The Concept of Self-Directed Learning: Implications for Practice in the Undergraduate Curriculum

Self-directed learning (SDL) is a modality where learners are expected to take responsibility for their own learning, diagnose gaps in their learning, frame their own goals and resources for learning, implement appropriate learning strategies and evaluate learning outcomes. Flexibility and creativity in designing assignments for students to work individually or collaboratively are the keys to promoting SDL. The recent competency-based curriculum document from the National Medical Commission does not elaborate the concept or implementation of SDL, leaving it open to individual interpretation. We, herein, discuss the concept of SDL, address common misconceptions surrounding SDL, and elucidate strategies by which SDL skills can be inculcated in medical students using pre-existing opportunities in the curriculum. Flipped classrooms, reciprocal teaching, technology-enhanced methods, problem-based learning, and group projects are excellent ways of promoting SDL. SDL requires efforts and policies both at the teachers’ level and at the institutional level; and is an important input to achieve the goal of being a lifelong learner by the Indian medical graduate.

Inadequacies of musculoskeletal medicine curriculum for undergraduate medical students: a cross-sectional study

ABSTRACT BACKGROUND: Musculoskeletal disorders account for up to one in four of general-practice consultations and almost one third of complaints in primary-care clinical practice. However, an insufficient amount of time and importance is given to their teaching in most medical schools. OBJECTIVE: To evaluate the acquisition of musculoskeletal competences in our institution, in order to identify flaws and propose changes to correct and improve the musculoskeletal curriculum. DESIGN AND SETTING: Cross-sectional study conducted in São Paulo, Brazil. METHODS: First to fifth-year medical students were enrolled in a survey using the Freedman and Bernstein musculoskeletal examination, in order to evaluate the acquisition of musculoskeletal competencies. Categorical data were analyzed using the chi-square test. Continuous data were analyzed using one-way analysis of variance (ANOVA). The level of significance was set as P < 0.05. RESULTS: A total of 545 students completed the questionnaire: from year 2, 115/167 (29.6%); from year 3, 118/138 (30.4%); from year 4, 98/130 (25.3%); and from year 5, 57/110 (14.7%). None of the students achieved the pass mark (established as 70%). The level of confidence in performing musculoskeletal examination was very low (3.7 ± 2.2; n = 386) and bore no relationship to the percentage of correct answers in the questionnaire (r = 0.331; 95% confidence interval, CI: 0.239-0.417; P < 0.001). CONCLUSION: Undergraduate teaching is the only exposure most general practitioners have to orthopedic problems. Universities are concerned about the adequacy of the musculoskeletal programs taught in their institutions. Student scores were found to be unsatisfactory in all the topics evaluated.

Promotion of safe motherhood in the nursing competency-based curriculum

Purpose@#Nurses play a significant role in maternal health. The nursing competency-based curriculum prepares students for this role. This study identified the competencies on safe motherhood expected of graduating nursing students, determined the degree of integration of these competencies in the curriculum, and described students' perceived levels of proficiency in performing said competencies. @*Design@#This is a descriptive cross-sectional study. The authors deduced concepts and principles of safe motherhood in nursing based on the 2006 standard competencies. A complete enumeration of 55 graduating students of a college of nursing in a state university in Manila participated in the study.@*Methods@#Students rated the competencies from A: “concepts were merely introduced” to D, “threaded through” in selected courses. The level of proficiency ranged from 1: “can perform well without supervision” to 4 “cannot perform despite supervision.” Ratings were analyzed using frequency counts, mode, and percentage distributions.@*Findings@#Seventy competencies on safe motherhood were derived. Cognitive and affective competencies on the basic nursing processes were threaded through in foundation, intervention, and intensive nursing process courses. Students could perform the cognitive and affective competencies without supervision but required assistance in performance of skills.@*Conclusion@#The nursing curriculum prepares students to promote safe motherhood; however, students need to improve their clinical skills to be fully competent.

Students' self-assessment of achievement of terminal competency and 4-year trend of student evaluation on outcome-based education / 한국의학교육

PURPOSE: This study was designed to allow a student at School of Medicine, Kyungpook National University (KNUSOM) to self-assess how well they had achieved competency and to analyze the differences and trends of the scores by year. Furthermore, students are asked to evaluate the need for curriculum improvement by competency, the tendency of the score is analyzed by year, and the results are reflected in the improvement of the curriculum. METHODS: We conducted a questionnaire survey for fourth-year students of KNUSOM who took medical education classes from 2015 to 2018. Questionnaire items were evaluated on the basis of their current achievement of 30 subordinate competencies of competency and the degree of necessity with respect to revising the curriculum. One-way analysis of variance was performed for the yearly difference analysis. RESULTS: The students' scores on the graduation competency were 2.03 to 4.06. In the yearly difference analysis, there was no significant difference in the average of 30 total competencies, but 16 of the sub-competencies showed significant year-to-year differences. The scores for the 30 graduation competencies were different for each year, but the competencies showing high scores and low scores were found to be similar each year. CONCLUSION: We found that the achievement level of the students was approximately 60% to 70%. We were able to confirm the contents of the education that the students continuously demand. The curriculum trend graphs for each year showed that the students' scores improved when the curriculum was being revised. We found that it is necessary to accept the students' self-evaluation reliable as the students indicated that the contents of the curriculum should be added to the areas where the contents were lacking in the present curriculum.

Transformative scale-up of the school of health sciences, University of the Philippines Manila

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> The School of Health Sciences (SHS), University of the Philippines Manila, established in 1976 offers a one-of-its kind ladder-type, community-based curriculum in health sciences.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study described the SHS curriculum and how it contributed to the transformative scale-up of the education of health professionals in the Philippines.</p><p style="text-align: justify;"><strong>METHODS:</strong> This study is a concurrent transformative mixed method design. Data were collected concurrently through interviews of university officials, faculty, students, alumni, communities, and partners as well as observations of review classes and office activities. Quantitative data were collected from school records and performance ratings of students. From the data emerged the basic principles of primary health care and community-based education and they were juxtaposed to describe transformative learning of SHS students and faculty.</p><p style="text-align: justify;"><strong>RESULTS:</strong> All of the 3,481 students admitted from 1976 came from geographically isolated and depressed areas; more than 95% of the graduates are still in the country and chose to serve the communities. The school's ladder-type, community-based curriculum produced competent midwives, nurses, and physicians. SHS did not just transform its students but also the faculty, communities, its partner local, national, and international agencies, and changed the landscape of community-based education in the region.</p><p style="text-align: justify;"><br /><strong>CONCLUSION</strong>: SHS produced health professionals who chose to serve the communities. It continues to evolve to institutionalize primary health care and community-based education.</p>

A case study of the implementation of a competency-based curriculum in a Caribbean Teaching Hospital / Un estudio de caso de la implementación de un currículo basado en competencias en un Hospital Docente del Caribe

OBJECTIVE: Several teaching hospitals are currently modifying their curriculum to comply with the changing demands in medical education. As a result, we decided to evaluate whether a competency-based curriculum implemented in a Caribbean teaching hospital fulfilled the requirements as defined by the CanMEDS framework. METHODS: We made use of a triangulation method in the survey to obtain information on the educational process. Two separate methods were used consisting of site visits by visiting professors and a medical educator. The focus was on the structure, content and assessments of the educational activities. RESULTS: Major recommendations included increased involvement of medical specialists in the educational activities in the clinical workplace. There was need for improvement of communication between medical specialists, patients, nurses, trainees and residents. Overall, improvements were observed in the structure of clinical rotations and content of the training programme. CONCLUSION: The implemented assessment programme provided necessary information for effective evaluation of the competency-based curriculum. We were able to identify new and feasible methods for improving the curriculum in our educational setting.

OBJETIVO: Varios hospitales docentes están actualmente modificando sus currículos a fin de satisfacer las demandas cambiantes de la educación médica. Por tal motivo, se tomó la decisión de evaluar si un currículo basado en competencias puesto en marcha en un hospital docente del Caribe cumplía con los requerimientos definidos por el programa de formación médica conocido como CanMEDS Framework. MÉTODOS: Se hizo uso de un método de triangulación en el estudio, a fin de obtener información sobre el proceso educativo. Se usaron dos métodos separados consistentes en visitas de inspección realizadas por profesores visitantes y un educador médico. La atención se centró en la estructura, el contenido, y la evaluación de las actividades educativas. RESULTADOS: Las recomendaciones principales incluyeron la necesidad de aumentar la participación de médicos especialistas en el lugar donde los estudiantes realizan su trabajo clínico. Se vio la necesidad de mejorar la comunicación entre especialistas médicos, pacientes, enfermeras, entrenados, y residentes. En general, se observaron mejoras en la estructura de las rotaciones clínicas y el contenido de los programas de entrenamiento. CONCLUSIÓN: El estudio realizado proveyó la información necesaria para la evaluación efectiva del currículo basado en competencias, e hizo posible identificar métodos nuevos y factibles para mejorar los planes de estudio en nuestro contexto educacional.

Organização curricular baseada em competência na educação médica / The competency-based medical curriculum

Competência, para fins de organização de currículos na área de saúde, deve ser concebida como a capacidade de mobilizar, articular e colocar em prática conhecimentos, habilidades e atitudes necessárias ao desempenho efetivo das atividades requeridas no contexto do trabalho. Currículos orientados por competência devem alinhar metodologias de ensino-aprendizagem, práticas pedagógicas, diferentes contextos e cenários de aprendizagem, métodos de avaliação e atividades de pesquisa com esse princípio de organização curricular. Caracteristicamente, são centrados na busca ativa pelo conhecimento, interdisciplinaridade, integração teórico-prática e interação ensino-sociedade, trazendo o desenvolvimento da identidade profissional para o centro das atividades de aprendizado. Sua construção envolve, inicialmente, a identificação e definição das competências necessárias à boa prática profissional. Em seguida, a definição de seus componentes e os níveis de desempenho. Posteriormente, deve ser elaborado um programa de avaliação que esteja prioritariamente a serviço do aprendizado (avaliação formativa) e que seja voltado para a detecção de conhecimentos, habilidades e atitudes assimilados pelos estudantes e não para sua classificação dentro de um grupo normativo.

Competency, as a model for organizing the medical curriculum, should be conceived as the ability to mobilize, link, and deploy knowledge, skills, and attitudes that are needed for efficient and effective performance in the context of professional practice. Competency-based medical education should align teaching strategies, educational practices, learning opportunities and settings, evaluation system, and research activities with this organizational principle in the curriculum. The model emphasizes an active search for knowledge, integration of disciplines, interaction between theory and practice, teaching, and social integration, while placing the development of professional identity at the center of the learning experience. Initially, the model's construction encompasses the identification and definition of a set of competencies related to good medical practices. Next, the components of competency and performance levels need to be determined. Finally, educators must develop an evaluation program aimed primarily at the learning process (formative evaluation) and focused on the detection of knowledge, skills, and attitudes assimilated by students rather than on their classification within a normative group.

Knowledge and critical thinking skills increase clinical reasoning ability in urogenital disorders: a Universitas Sriwijaya Medical Faculty experience.

Aim Clinical reasoning is one of the essential competencies for medical practitioners, so that it must be exercised by medical students. Studies on quantitative evidence of factors influencing clinical reasoning abilicy of students are limited. The aim of this study was to determine the influence of knowledge and other factors on the clinical reasoning abiliry ofthe students, which can serve as reference to establish methods for learning ctinical reasoning. Methods This is a cross-sectional study on fourth semester students enrolled in the Competency-based Curriculum of the Medical Faculty, University of Sriwijaya. Data on clinical reasoning abilily and risk factors during urogenital blockwere collected inApril 2008, when the students have just completed the btock. Clinical reasoning abiliry was tested using the Script Concordance test and the risk factors were evaluated based on formative tests, block summative assessments, and student characteristics. Data were analyzed by Cox regression. Results The prevalence of low clinical reasoning ability of the 132 students was 38.6%. The group with low basic knowledge was found to have 63% risk ol low clinical reasoning abiliry when compared to those with high basic knowledge (adjusted RR = 1.63; 95% conidence intewal (Ct): 1.10 -2.42). When compared to students with high critical thinking skitls, those with lory critical thinking skills had 2.3 time to be low clinical reasoning abitity (adjusted RR : 2.30; 9s% CI: 1.55 - 3.41). Conclusion Students with low critical thinking skills or with inadequate knowledge had a higher risk of low clinical reasoning ability.