Perspectives of medical undergraduate students toward self-directed learning

INTRODUCTION

The objective of medical education is to enrich the knowledge and skills along with empowering Indian medical graduates to be good clinicians, leaders and lifelong learners, according to the competency-based medical education (CBME) curriculum of India.^[1] Self-directed learning (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 as well as material resources for learning, choosing and implementing appropriate strategies and evaluating learning outcomes’.^[2] It comprises knowledge acquisition, accumulation and retrieving information by which the learner inculcates skills for effective SDL. The teacher takes up the role of facilitator and guides the learner about ‘learn how to learn’.^[3] In SDL, the onus of learning is on the learner and learning control is slowly transferred from facilitator to learner.^[4] The level of self-tuning of learners’ is found to be firmly correlated to their motivation, endurance, and academic performance.^[5] When SDL was included in the CBME curriculum to a larger extent, it was misinterpreted as lone-reading or instructing the students to refer to the books in an unattended manner. It was included in the teaching schedule as an ill-planned session.^[6] In higher education institutions such as professional courses, feedback and student evaluation is an integral element to measure the quality of learning they cater to. Assessment of student learning/effective teaching and course/content assessment has provided importance to preserving academic calibre, quality and relevance of course layout and delivery in the past few decades.^[7] In 2007, Williamson devised the self-rating scale of SDL (SRSSDL), which is an efficient teaching/learning instrument. This tool caters a chance for learners to reflect on their behaviour and learning curve as well as be self-driven.^[4] Self-learning skills have to be incorporated into students for lifelong and continuous academic development. Evaluating the SDL readiness among medical students will help the academicians to deduce the intent of education for SDL. Hence, the objective of the study was to understand the SDL readiness in undergraduate medical students and deduce whether SDL readiness varied between students of 2^nd and 3^rd professional years.

MATERIAL AND METHODS

Study instrument

SRSSDL Tool, which is a pre-validated and self-assessment tool for students to monitor their learning skills, was used as a study instrument. SRSSDL scale is a free-to-use scale, and permission from the original authors was requested through the mail. The scale includes 60 learning behaviour statements under five broad categories of awareness, learning strategies, learning activities, evaluation and interpersonal skills, with 12 questions in each section. Students’ responses for every statement are recorded using a five-point rating scale, following which the scores are calculated and interpreted, as shown in Figure 1.^[8]

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Figure 1:

Self-rating scale for self-directed learning score and its interpretation.

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The data were recorded with a self-administered pre-validated SRSSDL tool, which was provided to the students of 2^nd and 3^rd professional years of undergraduate medical students in two separate sessions through online Google Form after they were briefed about the intent of the study and manner of filling the study instrument. They were given a duration of 48 h to fill the form and record the response. The consent to be a part of the study was mentioned in the form as a check box, and the students were not compelled to take part in the survey.

RESULTS

The study was conducted on medical undergraduates in 2nd—and 3rd-year MBBS. A total of 285 participants took part in the study from both academic years. The demographic features of students are summarised below in Table 1.

The SRSSDL tool was considered to evaluate the readiness of students for SDL. Out of 285 students had a moderate level of readiness (56.8%) followed by a high level of readiness (42.9%). The majority of the students from both professional years had a moderate level of readiness toward SDL, as shown in Figure 2.

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Figure 2:

Level of readiness of study participants of both professional years. SRSSDL: Self-rating scale for self-directed learning, SDL: Self-directed learning.

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Five components of the SRSSDL tool were analysed to obtain the mean response score of the study participants, which is depicted in Table 2. This mean score reflects that the majority of participants’ responses recorded were either ‘sometimes’ or ‘often’ for various components of the SRSSDL tool. To understand whether academic year and gender influenced the scoring of the SRSSDL tool, subgroup analysis using an independent sample Mann–Whitney U-test was performed, which is depicted in Table 2. The distribution of awareness, learning strategy, learning activities, evaluation and interpersonal skills did not show any significant association across academic year and gender.

The Chi-square test was used to analyse any significant association regarding readiness toward SDL between 2^nd year and 3^rd year MBBS students. Students felt peer coaching, group discussions and role play as an effective way for complex learning. They consider the teacher as a facilitator. All the questions which showed significant differences are shown in Table 3.

DISCUSSION

CBME emphasises Indian Medical Graduates function as lifelong learners and have a continuous commitment to improve knowledge and skills.^[1] Primarily SDL is an advanced level active learning method that improves cognitive skills and accelerates self-sufficiency in learning of the students where the responsibility of learning is inclined toward the students.^[9] Goal achievement, autonomous behaviour, self-handling and motivation are a few of the personal attributes necessary for SDL to be effective.^[2]

Wang and Holcombe advise that the sustainability of self-moderated learning relies considerably on the level of persistence and effort the learner devotes to achieve the assigned tasks.^[10] Badyal et al. recommend that SDL if conducted appropriately, can have a high impact on medical education. The orientation of facilitators and the readiness of students must be considered well in advance to introduce SDL sessions efficiently.^[11] Patra et al. observed that 67% of the students were satisfied, and 66% were driven to study further following the SDL session.^[12] Hence, SDL can be considered an effective method of learning in motivated learners.

A confirmatory factor analysis was performed by Cadorin et al. to assess the validity of the SRSSDL tool, and it was found that it contributes to determining learning requirements among students and healthcare professionals. This helps facilitators to recognise and include tactics to improve SDL potential.^[13] However, Greveson and Spence have observed that contextual factors such as cultural, social, past experiences and educational settings impact the motivation and ability of learners to be self-directed. This may explain the concerns of learners’ difficulty and stability across different health professional groups and varying learning backgrounds.^[14]

In our study, the SRSSDL tool, which was used to analyse the readiness of students toward SDL, showed that 56.8% had a moderate level and 42.9% with a high level of readiness, which was similar to the findings by Madhavi and Madhavi 64 and 36 readiness toward moderate and high levels.^[15]

Koirala et al. observed the various factors affecting the readiness for SDL and found that grade and performance in the previous academic year exerted a significant association (P = 0.025) with SRSSDL levels.^[16] In a study by Atta and Alghamdi for assessing the effectiveness of SDL against problem-based learning, it was observed that SDL proves to be less valuable for promoting self-readiness in students with low scores in SRSSDL and frequent sessions in small groups or panel discussions are strongly advocated for students to improve readiness with SDL.^[17]

In our study, there was no significant association in the distribution of various components of the SRSSDL tool with gender, which was similar to findings by Gyawali et al. conducted on 1st-year medical students.^[18]

Prachita and Vrushali found that clinical students had significantly higher mean total SRSSDL scores as compared to pre-clinical students in all subdivisions of the tool, while Linda et al., in their study, noted that 1^st professional year students’ scores were considerably high on SRSSDL scale subcategories. This was attributed to students who casually recorded answers with respect to their belief that they should be essential and that they overestimated their strength of SDL skills or exhibited threshold effect and/or social desirability bias.^[19,20] In contrast to above findings, our study did not show any significant difference in mean total SRSSDL score among students of 2^nd and 3^rd professional years.

Few components, such as the inclusion of role play, group discussion and peer tutoring in the SRSSDL questionnaire, showed statistically significant values in our study. Sourya et al. observed that role-play could be utilised as an effective method for learning medicine as there was a significant improvement in the cognitive, affective and psychomotor domains.^[21] The same findings were reflected in our study as students felt role-play to be a useful method for complex learning. Roshni and Rahim, in their study, were in favour of group discussion as the scores for overall learning experience were found to be significantly higher for a group discussion as compared to the lecture. They strongly advocated that it improves the duration of attentiveness in students, analysing the concepts and recall, which was similar to our findings.^[22] Burgess et al. found that students were of the opinion that peer mentoring program offers opportunities as it provides a framework within the medical syllabus for students to practice and enrich their medical knowledge and academic expertise.^[23]

CONCLUSION

The moderate level of readiness in the majority of students shows that areas of improvement must be identified and evaluated with teacher guidance when necessary. The suitability of SDL as a learning method in students can be measured with the SRSSDL tool, as it helps to classify the student readiness toward SDL and its acceptance. Future studies under these categories are needed before larger consideration of the SRSSDL tool for surveys in medical education can be done.