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HOW WE LEARN
1 Department of Physiology, Melaka Manipal Medical College (Manipal Campus) 2 Department of Microbiology, Melaka Manipal Medical College (Manipal Campus) 3 Department of Community Medicine, Kasturba Medical College 4 Department of Pathology, Melaka Manipal Medical College (Manipal Campus), Manipal, Karnataka, India
Address for reprint requests and other correspondence: R. R. Abraham, Dept. of Physiology, Melaka Manipal Medical College (Manipal Campus), International Centre for Health Sciences, Manipal 576 104, Karnataka, India (e-mail: reemabraham{at}yahoo.com)
Abstract
Melaka Manipal Medical College (Manipal Campus; Manipal, Karnataka, India) conducts the Bachelor of Medicine and Bachelor of Surgery program, for which the admission intakes are during the months of March and September. The present study was undertaken to study the differences in learning approaches to physiology of undergraduate medical students in a partially problem-based learning (PBL)- and non-PBL-oriented curriculum. PBL was introduced as a curricular reform for the September 2006 batch of students (partially PBL group), whereas it was not incorporated for the March 2006 batch of students (non-PBL group). Learning approaches to physiology of both groups of students were compared using the short inventory of approaches to learning. Mean scores for deep and strategic approaches were found to be significantly higher for the partially PBL group compared with the non-PBL group. The results of the present study support the earlier observation that PBL promotes a deep approach to learning.
Key words: problem-based learning; deep approach
THE QUANTITY AND QUALITY OF LEARNING is determined by the learning approach students adopt. The way that students approach their learning plays an important role in determining the outcome of any educational endeavor. Recent research by Prosser and Trigwell (14) has made it clear that approaches to studying and perceptions of teaching are two of the most direct influences on the quality of student learning. Learning approaches of students have been found to be influenced by a number of factors, such as teaching characteristics, departmental characteristics, and assessment methods (10). Surface, deep, and strategic are the three basic learning approaches adopted by the students as identified by researchers in medical education. Students adopting the surface approach are predominantly motivated by either a desire to complete the course or a fear of failure. Their intention is to fulfill the course requirements by memorizing and reproducing the material they believe is likely to come up in the assessments. The outcome of the surface approach is just a superficial level of understanding. Students adopting the deep approach are motivated by an interest in the subject material and/or recognition of its vocational relevance. While studying the subject, the intention is to understand its meaning and relate it to previous knowledge and personal experiences (20). In addition, the deep approach was also found to facilitate the retention of factual details more effectively (9). For students adopting a strategic approach, the predominant motivation is the achievement of high grades. Their main intention is to be successful. They use either the surface or deep approach depending on what they feel would produce the most successful results.
The deep approach is the most appropriate and desirable way of learning that is closely linked to the intellectual processes we would wish to see in all medical students and is the means of life-long learning. A deep approach is likely to result from relevance of the subject matter to students’ interests (5); the interest, support, and enthusiasm shown by the instructor (16); and the environment where students have an opportunity to manage their own learning (17). It was also found to be related to what students perceive as "good teaching" and "freedom in learning" (choices in what and how to learn). The surface approach is usually found to be the result of either assessment methods that reward reproducing information (2), apprehension (5), or stress due to heavy workload (3). Measuring students’ approaches to learning has been seen as a means of the following:
PBL is an educational approach that is being implemented differently in different medical schools. PBL is said to stimulate student motivation and their interest toward learning. The present study aimed to compare the learning approaches to physiology of undergraduate medical students in a non-PBL (NPBL)- and partially PBL (PPBL)-oriented curriculum using the short inventory of approaches to learning (SIAL).
METHODS
The undergraduate medical program at Melaka Manipal Medical College (Manipal Campus) conducts the Bachelor of Medicine and Bachelor of Surgery program, which is of 5 yr in duration. Students spend the the first 2.5 yr in Manipal, Karnataka, India, and the remaining time in Malaysia. The first-year subjects include anatomy, physiology, and biochemistry. The first-year curriculum is divided into four blocks as follows:
SIAL was developed particularly to determine the learning approaches of undergraduate medical students to physiology. SIAL consists of 52 items, 11 of which were drawn from the revised approaches to studying inventory (4) and 44 items from the approaches to learning inventory (19). The 52 items of SIAL are grouped under 14 subscales, which again are grouped under 3 scales: surface, deep, and strategic approaches. SIAL has been proven to have reasonable reliability and internal consistency (1). Surface, deep, and strategic approaches are measured by 14, 26, and 12 items in SIAL, respectively.
SIAL was administered to the March 2006 batch of students (n = 114) at the end of the third block and to the September 2006 batch of students (n = 124) at the end of the first block. Students were asked to complete the inventory on the spot. Students were informed about the confidentiality of their responses. Students were asked to respond to each item on a 4-point scale (where 4 = strongly agree, 3 = agree, 2 = disagree, and 1 = strongly disagree) indicating the degree to which the statement was true for them. There was no time limit for the questionnaire, but it took an average of 15–20 min. Mean scores of items of surface, deep, and strategic approaches of NPBL and PPBL students were compared among themselves using two-way ANOVA (multivariate). Mean SIAL scores for the scales and subscales of NPBL and PPBL students were compared using an independent samples test. For all the data analyses, the SPSS statistical package was used.
RESULTS
Mean SIAL scores for surface, deep, and strategic approaches are shown in Table 1. Scores for deep and strategic approaches of PPBL students were found to be significantly higher compared with NPBL students. The difference in the score for the surface approach was found to be statistically insignificant between the two groups. The mean of the difference in mean scores of the approaches for NPBL and PPBL students are shown in Table 2. It was observed that there were no statistically significant differences among the three approaches for the NPBL group. Nevertheless, significant differences were observed for the PPBL students for the surface versus deep approach and surface versus strategic approach. There were no significant differences for the deep versus strategic approach.
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The present study reports the difference between learning approaches to physiology of students enrolled in a NPBL and PPBL-oriented curriculum. Compared with NPBL students, PPBL students were found to be adopting more of deep and strategic approaches than the surface approach (Table 1). Among the three approaches, surface and deep approaches were found to be significantly predominating in PPBL students (Table 2). PBL was introduced in the first-year undergraduate medical curriculum with the intention of promoting a deep approach in the students. A deep approach is very much essential to learn physiology as the subject demands more of understanding and application than mere recall. The assessment system in physiology consists of case studies and critical thinking questions, which again demands students’ understanding. SIAL was administered to PPBL students 1 wk before their first block examination. It was encouraging to find significantly higher scores for the deep approach for these students despite them having undertaken only the first block of the PPBL-oriented curriculum. Our findings are in parallel with the earlier observation that PBL promotes a deep approach to learning. In a study conducted by Tiwari et al. (20), it was found that nursing students adopted a deep approach to learning during a period of clinical education in which PBL was implemented.
A few items (12 items) under the three approaches were also found to show significant differences between the groups. For NPBL students, all the items for which the scores were higher were found to be under the surface approach. All the items under the surface approach for which the PPBL students’ scores were higher were found to be related to their apprehension toward the coming block examination. This could have been resulted from the fact that SIAL was administered to PPBL students 1 wk before their block examination.
Groves (5) assessed the influence of a graduate-entry PBL curriculum on the individual learning style of first-year medical students. The study reported a change from deep learning toward a more surface approach over the period of the study as well as a significant decrease in deep learning scores. Furthermore, the author suggested that factors like workload would be more important determinants of the learning approach. In the present study, for PPBL students, PBL was an additional strategy along with SDL and didactic lectures. Like NPBL students, these students also had summative examinations in physiology as well as anatomy and biochemistry. This could have added to the workload, leading to the increased scores for three items (items 28, 30, 46) under the surface approach and two items (items 6 and 17) under the strategic approach and to only a limited increase in a few items under the deep approach. The administration of SIAL at the end of first block, a time in which students are yet to acclimatize to the PBL curriculum, could also have added to the limited increase in their deep approach item scores. As PBL had been implemented recently in the curriculum, although the tutors were trained for a PBL-oriented curriculum, they were also new to the concept. This might also have led to the above findings.
In conclusion, the present study revealed that the implementation of PBL promoted more deep approach learning in the students rather than strategic and surface approaches compared with students who were not exposed to PBL. Among the three approaches, PPBL students were adopting more of deep and surface approaches than the strategic approach.
Footnotes
The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Received for publication August 8, 2007. Accepted for publication November 4, 2007.
REFERENCES
This article has been cited by other articles:
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  M. A. Tufts and S. B. Higgins-Opitz What makes the learning of physiology in a PBL medical curriculum challenging? Student perceptions Advan Physiol Educ, September 1, 2009; 33(3): 187 - 195. [Abstract] [Full Text] [PDF]
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