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Biomedical subjects

Michele Groves

Publications and source records attributed to Michele Groves.

9 recordsLinked to original sources
PubMed2006

Effects of a metacognitive intervention on students' approaches to learning and self-efficacy in a first year medical course.

AIM: To determine the influence of metacognitive activities within the PBL tutorial environment on the development of deep learning approach, reduction in surface approach, and enhancement of individual learning self-efficacy. METHOD: Participants were first-year medical students (N = 213). A pre-test, post-test design was implemented with intervention and control cohorts, with intervention students experiencing a program of metacognitive activities within their PBL tutorials of at least 20 weeks duration. All students completed the Medical Course Learning Questionnaire at the commencement, and again at the completion of, the study. The metacognitive intervention itself consisted of reflection on the learning in PBL coupled with peer- and self-assessment. RESULTS: Self-efficacy was significantly reduced for both control and intervention cohorts at the conclusion of the study. A significant reduction in the adoption of deep and strategic learning approach, matched by a corresponding increase in the use of surface learning, was demonstrated for both cohorts. There was a statistically significant association between high self-efficacy and deep learning approach, with older students over-represented in the group of efficacious deep learners. CONCLUSION: Over the course of first-year medical studies, students lose self-efficacy and move away from deep-strategic learning approaches towards more surface approaches. The program of metacognitive activities failed to reverse this trend. The substantial swing towards surface learning raises questions about the perceived capacity of PBL curricula to promote deep approaches to learning in dense curricula, and reinforces the importance of personal and contextual factors, such as study habits, workload and assessment, in determining individual approaches and idiosyncratic responses to learning situations.

Adult↗
PubMed2006

Peer assessment in problem-based learning: a qualitative study.

Peer assessment provides a powerful avenue for students to receive feedback on their learning. Although student perceptions of peer assessment have been studied extensively in higher education, little qualitative research has been undertaken with medical students in problem-based learning (PBL) curricula. A qualitative study of students' attitudes to, and perceptions of, peer assessment was undertaken within the framework of a larger study of metacognition with first-year medical students at the University of Queensland. A highly structured format for provision of feedback was utilised in the study design. Many recommendations from the higher education literature on optimal implementation of peer-assessment procedures were put into practice. Results indicated the existence of six main themes: (1) increased responsibility for others, (2) improved learning, (3) lack of relevancy, (4) challenges, (5) discomfort, and (6) effects on the PBL process. Five of these themes have previously been described in the literature. However, the final theme represents a unique, although not unexpected, finding. Students expressed serious concerns about the negative impact of peer assessment on the cooperative, non-judgmental atmosphere of PBL tutorial groups. The practical implications of these findings are considered.

Educational Measurement↗
PubMed2005

Tutoring in problem-based learning medical curricula: the influence of tutor background and style on effectiveness.

BACKGROUND: Evidence for the superiority of particular characteristics in PBL tutors in medical curricula is generally inconclusive. Most studies have investigated the effectiveness of content experts compared with that of non-experts as measured either by student satisfaction or academic achievement. A few have compared academic staff tutors with student tutors. The purpose of this study was to investigate the relationship between students' perception of overall tutor effectiveness, particular tutor behaviours, clinical qualifications and academic appointment. METHOD: A questionnaire designed to evaluate particular aspects of PBL tutoring technique, related either to subject-matter knowledge or to process-facilitation skill, as well as overall effectiveness, was distributed to students in first year of a PBL medical program at the end of each of three tutor terms. A total of 76 tutor terms were included in the study. Data analysis compared clinical with non-clinical tutors, and staff with non-staff tutors. RESULTS: Clinically qualified tutors used their subject-matter knowledge significantly more than non-clinical tutors and were seen as being more empathic with their students. Staff tutors placed more emphasis on assessment than non-staff tutors and were seen as having greater skill in establishing and maintaining an environment of cooperation within their PBL groups than non-staff tutors. CONCLUSION: These results suggest that both subject-matter knowledge and process-facilitation skills are necessary but not individually sufficient characteristics of effective tutors.

Analysis of Variance↗
PubMed2005

Problem-based learning and learning approach: is there a relationship?

AIM: To assess the influence of a graduate-entry PBL curriculum on individual learning style; and to investigate the relationship between learning style, academic achievement and clinical reasoning skill. METHOD: Subjects were first-year medical students completed the Study Process Questionnaire at the commencement, and again, at the end of the academic year when they also completed the Diagnostic Thinking Inventory, a measure of clinical reasoning skill. Subjects were classified on the basis of their predominant learning approach, and this was correlated with examination results and DTI score. RESULTS: There was a net shift in predominant learning approach away from deep learning towards a more surface approach over the period of the study, as well as a significant decrease in deep-learning scores. There was a statistically significant association between deep learning score and clinical reasoning skill as shown by total DTI score as well as on the structure of knowledge subscale. No correlation was found between learning approach and examination results. CONCLUSION: Although these results suggest that a deep learning approach may be beneficial in the development of clinical reasoning skill through its potential to enhance the development of knowledge representations, the substantial shift towards a surface learning approach brings into question previous conclusions that PBL curricula foster a deep approach to learning, and suggests that other factors, such as work load may be more determinants of learning approach than curriculum type. Taken together, these findings emphasise the context-dependent nature of learning approach as well as the importance of assessment as a driver of student learning and strongly suggest that further work to determine precisely the factors which influence learning approach in medical students is urgently needed.

Adult↗
PubMed2003

The clinical reasoning characteristics of diagnostic experts.

The aim of this study was to identify and describe the clinical reasoning characteristics of diagnostic experts. A group of 21 experienced general practitioners were asked to complete the Diagnostic Thinking Inventory (DTI)and a set of 10 clinical reasoning problems (CRP) to evaluate their clinical reasoning. Both the DTI and the CRPs were scored, and the CRP response patterns of each GP examined in terms of the number and type of errors contained in them. Analysis of these data showed that six GPs were able to reach the correct diagnosis using significantly less clinical information than their colleagues. These GPs also made significantly fewer interpretation errors but scored lower on both the DTI and the CRPs. Additionally, this analysis showed that more than 20% of misdiagnoses occurred despite no errors being made in the identification and interpretation of relevant clinical information. These rests indicate that these six GPs diagnose efficiently,effectively and accurately using relatively few clinical data and can therefore be classified as diagnostic experts. They also indicate that a major cause of misdiagnoses is failure to properly integrate clinical data. We suggest that increased emphasis on this step in the reasoning process should prove beneficial to the development of clinical reasoning skill in undergraduate medical students.

Adult↗
PubMed2003

The association between student characteristics and the development of clinical reasoning in a graduate-entry, PBL medical programme.

This study sought to assess the extent to which the entry characteristics of students in a graduate-entry medical programme predict the subsequent development of clinical reasoning ability. Subjects comprised 290 students voluntarily recruited from three successive cohorts of the University of Queensland's MBBS Programme. Clinical reasoning was measured once a year over a period of three years using two methods, a set of 10 Clinical Reasoning Problems (CRPs) and the Diagnostic Thinking Inventory (DTI). Data on gender, age at entry into the programme, nature of primary degree, scores on selection criteria (written examination plus interview) and academic performance in the first two years of the programme were recorded for each student, and their association with clinical reasoning skill analysed using univariate and multivariate analysis. Univariate analysis indicated significant associations between CRP score, gender and primary degree with a significant but small association between DTI and interview score. Stage of progression through the programme was also an important predictor of performance on both indicators. Subsequent multivariate analysis suggested that female gender is a positive predictor of CRP score independently of the nature of a subject's primary degree and stage of progression through the programme, although these latter two variables are interdependent. Positive predictors of clinical reasoning skill are stage of progression through the MBBS programme, female gender and interview score. Although the nature of a student's primary degree is important in the early years of the programme, evidence suggests that by graduation differences between students' clinical reasoning skill due to this factor have been resolved.

Adolescent↗
PubMed2003

Clinical reasoning: the relative contribution of identification, interpretation and hypothesis errors to misdiagnosis.

The aim of this study was to identify and describe the types of errors in clinical reasoning that contribute to poor diagnostic performance at different levels of medical training and experience. Three cohorts of subjects, second- and fourth- (final) year medical students and a group of general practitioners, completed a set of clinical reasoning problems. The responses of those whose scores fell below the 25th centile were analysed to establish the stage of the clinical reasoning process--identification of relevant information, interpretation or hypothesis generation--at which most errors occurred and whether this was dependent on problem difficulty and level of medical experience. Results indicate that hypothesis errors decrease as expertise increases but that identification and interpretation errors increase. This may be due to inappropriate use of pattern recognition or to failure of the knowledge base. Furthermore, although hypothesis errors increased in line with problem difficulty, identification and interpretation errors decreased. A possible explanation is that as problem difficulty increases, subjects at all levels of expertise are less able to differentiate between relevant and irrelevant clinical features and so give equal consideration to all information contained within a case. It is concluded that the development of clinical reasoning in medical students throughout the course of their pre-clinical and clinical education may be enhanced by both an analysis of the clinical reasoning process and a specific focus on each of the stages at which errors commonly occur.

Attitude of Health Personnel↗
PubMed2002

Assessing clinical reasoning: a method to monitor its development in a PBL curriculum.

The aim of this study was to develop and trial a method to monitor the evolution of clinical reasoning in a PBL curriculum that is suitable for use in a large medical school. Termed Clinical Reasoning Problems (CRPs), it is based on the notion that clinical reasoning is dependent on the identification and correct interpretation of certain critical clinical features. Each problem consists of a clinical scenario comprising presentation, history and physical examination. Based on this information, subjects are asked to nominate the two most likely diagnoses and to list the clinical features that they considered in formulating their diagnoses, indicating whether these features supported or opposed the nominated diagnoses. Students at different levels of medical training completed a set of 10 CRPs as well as the Diagnostic Thinking Inventory, a self-reporting questionnaire designed to assess reasoning style. Responses were scored against those of a reference group of general practitioners. Results indicate that the CRPs are an easily administered, reliable and valid assessment of clinical reasoning, able to successfully monitor its development throughout medical training. Consequently, they can be employed to assess clinical reasoning skill in individual students and to evaluate the success of undergraduate medical schools in providing effective tuition in clinical reasoning.

Adult↗