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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 232-236

Relationship between learning goals set by undergraduate medical students at the commencement and learning outcomes achieved at the end of early clinical phase


1 Department of Physiology, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University (Formerly University of Dammam), Al Jubail, Kingdom of Saudi Arabia
2 Melaka Manipal Medical College (Affiliated to Manipal Academy of Higher Education, India), Jalan Batu Hampar, Bukit Baru, 75150 Melaka, Malaysia

Date of Submission04-May-2019
Date of Decision25-Jun-2019
Date of Acceptance10-Jul-2019
Date of Web Publication2-May-2020

Correspondence Address:
Dr. Reem Abraham
Professor, Department of Physiology, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University (Formerly University of Dammam), Al Jubail
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_21_18

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  Abstract 


Background: Medical students entering the clinical term are in a transition phase, wherein the structured classroom environment suddenly changes to one that requires them to face practical as well as emotional challenges. It has been postulated that goal setting would prepare students to face the clinical environment with more readiness than experiencing a “shock of practice.” Aims: This study intended to assess the extent to which undergraduate medical students who experienced the transition phase from preclinical to clinical phase achieved their predetermined learning goals, at the end of clinical phase. Methodology: In the present study, undergraduate medical students (n = 220) at Melaka Manipal Medical College, Manipal Campus, India, on the commencement day of clinical phase, were requested to identify ten learning goals they wished to achieve. At the end of clinical phase, students were again requested to respond to a questionnaire, indicating the extent to which learning goals have culminated as learning outcomes, following which a frequency analysis of the responses was done. Results: Forty learning goals were identified by students, of which thirty learning goals were identified by more than 75% of students, at the commencement of clinical phase. At the end of clinical phase, ten learning goals among these thirty, for example, history taking (89.9%) and communication skills (75.8%), were reported to have achieved as learning outcomes to a great extent by more than 75% of students. Four learning goals, for example, diagnose diseases (42.3%) and manage emergency situations (31.5%), were reported to have achieved as learning outcomes to a great extent by <50% of students. The learning goals identified by students were found to be in line with the course objectives. Conclusions: The present study revealed that students could achieve most of the learning goals identified by them, if not all, which were enlisted in the course objectives, as reported by them.

Keywords: Clinical phase, learning goals, learning outcomes


How to cite this article:
Abraham R, Shamugam L, Sehgar T, Romeli R, Manogran B. Relationship between learning goals set by undergraduate medical students at the commencement and learning outcomes achieved at the end of early clinical phase. J Datta Meghe Inst Med Sci Univ 2019;14:232-6

How to cite this URL:
Abraham R, Shamugam L, Sehgar T, Romeli R, Manogran B. Relationship between learning goals set by undergraduate medical students at the commencement and learning outcomes achieved at the end of early clinical phase. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Jun 4];14:232-6. Available from: http://www.journaldmims.com/text.asp?2019/14/3/232/283581




  Introduction Top


A preclinical/clinical divide was firmly established as the norm in undergraduate medical education a century ago, at a time when biomedical science was proving its ability to explain disease and provide a theoretical basis for treatment.[1] Early clinical exposure offered to undergraduate medical students is considered as one of the benchmarks in an effective curriculum.[2],[3] It is in that environment where the challenge of application of theoretical knowledge to real life situations occur. Students entering the clinical phase are in a transition phase, where the structured classroom environment suddenly changes to one that requires them to face practical as well as emotional challenges.[4] Clinical exposure offers a multitude of learning opportunities in the form of relevant interactions with expert clinicians, patients, nurses, paramedical staff, and with their own peers. Studies report that it might facilitate the strengthening and deepening of students’ biomedical knowledge and also the understanding of their role as health professionals.[5] In addition, exposure to clinical environment is a pivotal platform for students to better understand the impact of disease on patients’ lives.[6],[7],[8] Students learn to function as part of a community and become apprised with the flow of work.[9]

Application of biomedical knowledge during patient encounters is not an easy task as reported.[10],[11] It should be “explicitly instructed to students” that they are required to activate their prior knowledge during patient contacts.[12],[13] Therefore, to make best use of the clinical encounters, we presumed that it is relevant to provide a platform for students to think about their learning goals at the beginning of the clinical phase before they encountered patients, so that they become aware of what they wanted to learn. Goal setting has been defined as the standards or specific outcomes of learning or performance that are personally established by an individual.[14] It has been postulated that as medical students are adult learners, clear objectives are essential for medical students to get the maximum out of their clinical training phase.[15] Goal setting would prepare students to face the clinical environment with more readiness than experiencing a “shock of practice.“[16] Goal setting is also cardinal to assist students toward self-regulated learning (SRL).[17] The pivotal role of SRL in molding lifelong learning has been mentioned in the literature.[17],[18],[19],[20],[21] SRL can start from undergraduate years of medical students and students need to be assisted in the process.[22],[23] According to Zimmerman, the first phase in SRL is goal identification, after which students supervise their activities and their engagement in the performance phase (second phase) to achieve those goals.[24] In the last phase, that is self-reflection phase, students self-evaluate their performance and plan about appropriate actions to improve the performance. Setting goals would serve as a regulatory factor, which guides students toward SRL.[25] Berkhout et al. reported that setting goals before the clinical training phase helped students to be more motivated and acted as a starting point from which they could work toward achieving those goals.[17]

Using the theory of goal setting as the framework, this study had the following research question:

  • To what extent, do students who are experiencing the transition phase from preclinical to clinical phase achieve their predetermined set of learning goals that they had identified to be accomplished in their clinical term?


The above research question was addressed through two objectives:

  1. To determine the learning goals of students at the beginning of the clinical phase
  2. To explore the extent to which students’ learning goals have culminated as learning outcomes at the end of clinical phase.



  Methodology Top


Study design

The present study was designed as a cross-sectional, descriptive research study.

Study setting

The undergraduate medical program at Melaka Manipal Medical College (MMMC), Manipal Campus, Manipal Academy of Higher Education, India offers the Bachelor of Medicine and Bachelor of Surgery program, which is 5 years in duration. Students spend the first 2½ years at MMMC, Manipal Campus in India and the remaining at Melaka Campus in Malaysia. The curriculum is divided into four blocks (teaching units), and the subjects such as anatomy, physiology, and biochemistry are taught in the 1st year, whereas pathology, pharmacology, microbiology, and forensic medicine are taught in the 2nd year. After 2 years of preclinical training, students experience 6 months of ‘early’ clinical phase in India, wherein they encounter patients through medicine, psychiatry, community medicine, obstetrics and gynecology, pediatrics, and surgery postings. In the present study, the term clinical phase/clinical term refers to the latter 6 months of training with patient encounters.

Participants

Undergraduate medical students in the clinical phase were chosen for this study.

Procedure

The study was approved by the Institutional Ethics Committee, Manipal Academy of Higher Education, India (KMC IEC 20/2015). On the 1st day of commencement of clinical phase (October 2015), before they would have experienced any patient encounters, students (n = 220) in the clinical phase were requested to write minimum ten learning goals which they wish to achieve during the forthcoming 6 months. After analyzing the learning goals, repetitions were excluded and a questionnaire with 40 items focusing on the learning goals which students mentioned was developed. Toward the end of clinical phase (February 2015), students were once again requested to indicate their responses in the above questionnaire on a 4-point Likert scale (4 = to a great extent, 3 = to some extent, 2 = to a smaller extent, and 1 = not at all) to what extent they have succeeded in transforming each of the learning goals to learning outcomes.

Data analysis

SPSS 16 statistical software was used for data analysis. Frequency analysis of the responses was performed and agreement to each item was calculated by adding the frequencies of “to a great extent” and “to some extent” responses. Disagreement to each item was calculated by adding the frequencies of “to a small extent” and “not at all” responses.


  Results Top


A total of 40 learning goals [Table 1] were identified by students at the commencement of their clinical term. The response rate was 100% at the beginning; however, it reduced to 67.7% when they were requested to respond to the questionnaire at the end of clinical phase. The first thirty [Table 1] were the learning goals identified by more than 75% of students at the commencement of clinical phase. Among these thirty, ten learning goals, including history taking (89.9%), communication skills (75.8%), empathy (78.5%), basic life support (85.9%), common hygienic measures in the hospital (86.6%), becoming more responsible (81.2%), proper bedside manners (78.5%), confidence of meeting patients (75.4%), psychiatry disorders (83.2%), and ethics in medicine (79.2%), were reported to have achieved as learning outcomes, to a great extent by more than 75% of students at the end of clinical phase. Four learning goals among the first thirty, including diagnose diseases (42.3%), manage emergency situations (31.5%), conveying bad news to family members (35.6%), and prescribing right medicine (25.5%), were reported to have achieved as learning outcomes to a great extent by <50% of students. Among the learning goals numbered 31–40, which were identified by <75% students at the commencement of clinical phase, two learning goals, including doctor–patient relationship (78.5%) and the right attitude a doctor needs (78.5%), were reported by more than 75% of students to have achieved as learning outcomes to a great extent, and two learning goals, including experiencing and sharing moments with medical staff (42.3%) and giving opinions to patients (50.3%), were reported by <50% to have achieved to a great extent.
Table 1: Learning goals and the extent to which these have culminated as learning outcomes

Click here to view



  Discussion Top


The present study explored students’ learning goals at the commencement of the clinical phase and also determined the extent to which the learning goals have culminated as learning outcomes at the end. The learning goals identified by the students in general belonged to the domains of patient care, development of skills (generic and practical), and professional behavior with some overlap among the three domains. It was indeed encouraging to note that these learning goals were mostly in line with the educational goals identified by the medical school (history taking, empathy, becoming more responsible, confidence of meeting patients, and ethics in medicine) for the clinical phase [Table 2]. It was also observed that, even before having patient encounters, students had relevant learning goals which are enlisted as outcomes in the Malaysian Qualifications Framework, as well as in good medical practice.[19] For example, the learning goals such as history taking, empathy, communication skills, and responsibility are enlisted in the knowledge–skills–performance and communication–teamwork–partnership domains of good medical practice.[19] The learning goals which were reported to have culminated as learning outcomes to a greater extent (history taking, communication skills, common hygienic measure in the hospital, learning responsibility, developing empathy toward patients, and also to learn the different types of psychiatric disorders) by more than 75% students at the end of clinical phase are part of the course syllabus, that they would be assessed later. Even though students were unaware of these learning goals at the commencement of clinical phase, having identified these learning goals by themselves, the awareness could have motivated them to work toward the achievement of these goals. Besides that, it is possible that the clinicians would have stressed more on certain topics, as these are the “must-knows” which could have motivated students to focus on achieving these learning outcomes.
Table 2: Educational goals identified by the institution for the clinical phase

Click here to view


Communication skills and empathy were reported in previous studies as the most frequently mentioned learning outcomes after early clinical exposure.[3],[26],[27] The learning goals related to diagnosing diseases, managing emergency situations, correct way to convey bad news to the family members, prescribing the right medication, and experiencing and sharing moments with medical staff were perceived to have culminated as learning outcomes to a greater extent by only <50% of students. Except for the last learning outcome mentioned above, the other four are not identified as educational goals for the clinical phase by the medical school. This is because, within the short span of time that students experience the clinical phase, it is practically difficult to incorporate these attributes into the curriculum. They could not share moments with the medical staff because of the fast work pace and intensity which would have refrained students from sharing their ideas and opinions with medical staff.

The purpose of the present study was to help students make the best use of the clinical phase, by giving them an opportunity to set goals at the commencement of the clinical phase, so that they will work toward achieving them. We also wanted students to be better prepared for their next training phase abroad, to become more sensitized to the clinical settings, to become more self-confident, and to develop self-efficacy (one's own feelings about one's abilities to perform any given task in a specific context).[18],[28] In the present study, students had to reflect upon (self-evaluation) their attainment of the intended learning goals as learning outcomes, at the end of clinical phase. Achieving the intended goals can boost up self-efficacy with regard to a particular task and self-satisfaction,[18] which can further motivate students to acquire the desired skills in a particular learning context and improve their clinical performance.


  Conclusions Top


The present study revealed that medical students’ learning process in the clinical environment could be made more meaningful by providing them opportunities for goal setting. Students could achieve most of the learning goals identified by them, if not all, which were enlisted in the course objectives, as reported by them. This indicates a positive response and probably reflects that the current clinical course structure is on the right track. The study also throws light upon the fact that strategies which could support students to achieve those learning goals which were not perceived to be achieved by majority of students could be incorporated in the clinical phase curriculum.

Limitations

The present study sample was only a single cohort of students from a single institution, which minimizes the generalizability of the conclusions. The study could have been more meaningful if it had generated data regarding the impact of goal setting activity on the SRL skills of students.

Acknowledgments

We are grateful to the students who participated in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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