A facilitative versus directive approach in training clinical skills? Investigating students' clinical performance and perceptions.

Over the years, many medical school curricula have started implementing diverse student-centred teaching and learning methodologies. Previous studies, however, have indicated that students prefer more traditional and directive methodologies instead, raising questions on which training approach should be advocated. This study contrasts the effects of a student-centred (i.e. facilitative) training approach on students' clinical skills learning with students' perceptions. More specifically, a quasi-experimental study was set up in which students experienced either a directive or facilitative training approach. Data were collected by means of an OSCE on the one hand, and a questionnaire on students' perceptions of the training sessions, and two open-ended questions about students' likes and dislikes on the other hand. While no general differences were found in terms of clinical knowledge and understanding, and actual clinical performance, an interaction between students' course-specific prior knowledge and the training approach was found. Especially students with low levels of knowledge benefited more from the facilitative training approach in terms of clinical knowledge, while highly knowledgeable students experienced a negative effect of this training approach. Moreover, students' perceptions revealed that facilitative-trained students reported more deep-level learning, while the directive training approach turned out to score higher in terms of quality and perceived effects.

Making more of it! Medical students' motives for voluntarily keeping an extended portfolio.

BACKGROUND: Although medical students' use of portfolios has been studied from many angles, little is known about their motivations. AIM: This article explores medical students' motives for voluntarily compiling a learning portfolio that widely exceeded the assignments. METHODS: Content analysis was performed on 22 (8%; n = 22/269) extensive portfolios, followed by a semi-structured interview with 11 medical students. Building on the theoretical work of Simons et al. (2004), interpretative analysis was used to reconstruct and understand the medical students' motives for the effort they put into the portfolios. RESULTS: Compiling an elaborate portfolio is mainly instigated by a personal instrumentality (internally regulated instrumental motivation). These medical students reflected on what they considered important and useful. The portfolio was a tool to achieve self-set goals, yet the specific goals turned out to be very different among the students, reflecting their particular needs and experiences during clerkship. CONCLUSION: Motivation theory shows that students who are internally regulated use more deep-level learning strategies and perform better. Internally regulated motivation mainly occurs when students use the portfolio to achieve their self-set goals. The formal portfolio assignments, enforced by the medical school, were more related with externally regulated motivation.