Given the nature of medicine as an academic discipline, with its high conceptual difficulty and content-heavy curriculum, it is likely that some students struggle to achieve success. Problem-based learning (PBL) represents a novel educational environment for many first-year students and their skills in learning self-regulation are challenged. This research investigated an intervention program of cognitive and metacognitive exercises and alternative assessment formats among first-year medical students in a PBL curriculum with the purpose of enhancing learning. Trends in approaches to learning and self-efficacy were measured over the duration of the first-year course. The ability of the intervention to improve three specific learning outcomes was determined, including adoption of deep, strategic learning, self-efficacy, and satisfaction with learning in PBL tutorials. In addition, the ability of students to accurately undertake participative assessment of PBL performance in tutorials was investigated.
First year students (N = 213) enrolled in the graduate-entry Bachelor of Medicine and Bachelor of Surgery Program (MBBS) at The University of Queensland were recruited to participate in a study of metacognition and participative assessment during 2004. A pre-test, post-test design was implemented with intervention (N = 125) and control (N = 88) students, with intervention students experiencing a program of cognitive and metacognitive activities within their PBL tutorials of at least 6 months duration. Control students experienced PBL in its unmodified format. All students completed the Medical Students Learning Questionnaire (MSLQ) at the commencement, and completion, of the study to gather data on three specific learning outcomes. The intervention program consisted of reflection on learning in PBL coupled with tutor, peer- and self-assessment of PBL performance within the tutorial setting. Both quantitative and qualitative data were collected.
Students’ self-efficacy was lower at the conclusion of the study (p < 0.001). A significant reduction in the adoption of deep and strategic learning approach, matched by a corresponding increase in the use of surface learning, was demonstrated (p < 0.001). This shift from deep, strategic learning to more surface approaches and decreased self-efficacy did not differ significantly between intervention and control students. Metacognitive and cognitive activities failed to positively impact on the three learning outcomes. There was a statistically significant association between high self-efficacy and deep learning approach (0.003 ≤ p ≤ 0.005). Older students (26 – 44 years) were over-represented in the group of efficacious deep learners.
The results revealed low correlation between scores derived from tutor and self-assessment (0.31 ≤ r ≤ 0.41), with students consistently under-marking their own performance to a substantial degree. Students with greater self-efficacy scored their PBL performance more highly. Peer-assessment was a more accurate measure, with peer-averaged scores correlating moderately with tutor ratings (0.40 ≤ r ≤ 0.60). Students consistently over-marked their peers, particularly those with casual or sceptical attitudes to the peer-assessment process. Peer over-marking led to less divergence from the tutor scoring than under-marking of one’s own work.
First-year medical students in a PBL curriculum were better able to assess the performance of their peers compared to their own performance. Students appear either unwilling or unable to accurately self-assess their performance in PBL tutorials. Over the course of their first-year studies, students lose self-efficacy and move away from deep, strategic approaches to learning and towards surface, apathetic approaches. The program of metacognitive activities failed to reverse this trend. The substantial swing towards surface learning raises timely questions about the perceived capacity of PBL curricula to promote deep learning in time intensive courses, and reinforces the importance of personal and contextual factors, such as life experience, heavy workload and challenging assessment formats, in determining individual approaches and idiosyncratic responses to learning situations.