Conceptualizing Medical Students' Self-directed Learning in the Clinical Setting - A Qualitative Study in Taiwan

10.6145/jme.202203_26(1).0002

Tzu-Hung Liu；Kai-Kuen Leung；Amy Marie Sullivan

self-directed learning ； clinical setting ； medical students ； qualitative interviews ； content analysis

Journal of Medical Education

26卷1期（2022 / 03 / 01）

46 - 58

英文

Clinical teachers have regarded self-directed learning (SDL) as an essential means of enabling students to take responsibility for their learning throughout clinical training. However, SDL in the clinical setting in Taiwan has not yet been described in the literature. Purpose: This study aims to illustrate Taiwanese student experiences of SDL in their clinical training and identify how local socio-cultural contexts differ from our previous study in the U.S. Methods: To conceptualize students' SDL experiences in the clinical setting, we conducted a qualitative study with 15 Taiwanese medical students at National Taiwan University College of Medicine. The semi-structured interviews were recorded and transcribed. Data were analyzed deductively and inductively using the Framework method of content analysis and our existing conceptual SDL model. Results: Our study showed that the essential themes across three SDL dimensions and six major steps in the process dimension in the contexts of Taiwan were compatible with the conceptual SDL model in our previous study in the U.S. While there were many similarities across the Taiwanese and American groups, some consistent differences emerged. When conducting SDL, American students tended to focus more on individual performance. Taiwanese students were strongly oriented to learning in a collaborative team and with their peers but avoided standing out when learning in a group. Conclusions: Our study contributes to the current SDL models with perspectives of the Taiwanese students and supports the applicability of ＂Person, Process, Context＂ dimensions of SDL. The findings in each SDL dimension also provide practical implications for clinical faculty and students in Taiwan.

1. Boeije, H(2002).A purposeful approach to the constant comparative method in the analysis of qualitative interviews.Qual Quant,36(4),391-409.
2. Brien, BC,Harris, IB,Beckman, TJ(2014).Standards for reporting qualitative research: A synthesis of recommendations.Acad Med,89(9),1245-1251.
3. Brockett, RG,Hiemstra, R.(1991).Self-direction in Adult Learning: Perspectives on Theory, Research, and Practice.New York, NY:Routledge.
4. Bunniss, S,Kelly, DR(2010).Research paradigms in medical education research.Med Educ,44(4),358-366.
5. Burk-Rafel, J,Santen, SA,Purkiss, J(2017).Study behaviors and USMLE Step 1 performance: Implications of a student self-directed parallel curriculum.Acad Med,92,S67-S74.
6. Candy, PC.(1991).Self-direction for Lifelong Learning: A Comprehensive Guide to Theory and Practice.San Francisco, CA:Jossey-Bass.
7. Cate, OTJ,Kusurkar, RA,Williams, GC(2011).How self-determination theory can assist our understanding of the teaching and learning processes in medical education.Med Teach,33(12),961-973.
8. Chitkara, MB,Satnick, D,Lu, WH(2016).Can individualized learning plans in an advanced clinical experience course for fourth year medical students foster self-directed learning?.BMC Med Educ,16(1),232.
9. Garrison, DR(1997).Self-directed learning: Toward a comprehensive model.Adult Educ Q,48(1),18-33.
10. Ge, X,Chua, BL(2019).The role of self‐directed learning in PBL: Implications for learners and scaff olding design.The Wiley Handbook of Problem‐Based Learning
11. Greveson, GC,Spencer, JA(2005).Self‐directed learning The importance of concepts and contexts.Med Educ,39(4),348-349.
12. Hiemstra, R,Brockett, RG(2021).Reframing the meaning of self-directed learning: An updated model.Adult Education Research Conference 2012: 2021 Conference proceedings
13. Hill, M,Peters, M,Salvaggio, M(2020).Implementation and evaluation of a self-directed learning activity for first-year medical students.Med Educ Online,25(1),1717780.
14. Hmelo-Silver, CE,Duncan, RG,Chinn, CA(2007).Scaffolding and achievement in problembased and inquiry learning: A response to Kirschner, Sweller, and Clark (2006).Educ Psychol,42(2),99-107.
15. Ho, MJ,Lin, CW,Chiu, YT(2012).A cross‐cultural study of students’ approaches to professional dilemmas: Sticks or ripples.Med Educ,46(3),245-256.
16. Huang, CD,Tseng, HM,Jenq, CC(2020).Active learning of medical students in Taiwan: A realist evaluation.BMC Med Educ,20(1),487.
17. Hwang, KK(2000).Chinese relationalism: Theoretical construction and methodological considerations.J Theory Soc Behav,30(2),155-178.
18. Knowles, MS(1975).Self-directed Learning: A Guide for Learners and Teachers.New York, NY:Association Press.
19. Krupat, E,Richards, JB,Sullivan, AM(2016).Assessing the effectiveness of case-based collaborative learning via randomized controlled trial.Acad Med,91(5),723-729.
20. Li, ST,Paterniti, DA,Co, JP(2010).Successful self-directed lifelong learning in medicine: A conceptual model derived from qualitative analysis of a national survey of pediatric residents.Acad Med,85(7),1229-1236.
21. Liaison Committee on Medical Education: Functions and structure of a medical school: Standards for accreditation of medical education programs leading to the MD Degree. Association of American Medical Colleges and the American Medical Association. Retrieved from: http://lcme.org/publications/. Accessed 27 January 2022.
22. Liu, TH,Sullivan, AM(2021).A story half told: A qualitative study of medical students’ self-directed learning in the clinical setting.BMC Med Educ,21(1),494.
23. Loyens, SM,Magda, J,Rikers, RM(2008).Self-directed learning in problem-based learning and its relationships with self-regulated learning.Educ Psychol Rev,20(4),411-427.
24. Murad, MH,Coto-Yglesias, F,Varkey, P(2010).The effectiveness of self-directed learning in health professions education: A systematic review.Med Educ,44(11),1057-1068.
25. Murad, MH,Varkey, P(2008).Self-directed learning in health professions education.Ann Acad Med Singapore,37,580-590.
26. Ritchie, J,Lewis, J,Nicholls, CM(2013).Qualitative Research Practice: A Guide for Social Science Students and Researchers.Thousand Oaks, CA:Sage.
27. Shilkofski, N,Shields, RY(2016).Adapting to a US medical curriculum in Malaysia: A qualitative study on cultural dissonance in international education.Cureus,8
28. Shokar, GS,Shokar, NK,Romero, CM(2002).Self-directed learning: Looking at outcomes with medical students.Fam Med,34,197-200.
29. Tong, A,Sainsbury, P,Craig, J(2007).Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups.Int J Qual Health Care,19(6),349-357.
30. Wynter, L,Burgess, A,Kalman, E(2019).Medical students: What educational resources are they using?.BMC Med Educ,19(1),36.
31. Young, M,Varpio, L,Uijtdehaage, S(2020).The spectrum of inductive and deductive research approaches using quantitative and qualitative data.Acad Med,95(7),1122.