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Does Medical Training Promote or Deter Self-Directed Learning? A Longitudinal Mixed-Methods Study

Premkumar, Kalyani MBBS, MD, MSc (Med Ed), PhD; Pahwa, Punam PhD; Banerjee, Ankona MSc; Baptiste, Kellen MD; Bhatt, Hitesh MSc; Lim, Hyun J. PhD

doi: 10.1097/ACM.0b013e3182a9262d
Research Reports

Purpose The School of Medicine, University of Saskatchewan curriculum promotes self-direction as one of its learning philosophies. The authors sought to identify changes in self-directed learning (SDL) readiness during training.

Method Guglielmino’s SDL Readiness Scale (SDLRS) was administered to five student cohorts (N = 375) at admission and the end of every year of training, 2006 to 2010. Scores were analyzed using repeated-measurement analysis. A focus group and interviews captured students’ and instructors’ perceptions of self-direction.

Results Overall, the mean SDLRS score was 230.6; men (n = 168) 229.5; women (n = 197) 232.3, higher than in the average adult population. However, the authors were able to follow only 275 students through later years of medical education. There were no significant effects of gender, years of premedical training, and Medical College Admission Test scores on SDLRS scores. Older students were more self-directed. There was a significant drop in scores at the end of year one for each of the cohorts (P < .001), and no significant change to these SDLRS scores as students progressed through medical school. Students and faculty defined SDL narrowly and had similar perceptions of curricular factors affecting SDL.

Conclusions The initial scores indicate high self-direction. The drop in scores one year after admission, and the lack of change with increased training, show that the current educational interventions may require reexamination and alteration to ones that promote SDL. Comparison with schools using a different curricular approach may bring to light the impact of curriculum on SDL.

Dr. Premkumar is curriculum consultant and faculty development specialist, and associate professor, Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Dr. Pahwa is professor, Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Ms. Banerjee was a third-year master’s student, Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, at the time this article was written.

Dr. Baptiste was a fourth-year medical student, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, at the time this article was written.

Mr. Bhatt is biostatistician, University of Alberta, Edmonton, Alberta, Canada. When this article was written, he was biostatistician, Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Dr. Lim is professor, Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Funding/Support: The authors gratefully acknowledge the funding from the College of Medicine, University of Saskatchewan.

Other disclosures: None.

Ethical approval: The study received ethical approval from the behavioral research ethics board of the University of Saskatchewan in June 2007.

Previous presentations: The initial findings of this study were presented at the 2008 Medical Education Conference AFMC-CAME-CFPC-MCC-RCPSC (Association of Faculties of Medicine of Canada–Canadian Association for Medical Education–College of Family Physicians Canada–Medical Council of Canada–Royal College of Physicians and Surgeons of Canada) in Montreal, Quebec, Canada, May 3–7, 2008, and at the Research Day organized by the Department of Community Health and Epidemiology, February 17, 2012, Saskatoon, Saskatchewan, Canada.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. Premkumar, Department of Community Health and Epidemiology, Health Science Building, 107 Wiggins Rd., University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N-5E5; telephone: (306) 966-1409; fax: (306) 966-7920; e-mail: kalyani.premkumar@usask.ca.

© 2013 by the Association of American Medical Colleges