Active learning of medical students in Taiwan: a realist evaluation

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RESEARCH ARTICLE

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Active learning of medical students in Taiwan: a realist evaluation Chien-Da Huang1,2,3* , Hsu-Min Tseng4, Chang-Chyi Jenq5 and Liang-Shiou Ou6

Abstract Background: Active learning is defined as any instructional method that engages students in the learning process. Cultural differences in learning patterns can play an important role in engagement with active learning. We aimed to examine process models of active learning to understand what works, for whom and why. Methods: Forty-eight sixth- and seventh-year medical students with experience of active learning methods were purposively selected to participate in ten group interviews. Interactions around active learning were analysed using a realist evaluation framework to unpack the ‘context-mechanism-outcome’ (CMO) configurations. Results: Three core CMO configurations, including cultural, training and individual domains, were identified. In the cultural context of a strong hierarchical culture, the mechanisms of fear prompted students to be silent (outcome) and dare not give their opinions. In the training context of teacher-student familiarity alongside teachers’ guidance, the mechanisms of learning motivation, self-regulation and enthusiasm were triggered, prompting positive learning outcomes and competencies (outcome). In the individual context of learning how to learn actively at an early stage within the medical learning environment, the mechanisms of internalisation, professional identity and stress resulted in recognising active learning and advanced preparation (outcomes). Conclusions: We identified three CMO configurations of Taiwanese medical students’ active learning. The connections among hierarchical culture, fear, teachers’ guidance, motivation, the medical environment and professional identity have been shown to affect the complex interactions of learning outcomes. Fear derived from a hierarchical culture is a concern as it is a significant and specific contextual factor, often sparking fear with negative outcomes. Keywords: Realist evaluation, Culture, Active learning, Hierarchy, Medical students

Background Active learning comprises an interactive approach to education and training designed to engage learners as they strive to acquire and understand knowledge [1]. Active learning is grounded in constructivist learning theories [2] whereby learners interacting with their subject matter facilitates the construction and ownership of * Correspondence: [email protected] 1 Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan 2 Department of Medical Education, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan Full list of author information is available at the end of the article

knowledge. Active learning is also related to adult learning theory [3] which is founded on the principles that effective training should be relevant, engaging, active, and learner-centred. The active learning classroom is