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ORIGINAL ARTICLE
J Edu Health Promot 2020,  9:231

Module to facilitate self-directed learning among medical undergraduates: Development and implementation


Department of Community Medicine, University College of Medical Sciences, Delhi, India

Date of Submission07-Feb-2020
Date of Acceptance07-Apr-2020
Date of Web Publication28-Sep-2020

Correspondence Address:
Dr. Somdatta Patra
Department of Community Medicine, University College of Medical Sciences, Delhi - 110 095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jehp.jehp_125_20

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  Abstract 


CONTEXT: Currently, self-directed learning (SDL) is emphasized in medical institutions all over the world. The skills of SDL enable one to be a lifelong learner, a necessity to cope up with fast-expanding medical knowledge.
AIMS: This study aims to develop and implement an “SDL” module for medical undergraduates and find out their perception about the same.
SETTINGS AND DESIGN: A cross-sectional study using a mixed-method design (having both qualitative and quantitative components) was conducted in the Department of Community Medicine, UCMS, Delhi, India.
METHODS: A module was developed following an extensive literature review and focus group discussions with the teaching staff of the institute. First-semester undergraduate students were invited to participate in the study and asked for feedback using a semi-structured questionnaire.
STATISTICAL ANALYSIS: Quantitative data were expressed in mean, range, and frequency. For qualitative data, thematic analysis was performed.
RESULTS: The module was implemented with 160 students, in November for 10 hour distributed over 5 weeks. Feedback could be obtained from 130 students. Sixty-seven percent of students were satisfied and 66% reported as motivated to study the allotted topic further. Qualitative analysis showed that though the students liked the learning process based on this module, they also felt facilitators could have been more active in imparting knowledge and skills.
CONCLUSIONS: To make learners equipped with the ability to learn throughout a professional learning course, SDL as a learning tool should be introduced in the medical undergraduate curriculum.

Keywords: Competency, medical students, self-directed learning


How to cite this article:
Patra S, Khan AM, Upadhyay MK, Sharma R, Rajoura OP, Bhasin SK. Module to facilitate self-directed learning among medical undergraduates: Development and implementation. J Edu Health Promot 2020;9:231

How to cite this URL:
Patra S, Khan AM, Upadhyay MK, Sharma R, Rajoura OP, Bhasin SK. Module to facilitate self-directed learning among medical undergraduates: Development and implementation. J Edu Health Promot [serial online] 2020 [cited 2020 Oct 22];9:231. Available from: https://www.jehp.net/text.asp?2020/9/1/231/296377




  Introduction Top


The goal of medical education is not only enhancement of knowledge and skills but also the creation of a medical professional who is a clinician, leader, and lifelong learner, as described in the recently launched medical undergraduate curriculum of India.[1] An individual who is equipped with self-directed learning (SDL) is a lifelong learner. Lifelong learning is a necessity to cope up with fast-expanding medical knowledge and enables a health professional to continue learning throughout the professional life course.[2],[3] According to published literature, SDL also helps to reduce the numbers of demotivated medical graduates.[4]

Globally, medical institutes are now emphasizing on SDL.[5],[6] SDL is the process in which the individuals take the initiative with or without the help of others in determining their needs, formulating learning goals, identifying resources of learning, choosing, and implementing learning strategies and evaluating learning outcomes.[7],[8]

In SDL, the learner is responsible for his or her own learning process and it gradually shifts the learning control from teacher to learner.[9] Studies also suggest that SDL learners perform better than traditional lecture group learners.[10],[11],[12]

The medical Council of India (MCI), in its newly released curriculum, has dedicated time for SDL for each subject. The present study was conducted with the following objectives: (a) to develop and implement an “SDL” module for medical undergraduates, (b) to find out the perceived level of motivation for further study and levels of satisfaction with this module.


  Methods Top


A cross-sectional study using mixed method design (having both qualitative and quantitative components) was conducted by the Department of Community Medicine in a Medical College of Delhi, India. All teaching staff (faculties and residents) of the department were invited to participate in the development of the module. Two focus group discussions (FGD) were held before the development of the module. Literature review and FGDs helped to form a framework and identify essential components of the module. The framework comprised: (a) creating a functional definition of SDL (b) deciding the principles for choosing teaching-learning activities (c) identifying the desired competencies associated with SDL (d) aligning teaching-learning activities and assessment with principles and competencies of SDL (e) Selecting the criteria for assessing a learner and (f) the evaluation of the module through students' feedback. The activities undertaken for the development of the module were part of the regular teaching-learning program of the department.

During the implementation of the module first-semester undergraduate students posted in the Department of Community Medicine for SDL activity in November 2019 were invited to participate in the study and asked for feedback using a semi-structured questionnaire. Feedback included information regarding an undergraduate student's level of satisfaction with this method of learning, perceived level of motivation and interest to further study the topic using the learning strategy selected by them. The information obtained from the students' was kept anonymous and confidential. Quantitative data were expressed in mean, range, and frequency. For qualitative data, thematic analysis was done. Clearance from the institutional ethics committee was obtained before the start of the study.


  Results Top


Development of the module

  1. Creating a functional definition of SDL: SDL was defined as a learning process where students in partnership with facilitators decide the learning objectives of a preselected topic, identify resources for consultation, decide activities for learning, and evaluating themselves
  2. Principles for choosing learning activities: It was decided that activities that encouraged teamwork, promoted feedback, and helped to reflect continuously on individual progress would be chosen. Some identified activities were student-led seminars, role plays, panel discussions, preparation of health education materials, and case studies, etc
  3. Identification of the competencies for SDL: the competencies to be acquired through SDL for a first-semester undergraduate medical students were discussed. Four competencies were identified based on discussion and an article by Patterson et al.[13] The level of each competency was decided considering the students' academic experience. The competencies were (i) teamwork: students discuss, decide, and work together to solve a given task (ii) Reflection: Students narrate incidents they come across, the positive and negative aspects of the incidents, what caused the occurrence and what could be done differently in future. (iii) critical thinking: student can answer critical questions raised by facilitators and starts formulating her own query (iv) self and peer evaluation: student can determine the level of achievement using evidence
  4. Planning and Programme Organization: the sequencing of the program was done considering the available workforce, time, and other resources. All facilitators involved in the exercise were sensitized and trained. Students were divided into five groups. For each group, the topic of SDL was predecided based on discussions among the faculty. Five different topics were chosen, which were thought appropriate for 1st-year medical undergraduates. The topics were obesity, adolescence, air pollution, balanced diet, and hygiene. Each group was supported by a faculty and three residents. The venue for each of the groups was arranged. As only two buses were available for transportation, it was decided only two groups can have a community exposure if decided and chosen by groups. Facilitators planned teaching-learning activities considering the competencies to be acquired and the principles of SDL.


Programme implementation

A total of 160 first-semester students were posted in the Department of Community Medicine in November for 10 hour distributed over 5 weeks. Hence, each session was of 2 h duration/week. Students worked in groups allocated to them. Each group had four facilitators with one faculty member and three postgraduate residents. Each group decided on their specific area of learning (based on selected topics), learning objectives, and activities for learning. The learning resources available for consultation were discussed. The facilitators helped groups and sub-groups discussions, monitored progress over the course, and managed differences of opinions. The teaching-learning activities chosen by different groups were discussions on case-based scenarios, flipped classrooms, student-led seminars, movie screening, panel discussion, role plays, pair and share, etc.

Assessment of learners

A learner was assessed with the help of a checklist developed for the purpose. The checklist included components such as (1) initiation, (2) communication, (3) critical thinking, (4) resources: finding and sharing, (5) team-work: responsibilities and respect for others, (6) overall involvement, and (7) self and peer evaluation. There was a mini examination at the end of the posting to assess the knowledge and skill gained during the posting.

Self and peer evaluation

A learner was asked to evaluate herself and a facilitator identified peer, regarding (1) responsibility and respect for others (2) information processing (3) communication (4) critical thinking, and (5) awareness on a scale of 1–5, where a score of 1 implied “totally disagree” and five implied “totally agree.” For self and peer assessment, we used the criteria developed by Papinczak et al.[14] The instrument was suitably modified to fit our context and consisted of a ten item checklist. The facilitators' ranking was matched with students self-evaluation and peer evaluation of a learner with self-evaluation for final assessment.

Students' feedback about the program

Although the program was implemented on 160 students, feedback could be obtained from 130 students only. Sixty-seven percent of students mentioned that they were satisfied with the current learning process, while 70% reported the program to be interesting. Sixty percent of the students reported that they were motivated to study the allotted topic further. The overall rating of the module on a scale of 0–10 got a mean score of 7.5 from the learners with the minimum and maximum score being 2 and 10.

Qualitative analysis of students' perception

Qualitative analysis of students' perception elicited both positive and negative responses. They are listed in [Table 1] and [Table 2].
Table 1: Supporting verbatim responses positively oriented toward the module following the question: “Things that you liked about this posting”

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Table 2: Supporting verbatim responses negatively oriented toward the module following the question: “Things that you did not like about this posting”

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  Discussion Top


SDL follows the principle of adult learning. This learning is the new age learning, where importance has been given to collaborative learning.[15] While preparing the module, the principles of competency-based medical education were followed by identifying and defining the competencies a self-directed learner should possess. Although SDL in an ideal situation is for motivated learners, care was taken to develop a learner who learns how to learn.

In the present study, the students felt that SDL sessions were effective, enjoyable, and innovative ways to learn. However, students also felt that facilitators could have been more active in imparting knowledge and skills. As in SDL students were supposed to be responsible for finding the answers for the learning objectives decided by them,[16] they were forced to think, do a search, do group discussion, and come up with the answer. The activities planned, made learners to consult available resources, read, discuss, and present, which they might not have done otherwise following a didactic lecture. Keeping the philosophy of SDL in mind, self, and peer assessment component was also included in the module, which is not usual criteria for assessment in the didactic teaching-learning process. We tried to follow Grow's staged SDL model,[17] which describes SDL in a phased manner. It is also known that a class of students always has a heterogeneous mixture of learners[18] who differ from others in terms of skills to be acquired by an SDL learner. It has been seen that students belonging to higher-scoring groups usually also performed better on SDL topics.[17] However, keeping in mind the proven long-term benefits of SDL, the activities to promote a self-directed learner need to be continued in a systematic way.

Limitations of the study

This study has several limitations. First, this was the first exposure to SDL for the students. A longitudinal program to follow these students as a self-directed learner in subsequent years might help to evaluate this module more effectively. Second, for the facilitators too, it was a maiden exposure on the implementation of SDL sessions. Each group with allotted facilitators identified their objectives, resources, teaching-learning activities, which might have created experiences which were not uniform for all the students. However, each student was a unique learner with their own learning preferences[19] and collectively, facilitators tried that each group follows a consistent process to enable SDL. Third, the module was of a short duration, 10 hour only and with 1st year medical undergraduates, which may limit its generalizability to all medical undergraduates. Fourth, the data about the evaluation of the module was based only on the perception of students.


  Conclusions Top


The results of this study suggest that SDL can be used as a teaching-learning method for medical undergraduates. Students enjoyed and were satisfied with the teaching-learning activities and assessment methods suggesting scope for change from the traditional methods of learning. Easy access to various resources for learning further facilitates the inclusion of SDL in the medical curriculum. Although the demand for the traditional lecture was also mentioned by the students, SDL sessions from the start of their medical career would go a long way in transforming them into lifelong learners. Individuals who have learned how to learn can organize their own learning and transfer new information to larger contexts, an ability which would be a prerequisite for the medical profession, which mandates constant updating of oneself. Students can become Self Directed Learners only when they are aware of the process of SDL rather than just the acquisition of knowledge and skills of the subject content. Following the recommendation of MCI for the new undergraduate medical curriculum, exposure to SDL is compulsory in India. However, more studies in different settings are required to implement SDL in the medical curriculum.

Acknowledgment

The authors are thankful to faculties and residents of UCMS, especially of Community Medicine, Delhi for their help while conducting the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Competency Based Undergraduate Curriculum for the Indian Medical Graduate. New Delhi: Medical Council of India; 2018. Available from: https://www.mciindia.org/CMS/information-desk/for-colleges/ug-curriculum. [Last accessed on 2019 Dec 25].  Back to cited text no. 1
    
2.
Pai KM, Rao KR, Punja D, Kamath A. The effectiveness of self-directed learning (SDL) for teaching physiology to first-year medical students. Australas Med J 2014;7:448-53.  Back to cited text no. 2
    
3.
Candy PC. Self-Direction for Life Long Learning: A Comprehensive Guide to Theory and Practice. San Francisco, CA: Jossey Bass; 1991.  Back to cited text no. 3
    
4.
Kar SS, Premarajan KC, Ramalingam A, Iswarya S, Sujiv A, Subitha L. Self-directed learning readiness among fifth semester MBBS students in a teaching institution of South India. Educ Health (Abingdon) 2014;27:289-92.  Back to cited text no. 4
    
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Ainoda N, Onishi H, Yasuda Y. Definitions and goals of “self-directed learning” in contemporary medical education literature. Ann Acad Med Singapore 2005;34:8-515.  Back to cited text no. 5
    
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Simon FA, Aschenbrener CA. Undergraduate medical education accreditation as a driver of lifelong learning. J Contin Educ Health Prof 2005;25:157-61.  Back to cited text no. 6
    
7.
Knowles M. Self-Directed Learning: A Guide for Learners and Teachers. New York: Association Press; 1975.  Back to cited text no. 7
    
8.
Gyawali S, Jauhari AC, Shankar PR, Saha A, Ahmad M. Readiness for self directed learning among first semester students of a medical school in Nepal. J Clin Diagn Res 2011;5:20-3.  Back to cited text no. 8
    
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Williams B. Self direction in a problem based learning program. Nurse Educ Toda 2004;24:277-85.  Back to cited text no. 9
    
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Lake DA. Student performance and perceptions of a lecture-based course compared with the same course utilizing group discussion. Phys Ther 2001;81:896-902.  Back to cited text no. 10
    
11.
Abraham GJ, Dhume VG, Diniz RS. Comparison of didactic lecture, self-reading and self-instruction as learning methods in medical students of Western India. Med Educ 1981;15:222-5.  Back to cited text no. 11
    
12.
Abraham RR, Upadhya S, Ramnarayan K. Self-directed learning. Adv Physiol Educ 2005;29:135-6.  Back to cited text no. 12
    
13.
Patterson C, Crooks D, Lunyk-Child O. A new perspective on competencies for self-directed learning. J Nurs Educ 2002;41:25-31.  Back to cited text no. 13
    
14.
Papinczak T, Young L, Groves M, Haynes M. An analysis of peer, self, and tutor assessment in problem-based learning tutorials. Med Teach 2007;29:5, e122-32.  Back to cited text no. 14
    
15.
Murad MH, Varkey P. Self-directed learning in health professions education. Ann Acad Med Singapore 2008;37:580-90.  Back to cited text no. 15
    
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Devi S, Bhat KS, Ramya SR, Ravichandran K, Kanungo R. Self-directed learning to enhance active learning among the 2nd-year undergraduate medical students in Microbiology: An experimental study. J Curr Res Sci Med 2016;2:80-3.  Back to cited text no. 16
  [Full text]  
17.
Grow, G. Teaching learners to be self-directed. Adult Educ Q 1991;41:125-49.  Back to cited text no. 17
    
18.
Bhat PP, Rajashekar B, Kamath U. Perspectives on self-directed learning – The importance of attitudes and skills. Biosci Educ 2007;10:1, 1-3.  Back to cited text no. 18
    
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Keator CS, Vandre DD, Morris AM. The challenges of developing a project-based self-directed learning component for undergraduate medical education. Med Sci Educ2016;26:801-5.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2]



 

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