Why should I prepare? A mixed method study exploring the motives of medical undergraduate students to prepare for clinical skills training sessions.

BACKGROUND: Although preparation for educational activities is considered beneficial for student learning, many students do not perform preparatory assignments. This phenomenon has received little attention in the literature although it might provide medical educators with the opportunity to enhance student learning. Therefore, we explored why students prepare or not prepare. METHODS: An explorative mixed methods study was performed. In a qualitative study, 24 short group interviews with medical undergraduate students (n=209) were conducted on why they prepared for skills training sessions. In a subsequent quantitative study the resulting themes were used to construct a questionnaire. The questionnaire was presented to all undergraduate medical students at Maastricht University and 847 students completed it. Scales were constructed by a combination of exploratory factor analysis, reliability analysis, and content analysis. Between-class differences in the scale scores were investigated using ANOVA. RESULTS: The qualitative study showed that students' opinions on preparation are influenced by both personal factors, categorized as 'personal learning style', 'attitudes and beliefs', and 'planning and organization', as well as external factors, including 'preparatory advice', 'pressure, consequence, and checking of preparation', 'teacher-related motivations', and 'contents and schedule of the training sessions'. The quantitative study showed that 'the objective structured clinical examination' and 'facilitation of both understanding and memorizing the learning material', were the two most motivating items. The two most demotivating aspects were 'other students saying that preparation was not useful' and 'indistinct preparatory advices'. Factor analyses yielded three scales: 'urge to learn', 'expected difficulties', and 'lack of motivation'. Between group differences were found between the three classes on the first two scales. CONCLUSIONS: Students make an active and complex choice whether to prepare or not, based on multiple factors. Practical implications for educational practice are discussed.

Students' opinions about the effects of preclinical patient contacts on their learning.

Several reasons have been given why students should have contacts with real patients early in the undergraduate medical curriculum, i.e., in the preclinical phase. However, it is not clear exactly what effects early patient contacts have with regard to knowledge construction and the development of clinical reasoning skills. We sought students' views of the effects of preclinical real patient contacts on their learning, knowledge construction and development of clinical reasoning. Twenty-four students in the third and last preclinical year of a 6-year undergraduate medical programme were divided into three focus groups which met twice, after which saturation was reached. The discussions were recorded and transcribed. Summaries of the discussions were approved by the students after some modifications. Atlas-ti software was used to create a coding framework resulting in identification of main themes and sub themes. Early patient contacts motivate students to study, help them understand the impact of illness on patients' lives, and enhance professional socialisation and memory processes. Students distinguish between analytic and non-analytic clinical reasoning in connection with real patients. Analytic reasoning involves clinical and basic science knowledge. Non-analytic reasoning involves pattern recognition and is made possible by experiential learning from different patient contacts. The students indicate that seeing real patients early in their training has several positive effects on their learning. The contacts enhance knowledge construction and clinical reasoning. Although our results will have to be validated by quantitative, observational and experimental research, they imply that educational benefits are to be gained from real patient contacts in the preclinical phase of medical education.

The effects of deliberate practice in undergraduate medical education.

INTRODUCTION: Ericsson and colleagues introduced the term 'deliberate practice' to describe training activities that are especially designed to maximise improvement. They stressed that how much one practises is as important as how one practises. Essential aspects of deliberate practice are the presence of well defined tasks, informative feedback, repetition, self-reflection, motivation and endurance. Deliberate practice is often difficult, laborious, and even unpleasant. Previous studies in the fields of sports and music have shown a positive relation between deliberate practice and level of expertise. PURPOSE: The present study investigated the relationship between several aspects of deliberate practice and study achievements among undergraduate medical students. METHODS: A questionnaire was developed to measure important aspects of deliberate practice. It was filled out by 777 medical students at Maastricht University Medical School (response rate 90%). Scores on 3 regular tests were used to define student levels of expertise. RESULTS: Positive correlations between aspects of deliberate practice (self-study, study resources, planning, study style and motivation) and study achievements were found. Furthermore, high achieving students showed more characteristics of deliberate practice than low achieving students. CONCLUSION: Some important aspects of deliberate practice appear to contribute to the performance of medical students.