위험군 의과대학생을 대상으로 한 의무 인지기술 프로그램의 설계와 효과성(Med Teach, 2010) [출력완료]

위험군 의과대학생을 대상으로 한 의무 인지기술 프로그램의 설계와 효과성(Med Teach, 2010)

An investigation into the design and effectiveness of a mandatory cognitive skills programme for at risk medical students

Kalman A. Winston, Cees P. M. Van der Vleuten & Albert J. J. A. Scherpbier

Background

의사가 부족할 것이라는 인식이 의과대학의 수 증가로 이어졌다. 이는 의과대학에 대한 접근성 확대broaden access와 함께 의대생 숫자의 증가로 이어져서 다양한, 비-전통적 배경의, 다양한 준비도의 학생이 들어오게 되었다.

Recognition of the growing shortfall of physicians (Dill & Salsberg 2008) has resulted in calls to increase the number of medical schools (AAMC 2006; Howe et al. 2008). This rise in student numbers, along with attempts to broaden access to medical school, is resulting in admission of students from diverse, non-traditional backgrounds (Howe et al. 2008; Jolly et al. 2008), of varying levels of preparedness for a medical curriculum.

미국과 캐나다 의과대학의 설문 결과를 보면 대부분 의과대학은 학생들에게 어떤 형태로든, 자발적 참여 형태의 프로그램으로서, 학업지원서비스academic support service를 제공하고 있다.

A survey of US and Canadian medical schools (Saks & Karl 2004) showed that most do provide some form of academic support service, in a variety of voluntary programmes.

이러한 자발적 참여 프로그램voluntary program의 문제는, 도움을 가장 필요로 해야 하는 학업에 어려움을 겪는 학생weak student들이 도움을 주려는 뜻을 무시하여 잘 참여하지 않는 경우가 흔하다는 것이다. Weaker 한 학생일수록 안 좋은 성적에도 불구하고 스스로를 능력이 충분하다고 생각하며, 스스로의 능력, 자료의 습득정도를 과대평가한다. 반대로, 자신감이 부족한 것은 도전적인 상황을 회피하게 만들고, 특히 자신의 자기-신념self-belief가 도전받는 상황을 회피하려고 한다. 따라서 위험군 학생들은 종종 자신의 실패를 학습문제가 아니라 개인적 이유때문에 실패했다고 생각하여, 그 전에 사용한 성공적이지 못했던 전략으로도 시간만 더 많이 들이면 더 좋은 결과가 나올 것이라고 생각한다. 그럼에도 불구하고, 이 학생들은 같은 과목에서 계속 fail하며, 재교육 없이 다시 그 과목을 듣게 되면 접근법은 그대로 둔 채 그냥 더 열심히 공부할 뿐이고, 결국 또 fail을 받는다.

A key problem with such voluntary programmes is that weak students who most need assistance often fail to seek it (Judd 1985; Weinsheimer 1998; Devoe et al. 2007), ignoring communications offering help (Cleland et al. 2005). Weaker students frequently regard themselves as competent students despite exam results suggesting otherwise, overestimating their ability (Cleland et al. 2008), their performance (Albanese2006) and how well they have mastered the material (Pashleret al. 2007). Conversely, a lack of confidence can result in the avoidance of challenging situations (Fenollar et al. 2007),especially when one’s self-beliefs are challenged (Mackenzie2007). Thus, at-risk students often blame their failure onpersonal reasons rather than study skills (Cleland et al. 2005)or believe that simply putting more time into previously unsuccessful strategies will give better results (Loyens et al.2007). Yet, regardless of their cited reasons, these students typically fail in the same subjects (Sayer et al. 2002), and when allowed to repeat without remediation, often simply work more intensively rather than try to change their approach and thus fail again (Mattick & Knight 2007). 

여러 재교육 프로그램의 효과가 입증된 바 있지만, 이러한 프로그램에 '자발적으로' 참여하겠다고 결정한 것 자체가 성공한 학생의 특성이자 성공요인이었을 수 있다. 그렇다면 '의무 참여mandatory attendance'가 차이를 만들 수 있을까?

This was a significant effect (chi-squared, p50.023), but it is possible that the decision to attend voluntarily is simply indicative of the character and determi- nation to succeed. Could mandatory attendance make a difference?

Devoe 등은 소규모의 '선제적pre-emptive 의무적 인터벤션'의 결과를 보고했는데, 윗학년 학생에 의한 구조화된 스터디그룹에서 '어떻게 배워야 하는가' 대신 '내용'에 초점을 맞춰 진행한 것이 유의한 향상이 없었음을 보고했다. 그러면서 참여가 '의무화'되어서는 안되며, 다만 인터벤션은 '선제적'으로 이뤄져야 한다고 생각한다고 주장했다. 이것은 Alexander 등의 주장과 상반되는데, 이들은 선제적 프로그램은 이 학생들에게 딱지labelled를 붙이는 것이 되며, 이들은 프로그램에 대한 반감이 생긴다. 또한 fail을 예측하는 방식이 정밀하지 못하기crude 때문에, 우선 fail로 드러난 다음에 인터벤션을 하는 것이 더 효과적일 것이라고 주장했다.

Devoe et al. (2007) report a small pre-emptive mandatory intervention (13 students), with structured study groups led by upper-level students, focusing on content rather than learning howto learn: results showed no significant improvements over controls, and they conclude that participation should not be mandated, although they still feel that intervention should happen pre-emptively. This is contradicted by Alexander et al. (2005), who felt that pre-selection ‘labelled’ these students and resulted in antagonism toward the programme, concluding that, based on the crudity of attempts to predict failure, interventions are more effective once the need has become manifest.

일부 의과대학은 위험군 학생을 위한 '속도를 늦춘 프로그램'을 제공했는데, 대부분은 '속도 늦추기' 외에 다른 지원책을 제공하지 않았고, 높은 유급률이 지속되었다.

Some schools provide decelerated programmes for at-risk students, although the majority of these provide no other support than deceleration itself (McGrath & McQuail 2004), and continue to show high dismissal rates.

비학업적 인터벤션은 보통 성과를 내지 못하며, 성공적인 지원 프로그램이 되기 위해서는 학습스킬개발과 학습내용강화가 모두 있어야 한다는게 대강의 컨센서스이다.

Non-academic interventions typically fail to improve the there outcomes (Weinsheimer 1998), and seems to be a broad consensus that successful support programmes should focus on both skills development and content boosting (Saks & Karl 2004; Brigman & Webb 2007; Carroll & Feltham 2007; Mattick & Knight 2007).

 

 

Muraskin의 연구는 다섯 개의 모범적 지원 프로그램에 대한 것이다. 이 프로그램은 '학생-주도 튜터링'에 초점을 덜 두었고, 학생튜터가 아니라 skilled faculty교수 가 운영하였으며, 개개인에 대한 인터벤션보다 그룹단위 인터벤션에 초점을 두었고, 모든 프로그램은 학생의 진급 혹은 입학에 어떤 통제권한control을 가지고 있었다.

Muraskin’s (1997) study describes five exemplary support programmes used in (non-medical) colleges and universities. These programmes focus less on student-led tutoring than other less successful programmes, preferring to rely on skilled faculty than student tutors, and have in common a focus on group rather than individual interventions, as well as all having some control over student promotions and admissions.

학생을 그룹 단위로 구성하여 지원 프로그램을 운영하는 것은 한정된 인적자원에서 최대한의 효과를 낼 수 있으며, 정서적 지지도 제공할 수 있다. 의과대학 학생은 흔히 엄청난 양의 학습분량에 압도당하는 기분을 느끼고, 이 때 튜터와 동료로부터 사회적으로 고립되고, 아무도 자신을 도와주지 않는다는 느낌을 받게 된다. 학생을 그룹 단위로 묶는 것은 '협력'을 가능하게 하고, 이는 학습의 효과적인 도구로서 널리 장점을 인정받은 것이다. 이는...

Working with groups of students maximises the capacity of scarce human resources (Muraskin 1997), and provides opportunities for emotional support: medical students com- monly feel overwhelmed by the volume of material, unsup- ported and socially isolated from tutors and peers (Boulos et al. 2006). Using groups also enables the collaboration that is widely touted as an effective tool for learning (Gokhale 1995; Rogoff 1999; Terenzini et al. 2001),

• 서로서로의 학습을 scaffold해줄 수 있으며
  allowing students to scaffold each other’s learning (Machado 2003),

• 구성주의적 대화를 통해 생각을 공유하고 학습 전략에 대해 성찰하여, 높은 성과를 이루게 한다.
  share ideas and reflect on learning strategies through constructivist dialogue (Mercer 2000; Mackenzie 2007) which promotes higher achievement,

• 높은 퀄리티의 추론
  higher quality reasoning,

• 더 많은 메타인지
  more metacognition and

• 더 많은 동기부여
  more intrinsic motivation (Reynolds et al. 2002; Pegler 2007).

 

또한 정기적인 참석을 통해서 그룹의 안정성이 유지되면 학생과 교수가 상호 신뢰를 쌓고 상호 이해를 하게 되어 프로그램이 성공적이 될 수 있다.

Furthermore, regular attendance promotes the group stability that is key to students and faculty building the mutual trust and understanding upon which the success of such programmes depends (Geertsma 1977; Tekian et al. 2000).

Methods

Research setting and methodology

연구대상: 인종, 연령, 배경, 성별 등이 다양함. 학기 단위 유급생. 20~50명/학기.

The population under study, diverse in ethnicity, age and background, with even gender distribution, is all students who repeat the first semester at the School (‘repeaters’) from 2007 onwards, which ranges from 20 to 50 students per semester. These repeaters now have, as a condition of their academic probation, a requirement to attend cognitive skills sessions.

'내용-전문가'는 아니지만 다양한 교육 및 과학 분야 출신의 경험이 많은 퍼실리테이터가 멘토 역할을 하여, 이들 학생을 지도하였다. 필요한 경우 개인별 세션을 하였다. 필요에 따라 일부 학생은 Counselling Department 로 의뢰하였다.

The department faculty members, who are all experienced facilitators with mixed education and science backgrounds (although not considered ‘content-experts’), act as mentors and guides for these students, and if necessary, individual sessions are arranged as needed. Where appropriate, some students are also referred to the Counselling Department for non-academic assistance.

The programme: Theory and description

 

학생 이해하기: 의과대학에서 fail하는 이유

The first step in course design has to be a good understanding of the learners. There seems to be agreement between the education literature and our own experience on the reasons for students failing at medical school. These include

• 수동적 학습에 지나친 의존
  over- reliance on passive learning (Dolan et al. 2002; Burns 2006),

• 내용 지식 또는 배경 지식 부족
  insufficient background and content knowledge (Slotnick 1981),

• 언어능력, 수리능력, 학습기술, 시험수행전략, 비판적 사고 부족
  weakness in literacy, numeracy, study skills, test-taking strategies and critical thinking, (Pelley 2002a; Sayer et al. 2002; Alexander et al. 2005; Winston & Houghton 2006; Garrett et al. 2007) and

• 학업성취와 관련된 일반적인 자기조절기술과 메타인지기술
  a general lack of the self-regulatory and metacog- nitive skills that are correlated with academic success (Cleland et al. 2005; Brigman & Webb 2007; Cao & Nietfield 2007; Carroll & Feltham 2007; Goldfinch & Hughes 2007; Loyens et al. 2007).

'전문성'에는 자기-인식과 지식을 더 크고 유의미한 패턴으로 조직화하는 것이 필요하다. Bourdieu는 학습자는 메타인지기술을 반드시 익혀야 하며, 비판적, 연역적, 성찰적 사고 프로세스에 관심을 기울여야 한다고 했다. 따라서 재교육 프로그램은 어떻게 개별 학생이 공부하고/생각하는지를 정기적으로, 오랜 시간에 걸쳐 바꿔야 한다.
Expertise requires self-awareness and organisation of knowledge into large, meaningful patterns (Glaser 1999). Bourdieu (1999) states that it is essential that learners acquire metacognitive skills, and pay attention to critical, deductive and reflective thought processes. Thus, a remedial programme needs to challenge how individuals study and think (Mattick & Knight 2007), regularly, over time.

 

피드백은 이 변화과정challenge에서 필수적인 부분이다. 그러나 학생이 능동적으로 자신의 사고 프로세스를 드러내지 않으면 피드백을 주기 어렵다. 이 과정에서 학생은 자신의 생각, 그리고 왜 이 대화가 학습의 중요한 매개요인인지를 설명하고, 정당화해야 한다. 이는 비판적 사고를 촉진하고, 지식의 construction을 촉진한다.

Feedback is an essential part of this challenge, However, it is impossible to give feedback unless students actively demon- strate their thought processes. This requires students to explain and justify their ideas (Hiebert et al. 1999), and is why dialogue and discourse are considered to be essential mediators of learning (Vygotsky 1978; Mercer 2000; Hicks 2003), fostering critical thinking (Freire & Macedo 1999) and knowledge construction (Murphy 1999).

반복적 주제

The recurrent themes are:

• 자기조절 self-regulation;

• 메타인지와 성찰 metacognition and reflection;

• 대화, 추론과정 드러내기 discourse and making reasoning explicit;

• 능동적 학습 active learning;

• 피드백 giving and receiving feedback;

• 기초과학내용과의 관련성 focus on relevance to basic science course content;

• 말 조심, 사고의 정확성 care with language and accuracy of thinking; and

• 감정과 동기부여 attention to affect and motivation.

 

이메일로 초청. 이메일에는 질문이 있음

Repeaters are initially emailed and invited to a ‘large’ group meeting of all first semester repeaters. This email includes a list of questions for

• 감정 성찰 reflection on feelings,

• 과거 fail/success의 이유 reasons for past failures and successes, and

• 효과적/비효과적 공부법 effective/ineffective study methods.

이 질문들은 전체 그룹 미팅 시에 토론의 기초자료가 되며, 학생들은 '실패'를 인정하는데 약간의 편안함을 느끼게 되고, 자신이 혼자가 아니라는 느낌이 생기고, 유대감이 생기고, 자신의 상황과 학교에 대해서 감정을 환기할 기회가 됨.

These questions form the basis for discussion at the large group meeting, where students gain some comfort from the realisation ‘failure’, that they are not alone in and some solidarity quickly develops when they are given the opportu- nity to vent their feelings about their situation and the school.

 

• '반복'에 대한 긍정적 태도 갖게하고, 의대공부 동기부여에 관한 긍정적 토론
  The session progresses towards positives about repeating and an appreciative discussion of their motivations for studying medicine.

• 프로그램 자료는 공유
  Programme data is shared and our expectations are made very clear.

• 매주 참석해야 하고, 학생은 과제를 제출해야 함. 성찰한 내용을 공유
  As well as weekly attendance, students have to complete weekly assignments relating to their basic science coursework, and to be prepared to share and reflect on ideas with their colleagues.

• 서로의 숙제에 대해서 비판해야 함. 이를 통해 스스로에 대해서 객관적으로 바라볼 수 있음. 변화와 향상의 전제조건이 됨.
  Indeed, it is this critiquing of each others’ work that enables them to get a more objective view of their own work, an essential pre-requisite for change and improve- ment (McConnell 2002).

• '특효약'을 주는 것이 아니며 여러 스킬의 부페에서 학생이 골라야 함.
  It is also made quite clear to the students that we are not providing them with a ‘magic bullet’: they are told that our objective is to present them with a smorgasbord of skills and techniques from which they can select the methods best suited to each particular person, subject and context.

• 소그룹으로 나눠짐
  The session finishes with break-out into their assigned small groups, with their professor, to discuss the first assignment and arrange the time for the first small group session.

• 주 단위 syllabus를 따름
  From then on, we follow the syllabus, in small groups, week by week. The titles of the different handouts we use with the students are ‘in italics’.

시간관리: 시간의 양보다 질이 중요함.

Good ‘Time Management’ is an important aspect of self-regulation, and has been shown to have a positive effect on exam scores (Vrugt & Oort 2008).

• Students are asked to plan out their week in detail and then record how they actually spend their week (Hammer & McCarthy 2005).

• When the discrepancies are discussed in the group, failings are admitted, successes are acknowledged and adjustments can be made.

• This process gets repeated according to need and desire, and usually leads to a discussion on the quality of time spent, as opposed to quantity, a common source of confusion for ‘weak’ students (Loyens et al. 2007).

학습 팁: 짧은/반복식/분산된 학습

This handout, along with ‘Study Tips’,

• introduces the idea that short, repeated, distributed study sessions are far superior for learning and memory than multiple hours on the same topic (Thalheimer 2003; Burns 2006; Larsen et al. 2008).

프리뷰: 새로운 지식을 옛 지식과 연결짓기

Then we practice techniques to ‘Preview’ for lectures, where the main goal is to stress the importance of linking new learning to prior knowledge (Harlen 2003).

• 얼마나 이전 자료를 잘 이해했는지가 새로운 자료의 이해해 중요함을 강조함.
  How well prior material is understood is essential for building understanding of new material (Dewhurst et al. 2007; Hay et al. 2008;).

• '이미 아는' 이란 단어를 명확히 정의해주고, 학생들에게 '스스로 생각하는 것 만큼 많이 알고 있지 않음'을 인정하게끔 함. '안다는 느낌의 환상'을 깨우치게 하며, '정의definition의 중요성', '명확한 언어를 사용하는 것의 중요성'을 반복적으로 강조함.
  When asked to clearly define terms they claim are ‘previously known’, students frequently struggle, and are then forced to acknowledge that they did not know as much as they thought, and here we begin to tackle the ‘illusion of knowing’ so common to weak students (Pashler et al. 2007). This focus on the importance of definitions and the need to use language accurately will be important throughout their careers as physicians (Groopman 2008), and is stressed repeatedly, most especially in

 

의학용어, 스스로 설명해보세요

work on ‘Medical Terminology’ and where clear ‘Explain yourself’, students are asked for terms,

• 학생들이 과학 전문용어를 편하게 사용하나, 그러한 용어의 사용이 '이해'를 답보하지 않음을 발견함.
  with explanations of supplemented analogies. Commonly we discover that even when students appear comfortable using scientific language, when challenged, it turns out that this ‘reproduction of disciplinary language does not guarantee understanding’ (Anderberg et al. 2008).

• '비유'를 사용하는 것의 중요성
  The use of analogy is an important aspect of getting at their thinking skills: making analogies has been claimed to be the ‘main business of human brains’ (Hofstadter 2007) – it deepens conceptual understanding, and certainly helps link new understanding to prior knowledge.

'핸드아웃 과제' '목록 조직화' '컨셉맵'

Similar themes of clarifying understanding by organising knowledge structures are continued in ‘Working with Handouts’, ‘Organizing Lists’ and ‘Concept Mapping’,

• '학습결과물'을 만들게 하여, 지식을 물리적으로 드러나게 함.
  which introduce ideas for making ‘study products’, physical repre- sentations of knowledge that enable students to build conceptual relationships and contextualise their understanding (Pelley 2002b; Torre et al. 2007).

• 컨셉맵을 협동적으로 구성하고, 같은 자료에 대한 개인의 생각을 서로 공유함
  The collaborative construc- tion of concept maps and the sharing of each others’ individual representations of the same lecture material (lists, summaries, tables, etc.) opens these students to each other’s ideas and increases reflection on their own work.

• 무엇이 더 중요하고 덜 중요한지 알게 함.
  This introduction to various kinds of ‘study product’ also helps these students learn to identify which facts are more or less important from the vast volume presented to them, a common difficulty for weak students (Burns 2006; Garrett et al. 2007).

질문하기

The process of exploring content and thinking skills, with its direct and obvious relevance to the students’ coursework, is continued in the exercise on ‘Asking Questions’,

• Bloom taxonomy에서 상위 단계로
  which draws on enquiry-based learning and Bloom’s taxonomy to encour- age students to make use of higher level questioning to deepen their understanding (Harlen 2003; Thalheimer 2003; Pashler et al. 2007).

• 질문을 하는 것은 괜찮은 것이며, 학습에 반드시 필요한 것임을 명확히 함.
  Typically, these students fail to question their professors or the material (Muraskin 1997), but here we make it clear that asking questions is not only okay, but essential for learning.

 

추론/가정

Critical thinking skills are further developed as we explore ‘Inferences’ and ‘Assumptions’.

• 문제해결에 성공하는지 여부는 추상적 수준에서의 사고능력과 관계됨
  Success in problem-solving depends on the ability to think at the appropriate level of abstraction (Hofstadter 2007), and

일반화하기

in ‘Generalising’

• 묘사의 수준을 일반적인 것-구체적인 것을 오가면서, 일반적 규칙의 새로운 사례를 찾음
  the challenge is to move between levels of description, generalising from specific examples in basic science coursework, and then finding new instances of the general rule.

 

암기/공식과 계산/듣기 기술

Other handouts include work on ‘Memory’ (Ellis 2003), ‘Equations and Calculations’ and ‘Listening Style’ (Worthington 2008).

객관식 문제에 대한 자료집

There are a number of handouts that deal with different aspects of tackling multiple choice questions (MCQs):

• 문제 rephrase해보기 rephras- ing questions to ensure that the question is understood (Explicit Reasoning),

• 정답과 오답 설명 explaining right and wrong choices,

• 핵심 단어 찾기 identifying key words,

• 다른 보기가 정답이 되게 바꿔보기 rewording questions to make alternate choices correct (Working with MCQs, MCQ learning) and

• MCQ만들기 writing their own MCQs (NBME guidelines), often creating clinical vignettes (Add Your Patient).

 

미국 의대생이 보는 시험은 거의 MCQ이다. 따라서 학생들이 처음에는 인정하기 주저하더라도 주된 문제는 MCQ에 대한 것이며, 시험을 보는 기술에 대한 것이라는 것을 인정하게 함. 또한 연습문제를 가지고 공부하는 것이 실력 향상에도 도움이 될 뿐만 아니라, 학생의 이해수준을 파악하는데도 도움이 되고, knowledge gap을 발견하게 해주고, 프로그램의 다른 요소들을 활용하게 함.

US medical students are tested almost exclusively with MCQs from the beginning of medical school through to their licensing exams (USMLE), so the students see this as most relevant. Indeed, although repeaters are sometimes reluctant to admit other weaknesses, they are usually convinced that their main problem is the MCQ exams and test-taking skills. Thus, not only working with practice questions has been shown by much research to directly improve performance (Thalheimer 2003; Gibbs & Simpson 2004; Sivagnanam et al. 2006; Pashler et al. 2007; Larsen et al. 2008; Marcell 2008), this also is a valuable way of exploring students’ understanding, helping them to identify knowledge gaps, and persuading them that other elements of our programme can be brought to bear in improving their performance on MCQs.

Results

Discussion

매우 긍정적인 효과. '학습에 대한 접근법'은 가르칠 수 있는 것이며, 특히 학생에게 그것이 중요한 문제가 되었을 때 가르치면 효과적이다. 다른 연구에 비해서 표본 크기도 크고 이 인터벤션에 대한 의구심을 별로 없다.

The outcomes so far have been very encouraging, and have certainly made a difference to the progress of these at-risk students compared to controls, confirming the belief that approaches to learning can be taught (Lonka et al. 2008),especially when the skills are applied in situations that matter to the students (Goodyear & Zenios 2007). There seems little doubt that this intervention, with a relatively large sample size compared to other studies (216, against550) has already shown highly significant short-term gains. 

몇년에 걸쳐서 기초과학 과목에 변화가 있었다는 것이 confounding variable이 되지만, 이것은 모든 교육연구의 문제이기도 하다. 한 인터벤현의 효과를 무한한 인간과 과목의 상호작용에서 구분해내기는 어렵다. 그러나 실제로 fail한 학생의 수가 매년 어느정도 비슷하게 유지되었따는 사실은 학생에게 영향을 준 다른 요소가 별로 없었음을 뜻한다.

A confounding variable is variation in course presentation for basic science courses over time. This, of course, is a problem for all educational research – it is hard to isolate the effects of one intervention among the myriad human interac-tions and courses undertaken at a large school. This problem is largely mitigated by the simple fact that if other changes do result in great improvements in student learning, we would expect the actual number of failing (and thus repeating)students to decrease steadily. As yet, there has been no such trend. However, we acknowledge that use comparison with historical controls, rather than the of a randomised protocol, could be a source of bias. 

출석attendance이 높아지면 성과가 높아진다는 결과가 있고, 이 결과를 초반에 학생들에게 제시하면, 학생의 참여를 높일 수 있으며, 장기 학습성과에 긍정적인 효과를 줄 수 있다. 또한 낮은 출석률을 보이는 학생은 학생부학장과 면담을 해야 하는 professionalism card를 받게 된다

The replication of findings that increased attendance in support programmes correlates directly with improved out-comes (Muraskin 1997) is important, and presentation of this data to students at the beginning of the programme may help to improve their attitudes and increase their attendance, with positive effect on long-term outcomes. Currently, poor attendance is addressed individually with the student, after which, failing improvement, professionalism cards have been given, which result in meetings with the Dean for Student Affairs.

'개입은 빠를수록 좋다'라는 오래된 지혜가 있다. 그러나 어쩌면 학생이 medical career를 더 많이 밟아온 학생일수록, 더 잃을 것이 많아지므로, 마지막 학기에서 학생들이 더 수용적receptive해질 수도 있다.

The conventional wisdomis that the earlier the intervention the better (Weinsheimer 1998; Burns 2006; Devoe et al. 2007). This could be challenged on the basis that the further a student has progressed along the path to a medical career, the more they have invested and the more they have to lose, thus making later semester participants potentially more receptive making later semester participants potentially more receptive to new ideas. Indeed, the School’s data show that a failure in any semester is equally predictive of ultimate failure to graduate as a physician. 

 

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Med Teach. 2010;32(3):236-43. doi: 10.3109/01421590903197035.

An investigation into the design and effectiveness of a mandatory cognitive skills programme for at-risk medical students.

Winston KA1, Van der Vleuten CP, Scherpbier AJ.

Author information

• 1Department of Academic Success, Ross University School of Medicine, Commonwealth of Dominica,West Indies. kwinston@rossmed.edu.dm

Abstract

BACKGROUND:

Many medical schools provide academic support programmes to aid increasing numbers of students from diverse backgrounds. There have been calls for research into successful intervention programmes, and for detailed descriptions of how they work.

AIMS:

To explore the efficacy of a mandatory intervention programme for at-risk medical students.

METHOD:

Students who failed and then repeated first semester were required to participate in a cognitive skills programme, following a syllabus based on principles drawn from both educational experience and multi-disciplinary theory and practice. Performance of programme participants was compared to the performance of students who repeated prior to the mandatory programme.

RESULTS:

Of the participants (n = 216), 91% passed their repeat semester, compared to 58% (n = 715) for controls (p < 0.0001). This significant effect persisted for progression through the school for the subsequent three semesters (p < 0.0005).

CONCLUSION:

A mandatory programme that draws on a blend of theories and research-proven techniques can make a positive difference to the outcomes for at-risk medical students.

PMID:

 

20218839

 

[PubMed - indexed for MEDLINE]