아일랜드 의전원생들의 임상술기 관련 SDL의 성과 (BMC Med Educ, 2015)

아일랜드 의전원생들의 임상술기 관련 SDL의 성과 (BMC Med Educ, 2015)

Outcomes of Irish graduate entry medical student engagement with self-directed learning of clinical skills 

Deirdre McGrath*, Louise Crowley, Sanath Rao, Margaret Toomey, Ailish Hannigan, Lisa Murphy and Colum P Dunne

평생학습

Life-long learning is an on-going process, which leads to “systematic acquisition, renewal, upgrading and completion of knowledge, skills and attitudes”; its success depends on learners’“increasing ability and motivation to engage in self-directed learning (SDL) activities” [1]. 

SDL의 개념

The concept of SDL was first outlined in the context of adult learning [2] and was defined as “ a process in which individuals take the initiative…in diagnosing their learning needs, formulating goals, identifying …resources for learning, choosing and implementing appropriate learning strategies, and evaluating learning outcomes”.

SDL 정의가 일관되지 않다.

In the context of medical education, there is inconsistency in how SDL is defined [3,4] 

초기의 불확실성에도 불구하고 SDL은 다양한 임상과에서 평생학습을 강조하는 수단으로 많이 사용되었다.

Despite some initial uncertainty [4,5], SDL has been proposed as a means of emphasising the importance of life-long learning, particularly in the context of professional competence for medical professionals across many disciplines

최근 수십년간 여러 의과대학들이 PBL을 교육전략으로 도입하였다. 비교적 새로운 접근법이기에 많은 연구가 되었지만, PBL에 대한 일관된 정의가 부족하고, 양질의 연구가 적어서 얼마나 활용되고 있는가를 이야기하긴 어렵ㄴ다.

In recent decades, medical schools are incorporating the educational strategy of Problem-based Learning (PBL) into their curricula to a lesser or greater extent. As it is a relatively innovative approach, much research has been done on PBL. However, due to lack of consistent definitions of PBL, and limited research of high quality, it is difficult to determine just how widespread its use is [14].

의과대학에서 일반적인 임식술기 교육 진행. 보여주고, 연습하고, 실제로 하고, 피드백 받고, 연습하고.

In medical schools, clinical skills training tends to occur in standardized, controlled and safe learning environments conducive to students “

• being shown what to do, 
• practicing (where possible) on models, simulated patients or one another, 
• performing (skills) under close supervision, 
• obtaining feedback, and then 
• practicing the skill with increasingly distant supervision until they are ‘licensed’ to perform the skill independently” [21]. 

임상교사를 충분히 모집하는 것이 어렵고, 비용이 많이 든다. 임상교육과 졸업후교육에서도 SDL 접근법이 매력적으로 다가온다.

However, recruitment of sufficient, relatively expensive, clinical teachers can be problematic and as students need to practise skills with increasingly distant supervision, SDL approaches to clinical skills training have become attractive and have expanded beyond the boundaries of effective pre-clinical teaching [22] into clinical and post graduate training.

아일랜드의 ULGEMS에서 이뤄진 연구이다. 

This study was completed at an exclusively graduate-entry medical school (ULGEMS) established at the University of Limerick, Ireland in 2007 [28,29]. Previous reports have described the progress of this school and the academic de- velopment of its students [30,31].

SDL에 대한 기록은 전자 SDL 예약기록 활용(후향적)

A retrospective analysis of the extent of student engagement with SDL was performed using the retained electronic records of SDL bookings for the academic years beginning September 2008-2010.

단면조사

A cross-sectional survey of all medical students in the school (two pre-clinical years and two clinical years, n = 358 registered between 2008 and 2010) was carried out in 2012. Students were contacted by email and provided a link to the Survey MonkeyTM online study instrument and to a concise, unbiased explanation of the survey topic. Participation was voluntary and anonymous. The first question of the survey asked students to confirm that they consented to the study.

주관식 문항 분석

Data were downloaded from Survey Monkey™ software to an electronic data file. Free text comments were analysed independently by two reviewers (LC, AH) to identify emergent themes. Researchers then met, discussed the themes emerging from the data, identified dominant themes and reached agreement around the clustering of themes into categories.

임상기술 교육에서 SDL을 적용하거나 효과성이 있을 것인가에 대한 많은 논이가 있었다. 본 연구에서 참여자는 다양한 배경을 가진 의전원 학생들이었는데 매 해 지날수록 임상술기 SDL에 대한 참여가 감소하는 것이 확인되었다.

There has been considerable discussion as to the applicability and efficacy of self-directed learning of clinical skills [21], allied to recognition of the challenges associated with students having the requisite self-awareness to take responsibility for determining their own learning needs and, indeed, the readiness of students to assume that role [34]. In this study, the participants were exclu- sively graduate entry medical students but from diverse primary degree disciplines and with varying levels of post-graduate experience. Despite variations in the com- position of student classes beginning medical studies in 2008, 2009 and 2010, and the assumed attitudinal differ- ences towards didactic and self-directed learning that such variation may bring, a year on year decline in en- gagement with clinical skills SDL was noted (Table 1).

이러한 결과는 시뮬레이션과 임상상황에서의 불일치 때문일 수 있다. 이는 주관식 응답에서도 확인되었다. 또한 참여가 감소한 것은 각 학년의 학생 수가 늘어나면서 SDL 실습실에 대한 접근이 제한되었기 때문일 수도 있다.

This could be interpreted as being reflective of disparity between simulation in medical teaching and practice in a supervised clinical setting, as reported elsewhere [18], which also emerged as a theme from the free text com- ments of students. This decline in engagement may also be as a result of increasing student numbers in each co- hort and reduced access to the SDL labs, another theme that emerged from students’ free text comments.

그러나 본 연구에서 SDL에 참여한 것이 대부분 항목에서 OSCE 수행능력을 높여주는 것으로 나오지 않았는데, 이는 학생들의 지도해주는 사람이 없는 상태에서 실수나 불확실한 부분이 더 악화되었을 수 있다. 혹은 SDL에 오는 학생이 이미 학업적으로 우수하지 못해서일 수도 있다. 

However, our analysis did not indicate any statistically significant effect of SDL engagement on OSCE performance (Tables 2 and 3) for most of the clinical skills examined. There is, therefore, a possibility that students may be compounding errors/uncertainties while practising skills unsupervised. Alternatively, it is possible that those students who may be academically weaker are accessing SDL to work on improving skills they feel they are weaker in, and hence any improvement they achieve may just bring their proficiency up to the mean of the group.

There is an argument for the development of strategies to promote greater engagement with clinical skills SDL, even if solely to avoid the financial implications of requiring additional clinical tutors for increased formal clinical skills training. In light of the results of this study, possibilities such as...

• supplementary workshops [36], 
• allied to encouragement of learning portfolio use by students such that they reflect on their progress, 
• diagnose learning needs and create learning plans [10], 

could potentially result in an overall increased use of SDL . 

That said, records of the timing of personal SDL bookings indicated that imminent clinical skills examinations incentivised engagement with SDL considerably, particularly in the second pre-clinical year. As this is the third time that students will have participated in OSCEs, the observed enhanced interest in SDL may be due to increased awareness of skill deficits and plans to mitigate these [37] or reflect assumption of greater responsibility for their own learning over time [38]. Introducing more informal/formative testing throughout the academic year may be another option to increase SDL engagement among students

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BMC Med Educ. 2015 Feb 19;15:21. doi: 10.1186/s12909-015-0301-x.

Outcomes of Irish graduate entry medical student engagement with self-directed learning of clinical skills.

McGrath D1, Crowley L2, Rao S3, Toomey M4, Hannigan A5, Murphy L6, Dunne CP7.

Author information

• 1Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity {4i}, University of Limerick, Limerick, Ireland. Deirdre.mcgrath@ul.ie.
• 2Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity {4i}, University of Limerick, Limerick, Ireland. Louise.Crowley@ul.ie.
• 3Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity {4i}, University of Limerick, Limerick, Ireland. Sanathmrao@gmail.com.
• 4Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity {4i}, University of Limerick, Limerick, Ireland. Margaret.Toomey@ul.ie.
• 5Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity {4i}, University of Limerick, Limerick, Ireland. Ailish.Hannigan@ul.ie.
• 6Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity {4i}, University of Limerick, Limerick, Ireland. Lisa.Murphy@ul.ie.
• 7Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity {4i}, University of Limerick, Limerick, Ireland. Colum.Dunne@ul.ie.

Abstract

BACKGROUND:

Existing literature is mixed as to whether self-directed learning (SDL) delivers improvements in knowledge, skills or attitudes ofmedical students compared with traditional learning methods. This study aimed to determine whether there is an association between engagement in SDL and student performance in clinical examinations, the factors that influence student engagement with SDL in clinical skills, and studentperceptions of SDL.

METHODS:

A retrospective analysis of electronic records of student bookings of SDL sessions from 2008 to 2010 was performed for students in the pre-clinical years of an Irish Graduate Entry Medical programme to assess their level of engagement with SDL. The extent to which this engagementinfluenced their performance in subsequent summative examinations was evaluated. A cross-sectional survey of students across the four years of the programme was also conducted to determine student perceptions of SDL and the factors that affect engagement.

RESULTS:

The level of engagement with SDL decreased over time from 95% of first years in 2008 to 49% of first years in 2010. There was no significant difference between the median exam performance for any clinical skills tested by level of engagement (none, one or more sessions) except for basic life support in first year (p =0.024). The main reason for engaging with SDL was to practice a clinical skill prior to assessment and the majority of respondents agreed that SDL sessions had improved their performance of the specific clinical skills being practised.

CONCLUSION:

Students viewed SDL as an opportunity to practise skills prior to assessment but there were no significant differences in subsequent summative assessment by the level of engagement for most clinical skills.

PMID:

 

25890332

 

[PubMed - in process] 

PMCID:

 

PMC4336507

 

Free PMC Article