Implementing problem-based learning in a family medicine clerkship

BACKGROUND AND OBJECTIVES: Problem-based learning (PBL) has been implemented in the curriculum of many medical schools, but limited information is available about the outcome of this learning technique. The educational intervention presented in this paper implemented a PBL learning component in our third-year family medicine clerkship and measured the outcomes of this curricular change. METHODS: One third of the curricular time devoted to didactic teaching in our family medicine clerkship was replaced with PBL activities. Simulated cases were developed and presented to students who, with the aid of faculty facilitators, studied the cases, gathered information about the cases, and developed diagnostic and management plans for the cases. The outcome of the intervention was measured by a) comparing students' scores on the National Board of Medical Examiners (NBME) family medicine clerkship examination to scores achieved by students in the year before PBL was introduced and b) students' evaluations of the relevance and success of PBL in the clerkship curriculum. RESULTS: Students' NBME clerkship examination scores increased from a mean of 66 the year before PBL began to 73 after PBL was implemented. More than 80% of students reported that PBL was a good way to learn family medicine, and 85% reported that the PBL technique provided sufficient information to formulate learning issues. CONCLUSIONS: PBL can be introduced into a third-year family medicine clerkship curriculum with general acceptance by students. Students rated the technique highly, and their examination scores improved.     

Molecular regulation of human IgE synthesis

The purpose of this study was to examine students' conception of their learning in a problem-based learning medical curriculum. A multiple case study design was used with two units of analyses: two PBL lab groups; and 15 individual students within each lab group. Data collected included weekly journals by students, video-tapes of PBL sessions, focus group interviews with students, two open-ended questionnaires completed by students, and interviews with the PBL tutors. Three thematic categories of students' conceptions of their learning emerged: (1) awareness of PBL goals and expectations; (2) efficiency and expertise; and (3) the role of the tutor.     

Effects of beliefs about the nature of knowledge on comprehension.

Two questions were addressed: "What are students' beliefs about the nature of knowledge?" and "How do these beliefs affect comprehension?" In Experiment 1, an epistemological questionnaire was administered to undergraduates. Factor analysis of the questionnaire resulted in 4 factors reflecting degrees of belief in innate ability, simple knowledge, quick learning, and certain knowledge. In Experiment 2, students read a passage about either the social sciences or the physical sciences, in which the concluding paragraph was removed. Then they related their confidence in understanding the passage, wrote a conclusion, and completed a mastery test. Belief in quick learning predicted oversimplified conclusions, poor performance on the mastery test, and overconfidence in test performance. Belief in certain knowledge predicted inappropriately absolute conclusions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Achievement goals in the classroom: Students' learning strategies and motivation processes.

We studied how specific motivational processes are related to the salience of mastery and performance goals in actual classroom settings. One hundred seventy-six students attending a junior high/high school for academically advanced students were randomly selected from one of their classes and responded to a questionnaire on their perceptions of the classroom goal orientation, use of effective learning strategies, task choices, attitudes, and causal attributions. Students who perceived an emphasis on mastery goals in the classroom reported using more effective strategies, preferred challenging tasks, had a more positive attitude toward the class, and had a stronger belief that success follows from one's effort. Students who perceived performance goals as salient tended to focus on their ability, evaluating their ability negatively and attributing failure to lack of ability. The pattern and strength of the findings suggest that the classroom goal orientation may facilitate the maintenance of adaptive motivation patterns when mastery goals are salient and are adopted by students. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploratory factor analysis of students' ratings of a problem-based learning curriculum

PURPOSE: To identify the factor structure underlying medical students' initial experience with a problem-based learning (PBL) curriculum and to examine the stability of this structure as students acquire further experience with PBL. METHOD: The PBL curriculum at the Michigan State University College of Human Medicine begins in the students' second year and is divided into 11 domains. In 1992-93 students were asked to evaluate their learning experiences in the first and last domains of their first PBL semester, by using a five-point Likert scale to rate 19 items. Principal-components analysis and varimax rotation were used to identify the factors underlying the students' ratings. RESULTS: Ratings of the first and last domains were available from 101 and 71 students, respectively. Analysis yielded four meaningful factors: learning materials, small-group process, tutor effectiveness, and academic support. These four factors shifted in relative importance as the students progressed through the curriculum: for the first domain, tutor effectiveness accounted for the highest percentage of variance in the data; for the last domain, this factor ranked third, after learning materials and small group process. Internal reliabilities for the ratings of the last domain of the semester were higher and more consistent, ranging from .92 to .97. CONCLUSION: The students' initial dependence on the tutor progressed to an emphasis on learning resources. This shift is congruent with the theoretical model of the dynamics of PBL. The results suggest that the survey instrument provides a reliable measure of the multidimensional constructs underlying students' experience with PBL.     

Changes in efficacy beliefs in mathematics across the transition to middle school: Examining the effects of perceived teacher and parent goal emphases.

This study examined the effects of change in teacher goal emphases on students' efficacy beliefs in mathematics across the transition to middle school. The sample (N = 929) included primarily White (65%) and Black (27%) students, and approximately one third received free or reduced-fee lunch. Analyses grouped children by cross-classification of teachers (N = 53 elementary and N = 34 middle school teachers). On average, students' efficacy beliefs remained stable and relatively high across the transition. Compared with their elementary school teacher, children reported declines in both perceived teacher mastery and performance goal emphases in middle school. A cross-classified hierarchical linear model was used to estimate the effects of perceived teacher and parent goal emphases during 6th and 7th grades on changes in students' efficacy beliefs. An increase in self-efficacy beliefs from elementary to middle school was predicted by an increase in group-level perceptions of teachers' mastery goal emphasis, even after controlling for parents' goal emphases. These findings underscore the important role that both teachers' and parents' goal emphases play as children develop a sense of efficacy in mathematics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Breast cancer screening knowledge and skills of students upon entering and exiting a medical school

PURPOSE: To assess needs for breast cancer screening education by comparing medical students' training and knowledge of breast cancer screening upon their entry to and exit from medical school. METHOD: Seventy-seven medical students at one medical school completed questionnaires as first-year students (in 1992) and again as fourth-year students (in 1996) that assessed their breast cancer screening knowledge. The fourth-year questionnaire included additional questions about the students' clinical training in breast cancer screening skills and their perceptions of needs for further training. RESULTS: Although the students performed significantly better on the knowledge-based questions in their fourth year than they did in their first year, considerable room for improvement remained. The students reported learning the most from surgery rotations and more from standardized patients than from faculty. Women medical students performed significantly more clinical breast examinations than did men students. CONCLUSIONS: Most of the medical students reported needing additional training in clinical breast examination. More curricular time devoted to education about breast cancer screening is needed.     

Advancing Achievement Goal Theory: Using Goal Structures and Goal Orientations to Predict Students' Motivation, Cognition, and Achievement.

The objective of this study was to investigate how different components of achievement goal theory were related to each other and to students' motivation, cognitive engagement, and achievement in mathematics. Junior high school students (N=525) completed a self-report survey that assessed their perceived classroom goal structures; personal goal orientations: and a collection of outcomes that included persistence, procrastination, choice, their use of cognitive and metacognitive learning strategies, and mathematics grade. Results indicate that mastery structure and mastery orientation were related to adaptive outcomes in all areas. The patterns of relations for performance-approach goal structure, and for performance-approach and performance-avoidance goal orientations were less uniform across outcomes. Implications for achievement goal theory and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tutoring in problem-based learning: perceptions of teachers and students

This study examined teacher and student perceptions during the first 2 years of a complete transition from a conventional to a problem-based learning (PBL) curriculum at Dalhousie University. Teaching staff who had tutored in the two pre-clinical years (n = 88) completed a questionnaire at the end of the 1993-94 academic year, and student assessments of their tutors were collated for all nine units (n = 597). Seven research questions were addressed in the study which examined the faculty, student and administrative aspects of tutoring. The results showed that faculty tutors rated PBL more highly than traditional medical school methods on eight of the nine items. Teaching staff were very satisfied with their tutoring experience, but expressed a need for further training in group facilitation, questioning, handling 'difficult' situations and evaluating students. They reported that their workload outside tutorials was cut almost in half in their second year of tutoring. Students expected a tutor to be a skilled group facilitator who would guide them in their learning, while helping to maintain a positive group climate. They did not want the tutor to teach the content as they perceived the task of learning to be their responsibility. Several major administrative factors affected tutors' and students' perceptions of tutorials, including: changing tutorial group composition and tutor every 8-10 weeks; team tutoring; end-of-unit exam; conflicting demands of basic science 'vertical' units and ongoing 'horizontal' units; departmental budgetary requirements for basic medical education; recognition of tutoring in promotion and tenure decisions; and recruitment of tutors.     

Teachers' coaching of learning and its relation to students' strategic learning.

This study examined types and frequency of coaching of learning at the middle school level and its relation to students' strategic learning. Teachers (n?=?11) were videotaped during daily instruction on 3 separate occasions, and students (n?=?235) responded to a self-report questionnaire about learning-strategy use. Consistent with previous research at the elementary level (E. B. Moely et al., 1992), average instances of teachers' coaching of learning (e.g., describing cognitive processes, suggesting strategy use) occurred in only 9% of the instruction segments. Teachers most frequently recommended use of learning aids, engagement in metacognitive activity, and use of elaboration strategies. Results from a multiple regression analysis indicate that students' strategic-learning activity was significantly related to teachers' coaching of learning (R2?=?.18). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Retention in situ and spectral analysis of fluorescent vacuole components in sections of plant tissues

This paper describes an educational programme where clinical guidelines are used in dental education and assesses the value of these guidelines as perceived by undergraduate students. It presents a comparison of students' own assessments of their performance with those of their instructors, according to such guidelines. The educational programme at the Faculty of Odontology, Lund University, is described through 3 main principles: problem-based learning, adoption of a holistic attitude to patient care and the promotion of oral health. The dental curriculum occupies 5 years comprising 10 semesters. 41, 5th semester students (16 male and 25 female) participated in the study. Students were introduced to guidelines in group discussions at the beginning of the semester. At the completion of a patient's planned course of treatment, the outcome was formally assessed both by students and clinical instructors. Performance was scored in various categories as "excellent", "acceptable" or "unacceptable" according to the standards defined. A total of 1373 scores were made by both students and instructors. 88% cent of students used the guidelines often or almost always and found them useful. Overall, no students received an "unacceptable" score and 40% of students achieved a score of "excellent". Female students tended towards a higher score, but this was not significant. Instructors' and students' scores agreed in almost 90% of instances. Students under-scored their performance more frequently than they over-scored it. It appears that the use of clinical guidelines may encourage an increased awareness of the decision-making processes involved in clinical practice, but it must be acknowledged that these guidelines are complex both in derivation and application.     

Perceived Achievement Goal Structure and College Student Help Seeking.

Two studies examined associations between college students' help seeking and perceptions of their classes' achievement goal structure. Study 1 established that students' help seeking (N = 883 in 6 chemistry classes) could be parsimoniously described by distinct approach (intentions to seek autonomous help from teachers) and avoidance patterns (threat, avoidance intentions, seeking expedient help). In Study 2, after controlling for students' personal achievement goal orientations (N = 852 in 13 psychology classes), within-class differences in perceived class emphasis on mastery positively predicted help-seeking approach and negatively predicted help-seeking avoidance patterns, whereas perceived class emphasis on performance-avoid goals positively predicted help-seeking avoidance. Students in classes with greater perceived emphasis on performance-avoid goals had higher levels of help-seeking avoidance patterns. Results complement previous research on help seeking and achievement goals with younger learners and provide support for the role of classroom achievement goal structure in student motivation and performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The immunological aspects of systemic enzyme therapy in the combined treatment of recurrent nephrolithiasis

BACKGROUND: Despite the popularity of complementary therapies with the public, knowledge and use of these therapies among doctors appear limited. However, studies show that physicians and medical students are positive toward complementary therapies and have a high level of interest in learning about them. METHODS: The attitudes of medical students toward complementary therapies were examined using a questionnaire distributed to 800 first-, third-, and fifth-year medical students at two universities in Melbourne, Australia. RESULTS: The survey revealed that whereas Australian medical students were positive toward complementary therapies, their self-reported knowledge was low, with 56% having no knowledge of the principles of complementary therapies. Attitudes toward different therapies were found to vary widely, with students having little knowledge of chiropractic and naturopathy, the two therapies most commonly used by Australians. Students consistently scored meditation, massage, and acupuncture the highest with regard to knowledge, perceived usefulness, intended patterns of referral after graduation, and desire for education in the undergraduate degree. CONCLUSIONS: When the medical course included some tuition on complementary therapies, students were more positive toward them. A single lecture on complementary therapies was found to have significant impact on medical students' views. Medical students have a high level of interest in complementary therapies that is not being satisfied by their undergraduate curricula.     

Medical students' attitudes toward radiology: comparison of matriculating and graduating students

RATIONALE AND OBJECTIVES: To determine graduating medical students' perceptions of radiology and to document changes in their perceptions since they entered medical school. MATERIALS AND METHODS: A survey questionnaire was distributed to 213 graduating students. Questions were similar to those answered by the same group of students as they entered medical school nearly 4 years earlier. RESULTS: The survey was anonymously completed by 140 students. Seventy percent of students changed their choice of medical specialty since entering medical school. Factors with a major or important influence on specialty choice included intellectual excitement (96%), high patient contact (86%), opportunity for a good family life (72%), and regular hours (57%). Radiology was perceived to be a well-paid (89%), "high-tech" (86%) specialty with a healthy lifestyle (82%), regular hours (99%), and good family life (92%), but it was not perceived to offer high patient contact (1%) and was intellectually exciting to only 33% of students. This perception was unchanged from freshman year. CONCLUSIONS: This 4-year longitudinal study of a medical student class documents surprisingly little change in the perception of radiology throughout medical school. High patient contact and intellectual excitement, both factors of major or important influence on specialty choice, were thought to be lacking in radiology.     

Role models' perceptions of themselves and their influence on students' specialty choices

PURPOSE: To examine the perceptions of faculty role models to learn whether their perceptions of role models' behaviors are congruent with those of their students. METHOD: In 1996 a survey was mailed to 210 student-identified faculty role models at the University of Washington School of Medicine and the University of North Carolina at Chapel Hill School of Medicine. The nominees were asked to rate to what extent each of 32 student-identified role model characteristics was representative of their behavior. They were then asked to rank order the characteristics they felt were most important to model for students. The role models were also asked to rate how much influence they perceived themselves to have on their students' specialty choices. A final, open-ended question inquired about the single characteristics they modeled to students that most influenced the students' specialty choices. The role models' specialties were grouped as either primary care (PC) or non-primary care (NPC). Data were analyzed with several statistical methods. RESULTS: Of the 210 mailed surveys, a total of 177 were returned, for a response rate of 84%. The role models perceived their behaviors much like their students did; the role models' self-ratings were generally high for all of the student-defined characteristics. Although clinical reasoning was considered the most important characteristic to model for students, the role models also believed that enthusiasm and love for their work were the characteristics that most influenced their students' specialty choices. Few differences were found between the PC and the NPC role models. CONCLUSION: The role models in this study agreed with their students about what is important to model. They did not intentionally try to recruit students to join their specialties but felt that demonstrating enthusiasm and a sincere love for what they did has a strong influence toward this end.     

Use of group hypnosis to improve college students' achievement

To examine whether group hypnosis would improve college students' achievement examination grades, including a midterm and final test of 30 educational psychology students who were hypnotized were compared with those of two control groups of 34 and 32 students. Analysis indicated for these intact classes the hypnotized group had a significantly higher mean score on final examination than those of the control groups, although differences in examination scores were nonsignificant at midterm. Suggestions for further research are made.     

The classroom environment and students' reports of avoidance strategies in mathematics: A multimethod study.

The relation between the learning environment (e.g., students' perceptions of the classroom goal structure and teachers' instructional discourse) and students' reported use of avoidance strategies (self-handicapping, avoidance of help seeking) and preference to avoid novelty in mathematics was examined. Quantitative analyses indicated that students' reports of avoidance behaviors varied significantly among classrooms. A perceived emphasis on mastery goals in the classroom was positively related to lower reports of avoidance. Qualitative analyses revealed that teachers in high-mastery/low-avoidance and low-mastery/high-avoidance classrooms used distinctively different patterns of instructional and motivational discourse. High incidence of motivational support was uniquely characteristic of high-mastery/ low-avoidance classrooms, suggesting that mastery goals may include an affective component. Implications of the results for both theory and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Problem-based learning in physical therapy: a review of the literature and overview of the McMaster University experience

Problem-based learning (PBL), as implemented in the health sciences, is an educational method in which the focus of learning is a small-group tutorial in which students work through health care scenarios. The goals of the health care scenarios are to provide a context for learning, to activate prior knowledge, to motivate students, and to stimulate discussion. Learning is student-centered rather than faculty-centered, and self-directed learning is emphasized. The method was developed in the McMaster University medical school program and has since been adopted by many health care professional schools around the world. The theoretical basis and suggested advantages and disadvantages of PBL are outlined. Three approaches to PBL have been identified in the literature: completely integrated PBL curricula, transitional curricula, and a single-course approach. The advantages and disadvantages of each approach are addressed. The physical therapist (PT) program at McMaster University is a completely integrated problem-based curriculum. The history and process of PBL in general and in the PT program are reviewed. The implications of our experience for the development of other PBL courses and curricula are discussed. Evidence for proposed differences in students' performance and outcomes in PBL versus traditional curricula is critically reviewed. Recommendations are made for implementing PBL in PT curricula.     

Which students benefit from self-paced mastery instruction and why.

Based on an attribute-by-treatment interaction paradigm, the determinants of 217 female college students' achievement were compared under conventional and self-paced mastery examination schedules in an anatomy and physiology course. Measures of general scholastic ability (e.g., Minnesota Scholastic Aptitude Test) did not interact with method, but prior preparation in science did. Ss with less science preparation showed greater achievement under self-paced mastery testing than their counterparts under conventional testing. This compensation was explained when study habits were explored. Under self-paced testing, study time was inversely related to amount of science background. Self-pacing Ss with less background reported greater textbook usage and indicated that unit test results aided in planning study effort. No such relationships were found for Ss in the conventional course. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On-line search strategies of third year medical students: perception vs fact

The curriculum at the University of New Mexico School of Medicine has evolved with a high priority on problem-based and life-long learning. As the information pool enlarges, a greater emphasis must be placed on the ability of physicians to access the biomedical literature following residency training. To foster information retrieval skills, our medical school has included on the ability of physicians to access the biomedical literature following residency training. To foster information retrieval skills, our medical school has included on-line searching instruction since 1987. On-line classes are taught by experienced medical librarians during the second month of the first year curriculum. After receiving training, students are assigned a code via Grateful Med software. The purpose of the study was to measure the long-term effectiveness of this training approach and to determine the students' ability to formulate a search strategy and run a search to answer clinical questions at the third year level. During the 1990-1991 school year, all third year students were asked to use Grateful Med to answer two questions related to surgical patient care and to complete a questionnaire showing how they use Grateful Med and how they view their training. The students' searches were compared to "gold standard" searches run by an experienced medical librarian. Nineteen percent of all searches resulted in zero retrieval, and the remainder missed 74-100% of the gold standard available citations. Additional instruction shortly after on-line training could identify problem areas (poor search behavior) and information retrieval skills should be integrated and encouraged in all levels of the curriculum.