Integration and assessment of critical outcomes in a learning programme for first-year medical students

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Date
2002-11
Authors
Beylefeld, Adriana Albertus
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University of the Free State
Abstract
English: It is currently a time of great change throughout medical education, as well as in the wider higher education context within which it operates. The problems generated by changed approaches to the delivery of curricula need to be addressed in innovative ways if educational outcomes of a high quality are to be ensured. Critical inquiry into one's own teaching practice is one of the most significant ways in which this goal may be achieved. The purpose of this study was to improve the integration and assessment of critical outcomes in the first year of the Programme for Professional Medicine, currently conducted at the UFS School of Medicine. The focal point of the research was Module MEA 112, which has the development of general skills as its theme, with a view to giving effect to the government and public demand to equip students at all levels of their higher education careers with employment-related, lifelong learning skills. In order to evaluate the effectiveness of interventions that took place in Module MEA112 over a period of three years, an action research was adopted. This means that actions taken were critically explored, evidence was gathered and perceptions were considered in order to develop an understanding of how critical outcomes could best be integrated and assessed within the parameters of the firstyear of the Programme for Professional Medicine. Features of the original Module MEA112 that demanded modification were pinpointed (cf. Chapter Seven); changes were described, and finally, the lessons learned were reflected on, with a view to re-planning and improvement of practice (cf. Chapter Eight and Chapter Nine). Three cycles of action research were completed. In Cycle One (1999-2000), the focus was on the design and implementation of a purpose-built module on general skills development that would be appropriate for the UFS School of Medicine context. The inference was drawn that the original model should be further contextualised to help students to see the relevance of general skills in a medical leaming programme; and that general skills development should form an integral part of core modules and not be confined to a stand-alone period of orientation. In Cycle Two (2000-2001), the potential for close collaboration between subject and skills specialists, with a view to encouraging the development of general skills inherent in performing authentic discipline-related tasks, was explored. The idea that a professional healthcare practitioner should be able to appraise her own work and that of others - a skill that is at the centre of professional medical practice - was instilled by introducing students to self- and peer assessment. The introduction of this skill at a relatively early stage of their study careers was premised on the belief that students should be skilled in the habits and attitudes that prepare them for a student-centered curriculum; for functioning as lifelong learners in their future careers, and also as responsible citizens, while they are still receptive to such influences. In Cycle Three (2001-2002), the difficulties associated with the incorporation of skills development in core modules and the evolution of alternative forms of assessment formed the focal points. Efforts to establish a portfolio-based assessment system featured most prominently, in furtherance of the idea that assessment strategies should reflect the educational aims of an outcomes-based learning programme. context. The inference was drawn that the original model should be further contextualised to help students to see the relevance of general skills in a medical leaming programme; and that general skills development should form an integral part of core modules and not be confined to a stand-alone period of orientation. In Cycle Two (2000-2001), the potential for close collaboration between subject and skills specialists, with a view to encouraging the development of general skills inherent in performing authentic discipline-related tasks, was explored. The idea that a professional healthcare practitioner should be able to appraise her own work and that of others - a skill that is at the centre of professional medical practice - was instilled by introducing students to self- and peer assessment. The introduction of this skill at a relatively early stage of their study careers was premised on the belief that students should be skilled in the habits and attitudes that prepare them for a student-centered curriculum; for functioning as lifelong learners in their future careers, and also as responsible citizens, while they are still receptive to such influences. The value of the research rests on its emancipatory nature in the sense that it helped to redefine the relatively narrow boundaries that were initially set for general skills development in 1999. In reporting the evolutionary process, credibility was pursued by documenting actions and their outcomes in a rigorous and systematic manner; and by giving an honest, autobiographical narrative on the laborious process of improvement.
Afrikaans: Geneeskunde-onderwys, sowel as die groter hoëronderwyskonteks, beleef tans 'n tyd van groot verandering. Ten einde leeruitkomste van 'n hoë gehalte te verseker, moet die probleme wat voortspruit uit veranderde benaderings tot onderrig en leer op 'n innoverende wyse benader word. Kritiese self-evaluering van onderrigpraktyk kan 'n beduidende bydrae lewer om hierdie doel te bereik. Hierdie studie was gerig op die verbetering van die integrasie en assessering van kritiese uitkomste in die eerste jaar van die Program vir Professionele Geneeskunde aan die Skool vir Geneeskunde, Universiteit van die Vrystaat. Module MEAl12 het die fokuspunt gevorm. Hierdie module het die ontwikkeling van algemene vaardighede as tema, ten einde uitvoering te gee aan publieke en regeringsaandrang op die voorbereiding van studente op alle vlakke van hoër onderwys vir die arbeidsmark en lewenslange leer. 'n Aksienavorsingsbenadering is gevolg om die effektiwiteit van ingrepe wat oor die afgelope drie jaar in Module MEA112 plaasgevind het, te evalueer. Hierdie proses het behels dat aksiestappe krities ondersoek is aan die hand van bewyse en persepsies van wat gedoen is. Sodoende is insigte bekom om die integrasie en assessering van kritiese uitkomste, binne die parameters van die eerste jaar van die Program vir Professionele Geneeskunde op die bes moontlike manier aan te pak. Die kenmerke van die oorspronklike Module MEA112 wat verandering geverg het, is uitgewys (vgl. Hoofstuk Sewe), en die veranderings wat aangebring is, is beskryf. Besinning op grond van lesse wat geleer is, het voortdurend plaasgevind met die oog op herbeplanning en verbetering van bestaande praktyk (vgl. Hoofstukke Agt en Nege). Drie siklusse van aksienavorsing is voltooi. In die eerste siklus (1999-2000), het die klem geval op die ontwerp en implementering van 'n module vir die ontwikkeling van algemene vaardighede, doelgemaak vir die behoeftes van die Universiteit van die Vrystaat se Skool vir Geneeskunde. Die afleiding is gemaak dat die oorspronklike model nog meer konteksgerig behoort te wees ten einde die relevansie van algemene vaardighede in 'n geneeskunde-leerprogram te beklemtoon; asook dat die ontwikkeling van algemene vaardighede 'n integrale deel van kemmodules moet uitmaak. In die tweede siklus (2000-2001) is die moontlikheid van noue samewerking tussen vak- en vaardigheidspesialiste ondersoek, met die oog op die ontwikkeling van vaardighede wat inherent deel uitmaak van outentieke dissipline-verwante werkopdragte. Studente is blootgestel aan die praktyke van self- en eweknieassessering, om hulle bewus te maak van hierdie allerbelangrike vaardigheid wat 'n integrale deel vorm van professionele gesondheidsorg. Hierdie vaardigheid is relatief vroeg in die studente se studieloopbaan aangespreek, op grond van die aanname dat studente voorberei moet word vir die eise van 'n studentgesentreerde kurrikulum, lewenslange leer en verantwoordelike burgerskap op 'n stadium dat hulle ontvanklik is vir nuwe denke, gewoontes en houdings. In die derde siklus (2001-2002) het probleme wat verband hou met die inkorporering van vaardigheidsontwikkeling in kemmodules en die evolusie van alternatiewe vorme van assessering aan die orde gekom. Pogings wat aangewend is om 'n portefeulje-gebaseerde assesseringsisteem tot stand te bring, het die fokus gevorm, in ooreenstemming met die gedagte dat assesseringstrategieë die onderwyskundige doelwitte van 'n uitkomsgebaseerde leerprogram behoort te weerspieël. Die waarde van die navorsing is gesetel in die emansieperende uitwerking wat dit gehad het op die relatiewe eng grense wat aanvanklik itt 1999 vir die ontwikkeling van algemene vaardighede in die vooruitsig gestel is. Geloofwaardigheid is nagestreef in die verslagdoening oor die evolusionêre proses, deurdat aksiestappe en die uitkoms daarvan nougeset en sistematies gedokumenteer en weergegee en die moeisame proses van praktykverbetering op 'n eerlike, outobiografiese wyse opgeteken is.
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Keywords
Action research, Alternative assessment, Authentic assessment, Critical cross-field outcomes, Fundamental learning, General skills, Medical education, Outcomes-based education, Professional development, Quality assurance, Curriculum-based education, Medical education -- South Africa -- Bloemfontein, Medical students -- Study and teaching, Competency-based education, Thesis (Ph.D. (Interdisciplinary Medical and Higher Education Studies))--University of the Free, 2002
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