Chinthaka Balasooriya

Impact of a new integrated medicine program on students’ approaches to learning

This paper presents the results of a study on the impact of a new integrated medical educational design on students’ approaches to learning. Although the new program was based on curriculum features identified in the research literature as likely to promote deeper approaches to learning, the results revealed a more complex response from students. While a proportion of students reacted as expected and changed to deeper approaches, a significant subgroup moved in the opposite direction and adopted more surface approaches. Further analysis revealed that specific features of the new curriculum – integration of content, requirement for both independent and collaborative learning – were likely to polarise students. The findings suggest that shifting students towards deeper approaches to learning may be a more complex task than previously understood. The authors suggest some ways in which such major curriculum change may be moderated so that all learners are more likely to benefit.

The Cross-Over Phenomenon: Unexpected Patterns of Change in Students' Approaches to Learning.

A key aim of educational course design is to encourage students to adopt deeper approaches to learning. This article reports the findings of three studies that explored how medical students responded to three carefully designed educational course units. The findings suggest that, while a subgroup of the students responded by adopting deeper approaches (as intended by the designers of the course units), another subgroup responded by adopting more surface approaches. Two further subgroups displayed minimal changes in their approaches despite significant changes in their learning contexts. The finding (in all three studies) of a notable proportion of students adopting more surface approaches is of particular concern, as this could adversely affect the impact of even the most carefully designed educational program. These findings suggest that the context‐dependent nature of approaches to learning merits further investigation, as it may be more complex than previously described in the literature.

The Teamwork Mini-Clinical Evaluation Exercise (T-MEX): a workplace-based assessment focusing on collaborative competencies in health care.

Purpose Teamwork is an important and challenging area of learning during the transition from medical graduate to intern. This preliminary investigation examined the psychometric and logistic properties of the Teamwork Mini-Clinical Evaluation Exercise (T-MEX) for the workplace-based assessment of key competencies in working with health care teams. Method The authors designed the T-MEX for direct observation and assessment of six collaborative behaviors in seven clinical situations important for teamwork, feedback, and reflection. In 2010, they tested it on University of New South Wales senior medical students during their last six-week clinical term to investigate its overall utility, including validity and reliability. Assessors rated students in different situations on the extent to which they met expectations for interns for each collaborative behavior. Both assessors and students rated the tool’s usefulness and feasibility. Results Assessment forms for 88 observed encounters were submitted by 25 students. The T-MEX was suited to a broad range of collaborative clinical practice situations, as evidenced by the encounter types and the behaviors assessed by health care team members. The internal structure of the behavior ratings indicated construct validity. A generalizability study found that eight encounters were adequate for high-stakes measurement purposes. The mean times for observation and feedback and the participants’ perceptions suggested usefulness for feedback and feasibility in busy clinical settings. Conclusions Findings suggest that the T-MEX has good utility for assessing trainee competence in working with health care teams. It fills a gap within the suite of existing tools for workplace-based assessment of professional attributes.

The interplay between students' perceptions of context and approaches to learning

The purpose of this study is to investigate whether the teaching, learning and assessment strategies conceived and implemented in a higher education chemistry course promote the development of higher‐order skills as intended. Thus, our main aim is to analyse the approaches to learning in chemistry undergraduates. This research was carried out in a naturalistic setting, within the context of chemistry classes for first‐year science and engineering courses at the University of Aveiro, Portugal. At the end of the academic year, the 10 chemistry students with the highest grades and the 10 chemistry students with the lowest grades were selected for interview. Data were also gathered by means of observation of chemistry classes, documentary analysis and the administration of the Portuguese version of the Approaches and Study Skills Inventory for Students. The students with the better grades revealed a conception of learning emphasising understanding, while the students with the lowest grades conceived learning as merely memorising and reproducing. The students with the highest grades diverged both in their learning approaches and in their preferences for teaching strategies. The students with the lowest grades adopted a surface or a combination of a surface and a strategic approach, and their preference for teaching matched their approach to learning. This chemistry course was intentionally designed to promote deep learning and understanding. However, students perceived the purposes and the context of this course in different ways. Introducing a constructivist learning environment seems to require detailed and systematic guidance by the teacher. Continuous feedback should also be provided to students to orientate their learning and to try to diminish surface approaches to learning.

A student-led process to enhance the learning and teaching of teamwork skills in medicine

CONTEXT The development of teamwork skills is a critical aspect of modern medical education. This paper reports on a project that aimed to identify student perceptions of teamwork-focused learning activities and generate student recommendations for the development of effective educational strategies. METHODS The project utilized a unique method, which drew on the skills of student research assistants (RAs) to explore the views of their peers. Using structured interview guides, the RAs interviewed their colleagues to clarify their perceptions of the effectiveness of current methods of teamwork teaching and to explore ideas for more effective methods. The RAs shared their deidentified findings with each other, identified preliminary themes, and developed a number of recommendations which were finalized through consultation with faculty. RESULTS The key themes that emerged focused on the need to clarify the relevance of teamwork skills to clinical practice, reward individual contributions to group process, facilitate feedback and reflection on teamwork skills, and systematically utilize clinical experiences to support experiential learning of teamwork. Based on these findings, a number of recommendations for stage appropriate teamwork learning and assessment activities were developed. Key among these were recommendations to set up a peer-mentoring system for students, suggestions for more authentic teamwork assessment methods, and strategies to utilize the clinical learning environment in developing teamwork skills. DISCUSSION The student-led research process enabled identification of issues that may not have been otherwise revealed by students, facilitated a better understanding of teamwork teaching and developed ownership of the curriculum among students. The project enabled the development of recommendations for designing learning, teaching, and assessment methods that were likely to be more effective from a student perspective.

Why is my design not working? The role of student factors

This paper brings together the findings of a series of studies that explored the impact of curricular changes on students’ approaches to learning. The findings, which were initially surprising, are confirmed by the identification of similar patterns across four different medical educational programmes within Australia and Sri Lanka. The four studies reported in this paper utilised similar methods to examine how students’ approaches to learning change in response to ‘deep‐approach‐enhancing’ educational programmes. The studies used the R‐SPQ‐2F questionnaire to measure students’ approaches to learning scores before and after students had experienced ‘deep‐approach‐enhancing’ educational programmes. Students were asked to use a unique identifier, which allowed comparison of each individual student’s approach scores before and after the relevant educational programme. Cluster analysis was performed on the data, and this revealed four patterns of change of deep approach scores. The patterns were similar (although not identical) across the four studies. A significant finding was that while a proportion of students responded by changing to deeper approaches (as expected), a similar proportion of students responded by changing to more surface approaches. The finding that a significant proportion of students adopted surface approaches in response to a ‘deep‐enhancing’ context is of some concern. This paper focuses on this subgroup of students, and explores possible factors that might relate to this unexpected response. From a theoretical perspective, the findings provide a new insight into the current theory of students’ approaches to learning by demonstrating a complex pattern of student response. The findings that a subgroup of students respond in ways contrary to that suggested by current educational theory, and the identification of features that characterise this subgroup are significant contributions to the literature. From a practical perspective, the findings have significant implications for designers of educational programmes who are aiming to foster deep approaches in their students.

Differential impact of student behaviours on group interaction and collaborative learning: medical students’ and tutors’ perspectives

BackgroundCollaboration is of increasing importance in medical education and medical practice. Students’ and tutors’ perceptions about small group learning are valuable to inform the development of strategies to promote group dynamics and collaborative learning. This study investigated medical students’ and tutors’ views on competencies and behaviours which promote effective learning and interaction in small group settings.MethodsThis study was conducted at UNSW Australia. Five focus group discussions were conducted with first and second year medical students and eight small group tutors were interviewed. Data were transcribed verbatim and thematic analysis was conducted.ResultsStudents and tutors identified a range of behaviours that influenced collaborative learning. The main themes that emerged included: respectfulness; dominance, strong opinions and openness; constructiveness of feedback; active listening and contribution; goal orientation; acceptance of roles and responsibilities; engagement and enthusiasm; preparedness; self- awareness and positive personal attributes. An important finding was that some of these student behaviours were found to have a differential impact on group interaction compared with collaborative learning. This information could be used to promote higher quality learning in small groups.ConclusionThis study has identified medical students’ and tutors’ perceptions regarding interactional behaviours in small groups, as well as behaviours which lead to more effective learning in those settings. This information could be used to promote learning in small groups.

The impact of programmatic assessment on student learning: what can the students tell us?

It has been my experience that the most challenging aspects of residency training have pertained to the ability to adapt to change, multitask and prioritise, and to the need for resiliency in the face of adversity. Despite this, I had very little guidance on how to appreciate and hone these skills during my formative training years in college and medical school. I urge that we respond to the increasing imperative of purposeful teaching in these non-clinical skills. Ultimately, I cannot foresee a training programme that removes the pager from the hip, but I can envision success for those that prepare trainees to manage the task of responding to the buzz.

Kolb’s Learning Styles and Approaches to Learning: The Case of Chemistry Undergraduates with Better Grades

The purpose of this study is to investigate if the teaching, learning and assessment strategies conceived and implemented in a higher education chemistry course promote the development of conceptual understanding, as intended. Thus, our aim is to analyse the learning styles and the approaches to learning of chemistry undergraduates with better grades.This study took place during the 1st semester of the school year 2009/2010. This research was carried out in a naturalistic setting, within the context of chemistry classes for 1st year science and engineering courses, at the University of Aveiro, in Portugal. The class was composed of 100 students. At the end of the semester, the 8 chemistry students with the highest grades were selected for interview. Data was collected through Kolb’s Learning Styles Inventory, through Approaches and Study Skills Inventory for Students, through non-participant observation, through the analysis of students’ participation in online forums and lab books.The overall results show that the students with better grades possess the assimilator learning style, that is usually associated to the archetypal chemist. Moreover, the students with the highest grades revealed a conception of learning emphasising understanding. However, these students diverged both in their learning approaches and in their preferences for teaching strategies. The majority of students adopted a deep approach or a combination of a deep and a strategic approach, but half of them revealed their preference for teaching-centred strategies.

Are we seeing the full picture of peer-assessment in medical education?

We read with interest the peer rating article by Basehore et al. (2014). We note that the findings of this study add to the growing body of evidence on the reliability of peer assessment. While acknowledging the many advantages of peer assessment, we suggest that it is important to consider some of the potential limitations of peer assessment: (1) The quality of feedback: the assessment of a clinical interaction needs to be accompanied by meaningful feedback that would enable the student to improve. Are peers at similar levels of development able to provide this level of meaningful feedback? (2) The authenticity of the assessment experience: the perceived authenticity and weighting attached to a peerassessment activity is different to that attached to an assessment by a clinical teacher. This has an impact on the ‘backwash effect’ of assessment, which plays a significant role in driving learning. Peer-to-peer interactions are limited in their ability to perform this function. (3) Reduced opportunities for student–clinician interaction: standard clinical assessment usually involves a multidimensional clinical experience that is guided by a clinician. This usually involves analysis of clinical issues beyond the narrow aspects being assessed, and is a critical component of clinical learning. Peers with limited clinical experience are unlikely to be able to facilitate such an experience. (4) Perpetuation of misconceptions that exist among peers: misconceptions around various aspects of clinical presentations are common amongst medical students, and these are often based on popular media. Peer-assessment is unlikely to identify and address these misconceptions, and may play a role in re-iterating and perpetuating these misconceptions. We therefore contend that the limitations of peerassessment need to be recognised in any decision to increase its use in medical education. We are particularly concerned that the move towards peer-assessment may be driven more by workload considerations rather than by educational considerations. As the authors of the study recognise, this is a major driver of peer-assessment, and we need to be cognisant of the trade-off that may be associated with such a move. An acceptable level of reliability should not be the sole determinant of the quality of assessment.