuals pursue teaching careers for numerous reasons, such as for instrumental or prosocial purposes.

AIMS

This study examined the personal (instrumental motivation) and social (prosocial motivation) utility of teaching as predictors of teaching quality in terms of clarity of instruction, classroom management, and cognitive activation.

SAMPLE

We used data from the Teaching and Learning International Survey (TALIS) 2018, which included 50,595 teachers from 1252 schools in 10 countries and regions.

METHODS

We performed a series of regression analyses to test a model of instrumental and prosocial motivation to predict three indicators of teaching quality (clarity of instruction, classroom management, and cognitive activation) while controlling for demographic characteristics (age, sex, educational level, and teaching experience). We examined this model in countries and regions from Eastern (Japan, Korea, Singapore, Shanghai and Taipei) and Western (Australia, Canada, New Zealand, United Kingdom and the United States of America) cultures.

RESULTS

Results demonstrated that instrumental motivation predicted clarity of instruction in the East and classroom management in both the East and West; prosocial motivation, however, was a more consistent predictor of all indicators of teaching quality, except classroom management in the West, across cultures.

CONCLUSION

Teachers' prosocial motivation to benefit others and contribute to society must be considered to understand teaching quality across various cultural contexts. Implications for theory, practice and policy are discussed.

Implementing and optimizing a communication curriculum in medical teaching: Stakeholders’ perspectives

Objective

The relevance of communication in medical education is continuously increasing. At the Medical Faculty of Hamburg, the communication curriculum was further developed and optimized during this project. This article aims to describe the stakeholders’ perceived challenges and supporting factors in the implementation and optimization processes.

Methods

The initial communication curriculum and its development after a one-year optimization process were assessed with a curricular mapping. A SWOT analysis and group discussions were carried out to provide information on the need for optimization and on challenges the different stakeholders faced.

Results

The curricular mapping showed that the communication curriculum is comprehensive, coherent, integrated and longitudinal. In both the implementation and the project-related optimization processes, support from the dean, cooperation among all stakeholders and structural prerequisites were deemed the most critical factors for successfully integrating communication content into the curriculum.

Conclusion

The initiative and support of all stakeholders, including the dean, teachers and students, were crucial for the project’s success.

Practice implications

Although the implementation of a communication curriculum is recommended for all medical faculties, their actual implementation processes may differ. In a “top-down” and “bottom-up” approach, all stakeholders should be continuously involved in the process to ensure successful integration.

Examining the dimensionality of pre-service teachers' enthusiasm for teaching by combining frameworks of educational science and organizational psychology

The aim of this study was to obtain a holistic understanding of pre-service teachers’ enthusiasm for teaching (a subject) by examining its structure as well as relevant factors that may be related to it in the first phase of teacher education. For this purpose, we considered two strands of research: educational science and organizational psychology. Accordingly, the professional competence model and the job demands and resources model helped to identify factors that are associated with pre-service teachers’ enthusiasm for teaching. Responses of 211 pre-service biology teachers indicated that enthusiasm for teaching can be considered as one-dimensional. Moreover, we found positive relationships between enthusiasm for teaching and academic self-concept, intrinsic career choice motives and occupational commitment. In contrast, we detected negative relations between enthusiasm for teaching and both emotional exhaustion and intention to quit. No significant relations could be found for enthusiasm for teaching and both professional knowledge and extrinsic career choice motives. Our findings highlight the importance of enthusiasm for teaching in the earliest stage of teachers’ careers. Thus, our study points out relevant factors that could help to maintain high enthusiasm and to keep (pre-service) teachers healthy and in the profession.

Effects of high-intensity training on the quality of life of cancer patients and survivors: a systematic review with meta-analysis

Cancer and associated medical treatments affect patients' health-related quality of life (HRQoL) by decreasing functional dimensions of physical, social, cognitive, and emotional well-being, while increasing short and late-term symptoms. Exercise, however, is demonstrated to be a useful therapy to improve cancer patients' and survivors' HRQoL, yet the effectiveness of high-intensity training (HIT) exercise is uncertain. This systematic review and meta-analysis aimed to analyse the effects of HIT on HRQoL dimensions in cancer patients and survivors as well as evaluate the optimal prescription of HIT. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) and examined Web of Science and PubMed (Medline) databases. Data were analysed utilizing Review Manager Software. Twenty-two articles were included in the systematic review and 17 in the meta-analysis. Results showed HIT improved global quality of life, physical functioning, role functioning, social functioning, cognitive functioning, fatigue, pain, dyspnea, and insomnia, compared to an inactive control group, yet no differences were found between HIT and low to moderate-intensity exercise interventions. Particular improvements in HRQoL were observed during cancer treatment and with a training duration of more than eight weeks, a frequency of 2 days/week, and a volume of at least 120 min/week, including 15 min or more of HIT. Our findings whilst encouraging, highlight the infancy of the extant evidence base for the role of HIT in the HRQoL of cancer patients and survivors.

Teaching bacterial infections in pharmaceutical studies: why not 'with students' instead of 'to students'?

In pharmaceutical studies, a course of bacteriology based on case studies provided by the teacher was transformed in a course based on a combination of student/teacher co-creation of cases and peer reviewing. Our objectives were to describe the perception of students about the new format and to assess the impact of changing on the learning outcomes. For teaching evaluation, we used a questionnaire and focus groups. The assessment of learning outcome was performed by comparing the students' scores in final tests with the previous and the revised course formats. The students embraced the creation of cases in small groups with the teacher. In addition, they reported a perception of weakened hierarchy between the teacher and themselves, an increase of their self-confidence and a better ability to transfer their learning to their professional activities in community pharmacies. Lastly, their opinion about the transferability of this format in other disciplines were divided.

Mental health interventions for college and university students during the COVID-19 pandemic: A critical synthesis of the literature

BACKGROUND

The aim of the study is to compare the emotional effects of COVID-19 among three different groups, namely: health personnel, medical students, and a sample of the general population.

METHODS

375 participants were recruited for this study, of which 125 were medical students (preclinical studies, 59; clinical studies, 66), 125 were health personnel (COVID-19 frontline personnel, 59; personnel not related with COVID-19, 66), and 125 belonged to the general population. The PHQ-9, GAD-7, and CPDI scales were used to assess the emotional impact. A multinomial logistic regression was performed to measure differences between groups, considering potential confounding factors.

RESULTS

Regarding CPDI values, all other groups showed reduced values compared to COVID-19 frontline personnel. However, the general population, preclinical and clinical medical students showed increased PHQ-9 values compared to COVID-19 frontline personnel. Finally, confounding factors, gender and age correlated negatively with higher CPDI and PHQ-9 scores.

CONCLUSIONS

Being frontline personnel is associated with increased COVID-19-related stress. Depression is associated, however, with other groups not directly involved with the treatment of COVID-19 patients. Female gender and younger age correlated with COVID-19-related depression and stress.

Rational emotive education for reducing stress of undergraduate students of religious education program: An experimental study

BACKGROUND

Rational emotive education (REE) program aims to improve the behavioral and mental health of students. This study objective was to evaluate the effect of an REE program on stress among undergraduate students of religious education program in Nigerian Universities.

METHOD

One hundred and fifty (150) religious education undergraduates who had high level of stress participated in the study. Participants were assigned to 2 different groups. The treatment group had 75 participants and while control group also had 75 participants. Data collection was done using the Perceived Stress Scale (PSS-10) while data analysis was done using independent sample t test and paired t test statistics at .05 probability level.

RESULTS

The REE program resulted in a significant decrease in level of stress among undergraduate students of religious education program in the treatment group compared with those students in the control group. Also, the effect of the REE program was maintained during the follow-up among undergraduate students of religious education program exposed to it.

CONCLUSION

The REE program can be used to assist undergraduate students of religious education program to manage their stress.

How Medical Educators Can Foster Equity and Inclusion in Their Teaching: A Faculty Development Workshop Series

PROBLEM

Diversity, equity, and inclusion are increasingly highlighted in medical education, but bias continues to disproportionately impact learners from racial and ethnic groups traditionally underrepresented in medicine. Many faculty struggle to engage with these concepts in their teaching and fear making mistakes, but few opportunities exist for faculty to develop their skills.

APPROACH

To advance the goal of fostering an equitable educational environment, the authors envisioned a series of faculty development workshops to cultivate faculty skills and comfort with incorporating equity and inclusion in their teaching, assessment, and curriculum development work. The authors conducted a needs assessment and followed Kern's 6-step process for curriculum development to build the workshop series.

OUTCOMES

Using local resources and expertise, the authors built a workshop series that culminated in a certificate in Teaching for Equity and Inclusion. The development process took 24 months; 22 faculty volunteered to design and teach 7 new workshops. Initial workshop offerings have reached 101 participants, and 120 faculty members have enrolled in the certificate. The workshops have been well received and are rated on par with or more highly than other faculty development offerings at the University of California, San Francisco.

NEXT STEPS

Future directions include assessing the impact of the certificate on participants and workshop faculty, creating opportunities for workshop faculty to share best practices, and exploring alternative models for participation. The authors' experience demonstrates the feasibility of creating a self-sustaining program that will advance faculty competence in the critical areas of diversity, equity, and inclusion.

Mentors' Beliefs About Their Roles in Health Care Education: A Qualitative Study of Mentors' Personal Interpretative Framework

PURPOSE

How mentors shape their mentoring is strongly influenced by their personal beliefs about the goals and purpose of mentoring, the possible activities associated with it, who decides on the focus of the mentoring relationship, and the strategies mentors choose to enact these beliefs in practice. In accordance with the personal interpretative framework, the authors operationalized mentors' beliefs as professional self-understanding (the what) and subjective educational theory (the how) of teaching and sought to identify different mentoring positions.

METHOD

Using a qualitative approach, the authors conducted semistructured interviews between December 2017 and January 2018 with 18 undergraduate mentors from Maastricht University in Maastricht, the Netherlands. The aim of the interviews was to reconstruct their personal interpretative framework. Before building a general pattern of explanation in a cross-case analysis, the authors performed a within-case analysis of the data, analyzing individual mentors.

RESULTS

This approach resulted in the identification and description of 4 mentoring positions: the (1) facilitator (service providing and responsive), (2) coach (development supporting and responsive), (3) monitor (signaling and collaborative), and (4) exemplar (service providing or development supporting and directive). Each position represents a coherent pattern of normative beliefs about oneself as a mentor (professional self-understanding) and how to enact these beliefs in practice (subjective educational theory).

CONCLUSIONS

Awareness of their mentoring position can help mentors understand why they act the way they do in certain situations and how this behavior affects their mentees' learning and development. It can also help mentors identify personal learning needs and, consequently, provide opportunities for faculty development.

Clinical Teachers' Perceptions of Their Role in Professional Identity Formation

PURPOSE

A fundamental goal of medical education is supporting learners in forming a professional identity. While it is known that learners perceive clinical teachers to be critically important in this process, the latter's perspective is unknown. This study sought to understand how clinical teachers perceive their influence on the professional identity formation of learners.

METHOD

In 2017, a research assistant conducted 16 semistructured interviews of clinical teachers from 8 specialties at McGill University. The research assistant audiorecorded and subsequently transcribed interviews for analysis. Following principles of qualitative description, the research team developed a coding scheme using both inductive codes (from the words of the participants) and deductive codes (based on the literature and the theory of communities of practice). Through a cross-case analysis, the team then identified salient themes.

RESULTS

Participants struggled to describe their influence on learners' professional identity without first being prompted to focus on their own identity and its formation. Once prompted, clinical teachers reported viewing their personal and professional identities as integrated and believed that caring for patients was integral to forming their professional identity. They identified explicit role modeling, engaging in difficult conversations, and providing graded autonomy as ways in which they could influence the identity development of learners. However, they had difficulty discerning the magnitude of their influence.

CONCLUSIONS

This study was the first to explore professional identity formation from the perspective of clinical teachers. The 2010 Carnegie Foundation report called for an increased focus on professional identity formation. Giving clinical teachers the space and guidance to reflect on this process, helping them make the implicit explicit, and supporting them in using their own experiences as learners to inform their teaching appear to be critical steps in achieving this goal.

The modified Peyton's approach and students' learning style

BACKGROUND

The aim of the study was to determine the predominant learning style and type of intelligence based on the VARK questionnaire and Multiple Intelligences Questionnaire respectively in second year medical students. Determining the relationship between individual preferences of students, based on their learning style and predominant type of intelligence and the perception of the modified Peyton's four-step approach used to teach cardiac auscultation.

METHODS

The opinion of participants 236 of the modified four-step approach was attained through the use of anonymous questionnaires. Using the VARK questionnaire, the participants' learning style was defined. The predominant type of intelligence was determined by the Multiple Intelligences Questionnaire.

RESULTS

The kinesthetic style was the predominant unimodal learning style in second year medical students (in Polish and international students). The most predominant type of intelligence in Polish students was visual-spatial and mathematical and logical, while in international students the predominant types were visual-spatial and mixed type of intelligence. Quantitative analysis indicated that the modified Peyton's approach is a valuable learning and teaching method for most students, independent of their predominant learning style or intelligence type. The exception was a small group of students with linguistic intelligence predominance according to the Multiple Intelligence Questionnaire, for which the Peyton method was more difficult.

CONCLUSIONS

This study proves that the modified Peyton's approach is useful and effective didactic tool and can be successfully applied to most students. This is a new learning strategy for teaching cardiac auscultation in laboratory conditions in classes for a significant majority. Due to the fact that a group of students with a predominance of linguistic intelligence more often perceived the Peyton method to be difficult, it is worth combining traditional methods with new ones in class so that all students, regardless of unimodal learning style or prevailing type of intelligence, are taught satisfactorily.

Art intervention among Finnish older people and their caregivers: Experiences of art pedagogies

The benefits of art therapies on older people's health have been well documented. However, studies into the perspectives of pedagogues on conducting arts interventions are scarce and no empirical evidence of the views of professional pedagogues views have been published to date. In this study, seven professional art pedagogues were interviewed using a thematic interview approach focusing on the pedagogues' experiences of conducting arts interventions with a family caregiver and care recipient dyads. The interviews were analysed inductively using thematic content analysis. According to the analysis, three intersecting themes were found that both steered the pedagogical process and emerged from the process: holistic pedagogy, professional development and witnessing. The themes revealed a further understanding of approaches to the interviewees' teaching and the value of participatory community arts in practice. The pedagogues' experiences encourage art pedagogy to be acknowledged in a wider context within communities and healthcare environments. Further studies on interdisciplinary projects in collaboration with art pedagogues and healthcare professionals are encouraged.

Leveraging Psychosocial Interventions to Motivate Instructor Participation in Teaching Professional Development

To promote undergraduate education reform, teaching professional development (TPD) efforts aim to encourage instructors to adopt evidence-based practices. However, many instructors do not attend TPD. There may be many reasons for this, including low intrinsic motivation to participate in TPD. Psychologists have dealt with motivational barriers in educational contexts using psychosocial interventions, brief activities that draw on a rich history of psychological research to subtly alter key, self-reinforcing psychological processes to yield long-term intrinsic motivation and behavioral changes. Psychosocial interventions, for example, have been used to alter students' noncognitive attitudes and beliefs, such as attributions and mindset, which positively influence students' motivation and academic performance. Here, we propose that insights from research on psychosocial interventions may be leveraged to design interventions that will increase instructors' motivation to participate in TPD, thus enhancing existing pedagogical reform efforts. We discuss psychological principles and "best practices" underlying effective psychosocial interventions that could guide the development of interventions to increase instructors' motivation to attend TPD. We encourage new interdisciplinary research collaborations to explore the potential of these interventions, which could be a new approach to mitigating at least one barrier to undergraduate education reform.

Exploring Chinese EFL teachers' knowledge and beliefs relating to the teaching of English reading in public primary schools in China

The present study explored knowledge and beliefs about reading instruction of Chinese teachers teaching English as a foreign language (EFL). Theoretical Orientation to Reading Profile and the Survey of Basic Language Constructs Related to Literacy Acquisition were administered to 262 EFL teachers in the south-eastern part of China. Additionally, three teachers were interviewed, and their instructional practices were observed. The results showed that there was no correlation between teachers' self-efficacy beliefs and the performance on the knowledge of basic language construct survey. However, it was found that teachers' knowledge, beliefs, and instructional practices were mediated by the Chinese EFL contextual factors. Educational and practical implications are discussed.

Testing Boundaries COVID-19 made the USMLE, Clerkships a Moving Target for Med Students

Medical schools typically have predictable schedules. The timing of lectures, clerkships, exams, and even extracurricular activities tend to follow in the same grooves year after year. Students can reliably block out even minor events months ahead of time and be confident they'll take place. All that changed with COVID-19. Since March, when the pandemic began closing down schools, businesses, and other institutions across the state, figuring out what comes next in medical school has been anything but predictable.

An exploration of the relationship between phonological and phonics knowledge, and self-efficacy for teaching

The purpose of the present study was to survey trainee teachers to find out if there was a relationship between phonological and phonics content knowledge, perceived proficiency in this knowledge, and feelings of self-efficacy as teachers. Participants were 51 undergraduate international teacher trainees from Malaysia studying in a 4-year university program to teach English as another language. They completed a phonological and phonics knowledge survey as well as a short questionnaire relating to self-efficacy for teaching. The survey results showed, similar to previous studies of the linguistic knowledge of teachers and teacher trainees, difficulties with phonological and phonics knowledge. Students who thought they were proficient in phonological and phonics knowledge were higher in phonological knowledge but not in phonics scores than were students who thought they were less proficient. The results for teaching self-efficacy showed that students with higher phonological knowledge had higher levels of external teaching self-efficacy in that they tended to disagree that factors outside their control made it difficult for some pupils to succeed. This suggests that higher levels of phonological knowledge gives prospective teachers more self-belief in their ability to help all their pupils.

Case presentation methods: a randomized controlled trial of the one-minute preceptor versus SNAPPS in a controlled setting

INTRODUCTION

One-minute preceptor (OMP) and SNAPPS (a mnemonic for Summarize history and findings; Narrow the differential; Analyze the differential; Probe the preceptor about uncertainties; Plan management; and Select case-related issues for self-study) are educational techniques developed to promote learners' expression of clinical reasoning during the case presentation in the workplace. The aim of this present study was to compare the content of the case presentation between the SNAPPS and the OMP methods.

METHODS

This was a randomized controlled trial comparing SNAPPS and OMP in 60 medical students at the beginning of their fifth year of medical school. After an introduction session, students presented and discussed two cases based on real patients and provided in written format. All case presentations were recorded and evaluated by two researchers. The assessed elements of the case presentations were divided into three subgroups related to expression of clinical reasoning, time and initiative to guide the presentation.

RESULTS

There were 30 participants in each group. There was no difference in the expression of clinical reasoning between OMP and SNAPPS groups (number of differential diagnoses, justification of most likely diagnosis and differential diagnosis, expression of comparing and contrasting hypotheses). However, students in the SNAPPS group expressed significantly more questions and uncertainties (p < 0.001), and more often took the initiative to present and justify the most likely diagnosis, differential diagnosis and management plan than students in the OMP group, both in simple and complex cases (all p values <0.001) without extending the length of the teaching session.

CONCLUSION

OMP and SNAPPS equally promote medical students' expression of clinical reasoning. The SNAPPS technique was more effective than the OMP technique in helping students to take on an active role during case presentation. We propose SNAPPS as an effective learning tool, engaging students and promoting the expression of their clinical reasoning as part of a case presentation.

A Reflective Cybernetic Study on the Experiences of a Gay Male Teacher in the Free State Province

Sexuality education has become a core component in advancing the ideals of social justice and inclusivity within schooling environments. Its implementation has, however, been met with resistance as its sensitive nature often leads to conflicting messages, especially in relation to the myriad cultures and ambiguity thereof when placed against the contrasting values characteristic of multicultural South Africa. This article speaks to my experiences as a gay male teacher within the context of teaching at primary and secondary schools in the Free State province. I draw on the challenges and barriers I experienced, especially as a new teacher, and reflect critically on how this influenced my growth as an educator in the following years. Primarily, my approach and pedagogy were positioned within silence and uncritical reflection as to how my teachings can align with the ideals of social justice and inclusivity. Framed through a cybernetic perspective, I investigate how my pedagogy has adapted and transformed toward a less reactive approach and in turn aligned more actively with these ideals. This study is a self-reflective narrative that accounts for my experiences within different systems and how my presence influenced the systemic dynamics of the schools in which I taught.

Longitudinal team training programme in a Norwegian surgical ward: a qualitative study of nurses' and physicians' experiences with teamwork skills

OBJECTIVES

Teamwork and interprofessional team training are fundamental to ensuring the continuity of care and high-quality outcomes for patients in a complex clinical environment. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based team training programme intended to facilitate healthcare professionals' teamwork skills. The aim of this study is to describe healthcare professionals' experiences with teamwork in a surgical ward before and during the implementation of a longitudinal interprofessional team training programme.

DESIGN

A qualitative descriptive study based on follow-up focus group interviews.

SETTING

A combined gastrointestinal surgery and urology ward at a hospital division in a Norwegian hospital trust.

PARTICIPANTS

A convenience sample of 11 healthcare professionals divided into three professionally based focus groups comprising physicians (n=4), registered nurses (n=4) and certified nursing assistants (n=3).

INTERVENTIONS

The TeamSTEPPS programme was implemented in the surgical ward from May 2016 to June 2017. The team training programme included the three phases: (1) assessment and planning, (2) training and implementation and (3) sustainment.

RESULTS

Before implementing the team training programme, healthcare professionals were essentially satisfied with the teamwork skills within the ward. During the implementation of the programme, they experienced that team training led to greater awareness and knowledge of their common teamwork skills. Improved teamwork skills were described in relation to a more systematic interprofessional information exchange, consciousness of leadership-balancing activities and resources, the use of situational monitoring tools and a shared understanding of accountability and transparency.

CONCLUSIONS

This study suggests that the team training programme provides healthcare professionals with a set of tools and terminology that promotes a common understanding of teamwork, hence affecting behaviour and communication in their daily clinical practice at the surgical ward.

TRIAL REGISTRATION NUMBER

ISRCTN13997367.

Pharmacy educators' views on graduate attributes and case-based learning in an undergraduate degree

BACKGROUND AND PURPOSE

The nature, form, and process of activating graduate attributes is an expanding research focus within the field of professional education. The focus on graduate capabilities has led to higher education institutions interrogating current curricula practices with a view to exploring innovative ways to transform curricula and pedagogy. This article explores pharmacy educators' views on which graduate attributes are important and investigates the role of case-based learning (CBL) in developing graduate attributes in a single university program.

EDUCATIONAL ACTIVITY AND SETTING

This qualitative study is based on data drawn from reflective interviews with pharmacy educators on graduate attributes and from document analysis. Data were analyzed against a framework of graduate attributes and grouped into three domains encompassing knowledge and action as well as construction of graduates' identities as members of a profession.

FINDINGS

The graduate attributes identified by pharmacy educators resonated with the extant literature, organizational policy documents, and the professional council's accreditation framework. The domains of knowledge (Domain 1) and possessing and displaying (Domain 2) are sufficiently addressed in the curriculum. However, engagement with identity construction and roles and responsibilities (Domain 3) appears to be relatively less-developed through CBL.

SUMMARY

While CBL in its current form exhibits limitations with regard to developing Domain 3, it has the potential to develop this through emotionally rich cases, role models, and greater integration of CBL and inter-professional education (IPE) as well as making graduate attributes more explicit within the curriculum.

Perceiving a calling, living a calling, and calling outcomes: How mentoring matters

In this study, we integrate two careers-related literatures-callings research and mentoring research-by examining how mentoring relationships might help close the gap between people's perception of a calling and actually living out their calling. Drawing on work as calling theory (WCT; Duffy, Dik, Douglass, England, & Velez, 2018) as a framework, our results first revealed that, consistent with previous research, perceiving a calling is an important antecedent to living a calling. However, in our sample of 129 U.S. teachers, results further showed that the relationship between perceiving a calling and living a calling is stronger for those with a mentor in their profession. We additionally extend WCT by examining both positive and potentially negative outcomes associated with living a calling, focusing on stress-related outcomes. Our findings revealed that, in addition to reporting higher levels of job satisfaction and work engagement, those who were living their calling experienced lower rates of stress-related absenteeism and reported fewer somatic complaints than those who did not believe they were living their calling. In sum, this study is unique in its integration of two focal careers-related literatures, and it provides practical implications for professionals, counselors, educators, and organizations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Investigating the Effects of Spacing on Working Memory Training Outcome: A Randomized, Controlled, Multisite Trial in Older Adults

OBJECTIVE

The majority of the population will experience some cognitive decline with age. Therefore, the development of effective interventions to mitigate age-related decline is critical for older adults' cognitive functioning and their quality of life.

METHODS

In our randomized controlled multisite trial, we target participants' working memory (WM) skills, and in addition, we focus on the intervention's optimal scheduling in order to test whether and how the distribution of training sessions might affect task learning, and ultimately, transfer. Healthy older adults completed an intervention targeting either WM or general knowledge twice per day, once per day, or once every-other-day. Before and after the intervention and 3 months after training completion, participants were tested in a variety of cognitive domains, including those representing functioning in everyday life.

RESULTS

In contrast to our hypotheses, spacing seems to affect learning only minimally. We did observe some transfer effects, especially within the targeted cognitive domain (WM and inhibition/interference), which remained stable at the 3-month follow-up.

DISCUSSION

Our findings have practical implications by showing that the variation in training schedule, at least within the range used here, does not seem to be a crucial element for training benefits.

Stress in Physical Education Teachers: A Systematic Review of Sources, Consequences, and Moderators of Stress

Purpose: The purpose of this systematic review was to identify sources of stress, consequences of chronic stress and moderators of stress in physical education teachers and to formulate implications for future research and teacher education. Methods: The initial search identified 2483 publications, including 47 that met the inclusion criteria. Results: The most important sources of stress in physical education teachers were the curriculum, inadequate facilities/equipment, the low status of PE and students´ discipline problems. Regarding the consequences of chronic stress, the majority of studies assessed burnout and reported low to moderate levels of burnout in general. However, of the studies that reported percentages, 20-25% of physical education teachers indicated high levels of burnout. Conclusions: Regarding the relationship between sources of stress and consequences of chronic stress in physical education teachers, future studies should (a) take into account the whole stress process (b) use more adequate measures for stress and (c) address potential moderators of stress. In terms of practical implications, PE teachers should receive an adequate pre- and in-service training that aims at being aware of the main sources of stress in PE teachers and building up adequate coping strategies. In addition, PE teacher education should consider interventions to prevent health consequences of stress such as voice disorders.

Evaluation of educational quality performance on virtual campuses using fuzzy inference systems

The general objective of this study is to analyze student satisfaction with the use of virtual campuses in university teaching in order to discover the main variables influencing the overall online teaching-learning process that give quality to the virtual educational process. To this end, an ex-post-facto research methodology was applied to 1084 university students, who completed an ad hoc designed questionnaire, which allowed us to carry out descriptive analysis, classification trees and fuzzy inference systems using SPSS and Matlab software. The results suggest that four variables predominantly influence the quality of the teaching-learning processes in virtual campuses: satisfactory teacher responses to student questions and observations, the positive attitude of teachers towards the use of information and communication technologies, students having appropriate digital skills, and activities that encourage ideas and debate.

Differences in study workload stress and its associated factors between transfer students and freshmen entrants in an Asian higher education context

Unlike the studies of freshmen entrants, the learning experiences of community college transfer (CCT) students in the receiving university is a topic that has only started to gain attention in recent decades. Little is known about the differences between CCT and freshmen entrants with regard to their study workload stress and its relationship with their perceptions of the teaching and learning environment, approaches to learning, self-efficacy and generic skills. The purpose of our study was to address this gap. This was a cross-sectional survey study conducted from April 2018 to November 2018 in a university in Hong Kong. The HowULearn questionnaire was adapted to local usage and validated for data collection. In total, 841 CCT students and 978 freshmen entrants completed the survey. The respondents were aged between 19 and 52 years (mean = 21.6, SD = 1.92), and 66.0% were women. The HowULearn questionnaire was determined by factor analyses to have eight factors. The reliabilities of the eight factors were found to be acceptable (Cronbach alphas = 0.709-0.918). The CCT students scored significantly higher than the freshmen entrants for perceived study workload stress and surface approaches to learning, but lower on teaching for understanding & encouraging learning, peer support, and self-efficacy beliefs. The surface approach to learning, deep & organized studying, alignment & constructive feedback, and generic skills were found to be predictors of study workload stress in both groups of students, and in the overall student data. This study has shown that CCT students and freshmen entrants differed with regard to their study workload stress and learning experiences. Our findings provide a message, both for educators in higher education and policy makers in the government-there is not a one-size-fits-all approach to different student populations when it comes to enhancing their learning experiences.

Learning Challenges, Teaching Strategies, and Cognitive Load: Insights From the Experience of Seasoned Endoscopy Teachers

PURPOSE

Learners of medical procedures must develop, refine, and apply schemas for both cognitive and psychomotor constructs, which may strain working memory capacity. Procedures with limitations in visual and tactile information may add risk of cognitive overload. The authors sought to elucidate how experienced procedural teachers perceived learners' challenges and their own teaching strategies in the exemplar setting of gastrointestinal endoscopy.

METHOD

The authors interviewed 22 experienced endoscopy teachers in the United States, Canada, and the Netherlands between May 2016 and March 2019 and performed thematic analysis using template analysis method. Interviews addressed learner challenges and teaching strategies from the teacher participants' perspectives. Cognitive load theory informed data interpretation and analysis.

RESULTS

Participants described taking steps to "diagnose" trainee ability and identify struggling trainees. They described learning challenges related to trainees (performance over mastery goal orientation, low self-efficacy, lack of awareness), tasks (psychomotor challenges, mental model development, tactile understanding), teachers (teacher-trainee relationship, inadequate teaching, teaching variability), and settings (internal/external distractions, systems issues). Participants described employing strategies that could match intrinsic load to learners' levels (teaching along developmental continuum, motor instruction, technical assistance/takeover), minimize extraneous load (optimize environment, systems solutions, emotional support, define expectations), and optimize germane load (promote mastery, teach schemas, stop and focus).

CONCLUSIONS

Participants provided insight into possible challenges while learning complex medical procedures with limitations in sensory channels, as well as teaching strategies that may address these challenges at individual and systems levels. Using cognitive load theory, the authors provide recommendations for procedural teachers.

Preschool teachers' language and vocabulary knowledge: Development and predictive associations for a new measure

The present study reports on the development, structure, and associations with practice for a new measure of preschool teachers' knowledge about language and vocabulary development and how to support this development in the classroom. Results from item response theory models with responses from a sample of 248 preschool teachers indicated that four scales measuring pedagogical content knowledge and content knowledge for vocabulary and language, respectively, had adequate psychometric characteristics. Confirmatory factor analyses further supported a four-factor structure, although all scales were correlated. In an overlapping sample of 94 preschool teachers, preliminary investigation of associations between knowledge and teachers' self-reported practices, observed instructional time allocation, and the quality of classroom language environments were mixed. Results indicate promise for the measure yet add to prior research suggesting that connections between knowledge and practice are highly complex and likely interwoven with many other influences on instructional decision-making in early childhood classrooms.

Going beyond defining: Preschool educators' use of knowledge in their pedagogical reasoning about vocabulary instruction

Previous research investigating both the knowledge of early childhood educators and the support for vocabulary development present in early childhood settings has indicated that both educator knowledge and enacted practice are less than optimal, which has grave implications for children's early vocabulary learning and later reading achievement. Further, the nature of the relationship between educators' knowledge and practice is unclear, making it difficult to discern the best path towards improved knowledge, practice, and children's vocabulary outcomes. The purpose of the present study was to add to the existing literature by using stimulated recall interviews and a grounded approach to examine how 10 preschool educators used their knowledge to made decisions about their moment-to-moment instruction in support of children's vocabulary development. Results indicate that educators were thinking in highly context-specific ways about their goals and strategies for supporting vocabulary learning, taking into account important knowledge of their instructional history with children and of the children themselves to inform their decision making in the moment. In addition, they reported thinking about research-based goals and strategies for supporting vocabulary learning that went beyond simply defining words for children. Implications for research and professional development are discussed.

Teachers' knowledge about language constructs related to literacy skills and student achievement in low socio-economic status schools

Teachers' knowledge is a critical component to students learning to read proficiently. The present research sought to determine the literacy knowledge of 150 urban, elementary school teachers from 11 low socio-economic schools in one of nation's largest cities. Teachers' ability to understand concepts relating to phonological awareness, phonemic awareness, alphabetic principle/phonics, and morphology as well as their knowledge about teaching these fundamental skills were assessed through a standardized measure. Using exploratory factor analysis to understand the latent constructs underlying the survey scores and hierarchical linear modelling on factor scores of each construct, the results revealed that teachers located in low socio-economic status schools did not have explicit knowledge needed to effectively teach struggling readers. Although the teachers possessed a high level of knowledge regarding syllable counting skills, they lacked knowledge related to morphology. Practical implications are provided to assist teachers in increasing their literacy knowledge.

Early childhood educators' knowledge about language and literacy: Associations with practice and children's learning

Educators' language and literacy knowledge is considered important for informing classroom practices and thereby supporting children's early language and literacy development. This includes both disciplinary content knowledge (knowledge concerning how oral and written language are structured and map to one another) and knowledge for practice (knowledge of effective strategies and practices for supporting early language and literacy). In this study, we examined the associations among 485 early childhood educators' content knowledge and knowledge for practice, their observed language and literacy practices, and the emergent literacy learning of 2004 children enrolled in their classrooms. We found significant, positive correlations between measures of educators' content knowledge and knowledge for practice and classroom practice, indicating that early childhood educators with greater levels of knowledge tended to exhibit more desirable classroom language and literacy practices. We also found significant, positive associations between educators' knowledge and children's print concept, letter naming, and phonological awareness learning, but not children's oral language learning. The associations between educators' knowledge and children's print concept learning were mediated by classroom practice. Together, these results reiterate the importance of educators' language and literacy knowledge and also provide some support for practice as the mechanism through which knowledge relates to children's learning.

Preservice educators' and noneducators' knowledge and perceptions of responsibility about dyslexia

More individuals are affected by dyslexia than any other learning disability. The success of students with dyslexia receiving early identification and evidence-based interventions is dependent upon the knowledge and skills of the school practitioners responsible for their academic programmes. This study investigated knowledge of dyslexia and perceptions of responsibility by administering the Knowledge and Insights of Dyslexia Survey (KIDS) to 243 university students. Survey responses of students (n) majoring in degrees in education (education majors [EM], n = 154) were compared with the responses of students majoring in degrees in architecture (noneducation majors [NEM], n = 89). In addition, the results were further examined between students majoring in General Education, Special Education, and School Psychology. Results indicated no significant differences in knowledge existed between EM and NEM or within EM. Of the topics investigated, participants knew the least about the treatment of dyslexia and demonstrated confusion about the components of appropriate instruction. Analysis of participant definitions revealed pervasive confusion about the characteristics of dyslexia with most believing myths that those with dyslexia "see and read backwards." Additionally, EM rated themselves as being moderately responsible for educating students with dyslexia and believed special educators hold the greatest level of responsibility.

Medical students' ratings of the relevance and actual implementation of interprofessional education and preferences for teaching formats: comparison by gender and prior education

Objectives: Interprofessional education is becoming increasingly important for collaboration in patient care. In the national context, there are few empirical studies on the assessment of medical students as important stakeholders in their education. Method: Students (N=2,974) participated in a semester-wide online evaluation of the modular curriculum of medicine at the Charité Berlin. Socio-demographic data (including gender, completion of prior education/studies), assessments of the relevance and extent of interprofessional collaboration and preferences for interprofessional education in various teaching formats were collected. Results: In total, data from 1,019 students were included in the evaluation. The relevance of interprofessional collaboration was considered high by medical students. Female students rated the relevance higher than male students. The completion of pre-education (vocational training or study) had no additional influence. The actual implementation of interprofessional education was rated equally low by female and male students. Medical students rated patient-centred, interactive small group formats as particularly suitable for interprofessional education. There were no gender differences, but the effect was more pronounced among students with vocational training. Conclusion: The assessments of female and male students show a large difference between the perceived relevance and the actual implementation of interprofessional collaboration in the modular curriculum of medicine. This study provides an empirical basis for the actual implementation of interprofessional collaboration and students' views on suitable teaching formats for interprofessional education.

Using lectures to identify student misconceptions: a study on the paradoxical effects of hyperkalemia on vascular smooth muscle

Medical students have difficulty understanding the mechanisms underlying hyperkalemia-mediated local control of blood flow. Such control mechanisms are crucial in the brain, kidney, and skeletal muscle vasculature. We aimed to identify medical students' misconceptions via assessment of students' in-class knowledge and, subsequently, improve future teaching of this concept. In-class polling was performed with the TurningPoint clicker response system (n = 860) to gauge students' understanding of three physiological concepts related to hyperkalemia: membrane potential (V_m), conductance, and smooth muscle response. V_m includes the concepts of equilibrium potential (V_eq) for specific ions, as well as driving force (DF = V_m - V_eq). Students understood the concept of DF (~70% answered correctly), suggesting their understanding of V_m. However, students misunderstood that hyperkalemia results in depolarization (~52% answered correctly) and leads to an increase in potassium conductance (~31% answered correctly). Clarification of the type of smooth muscle as vascular increased the percentage of correct responses (~51 to 73%). The data indicate that students lacked knowledge of specific potassium conductance in various muscle types, resulting in divergent responses, such as the canonical depolarization in skeletal muscle versus hyperpolarization in smooth muscle cells during hyperkalemia. Misunderstanding of this crucial concept of conductance is directly related to the students' performance. Furthermore, we connected the paradoxical effect of hyperkalemia to pathological acute and chronic hyperkalemia clinical scenarios.

Application of Absorb-Do-Connect learning framework to foster experiential, practice, and career-ready learners

INTRODUCTION

As educators, we have the opportunity to produce experiential-ready, practice-ready, and career-ready practitioners. Student attitudes and values influence how learned knowledge and skills will be enacted, and therefore are key determinants of career-readiness. However, attitudes and values can be challenging to see and measure in learners. In this commentary, the authors propose purposeful selection and application of an educational framework to foster those less tangible, but powerful, factors.

PERSPECTIVE

To illustrate this perspective, authors describe key components of the Absorb-Do-Connect learning framework and provide rationale for the framework's alignment with self-efficacy theory. The authors propose that Absorb-Do-Connect can be applied within pharmacy education to design learning activities that establish relevance in learning and subsequently foster self-efficacy through growth in attitudes and values.

IMPLICATIONS

The Accreditation Council for Pharmacy Education Standards emphasize connecting current education to past experiences and future practice to establish relevance in learning. In this manner, authors suggest Absorb-Do-Connect can be used by schools and colleges of pharmacy to inform new innovations and revise existing coursework to meet the standards. Opportunity exists to formally assess the relationship between absorbing, engaging with and purposely connecting knowledge and skills, and the development of self-efficacy in student pharmacists.

Evaluation of a point-of-care ultrasound curriculum taught by medical students for physicians, nurses, and midwives in rural Indonesia

PURPOSE

In the Indonesian health-care system, nurses and midwives often serve as the primary health-care providers due to physician shortages. Seeking to address the need for medical care in resource-limited environments, some have advocated for portable equipment in the hands of health-care providers. We hypothesized that medical students are able to effectively teach point-of-care ultrasound (POCUS) to physicians, nurses, and midwives in rural Indonesia.

METHODS

We conducted a prospective, observational study using health-care practitioners from a clinic and accredited school for nursing and midwifery in Mojokerto, East Java, Indonesia. Enrolled practitioners took part in a 4-week POCUS course followed by postinstructional testing.

RESULTS

A total of 55 health-care practitioners completed the course. This included 19 physicians, 13 nurses, and 19 midwives. Of the 55 clinicians, 43 (72%) passed the course and 12 (28%) failed.

CONCLUSIONS

Physicians, nurses, and midwives in rural Indonesia showed significant acquisition of ultrasound (US) knowledge and skills following a 4-week US course. Following training, all three groups displayed skills in practical US use during a postcourse practical examination. This is one of the first studies to assess the efficacy of medical students teaching POCUS to midwives and nurses.

Analysis of Student Perceptions of Just-In-Time Teaching Pedagogy in PharmD Microbiology and Immunology Courses

Just-In-Time Teaching (JiTT) active learning pedagogy is utilized by various disciplines, but its value in a professional pharmacy curriculum has not yet been demonstrated. The purpose of our research study is to implement and evaluate JiTT in a Doctor of Pharmacy (PharmD) program. The impetus in implementing JiTT into a PharmD curriculum was to provide students with an out-of-classroom learning opportunity to enhance knowledge-based skills. The current study summarizes the implementation of JiTT in four distinct instances: two iterations of the required courses "Integrated Microbiology and Virology" (Fall 2016 and Fall 2017) and "Integrated Immunology" (Winter 2016-2017 and Winter 2017-2018). JiTT included knowledge-based questions in multiple-choice format, integrated case studies, and student responses prior to the actual lecture session. After the conclusion of each course, students were asked to provide feedback on the utilization of JiTT by way of an anonymous survey. Following the Fall 2016 iteration of the Microbiology & Virology course, students found the integrated case studies to be beneficial (mean = 3.27 out of a maximum of 4, SD = 0.62), and their overall endorsement of JiTT was high (mean = 3.61 out of 4, SD = 0.50). For the other three courses included in this study, the primary dependent variable was the student's average rating of JiTT, rated on a five-point scale. Aggregating the scores from the Fall 2017 iteration of the Integrated Microbiology & Virology course and both instances of the Immunology course, students rated JiTT very favorably (mean = 4.17 out of a maximum of 5, SD = 0.77). Students' performances in JiTT-based courses were compared against non-JiTT-based courses. Analysis of assessment data for student's performance on knowledge-based questions showed JiTT was helpful for student learning and JiTT-based courses had more consistent exam scores compared to non-JiTT-based courses. The current results are a promising initial step in validating the usefulness of JiTT in a pharmacy program and lays the foundation for future studies aimed at a direct comparison between a traditional lecture style and JiTT pedagogy implemented into PharmD curricula.

Threshold concepts: A portal into new ways of thinking and practising in psychiatry

Introduction: The theory of threshold concepts conjectures that there are areas in every educational curriculum that are challenging; however, mastering these areas transform the learner's view of the subject. In psychiatry, research into threshold concepts can inform educators so that they can better support students with mastering these challenging areas.Purpose: To identify threshold concepts, we conducted semi-structured interviews with six psychiatry educators and free-text surveys with medical students. To identify avenues for improving the curriculum, we discussed with educators, ways of improving understanding and looked at different approaches to learning.Materials and methods: From our analysis of all responses, we derived three threshold concepts: Therapeutic Risk-Taking, the Biopsychosocial Model, and the Concept of Diagnosis in psychiatry. The majority of students experienced difficulties grasping these concepts and applying them in their patient interactions.Results and conclusions: Hence, we propose focused teaching activities that can help students cross these thresholds: student Balint groups exploring therapeutic risk, student Balint groups exploring the role of a psychiatrist, exposure to psychological therapies/psychotherapy skills and explicit diagnostic reasoning. These activities can be integrated into the undergraduate curriculum to help medical students develop a better understanding and appreciation of psychiatry.

When did "teaching" become a taboo word for clinician educators?

In our recent work with clinician educators leading UME small groups, we noticed a phenomenon - many clinician educators are saying they don't teach, they just facilitate. Medical schools have moved to a new model of curriculum that integrates basic, clinical, and social science concepts. As curriculum shifts, so too must the definition and role of a teacher in medical education. The purpose of this article is to explore the work of current clinician educators and to encourage clinician educators to embrace their teaching role and seek educator development opportunities. In this article, we explore the history of how and why the word "teaching" became taboo for clinician educators. Then we explain the current state of the complex work of teaching for today's clinician educators and its implications for educator development.

Does a novel teaching approach work? A Students' perspective

BACKGROUND

There is always a call for educational reform and further research to improve educational programs. The continuous development of new educational approaches is a work in progress. Educational strategies like team-based learning, flipped classroom, and lottery-based token economy, were used to develop a novel teaching approach.

AIM

This study had two major goals. The first goal was to introduce a novel teaching approach in professional healthcare academies. The second goal was to get an in-depth understanding, from the students' perspective, about the benefits and limitations of this new teaching approach.

METHOD

The study was conducted using a qualitative, phenomenological research design. Third and fourth-year nursing students completed reflective journals to describe their personal experience with the new teaching approach at the end of the semester. The students' responses were analyzed and coded using Kember's four-category coding schema for reflective writing, to extract themes using thematic analysis.

FINDINGS

Seventy-five students completed and returned their reflective journals. The analysis showed various challenges and facilitators/benefits of the students' experiences. The themes that emerged from the analysis were: lack of exposure vs. a sense of achievement; lack of teamwork skills vs. role fulfillment; working with new people vs. conflict resolution; variation vs. collaboration/creativity; time management vs. constructive competition; wasting resources vs. flexibility, and proactivity/active engagement. These themes summarized why the new teaching approach worked and what barriers students faced with the new assembly.

CONCLUSION

Results from the current study demonstrated the great potential of the new teaching approach. Recommendations for future research were also discussed.