Exploring challenges in learning and study skills among first-year medical students: a case study.

BACKGROUND: Despite being high-achieving students, many medical students face academic challenges, particularly during their first year of study. Research indicates that self-regulated learning, involving metacognitive processes and adaptive strategies, can positively influence academic achievement. This study aimed to assess the early learning and study skills of first-year medical students in an international medical school with the goal of developing a learner-centered educational intervention to promote self-regulated learning. METHODS: We conducted a retrospective analysis of the Learning and Study Skills Inventory (LASSI) questionnaire that was administered annually each August to first-year medical students from 2019 to 2022. The distribution of students across different percentile ranges for each selected variable was determined for each year and all years collectively. Students were counted within distinct percentile brackets (50th and below, between 51st and 75th, and above 75th ) for each variable. RESULTS: A total of 147 students completed the LASSI questionnaire over the 4-year time period. Using academic resources was the greatest concern, with 67% of students in the 50th or below percentile, followed by selecting the main idea (56%), motivation (51%), and concentration (50%). Attitude scored highest across all cohorts, scoring between 21.55 ± 0.73 and 26.49 ± 0.34. In comparing mean scores of LASSI variables across all cohorts, attitude, motivation, test-taking strategies, time management, and the use of academic resources differed significantly (p < 0.05). CONCLUSION: LASSI data can provide an early picture of students' support needs. We posit that early identification of student learning and study skills and areas of struggle can inform personalized educational interventions and programs to support first-year medical students.

Virtual learning allows for adaptation of study strategies in a cohort of U.S. medical students.

BACKGROUND: In response to the COVID-19 pandemic, most U.S. medical schools acutely transitioned from regimented in-person learning to highly flexible virtual asynchronous learning. This transition at our medical school provided a unique opportunity to evaluate if and how students adapted their academic and personal lives in response. METHODS: Medical students in a single class that made this transition were retrospectively provided with 24-hour diaries for three periods - one shortly before the transition, a second early in the transition, and third several months into the transition - and asked to select the academic or personal activities done in each hour. The percentage of medical students performing each activity each hour was analyzed, as was the time spent on each activity per day, and per morning, afternoon, per evening within the day. RESULTS: Overall study time did not change in either virtual period but shifted significantly to the morning (6 AM to 12 PM). Time spent studying in groups fell significantly during both virtual periods, concordant with a significant increase in alone study time in the early virtual period. Early in the transition to virtual learning, students replaced in-person didactics with online faculty lectures; several months later in virtual learning, they had replaced online faculty lectures with commercial products. There was no significant change in time spent on specific personal activities. CONCLUSIONS: Consistent with extensive constraints imposed by the heavy cognitive load of a medical school curriculum, students did not significantly change their overall study time and any self-care-related activities in the transition to virtual learning. However, transitioning to virtual learning allowed our students to adapt their study strategies, i.e. reducing group study time and increasing lone studying time. Furthermore, students shifted studying time to the morning to optimize the management of the cognitive task-load they faced.

Effect of an online module designed to promote first-year dental students' evidence-based study strategies.

OBJECTIVE: The aim of this study was to investigate the effect of an online module in promoting study strategies based on neuroscience applied to education for first-year dental students at the University of the Andes in Santiago, Chile. METHODS: Four weeks after the start of the 2018 first academic semester, all 82 first-year dental students (72% females, 28% males, average 19.0 years old) were invited to voluntarily and anonymously complete the self-reported Study Strategies Questionnaire (SSQ) in a session of an Introduction to Dentistry course, which served as a baseline. Subsequently, the session included an interactive workshop on learning how to learn so that students could analyse how the human brain learns and relate this information to mental tools to foster learning. Furthermore, during the semester, students were sent information via email to reinforce the content they were exposed to during the learning how to learn activity so that they could use the toolbox of study techniques to improve their learning in all subjects. At the end of the semester, students were invited to voluntarily and anonymously complete a second SSQ to assess the effects of the study intervention. Exam marks from the previous (2017) and studied year (2018), as well as both SSQ results, were compared and analysed using IBM Statistical Package for the Social Sciences (SPSS). RESULTS: A total of 75 and 71 students answered the SSQ before and after the intervention, respectively. The mean exam mark from 2017 was 63.7% (SD = 8.8), whilst in 2018, it was 69.6% (SD = 5.0) (p < .044); the effect size of the intervention was 0.75. The most significant changes observed after the intervention were reductions in the number of students who studied whilst checking messages on their smartphones (p = .001), studied by highlighting and/or underlining in their notes or textbooks (p ≤ .0001) and studied the day before an examination (p ≥ .0001). On the contrary, there were significant increases in the number of students who studied without access to social networks (p = .046), wrote notes or words in the margins of texts (p = .001), practised self-testing (p = .001) and studied the day before an examination (p ≤ .0001). CONCLUSIONS: An online module to promote evidence-based study strategies in first-year dental students can have an impact on increasing students' marks as well as on some practices that can improve their academic achievements and learning.

Using Strategies from Physical Training of Athletes to Develop Self-Study Programs for Veterinary Medical Students.

Veterinary medical students, similar to elite collegiate athletes, are developing strategies for learning new skills and for self-care to take their performance to the next level. As veterinary students learn to successfully navigate an information-dense, high-volume curriculum, many sacrifice wellness, leadership opportunities, extracurricular activities, and social interactions. Strategies from athletes' physical training were used to design a self-study program for first-year veterinary medical students. Major considerations in program design were the characteristics of the human being, learning goals, and contextual constraints. The study program included a warm-up, study sessions, and a cooldown. The program was offered to first-year veterinary medical students at Purdue University's College of Veterinary Medicine. Thirty-two students requested study programs and 21 completed surveys at the semester end. Results were analyzed quantitatively and by using an adapted conventional content analysis approach. Responses were organized into three main domains: reason for participation, program utility, and program satisfaction. Students shared that the most helpful aspects of the program were assisting with organization and time management, providing accountability, and reducing overwhelm by enhancing well-being and performance; they reported that these learned skills would support their well-being as future professionals. This article describes the experiences of one group of veterinary students at one college using these programs. The long-term goal is to develop a model program for all veterinary students to manage curricular demands while maintaining well-being.

The Use of Lecture Recordings as Study Aids in a Professional Degree Program.

Lecture recording is now common in many educational institutions, leading to discussion about how best to support student learning. In this mixed methods study, we used a survey (n = 46 participants), think-aloud methodologies in observed study sessions (n = 8 participants) and recording analytics (n = 637 recordings) to characterize how veterinary students utilize recordings during their studies. Only 48% of survey respondents considered they were more likely to use recordings as exams approached, but 78% considered they used recordings more when the topic was difficult. In the observed study sessions, students characterized their use of recordings as helping them to control their learning environment, allowing them to pause and rewind challenging topics, and as a jumping off point for future study, allowing them to structure the seeking out of additional information. In a linear model describing the recording analytics, students who had entered higher education directly from high school were more likely to watch more of a lecture than graduate entry students. In addition, the most visited lectures were also the ones with more view time (F(5, 631) = 129.5, R2 = 0.50, p < .001). Overall, this study suggests that veterinary students were selective about their use of recordings in their study strategies, often using them to make up for deficits in their knowledge and understanding, or to supplement their experience at veterinary school. We discuss the consequences and implications for student study skills support.

Metacognitive study strategies in a college course and their relation to exam performance.

Several strands of prior work have evaluated students' study strategies and learning activities. In this work, we focus on integrating two of those strands. One has focused on student self-reports of their study practices from a cognitive psychology perspective. The other has focused on classifying student learning activities from a learning sciences perspective using the Interactive, Constructive, Active, and Passive (ICAP) framework (Chi & Wylie, 2014). The current study aims to integrate these two strands of research by testing the implications of the ICAP framework with students' self-reports in a classroom context. Another goal was to address the measurement limitations of the metacognitive study strategy literature by using assessment-specific self-reports with both closed and open-ended questions. Across three noncumulative exams, 342 undergraduates self-reported their study practices before each exam. We then categorized their strategies as either active or constructive in alignment with the ICAP framework. Next, we examined whether these strategies were related to each other and then tested the hypothesis that constructive strategies would be positively associated with better exam performance than active strategies. Students reported using a variety of study practices in which a few active strategies were related to constructive strategies, but constructive strategies were more likely to be related to each other. Lastly, supporting the ICAP framework, many of the constructive strategies were positively related to exam performance, whereas the active strategies were not. This work provides insight into the measurement of students' study strategies and their relations to each other and learning outcomes.

Do students really prefer repeated rereading over testing when studying textbooks? A reexamination.

Experimental studies have shown that testing promotes better long-term retention than repeated rereading. Regarding implications for educational practice, based on a survey study seemingly showing that students prefer repeated rereading over testing when studying [Karpicke, J. D., Butler, A. C., & Roediger, H. L. (2009). Metacognitive strategies in student learning: Do students practise retrieval when they study on their own? Memory, 17, 471-479. doi: 10.1080/09658210802647009 ], it has been concluded that increasing the number of tests may boost students' achievement. However, a closer look at the survey study reveals that "repeated rereading" has been operationalised in terms of "restudying" which represents a term that may subsume a variety of study strategies. We reexamined the study behaviour of students in a more fine-grained way by surveying both their hypothetical (Study 1) and real (Study 2) study behaviour when restudying texts. Results showed that rereading is preferred only by few students early in the learning process, with almost all shifting to testing late in the learning process, and that rereading is mainly performed in terms of "rereading not understood parts", and rarely in terms of "repeated rereading". These results indicate that the implications of the testing effect for educational practice may have to be reconsidered.

Changes in Student Perceptions and Study Strategies Over Time in a Veterinary Clinical Pathology Course Using Case-Based Instruction.

Veterinary students are challenged to develop new, nonlinear ways of thinking as they learn diagnostic reasoning skills. To support this process, we use real-life cases in our clinical pathology course. Changes in student perceptions regarding the use of cases and changes in study strategies over time have not been previously investigated or compared to student grades. Students participated in three voluntary online surveys that included 4-point Likert scale questions and open-ended questions on the helpfulness of cases for learning and study strategies used during the course. We used Friedman tests to detect any differences in perceptions over time; McNemar's test and Wilcoxon signed-rank tests were used to detect any differences in study strategies over time. Fisher's exact tests were used to examine the association between the Likert scale responses and grades in quartiles. Before beginning the course, 29% of students responded that cases were very helpful to their learning, with similar responses for helpfulness in applying course material and grasping important concepts. There was a significant trend of increasing positivity over the duration of the course, with 74% responding that cases were very helpful at the end of the course. The most-reported study strategy was working individually on cases before the midterm (74% of students), and the most helpful study strategy was attending class regularly (88% reported it as very helpful). Study strategies did not change significantly over time. Overall, perceptions and study strategies did not vary significantly with grades.

The what, how much, and when of study strategies: comparing intended versus actual study behaviour.

The study behaviours of students can be assessed from several perspectives, such as what study strategies are used, the total number of hours of study, and the distribution of studying over time. Here, we present the results of a survey study that considered each of these perspectives by asking students to report the what, how much, and when of their study behaviours over the course of a semester. As important, to better understand students' use of study strategies, we also had students report at the beginning of the semester how they intended to study and their beliefs about the effectiveness of a variety of common strategies. Our results indicate that during the semester, students rely on relatively ineffective strategies and mass their studying the day or two before an exam. However, students intended to begin studying earlier and to use a mix of effective and ineffective study habits. Despite their use of some ineffective strategies, they did have a relatively accurate assessment of which strategies were less versus more effective. Taken together, our results suggest that students have some excellent intentions but may falter because massing study the evening before an exam limits their use of more effective study strategies.

Can kinomics and proteomics bridge the gap between pediatric cancers and newly designed kinase inhibitors?

The introduction of kinase inhibitors in cancer medicine has transformed chronic myeloid leukemia from a fatal disease into a leukemia subtype with a favorable prognosis by interfering with the constitutively active kinase BCR-ABL. This success story has resulted in the development of multiple kinase inhibitors. We are currently facing significant limitations in implementing these kinase inhibitors into the clinic for the treatment of pediatric malignancies. As many hallmarks of cancer are known to be regulated by intracellular protein signaling networks, we suggest focusing on these networks to improve the implementation of kinase inhibitors. This viewpoint will provide a short overview of currently used strategies for the implementation of kinase inhibitors as well as reasons why kinase inhibitors have unfortunately not yet been widely used for the treatment of pediatric cancers. We argue that by using a future personalized medicine strategy combining kinomics, proteomics, and drug screen approaches, the gap between pediatric cancers and the use of kinase inhibitors may be bridged.

Instructor and student knowledge of study strategies.

Students' self-reported study skills and beliefs are often inconsistent with empirically supported (ES) study strategies. However, little is known regarding instructors' beliefs about study skills and if such beliefs differ from those of students. In the current study, we surveyed college students' and instructors' knowledge of study strategies and had both groups evaluate the efficacy of learning strategies described in six learning scenarios. Results from the survey indicated that students frequently reported engaging in methods of studying that were not optimal for learning. Instructors' responses to the survey indicated that they endorsed a number of effective study skills but also held several beliefs inconsistent with research in learning and memory (e.g., learning styles). Further, results from the learning scenarios measure indicated that instructors were moderately more likely than students to endorse ES learning strategies. Collectively, these data suggest that instructors exhibited better knowledge of effective study skills than students, although the difference was small. We discuss several notable findings and argue for the improvement of both students' and instructors' study skill knowledge.

Dynamics of study strategies and teacher regulation in virtual patient learning activities: a cross sectional survey.

BACKGROUND: Students' self-regulated learning becomes essential with increased use of exploratory web-based activities such as virtual patients (VPs). The purpose was to investigate the interplay between students' self-regulated learning strategies and perceived benefit in VP learning activities. METHOD: A cross-sectional study (n = 150) comparing students' study strategies and perceived benefit of a virtual patient learning activity in a clinical clerkship preparatory course. Teacher regulation varied among three settings and was classified from shared to strong. These settings were compared regarding their respective relations between regulation strategies and perceived benefit of the virtual patient activity. RESULTS: Self-regulation learning strategy was generally associated with perceived benefit of the VP activities (rho 0.27, p < 0.001), but was not true in all settings. The association was higher in the two strongly regulated settings. The external regulation strategy did generally associate weakly with perceived benefit (rho 0.17, p < 0.05) with large variations between settings. CONCLUSIONS: The flexible student-autonomous appeal of virtual patients should not lead to the dismissal of guidance and related course activities. External teacher and peer regulation seem to be productive for increasing learners' perceived benefit. Awareness of the interplay among teacher regulation (external) and various study strategies can increase the value of flexible web-based learning resources to students.

Old Habits Die Hard: Regression in Learning and Study Strategies Inventory Scores in PharmD Students.

OBJECTIVE: Prior studies have demonstrated that "learning to learn" (L2L) courses can lead to significant improvements in students' Learning and Study Strategies Inventory (LASSI) scores immediately following the course. This study aimed to analyze whether improvements in LASSI scores are sustained 1 year following an L2L elective course. METHODS: First-year pharmacy students in the classes of 2024 and 2025 completed the LASSI at the start of the fall semester and again immediately following an L2L course. One year later, during the second professional year, students completed the LASSI a third time. Repeated-measures multivariate analysis of variance was used to analyze within-participant differences in LASSI scores across each of the 10 LASSI scales. Univariate analysis of variance with Bonferroni correction was used for pairwise comparison. RESULTS: A total of 119 students completed all 3 LASSI assessments. LASSI scores improved in all 10 scales following completion of the L2L course. However, 1 year after the completion of the course, there was a statistically significant regression in all 10 scale scores (Wilks' Λ [20,98] = 8.7). Among the 10 scales, scores for the Attitude and Concentration scales were statistically significantly lower during the second professional year relative to baseline at the start of the first professional year. Selecting Main Ideas was the only scale with a higher score during the second professional year relative to baseline. CONCLUSION: Despite marked improvements in LASSI scores following the implementation of a "learning to learn" course for first-year pharmacy students, the improvements were not sustained after 1 year.

Pre- and post-examination reflections of first-year medical students in an integrated medical anatomy course.

Due to the rigor and pace of undergraduate medical anatomy courses, it is not uncommon for students to struggle and fail initially. However, repetition of coursework places an additional burden on the student, instructor, and institution. The purpose of this study was to compare the exam preparation strategies of repeating and non-repeating students to identify areas where struggling students can be supported prior to course failure. As part of their integrated anatomy course, first-year medical students at Indiana University completed a metacognitive Practice-Based Learning and Improvement (PBLI) assignment prior to and after their first exam. In the PBLIs, students were asked to reflect on their exam preparation strategies, confidence, and satisfaction, as well as their predicted and actual exam performance. PBLI responses from non-repeating and repeating students were then analyzed quantitatively and qualitatively. A total of 1802 medical students were included in this study, including 1751 non-repeating and 51 repeating students. Based on their PBLI responses, non-repeating students were appropriately confident, somewhat satisfied, and more accurate when predicting their exam performance. Repeating students were overconfident, dissatisfied, and inaccurate when predicting their first exam performance on their initial, unsuccessful attempt but were more successful on their second, repeat attempt. Qualitative analysis revealed that repeating students aimed to improve their studying by modifying their existing study strategies and managing their time more effectively. In conjunction with other known risk factors, these insights into repeater and non-repeater exam preparation practices can help anatomy educators better identify and support potential struggling students.

Integrated Case-Based Learning Session for Breast and Upper Limb Anatomy.

Introduction: Medical students are frequently introduced to medical school curricula through anatomy coursework, which often includes histology and embryology content. As medical education has increasingly emphasized integration of content areas, use of activities such as case-based learning (CBL) sessions has grown. Little published work has demonstrated the effectiveness of CBL sessions in integrating anatomy, embryology, and histology on first-year medical students' ability to improve content mastery and adapt their study techniques. Methods: We developed a CBL session that included anatomy, embryology, and histology content covering the upper extremity and breast pathology that was taught to incoming first-year medical students (N = 51) during a prematriculation program in the summers of 2022 and 2023. The session involved completion of an individual pre- and postsession quiz; group completion of clinical cases involving image interpretation, matching exercises, and construction of diagrams, flowcharts, or tables; and a postsession survey with Likert-style and free-response questions about preparation and session effectiveness. Results: Postsession quiz scores significantly improved (p < .001). On the postsession survey (response rate: 59%), students commented that they enjoyed the real-life application and integration of the cases and that the sessions improved their understanding of the connections between content areas. Other comments demonstrated that students were evaluating and adapting their study approach in preparation for the sessions, often using techniques introduced and practiced in the sessions. Discussion: CBL sessions can provide opportunities to incoming first-year medical students to practice, adapt, and evaluate study techniques while delivering integrated content.

All "wrapped" up in reflection: supporting metacognitive awareness to promote students' self-regulated learning.

Self-regulated learning (SRL) is the process of utilizing effective strategies to acquire knowledge or skills and is influenced by motivation, metacognitive processing, and study-related behaviors. We hypothesized that by using survey tools that allow reflection on and refinement of students' study strategies, we could nurture metacognitive skill development, encourage positive motivation and study-related behaviors, and hence promote academic success. Undergraduate students in a semester-long, second-year biology course were provided with resources to promote SRL and three survey instruments that encouraged them to create study plans and reflect on the effectiveness of their study strategies. Using a student-partnered approach, we sought to investigate the role of metacognition, motivation, and study-related behaviors on academic performance by (i) identifying the self-regulated learning strategies most utilized by students, (ii) investigating the role of reflection in enhancing metacognitive processing and academic performance, and (iii) understanding whether students created and/or modified their study strategies as an outcome of self-regulation. Survey responses allowed us to understand the repertoire of study strategies used by students. Our analyses suggest that students demonstrated metacognitive skill development through the use of the resources and reflection instruments, as they accurately reported on the effectiveness of their study strategies and indicated future plans to shift study-related behaviors from passive to active reviewing techniques. Students across the grade spectrum perceived the reflection instruments as beneficial in identifying areas of improvement and developing long-term study habits, suggesting that these instruments were effective in promoting metacognitive skill development for a variety of student learners. We conclude that supporting students with resources that promote SRL and providing opportunities for timely reflection can promote metacognitive skill development, a key feature of academic success.

Improving Learning and Study Strategies in Undergraduate Medical Students: A Pre-Post Study.

We aimed to describe the impact of a structured interventional program to improve learning and study skills in undergraduate medical students from a Latin American medical school. The interventional program's design was based on diagnostic/prescriptive assessment test scores measuring ten scales. The program consisted of five tailored workshops. The cohort studied consisted of 81 third-year medical students. The outcome variable was the difference between "pre" and "post" test scores. The unadjusted score percentiles were used to compare improvement in learning and study skills. In addition, a sensitivity analysis was conducted to assess variation in the mean difference of the test scores by the number of workshops attended. The response rate was 100% (81/81) for the pre test and ~77% (62/81) for the post test. After the interventional program, nine out of ten scales showed statistical improvement, except for the scale of motivation. The scales with the highest and lowest percent change improvement were time management (66%, p-value: <0.001) and motivation (14.9%, p-value: 0.06). The students who attended more workshops obtained a higher percent change improvement in the post test. These findings suggest that through a well-designed interventional program, it is possible to improve learning and study skills among medical students.

Prior anatomy experience among medical students: What difference does it make?

Prior research has reported that experience in undergraduate anatomy did not significantly affect students' grades in professional schools, yet students would still recommend anatomy experience prior to medical school. It has been further posited that this prior experience may have benefits that do not appear in grade outcomes, such as decreased stress levels or different study strategies. The present study investigated whether different study strategies in anatomy were reported between students with and without prior experience. The data were collected using surveys administered near the beginning and the end of the medical anatomy course. The surveys included questions about study strategies used for the course, basic demographics, and prior experience in anatomy and/or physiology. Results confirmed very few differences in course outcomes between students with and without prior experience in anatomy and/or physiology; however, differences were noted in the study strategies reported. Students with prior experience in anatomy were more likely to report use of a wider variety of strategies and less changes in strategies between the surveys. However, these differences were only noted with prior courses of a certain number and level. It is posited that students with prior experience may have already created a basic scaffold of information in their mind that they could then plug additional information into rather than creating an entirely new knowledge structure. While this did not largely change course outcomes, it is likely to have positive effects on students' perceptions of stress and feelings of being overwhelmed during the course.

Predictive factors of academic success in neuromusculoskeletal anatomy among doctor of physical therapy students.

Predictors of academic success in anatomy have been studied, but not in Doctor of Physical Therapy (DPT) students. The objectives of this study were to (1) explore predictors of academic success in a DPT anatomy course, (2) evaluate sex-based differences in the predictors of academic success and their influence on anatomy course grade, and (3) investigate the influence of the DPT anatomy course on visual-spatial ability. Forty-nine DPT students completed a demographic questionnaire, Learning and Study Strategies Inventory (LASSI), and Mental Rotations Test (MRT) before the ten-week anatomy course (MRT-1) and repeated the MRT at the end of the course (MRT-2). Anatomy course grade was determined based on quizzes and written and practical examinations. Multiple regression analysis showed significant associations between the predictor variables age (p = 0.010) and the LASSI anxiety subscale (p = 0.017), which measures anxiety coping, with the anatomy course grade. On the MRT-1, male DPT students attempted and correctly answered more questions than females (both, p < 0.0001). Female students had higher LASSI self-regulation and use of academic resources subscale scores (both, p < 0.05). In the 44 DPT students that completed the MRT-2, the number of correct and attempted responses increased following the anatomy course (p < 0.0001). Age and anxiety coping, but not sex, are predictors of anatomy course grades in DPT students. Mental rotations test scores improved following the anatomy course. The LASSI should be used in other cohorts to identify students with low anxiety subscale scores in order to provide targeted support.

Study strategies and "study drugs": investigating the relationship between college students' study behaviors and prescription stimulant misuse.

ObjectiveThe current study examined the regular use of study strategies between college students who misused prescription stimulants (N = 36) and college students who did not misuse prescription stimulants (N = 298) in an undergraduate sample. Participants: 334 college students at a large, Midwestern university. Methods: Using logistic regression, we examined whether students who misused prescription stimulants did so to compensate for poor study strategies and/or a lack of study strategies overall. We hypothesized that regularly spacing studying, using more study strategies, and using more effective study strategies would predict lower odds of prescription stimulant misuse among students. In contrast, we hypothesized that using more ineffective study strategies would predict higher odds of prescription stimulant misuse. Results: Results indicated that a greater number of total study strategies and effective study strategies, and higher importance of school predicted higher odds of prescription stimulant misuse. Conclusions: Thus, students may not be misusing prescription stimulants as a substitute for effective studying but, rather, to augment effective study habits.