보건의료인 교육에서 자기주도학습(SDL)의 효과: systematic review (Med Educ, 2010)

보건의료인 교육에서 자기주도학습(SDL)의 효과: systematic review (Med Educ, 2010)

The effectiveness of self-directed learning in health professions education: a systematic review

Mohammad H Murad,1,2 Fernando Coto-Yglesias,3 Prathibha Varkey,1 Larry J Prokop4 &

Angela L Murad2

과연 SDL이 효과가 있는가에 대해 답하고자 할 때 어려운 점은 SDL을 정의하는 것의 어려움과 SDL 기반의 교육과정이 매우 이질적이라는 것이다. 1975년 Malcolm Knowles는 가장 흔하게 인용되면서 가장 포괄적인 SDL의 정의를 다음과 같이 내렸다. 

"SDL은 개개인이 이니셔티브를 쥐고, 다른 사람의 도움이 있거나 없는 환경에서 스스로의 학습 요구를 파악하고 목표를 설정하고 학습에 필요한 인적 자원과 물적 자원을 찾아서 적절한 학습 전략에 도입하고, 그 결과를 평가하는 것을 말한다.'

The main challenges to answering this question involve the difficulty of defining SDL and the heterogeneity of SDL-based curricula. In 1975, Malcolm Knowles provided one of the most commonly cited and comprehensive definitions of SDL: ‘SDL is a process in which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating goals, identifying human and material resources for learn- ing, choosing and implementing appropriate learn- ing strategies, and evaluating learning outcomes.’4"

Knowles는 SDL의 여러 주요 요소에 대해서 말했다.

• the educator should be a facilitator of learning and not a content source; 
• learners should be involved in identifying their learning needs, objectives and resources, and 
• learners should be involved in implementing the learning process, should commit to a learning contract and should evaluate the learning process.4

Knowles described several essential components of SDL: the educator should be a facilitator of learning and not a content source; learners should be involved in identifying their learning needs, objectives and resources, and learners should be involved in imple- menting the learning process, should commit to a learning contract and should evaluate the learning process.4"

다양한 교육적 인터벤션은 SDL의 일부 요소들을 공유하며, 아주 제한된 요소만 가지고 그렇게 불리기도 한다.

Numerous educational interventions share some elements of SDL and are often labelled as such,"

그러나 학습자들이 진정으로 자기주도성을 갖추기 위해서는 Knowles가 내린 정의의 다른 요소들도 포함되어야 한다.

Yet, for learners to be truly self-directed, some of the other components contained in Knowles’ definition4 should be incorporated in the learning process"

학습자들은 42%에서는 무작위 배정되었지만, 무작위 배정의 세부 사항이나 질적 평가를 위한 연구의 다른 특징들은 제대로 보고되지 않은 경우가 많다.

Learners were randomly allocated to SDL in 25 studies (42%); however, details about randomisation and other study characteristics needed for quality assessment were poorly reported."

분석한 연구 논문들의 목록

A detailed description of included studies is presented in Table S1."

40개의 연구가 지식 영역, 9개 연구가 술기 영역, 5개 연구가 태도 영역

Forty studies reported outcomes in the knowledge domain, nine studies reported outcomes inthe skills domain, and five reported outcomes intheattitudes domain."

상호작용화된 컴퓨터 모듈 사용이 13개 연구, 나머지는 비-상호작용 (책, 시청각자료) 자료 활용

Learning resources included interactive computer- ised modules in 13 studies (22%) and non-interactive (reading materials, audiovisual resources) in the remaining studies."

지식 영역에서는 중등도의 향상이, 태도와 술기 영역에서는 통계적으로 유의미하지 않은 매우 작은 향상이 있었음.

When data were pooled in meta-analysis and out- comes compared with those of traditional teaching methods, SDL was associated with a moderate increase in the knowledge domain (SMD 0.45, 95% CI 0.23–0.67; I2 = 92%) (Fig. 2), a trivial and non- statistically significant increase in the skills domain (SMD 0.05, 95% CI ) 0.05 to 0.22; I2 = 2%) (Fig. 3), and a non-significant increase in the attitudes domain (SMD 0.39, 95%CI ) 0.03 to 0.81; I2 = 91%) (Fig. 4)."

학습자들의 learning resource를 선택할 경우에 다른 경우에 비해서 지식 영역에 통계적으로 유의미한 향상이 있었다.

There was a statistically significant interaction suggesting that when learners were involved in choosing learning resources, they made larger improvements in the knowledge domain."

SDL 인터벤션의 기간과 effect size 사이에는 상관관계가 없었다. 

In meta-regression, there was no correlation betweenthe observed effect size and the length of SDL intervention (p = 0.64) or the time interval between the completion of the intervention and outcome assessment (p = 0.14)."

SDL은 학습자들이 학습자원 탐색에 참여했을 때 더 효과적이었다.

In addition, SDL seemed to be more effective when learners were involved in identifying their learning resources."

Knowles는 자기주도적 학습자는 교육자와의 상담을 통해서 그들의 스타일과 교육과정의 목표에 가장 잘 맞는 학습 방법과 학습 자원을 찾는다고 주장하였다. 예컨대 인지적 목표는 written resource나 panel discussion을 통해서, 행동적 목표는 role-play난 case-based learning을 통해서, 정의운동 목표는 role-play와 simulation을 통해서 가장 잘 달성될 수 있다. 유사하게 자기주도적 학습자는 자신의 학습 유형에 가장 잘 부합하는 학습 방법을 선택할 수 있는 능력이 있다.

Knowles suggested that learners who are self-directed should consult with educators and determine the methods and resources that best fit their learning style and the curriculum objectives.4 For example, cognitive objectives can be achieved using written resources or panel discussions; behavioural objectives can be attained using role-play and case-based learning, and psychomotor objectives are best fulfilled by role-play and simulation. Simi- larly, self-directed learners should have the ability to choose the learning method that suits their individual learning styles (e.g. a visual learner may choose a video-based method, etc.)."

이렇게 이질적인 분석결과를 다음과 같이 설명할 수 있다. (1)SDL의 잇점은 학습자가 학습 방법, 전략, 자원을 선택할 때 가장 잘 나타난다. (2)초보 학습자보다 advanced 학습자가 SDL로부터 더 많이 배운다 (3)전공(학과)에 따라서 SDL 의 기대 효과가 다르다.

We were able to partially explain the heterogeneity by finding that: (i) the benefit of SDL increases when learners are involved in choosing their learning methods, strategies and resources, a key component that defines SDL according to Know- les;4 (ii) advanced learners may benefit more from SDL compared with less advanced learners, and (iii) learner type (discipline) may also affect the anticipated benefits of SDL (nurses had a larger SMD compared with other health professionals)."

이 리뷰에서 추론할 수 있는 것은 SDL이 기존의 교육방법과 거의 비슷한 수준으로 효과적이라는 것이다. SDL은 특정 상황에서 추천되어왔으며(성인학습자, advanced 학습자, 학교 시설과 교사에 대한 접근이 어려운 상황), 학습할 내용이 많을 때 보조적인 방법으로 사용되어왔다. SDL은 비용-효과적이기도 하다.

Inference from this review implies that SDL is likely to be as effective as traditional learning methods. Self-directed learning has been suggested in certain settings (e.g. for adult learners and advanced learn- ers, and in contexts in which access to academic institutions or teachers is limited) and as a supple- mental method of learning when learning content is large.6 It is also plausible that SDL is cost-effective."

SDL에 대한 다양한 묘사가 존재하지만 Knowles가 아마 가장 포괄적이고 가장 빈번하게 인용될 것이다. 그 정의는 하지만 타당화되지 않았으며, 교육자들은 교육과정을 개발하면서 Knowles가 말한 요소 일부 중 그들의 환경에 활용가능하고 관련성이 있어 보이는 부분만 포함시킨다.

Although several descriptions of SDL exist, that byKnowles4 is perhaps the most comprehensive and most frequently cited. This definition has not beennecessarily validated; thus, educators developing SDL curricula have incorporated some of the elements described by Knowles as they have deemed relevant and feasible in their learning environments"

현재까지는, 우리의 판단은 SDL은 기존의 교육방법에 비해서 세 가지 영역 모두에서 비슷하게 효과적이라는 것이다.

At present and according to our findings, we believe that SDL in health professions education is at least as effective as traditional learning in all three domains."

SDL은 지식 영역에서 더 효과적인 것으로 보인다. 우리는 교육자들이 SDL 교육과정을 도입할 때 다음을 고려해야 한다.

Self-directed learning may preferentially be more effective in the knowledge domain. We recommend that educators embarking on developing SDL curricula for learners in health professions should: 

• involve learners in choosing learning resources and strategies to enable them to find the most appropriate resources to fit their individual learning styles as well as the overall learning objective; 
• consider SDL as an effective strategy for more advanced learners (e.g. those in the later years of medical school or residency and doctors in practice), and 
• consider SDL particularly when the learning outcome falls in the knowledge domain."

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Med Educ. 2010 Nov;44(11):1057-68. doi: 10.1111/j.1365-2923.2010.03750.x.

The effectiveness of self-directed learning in health professions education: a systematic review.

Murad MH1, Coto-Yglesias F, Varkey P, Prokop LJ, Murad AL.

Author information

• 1Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. Murad.mohammad@mayo.edu

Abstract

OBJECTIVES:

Given the continuous advances in the biomedical sciences, health care professionals need to develop the skills necessary for life-long learning. Self-directed learning (SDL) is suggested as the methodology of choice in this context. The purpose of this systematic review is to determine the effectiveness of SDL in improving learning outcomes in health professionals.

METHODS:

We searched MEDLINE, EMBASE, ERIC and PsycINFO through to August 2009. Eligible studies were comparative and evaluated the effect of SDL interventions on learning outcomes in the domains of knowledge, skills and attitudes. Two reviewers working independently selected studies and extracted data. Standardised mean difference (SMD) and 95% confidence intervals (95% CIs) were estimated from each study and pooled using random-effects meta-analysis.

RESULTS:

The final analysis included 59 studies that enrolled 8011 learners. Twenty-five studies (42%) were randomised. The overall methodological quality of the studies was moderate. Compared with traditional teaching methods, SDL was associated with a moderate increase inthe knowledge domain (SMD 0.45, 95% CI 0.23-0.67), a trivial and non-statistically significant increase in the skills domain (SMD 0.05, 95% CI-0.05 to 0.22), and a non-significant increase in the attitudes domain (SMD 0.39, 95% CI-0.03 to 0.81). Heterogeneity was significant in all analyses. When learners were involved in choosing learning resources, SDL was more effective. Advanced learners seemed to benefit more from SDL.

CONCLUSIONS:

Moderate quality evidence suggests that SDL in health professions education is associated with moderate improvement in the knowledge domain compared with traditional teaching methods and may be as effective in the skills and attitudes domains.

© Blackwell Publishing Ltd 2010.

Comment in

• What are we missing? On our problems of definition in health professions education. [Med Educ. 2010]