Scenario-based learning: preliminary evaluation of the method in terms of students' academic achievement, in-class engagement, and learner/teacher satisfaction.

We sought to evaluate the effectiveness of a newly developed scenario-based learning (SBL) module considering students' academic achievement, in-class engagement, and learner/teacher satisfaction. Third-year students in a 6-year medical education program, who had preexperience in problem-based learning, studied in small groups with facilitators throughout a week allocated for the SBL module. SBL processes, student/facilitator roles, and expectations were explained to students and facilitators in online training before implementation. Three online discussion sessions were scheduled, but the groups were allowed to organize extra online meetings. The students provided with learning objectives were asked to create a problem-based learning (PBL) scenario with a facilitator's guide including answers to scenario questions, evidence-based information, and tips for facilitators. Evaluated outcomes were learner/teacher satisfaction, students' academic achievement, and engagement. Satisfaction was determined using semistructured feedback forms. Generated scenarios were assessed using a checklist. A written exam was performed to assess students' knowledge and reasoning skills. Student engagement during the sessions was evaluated using forms completed by facilitators and students. SBL module outcomes were compared to students' grade point averages (GPAs) and former PBL outcomes. Mean scenario evaluation, student engagement, and satisfaction scores were around 90%. Mean scores for facilitator satisfaction and whole module success were around 80% and 77%, respectively. Academic achievement and student satisfaction were higher in SBL compared to GPA and previous PBL modules. Facilitator satisfaction and student engagement did not differ between SBL and PBL. Student satisfaction and academic achievement were higher in online SBL compared with PBL without any differences in in-class engagement and facilitator satisfaction.NEW & NOTEWORTHY A newly developed scenario-based learning (SBL) module was implemented assigning third-year medical students to create (highest cognitive level) a problem-based learning facilitator scenario studying in small groups with a facilitator. The 1-wk online SBL module was composed of three scheduled and an unlimited number of nonscheduled sessions. The students and facilitators positively received SBL with some recommendations for improvement. Preliminary evaluation suggests SBL can be implemented without compromising (maybe improving) students' academic achievement, satisfaction, and engagement levels.

Do learning approaches of medical students affect their satisfaction with problem-based learning?

The aim of this research was to determine the satisfaction of medical students with problem-based learning (PBL) and their approaches to learning to investigate the effect of learning approaches on their levels of satisfaction. The study group was composed of medical students from three different universities, which apply PBL at different levels in their curricula. The revised two-factor study process survey was applied to the study group to determine their approaches to learning as "deep" or "surface" learning. In addition, another survey of 20 questions was used to determine satisfaction levels of students with PBL and other variables. Of the study group, 64.6% were found to adopt a deep approach to learning, and we confirmed that these students were reasonably more satisfied with PBL.

Depression and Psychological Distress in Medical Students, A Prospective Study.

Introduction: The aim of the study is to determine the changes in psychological distress and depressive symptoms of medical students in the first two years of their education process, in comparison with other faculty students. Methods: All first-year students in the Faculties of Medicine, Economics and Sport Sciences were asked to fill out a detailed self-reported questionnaire aimed at measuring possible stressful life events and habits, General Health Questionnaire (GHQ-12), Beck Depression Inventory (BDI) during the first week of their first semester in 2017-2018. This process was repeated to the same students again in the second year, and the change was examined prospectively. Results: The GHQ-12 score average increased from 11.19 to 13.7 in medical students (p<0.001). The prevalence of psychological distress increased from 53.8% to 61.8%. The BDI score average was 8.04 in the beginning and reached 10.1 in the second year (p<0.001). Depressive symptom prevalence increased from 8.8% to 19.5%. No significant increase was observed in the GHQ-12, BDI score average, depressive symptoms, and psychological distress prevalence of other faculty students. The incidence of depressive symptoms in medical students was 15.9%. As a result of multivariate analysis, "dissatisfaction with social activities" and "exposure to psychological pressure and violence" which were stressful life events were statistically associated with both GHQ-12 and BDI. Conclusion: It was determined that the mental health of the students was negatively affected in the first year of medical school education. It is recommended to raise awareness for medical students at risk of mental illness and to plan interventions that will protect their mental health.

Ways of coping as predictors of satisfaction with curriculum and academic success in medical school.

The purpose of the present study was to determine the coping strategies of medical students and to investigate the effects of coping strategies on student satisfaction and academic achievement with different instruction methods. A total of 152 medical students was followed throughout the first 2 yr of medical education between 2008 and 2010. Students completed a sociodemographic questionnaire and revised form of the Ways of Coping questionnaire both at the beginning of the first year and at the end of the second year. These forms provided data about the characteristics and main coping strategies (problem focused or emotion focused) of the students and revealed the change over time. At the end of the second year, participants also completed a satisfaction questionnaire asking their satisfaction with lectures, problem-based learning, and practicals. The authors used block, problem-based learning, and practical exam scores of the students attained in the past 2 yr as academic achievement indicators. No sociodemographic variable was related to coping strategy. The majority of students (80.9%) adopted problem-focused coping. A shift occurred in the main coping strategies of some students in both sides. Problem-focused coping scores decreased over time. Problem-focused coping positively correlated with satisfaction with practicals and practical exam scores, whereas emotion-focused coping showed the same correlation negatively. The main coping strategy also predicted satisfaction and exam success in practicals. In conclusion, a main coping strategy may be helpful to predict student satisfaction and academic achievement with some student-centered instruction methods. Determining undesired coping strategies may provide an opportunity for intervention to prevent relevant dissatisfaction and failure.

The effect of using standardized patients in the Simulated Hospital Environment on first-year nursing students psychomotor skills learning.

BACKGROUND: The aim of this study was to determine the effect of using standardized patients in the Simulated Hospital Environment on first-year nursing students' psychomotor skills. METHODS: This semi-experimental study was carried out in the one-group pretest-posttest design. Students performed the psychomotor skills in the Non-Simulated Clinical Skill Laboratory and Simulated Hospital Environment. The skill performances of the students were evaluated with the Objective Structured Clinical Assessment form. At the same time, students' views on both environments were received. RESULTS: Students' mean Objective Structured Clinical Assessment score in the Simulated Hospital Environment (69.42 ± 10.94) was significantly higher than their mean score in the Non-Simulated Clinical Skill Laboratory (57.07 ± 10.05) (p < 0.05). The differences in scores were particularly significant in the stages of meeting the patient, performing the procedure in accordance with the steps and ending the procedure. The majority of the students stated that they could not do some applications in the Non-Simulated Clinical Skill Laboratory in a similar way to the hospital clinic (85.9%), and they felt like they were in a real hospital clinic in the Simulated Hospital Environment (100%). CONCLUSIONS: The results showed that students developed psychomotor skills more fully in a learning environment designed in a similar way to a real hospital clinic setting.

Can learning style predict student satisfaction with different instruction methods and academic achievement in medical education?

The curriculum of our medical school has a hybrid structure including both traditional training (lectures) and problem-based learning (PBL) applications. The purpose of this study was to determine the learning styles of our medical students and investigate the relation of learning styles with each of satisfaction with different instruction methods and academic achievement in them. This study was carried out with the participation of 170 first-year medical students (the participation rate was 91.4%). The researchers prepared sociodemographic and satisfaction questionnaires to determine the characteristics of the participants and their satisfaction levels with traditional training and PBL. The Kolb learning styles inventory was used to explore the learning styles of the study group. The participants completed all forms at the end of the first year of medical education. Indicators of academic achievement were scores of five theoretical block exams and five PBL exams performed throughout the academic year of 2008-2009. The majority of the participants took part in the "diverging" (n = 84, 47.7%) and "assimilating" (n = 73, 41.5%) groups. Numbers of students in the "converging" and "accommodating" groups were 11 (6.3%) and 8 (4.5%), respectively. In all learning style groups, PBL satisfaction scores were significantly higher than those of traditional training. Exam scores for "PBL and traditional training" did not differ among the four learning styles. In logistic regression analysis, learning style (assimilating) predicted student satisfaction with traditional training and success in theoretical block exams. Nothing predicted PBL satisfaction and success. This is the first study conducted among medical students evaluating the relation of learning style with student satisfaction and academic achievement. More research with larger groups is needed to generalize our results. Some learning styles may relate to satisfaction with and achievement in some instruction methods.

Does clinical training period support patient-centeredness perceptions of medical students?

BACKGROUND: Learning environment influences students' professional formation and patient-centered attitudes and behaviors. OBJECTIVE: The purpose of this study is to investigate how hidden curriculum of learning environment and the previous experience with chronically ill patients affect patient-centeredness perceptions of medical students. DESIGN: We followed 144 students and determined their opinions on 'ideal patient-centered practice and learning environment' via patient-centeredness questionnaire (PCQ) just before (third year) and at the end (sixth year) of clinical training years of medical school. At the end of each clinical training year (fourth, fifth, and sixth years), we determined experiences of the students about 'patient-centeredness of the learning environment' using a relevant survey called communication, curriculum, and culture (C3) instrument. We also compared PCQ and C3 instrument scores of the participants who had chronically ill patient in their families/friends and who do not. RESULTS: C3 scores worsened over the years, namely, students faced increasing number of examples against patient centeredness. Final PCQ scores were worse than initial ones. C3 and PCQ scores of the students who had previous experience with chronically ill patients were not different from the scores of the remaining students. CONCLUSION: Medical students, even those who have a chronically ill patient in their families or friends, lose their idealism about patient centeredness to some degree possibly due to hidden curriculum of the medical school.

A multicenter study: how do medical students perceive clinical learning climate?

BACKGROUND: The relationship between students and instructors is of crucial importance for the development of a positive learning climate. Learning climate is a multifaceted concept, and its measurement is a complicated process. The aim of this cross-sectional study was to determine medical students' perceptions about the clinical learning climate and to investigate differences in their perceptions in terms of various variables. METHODS: Medical students studying at six medical schools in Turkey were recruited for the study. All students who completed clinical rotations, which lasted for 3 or more weeks, were included in the study (n=3,097). Data were collected using the Clinical Learning Climate Scale (CLCS). The CLCS (36 items) includes three subscales: clinical environment, emotion, and motivation. Each item is scored using a 5-point Likert scale (1: strongly disagree to 5: strongly agree). RESULTS: The response rate for the trainees was 69.67% (n=1,519), and for the interns it was 51.47% (n=917). The mean total CLCS score was 117.20±17.19. The rotation during which the clinical learning climate was perceived most favorably was the Physical Therapy and Rehabilitation rotation (mean score: 137.77). The most negatively perceived rotation was the General Internal Medicine rotation (mean score: 104.31). There were significant differences between mean total scores in terms of trainee/intern characteristics, internal medicine/surgical medicine rotations, and perception of success. CONCLUSION: The results of this study drew attention to certain aspects of the clinical learning climate in medical schools. Clinical teacher/instructor/supervisor, clinical training programs, students' interactions in clinical settings, self-realization, mood, students' intrinsic motivation, and institutional commitment are important components of the clinical learning climate. For this reason, the aforementioned components should be taken into consideration in studies aiming to improve clinical learning climate.