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What can we learn from problem-based learning tutors at a graduate entry medical school? A mixed method approach.

ABSTRACT: Problem-based learning (PBL) has been adopted by many medical schools as an innovative method to deliver an integrated medical curriculum since its inception at McMaster University (Dornan et al., Med Educ 39(2):163-170, 2005; Finucane et al., Med Educ 35(1):56-61, 2001; Barrows, Tutorials in problem-based learning: A new direction in teaching the health professions, 1984). The student experience in PBL has been explored in detail (Merriam, New Directions for Adult and Continuing Education 89: 3-13, 2001; Azer, Kaohsiung J Med Sci 25(5): 240-249, 2009; Boelens et al., BMC Med Ed 15(1): 84, 2015; Dolmans et al., Med Teach 24(2):173-180, 2002; Lee et al., Med Teach 35(2): e935-e942, 2013) but the tutors who facilitate PBL have valuable insight into how PBL functions and this aspect has not been extensively researched. The integrated curriculum for years 1 and 2 at the Graduate Entry Medical School at the University of Limerick is delivered though problem-based learning (PBL). This programme requires collaborative teamwork between students and the tutors who facilitate small-group tutorial sessions. All PBL tutors at GEMS are medically qualified, with the majority (68%) currently working in clinical practice.A mixed-methods approach was adopted, utilising two surveys and follow-up focus groups to fully understand the tutor experience. Thirty-three tutors took part in two online surveys with a response rate of 89%. Thirteen tutors participated in two focus groups. Descriptive analysis was completed on survey data and thematic analysis on focus group discussions which highlighted five main themes.Tutors reported challenges with managing group dynamics, development of confidence in tutoring with experience and a willingness to learn from peers to improve practice. Findings are in keeping with previously published work. Results also identified several less commonly discussed issues impacting student engagement in PBL including the use of mobile device technology, unauthorised access to learning objectives and PBL cases, and the importance and need for professional development amongst tutors, including the impact of tutoring on clinical practice. This study revealed that experienced tutors spend considerable time preparing for PBL tutorials in the basic sciences and that this input is rewarded by the benefits it brings to their clinical practice.Understanding PBL from the tutor's perspective reveals valuable insights which can inform ongoing tutor development and support. Limited research exists in the area of PBL tutor's experiences which may be of interest to medical educators, clinicians and the wider medical community. Findings highlight the value of shared tutor experiences as a resource that can be capitalised on to benefit both novice and experienced tutors.

SUBMITTER: O Doherty D

PROVIDER: S-EPMC5935969 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Psychological distress in medical students is a global issue and poses a risk to their health, academic performance, and ability to care for patients as clinicians. There has been limited research on psychological distress levels in students prior to starting medicine and no direct comparison between undergraduate and graduate-entry students. METHODS:Psychological distress was assessed using the 21-item Depression Anxiety and Stress Scale in 168 undergraduate-entry and 84 graduate-entry medical students at two separated campuses of the same university in the orientation week prior to starting classes. Mean scores and severity proportions were compared between the two cohorts of students. Demographic data was also collected and compared to distress scores using subgroup analysis. RESULTS:The response rate for the study was 60.9%. The majority of undergraduate and graduate-entry medical students were within the normal limits for depression (67.2% versus 70.2%, p = 0.63), anxiety (56.5% versus 44.0%, p = 0.06), and stress scores (74.4% versus 64.2%, p = 0.10). There was no significant difference between severity groups except for severe stress (2.3% versus 9.5%, p = 0.01). The mean scores of the clinically distressed groups indicated moderate levels of depression, moderate anxiety, and moderate stress scores. There were no significant differences between undergraduate or graduate-entry students for depressive ([Formula: see text] = 17.02 versus 15.76, p = 0.43), anxiety ([Formula: see text] = 14.22 versus 13.28, p = 0.39), and stress scores ([Formula: see text] = 20.83 versus 22.46, p = 0.24). Female gender and self-believed financial concerns were found be associated with higher levels stress in graduate entry students. CONCLUSIONS:The majority of medical students enter medical school with normal levels of psychological distress. However, a large number of undergraduate and graduate-entry medical students have significant levels of depressive, anxiety, and stress levels, without a significant difference between undergraduate or graduate-entry students. There are several limitation of this study but the results suggest that education and intervention may be required to support students from the earliest weeks of medical school.

Project description:Background: Problem-based learning (PBL) is an essential element of the curriculum of the Medical University of Vienna (MUV) and is performed in an eight steps model with: clarifying, defining, analysing, shifting & sorting, identifying learning objectives, going to learn and coming back to talk and feedback. With an annual intake of up to 740 students the MUV has to recruit PBL tutors from various academic backgrounds including undergraduate near-peer students. Therefore, we were interested to see whether a tutor's academic background had an influence on the resulting PBL sessions as reflected by the percentage of learning objectives (LOs) which were actually achieved in relation to the intended LOs. Methods: For each PBL session “intended learning objectives” (ILOs) were defined. ILOs were communicated to all tutors by means of PBL session guides in order to provide homogenous learning opportunities to all students. However, it was not mandatory to reach all ILOs. The PBL coordination regarded a range of two thirds to three quarters of ILOs as a desirable goal. For analysis we retrieved data concerning ILOs, characteristics of tutors and PBL groups from the institution's PBL quality assurance system.Results: From 2012-2014, 216 PBL groups were facilitated by 106 tutors with different academic backgrounds. On average, 70.8% (95% CI: 69.2-72.5%) of the ILOs were achieved; MUV clinicians reached 74.3% (70.8-77.8%), MUV non-clinicians 74.2% (71.7-76.6%), external faculty (clinicians and non-clinicians) 68.6% (64.4-72.8%), and near-peer students 64.7% (61.8-67.7%). Statistically significant differences were found between near-peer students and MUV clinicians (p<.001) as well as MUV non-clinicians (p<.001). Conclusions: ILOs were reached within a satisfactory range. However, groups taught by near-peer students reached significantly fewer ILOs than groups taught by MUV faculty tutors. This finding raises the question whether tutor training for near-peer students should be intensified. Also, further research is needed to explore the group dynamics of student-led PBL groups.

Project description:OBJECTIVE:To explore graduate-entry medical students experiences of undergraduate training in the context of academic underperformance of medical students from ethnic minority backgrounds. DESIGN:Qualitative study using semi-structured focus groups. SETTING:A West Midlands medical school. PARTICIPANTS:24 graduate-entry MBChB students were recruited using volunteer and snowball sampling; all students self-identified as being from Black and Minority Ethnic (BME) backgrounds. RESULTS:BME students reported facing a range of difficulties, throughout their undergraduate medical training, that they felt impeded their learning and performance. Their relationships with staff and clinicians, though also identified as facilitators to learning, were also perceived to have hindered progress, as many students felt that a lack of BME representation and lack of understanding of cultural differences among staff impacted their experience. Students also reported a lack of trust in the institution's ability to support BME students, with many not seeking support. Students' narratives indicated that they had to mask their identity to fit in among their peers and to avoid negative stereotyping. Although rare, students faced overt racism from their peers and from patients. Many students reported feelings of isolation, reduced self-confidence and low self-esteem. CONCLUSIONS:BME students in this study reported experiencing relationship issues with other students, academic and clinical staff, lack of trust in the institution and some racist events. Although it is not clear from this small study of one institution whether these findings would be replicated in other institutions, they nevertheless highlight important issues to be considered by the institution concerned and other institutions. These findings suggest that all stakeholders of graduate-entry undergraduate medical education should reflect on the current institutional practices intended to improve student-peer and student-staff relationships. Reviewing current proposals intended to diversify student and staff populations as well as evaluating guidance on tackling racism is likely to be beneficial.

Project description:Defining professionalism in this constantly evolving world is not easy. How do you measure degrees of benevolence and compassion? If it is so obvious to our profession, what professionalism is, then why is it so difficult to teach it to medical students and residents? Today's definition of medical professionalism is evolving - from autonomy to accountability, from expert opinion to evidence-based medicine, and from self-interest to teamwork and shared responsibility. However, medical professionalism is defined as the basis for the trust in the patient-physician relationship, caring and compassion, insight, openness, respect for patient dignity, confidentiality, autonomy, presence, altruism, and those qualities that lead to trust-competence, integrity, honesty, morality, and ethical conduct. The purpose of this study is to explore professionalism in terms of its fundamental elements among medical students of Universiti Sultan Zainal Abidin (UniSZA). This was a cross-sectional study carried out on medical students of UniSZA. The study population included preclinical and clinical medical students of UniSZA from Year I to Year V of academic session 2014/2015. The simple random sampling technique was used to select the sample. Data were collected using a validated instrument. The data were then compiled and analyzed using SPSS Version 21. Out of 165 questionnaires distributed randomly among Year I to Year V medical students of UniSZA, 144 returned, giving a response rate of 87%. Among the study participants, 38% (54) and 62% (90) were males and females, respectively. The grand total score was 170.92±19.08. A total of 166.98±20.15 and 173.49±18.09 were the total professionalism score of male and female study participants, respectively, with no statistically significant (P=0.61) differences. This study found almost similar levels of familiarity with all fundamental issues of professionalism with no statistically (P>0.05) significant differences. Medical faculty members should give more effort for the professional development of medical doctor. Henceforth, researchers believe and expect that the country will produce more rational and holistic medical doctors.

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What can we learn from problem-based learning tutors at a graduate entry medical school? A mixed method approach.

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