Purpose This study aimed to explore how the grading system affected medical students’ academic performance based on their perceptions of the learning environment and intrinsic motivation in the context of changing from norm-referenced A–F grading to criterion-referenced honors/pass/fail grading.
Methods The study involved 238 second-year medical students from 2014 (n=127, A–F grading) and 2015 (n=111, honors/pass/fail grading) at Yonsei University College of Medicine in Korea. Scores on the Dundee Ready Education Environment Measure, the Academic Motivation Scale, and the Basic Medical Science Examination were used to measure overall learning environment perceptions, intrinsic motivation, and academic performance, respectively. Serial mediation analysis was conducted to examine the pathways between the grading system and academic performance, focusing on the mediating roles of student perceptions and intrinsic motivation.
Results The honors/pass/fail grading class students reported more positive perceptions of the learning environment, higher intrinsic motivation, and better academic performance than the A–F grading class students. Mediation analysis demonstrated a serial mediation effect between the grading system and academic performance through learning environment perceptions and intrinsic motivation. Student perceptions and intrinsic motivation did not independently mediate the relationship between the grading system and performance.
Conclusion Reducing the number of grades and eliminating rank-based grading might have created an affirming learning environment that fulfills basic psychological needs and reinforces the intrinsic motivation linked to academic performance. The cumulative effect of these 2 mediators suggests that a comprehensive approach should be used to understand student performance.
Purpose We examined United States medical students’ self-reported feedback encounters during clerkship training to better understand in situ feedback practices. Specifically, we asked: Who do students receive feedback from, about what, when, where, and how do they use it? We explored whether curricular expectations for preceptors’ written commentary aligned with feedback as it occurs naturalistically in the workplace.
Methods This study occurred from July 2021 to February 2022 at Southern Illinois University School of Medicine. We used qualitative survey-based experience sampling to gather students’ accounts of their feedback encounters in 8 core specialties. We analyzed the who, what, when, where, and why of 267 feedback encounters reported by 11 clerkship students over 30 weeks. Code frequencies were mapped qualitatively to explore patterns in feedback encounters.
Results Clerkship feedback occurs in patterns apparently related to the nature of clinical work in each specialty. These patterns may be attributable to each specialty’s “social learning ecosystem”—the distinctive learning environment shaped by the social and material aspects of a given specialty’s work, which determine who preceptors are, what students do with preceptors, and what skills or attributes matter enough to preceptors to comment on.
Conclusion Comprehensive, standardized expectations for written feedback across specialties conflict with the reality of workplace-based learning. Preceptors may be better able—and more motivated—to document student performance that occurs as a natural part of everyday work. Nurturing social learning ecosystems could facilitate workplace-based learning such that, across specialties, students acquire a comprehensive clinical skillset appropriate for graduation.
This study aimed to find the self-directed learning quotient and common learning types of pre-medical students through the confirmation of 4 characteristics of learning strategies, including personality, motivation, emotion, and behavior. The response data were collected from 277 out of 294 target first-year pre-medical students from 2019 to 2021, using the Multi-Dimensional Learning Strategy Test 2nd edition. The most common learning type was a self-directed type (44.0%), stagnant type (33.9%), latent type (14.4%), and conscientiousness type (7.6%). The self-directed learning index was high (29.2%), moderate (24.6%), somewhat high (21.7%), somewhat low (14.4%), and low (10.1%). This study confirmed that many students lacked self-directed learning capabilities for learning strategies. In addition, it was found that the difficulties experienced by each student were different, and the variables resulting in difficulties were also diverse. It may provide insights into how to develop programs that can help students increase their self-directed learning capability.
Purpose The current study aimed to use network analysis to investigate medical and health students’ readiness for online learning during the coronavirus disease 2019 (COVID-19) pandemic at the University of Medicine and Pharmacy, Hue University.
Methods A questionnaire survey on the students’ readiness for online learning was performed using a Google Form from May 13 to June 22, 2021. In total, 1,377 completed responses were eligible for analysis out of 1,411 participants. The network structure was estimated for readiness scales with 6 factors: computer skills, internet skills, online communication, motivation, self-control, and self-learning. Data were fitted using a Gaussian graphical model with the extended Bayesian information criterion.
Results In 1,377 students, a network structure was identified with 6 nodes and no isolated nodes. The top 3 partial correlations were similar in networks for the overall sample and subgroups of gender and grade levels. The self-control node was the strongest for the connection to others, with the highest nodal strength. The change of nodal strength was greatest in online communication for both gender and grade levels. The correlation stability coefficient for nodal strength was achieved for all networks.
Conclusion These findings indicated that self-control was the most important factor in students’ readiness network structures for online learning. Therefore, self-control needs to be encouraged during online learning to improve the effectiveness of achieving online learning outcomes for students.
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Purpose This study aimed to translate simulation-based dietitian nutritionist education to clinical competency attainment in a group of practicing registered dietitian nutritionists (RDNs). Using a standardized instrument to measure performance on a newly-required clinical skill, the nutrition-focused physical exam (NFPE), competence was measured both before and after a simulation-based education (SBE) session.
Methods Eighteen practicing RDNs were recruited by their employer, Spectrum Health. Following a pre-briefing session, participants completed an initial 10-minute encounter, performing NFPE on a standardized patient (SP). Next, participants completed a 90-minute SBE training session on skills within the NFPE, including hands-on practice and role play, followed by a post-training SP encounter. Video recordings of the SP encounters were scored to assess competence in 7 skill areas within the NFPE. Scores were analyzed for participants’ initial competence and change in competence.
Results The proportions of participants with initial competence ranged from 0% to 44% across the 7 skill areas assessed. The only competency where participants initially scored in the “meets expectations” range was “approach to the patient.” When raw competence scores were assessed for changes from pre- to post-SBE training, the paired t-test indicated significant increases in all 7 competency areas following the simulation-based training (P<0.001).
Conclusion This study showed the effectiveness of a SBE training program for increasing competence scores of practicing RDNs on a defined clinical skill.
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Purpose To determine dental students’ motivational profiles through a person-centred approach and to analyse the associations with the satisfaction of their basic psychological needs, study strategies, academic performance, self-esteem, and vitality.
Methods A total of 924 students from the University of San Sebastian (Chile) participated in this cross-sectional cor¬relational study in spring 2016. Data were collected through 5 self-reported instruments, in addition to students’ academic performance. The Cronbach alpha, descriptive statistics, and correla¬tion scores were computed. A k-means cluster analysis with intrinsic and controlled motivation was conducted to identify different mo-tivational profiles. Subsequently, multivariate analysis of covariance controlling for the effects of gender and year of study was carried out to assess differences among the retained motivational profiles and learning variables.
Results All instruments showed acceptable Cronbach alpha scores. A 4-cluster solution was retained for the motivational profile over a 3- or 5-cluster solution. Students’ motiva-tional profiles were characterized by different degrees of intrinsic and controlled motivation. The high intrinsic motivation groups showed higher perceptions of their basic psychological, a greater propensity for a deep rather than surface study strategy, better academic performance, and higher scores for self-esteem and vitality than the low intrinsic motivation groups, regardless of the degree of controlled motivation.
Conclusion Students with a high intrinsic motivation profile, regardless of their controlled motivation scores, reported better learning characteristics. Therefore, special attention should be paid to students’ motivational profiles, as the quality of motivation might serve as a basis for interventions to support their academic success and well-being.
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Purpose This study aimed at conducting a systematic review in health professions education of determinants, mediators and outcomes of students’ motivation to engage in academic activities based on the self-determination theory’s perspective. Methods: A search was conducted across databases (MEDLINE, CINHAL, EMBASE, PsycINFO, and ERIC databases), hand-search of relevant journals, grey literature, and published research profile of key authors. Quantitative and qualitative studies were included if they reported research in health professions education focused on determinants, mediators, and/or outcomes of motivation from the self-determination and if meeting the quality criteria. Results: A total of 17 studies met the inclusion and quality criteria. Articles retrieved came from diverse locations and mainly from medical education and to a lesser extent from psychology and dental education. Intrapersonal (gender and personality traits) and interpersonal determinants (academic conditions and lifestyle, qualitative method of selection, feedback, and an autonomy supportive learning climate) have been reported to have a positive influence on students’ motivation to engage in academic activities. No studies were found that tested mediation effects between determinants and students’ motivation. In turn, students’ self-determined motivation has been found to be positively associated with different cognitive, affective, and behavioural outcomes. Conclusion: This study has found that generally, motivation could be enhanced by changes in the educational environment and by an early detection of students’ characteristics. Doing so may support future health practitioners’ self-determined motivation and positively influence how they process information and their emotions and how they approach their learning activities.
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Purpose Problem-based learning (PBL) is usually conducted in small-group learning sessions with approximately eight students per facilitator. In this study, we implemented a modified version of PBL involving collaborative groups in an undergraduate chiropractic program and assessed its pedagogical effectiveness. Methods: This study was conducted at the International Medical University, Kuala Lumpur, Malaysia, and involved the 2012 chiropractic student cohort. Six PBL cases were provided to chiropractic students, consisting of three PBL cases for which learning resources were provided and another three PBL cases for which learning resources were not provided. Group discussions were not continuously supervised, since only one facilitator was present. The students’ perceptions of PBL in collaborative groups were assessed with a questionnaire that was divided into three domains: motivation, cognitive skills, and perceived pressure to work. Results: Thirty of the 31 students (97%) participated in the study. PBL in collaborative groups was significantly associated with positive responses regarding students’ motivation, cognitive skills, and perceived pressure to work (P<0.05). The students felt that PBL with learning resources increased motivation and cognitive skills (P<0.001). Conclusion: The new PBL implementation described in this study does not require additional instructors or any additional funding. When implemented in a classroom setting, it has pedagogical benefits equivalent to those of small-group sessions. Our findings also suggest that students rely significantly on available learning resources.
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Purpose Internalization of students’ motivation towards an intrinsic form is associated with increased interest, commitment, learning, and satisfaction with education. Self-Determination theory postulates that intrinsic motivation and autonomous forms of self-regulation are the desired type of motivation; as they have been associated with deep learning, better performance and well-being. It claims three basic psychological needs have to be satisfied in order to achieve intrinsic motivation. These are the needs for autonomy, competence and relatedness. This study aims to provide a review on how these basic psychological needs are encouraged in undergraduate students so they can be transferred to the clinical teaching environment. Methods: Electronic searches were performed across four databases (Medline, Embase, PsycINFO, and ERIC), relevant journals, and retrieved bibliography of selected articles. In total, searches produced 4,869 references, from which 16 studies met the inclusion criteria. Results: Main themes were coded in three categories: The support of autonomy, competence and relatedness. The research-based evidence appears to be of reasonable quality, and indicates that teachers should work to satisfy students’ basic psychological needs to foster internalization of self-regulation. Our findings suggest that teachers should interact with students in a more ‘human centred’ teaching style, as these actions predict motivational internalization. Several themes emerged from different contexts and further investigation should expand them. Conclusion: This review identified actions that clinical teachers could implement in their daily work to support students’ self-determination. Autonomy supportive teaching in health professions educations would benefit students and may actually result in more effective health care delivery.
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Purpose At present, transformative learning is one of the most important issues in medical education, since a conventional learning environment is prone to failure due to changing patterns among students. Ethnographic edutainment is a concept that consists of reward, competition, and motivation strategies that be used to effectively engage with learners. Methods: A total 321 first-year medical students took part in ethnographic edutainment sessions in 2011. We defined four preset learning objectives and assigned a term group project using clouding technologies. Participatory evaluation was conducted to assess the delivery of and attitudes towards this method. Results: Career lifestyles in the general population and expected real-life utilization of the final product were used as motivating factors, with competition and rewards provided through a short film contest. Nineteen out of twenty groups (95%) achieved all learning objectives. Females were more satisfied with this activity than males (P<0.001). We found statistically significant differences between lecture-based sessions and field visit sessions, as well as ethnographic edutainment activity sessions and other instructional approaches (P<0.01). The results were consistent in male and female groups. Conclusion: Ethnographic edutainment is well accepted, with higher satisfaction rates than other types of teaching. The concepts of health promotion and the social determinants of health can be learned through ethnographic edutainment activities, which might help train more humanized health professionals.
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