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34300002087355
Universiteit Vrystaat
THE IMPACT OF AN INTERACTIVE
EDUCATION STRATEGY IN
RADIOGRAPHY EDUCATION
by
S.M. Brussow
Script submitted in partial fulfilment of the demands
for the Module HPE 792 being part of the
requirements for the degree
Magister in Health Professions Education (M.HPE)
(consisting of seven modules, a research project and a script)
in the
DIVISION OF EDUCATIONAL DEVELOPMENT
FACULTY OF HEALTH SCIENCES
UNIVERSITY OF THE FREE STATE
NOVEMBER 2003
Study leader: Prof. Dr M.M. Nel
Co-study leader: Prof. G. Joubert
-
Un1v.r.ltelt von die
orIflJt-Vry.toot
BLO'l1FONTEIH
2 - JUN 2004
'-u-o-v~s -'-A-!_~-._'I-~_Ll0..__T._EE-K-
ii
DECLARATION
I hereby declare that the work, which is submitted hereby, is the result of
my own independent investigation. Where help was sought, it was
acknowledged. I further declare that this work is submitted for the first time
at this university/faculty towards an M.HPE degree in Health Professions
Education and that it has never been submitted to any other
university/faculty for the purpose of obtaining a degree.
s.
I hereby cede copyright of this product in favour of the University of the
Free St
iii
ACKNOWLEDGEMENTS
I wish to express my sincere appreciation to the following:
• My study leader, Prof. Dr M.M. Nel, Head of the Division of
Educational Development, Faculty of Health Sciences, University of
the Free State, for her guidance, support and advice during the
study.
• My co-study leader, Prof. G. Joubert, Head of the Department of
Biostatistics, Faculty of Health Sciences, University of the Free
State, for her guidance, support and advice during the study.
• Prof. F.J. Veldman, Professor in Biomedical Technology, Faculty of
Health and Environmental Sciences, Central University of
Technology, for his support during the analysis of the data.
• The second-year learners in radiography (2002) who participated in
the study and without whom this investigation would not have been
possible.
• My family for supporting me in completing this work.
• Soli Gloria Deo.
iv
TABLE OF CONTENTS
CHAPTER 1
ORIENTATION TO THE STUDY
Page
1.1 INTRODUCTION 1
1.2 ACADEMIC ACHIEVEMENT 5
1.3 FACTORS ASSOCIATED WITH ACADEMIC ACHIEVEMENT 5
1.3.1 Cognitive ability 6
1.3.2 Self-regulation 7
1.3.3 Self-efficacy 7
1.3.4 Motivation 8
1.3.5 Approaches to learning 8
1.3.6 Study skills 8
1.3.7 Learning styles 9
1.4 EDUCATIONAL STRATEGIES 9
1.4.1 Learner-centred learning 10
1.4.2 Active learning 10
1.4.3 Interactive learning 11
1.4.4 Learning guides 11
1.4.5 Key solution 11
1.5 STATEMENT OF THE PROBLEM 12
1.6 GOAL, AIM AND OBJECTIVES OF THE STUDY 14
1.6.1 Goal 14
1.6.2 Aim 14
1.6.3 Objectives 14
1.7 SCOPE OF THE STUDY 15
1.8 SIGNIFICANCE AND VALUE OF THE STUDY 16
v
1.9 METHODS OF INVESTIGATION 17
1.9.1 Study design 17
1.9.2 Target group 18
1.9.3 Measurement 19
1.9.4 Pilot study 19
1.9.5 Analysis 19
1.10 DEFINITION OF TERMINOLOGY 20
1.11 ARRANGEMENT OF THE REPORT 22
1.12 CONCLUSION 23
CHAPTER 2
ACADEMIC ACHIEVEMENT: RELATED FACTORS AND
EDUCATIONAL STRATEGIES
2.1 INTRODUCTION 24
2.1.1 Search criteria 25
2.2 ACADEMIC ACHIEVEMENT 25
2.3 FACTORS ASSOCIATED WITH ACADEMIC ACHIEVEMENT 27
2.3.1 Cognitive ability 28
2.3.2 Self-regulation 29
2.3.3 Self-efficacy 31
2.3.4 Motivation 33
2.3.5 Approaches to learning 34
2.3.6 Study skills 36
2.3.7 Learning styles 38
2.4 EDUCATIONAL STRATEGIES 42
2.4.1 Learner-centred learning 43
2.4.2 Active learning 45
vi
2.4.3 Interactive learning 47
2.4.4 Learning guides 50
2.5 SUMMARY AND CONCLUSION 51
CHAPTER 3
RESEARCH DESIGN AND METHODS
3.1 INTRODUCTION 53
3.2 STUDY DESIGN 53
3.3 TARGET GROUP 54
3.4 PROCEDURE 54
3.4.1 Learning preference inventory 54
3.4.2 Division of groups 55
3.4.3 Learning content 55
3.4.4 Formal lectures 56
3.4.5 Self-activities 56
3.4.6 Independent self-study 57
3.4.7 Pre-test 57
3.4.8 Structured interactive sessions 58
3.4.9 Post-intervention test 60
3.4.10The questionnaire 60
3.4.11The pilot study 61
3.4.12Scholastic Aptitude Tests (SAT) 61
3.5 METHODOLOGICAL AND MEASUREMENT ERRORS 61
3.6 ANALYSIS 62
3.7 ETHICAL ASPECTS 63
3.8 CONCLUDING REMARKS 63
vii
CHAPTER 4
RESULTS AND FINDINGS
4.1 INTRODUCTION 64
4.2 STUDYGROUP 64
4.3 LEARNINGPREFERENCEINVENTORY(LPI) 65
4.3.1 Association between SAT range and first learning
preference 67
4.4 PRE-TESTSCORES 68
4.5 POST-INTERVENTIONTESTSCORES 68
4.6 SCHOLASTICAPTITUDETEST (SAT) 70
4.6.1 Associations between the SAT and the pre-test scores 71
4.6.2 Associations between the SAT and the post-intervention
test scores 71
4.6.3 Correlations between SAT, average test scores, pre- and
post-intervention test scores and improvement from pre-
to post-intervention test scores 72
4.6.4 Association between mean % increase in test scores and
SAT range 73
4.7 QUESTIONNAIRE 75
4.7.1 Teaching methods which improved marks 75
4.7.2 The role of the lecturer 76
4.7.3 Preferences for study methods 77
4.7.4 Preference for assessment methods 78
4.7.5 General factors associated with learning 79
4.7.6 Experience with teaching methods 81
4.7.7 Personal factors influencing learning 81
4.8 SUMMARY 82
viii
CHAPTER 5
DISCUSSION AND RECOMMENDATIONS
5.1 INTRODUCTION 84
5.2 VALIDITY OF THE STUDY 85
5.3 STUDY METHODOLOGY 85
5.3.1 The Learning Preference Inventory (LPI) 86
5.3.2 Choice of content 87
5.3.3 The division of groups 87
5.3.4 The intervention 88
5.3.5 The learning guide 89
5.3.6 The pre- and the post-intervention tests 90
5.3.7 The questionnaire 90
5.4 LIMITATIONS OF THE STUDY 91
5.5 FINDINGS 93
5.6 RECOMMENDATIONS 95
5.7 IMPLICATIONS OF THE RESEARCH STUDY 97
5.8 SUMMATIVE PERSPECTIVE OF THE RESEARCH STUDY 98
5.9 CONCLUSION 100
REFERENCES 104
APPENDICES 118
A. MEASUREMENT 119
B. STUDY DESIGN 124
C. INTERVENTION 129
D. ETHICS 132
ix
LIST OF APPENDICES
A. MEASUREMENT 119
I. Learning Preference Inventory (LPI) 120
II. Pre-intervention test 121
III. Post-intervention test 122
IV. Learner questionnaire 123
B. STUDYDESIGN 124
V. Division of learners and test scores 125
VI. Study group I: Formal lectures 126
VII. Study group II: Self-activities 127
VIII. Study group III: Self-study 128
C. INTERVENTION 129
IX. Interactive lecture 130
X. Interactive learning guide 131
D. ETHICS 132
XI. Consent form 133
XII. Ethics Committee approval (ETOVS nr 39/03) 134
x
LIST OF TABLES
Table 1.1: Enrolments versus learners who fail an academic
year 2
Table 2.1: Learning preference characteristics 42
Table 4.1: Background information on the study population 65
Table 4.2: Ranking of learning preferences 67
Table 4.3: SAT range and first learning preference 67
Table 4.4: Test scores before and after the intervention 68
Table 4.5: Descriptive statistics of the improvement in test
scores 69
Table 4.6: Correlations between changes from pre-
intervention to post-intervention test scores 70
Table 4.7: SAT scores 70
Table 4.8: SAT and pre-test scores 71
Table 4.9: SAT and post-intervention test scores 72
Table 4.10: Correlations between SAT, ATS, pre- and post-
intervention test scores and improvement from pre-
to post-intervention test scores 73
Table 4.11: Association betweenmean increase in test scores
and SAT range 74
Table 4.12: Teaching method which improves learning
experience 76
Table 4.13: The role of the lecturer 77
Table 4.14: Preferred methods of study 78
Table 4.15: Preferred methods of assessment 79
Table 4.16: General factors associated with learning 80
Table 4.17: Experience with teaching methods 81
Table 4.18: Personal factors influencing learning 82
xi
LIST OF FIGURES
Figure 1.1: Study design 18
Figure 4.1: First learning preference 66
Figure 4.2: SAT, pre-test and post-intervention test scores 72
Figure 4.3: Association between mean increase in test scores
and SAT range 74
Figure 5.1: Summative perspective of the research study 99
xii
LIST OF ACRONYMS
ANOVA Analysis of Variance
ATS Average Test Scores
APBC Academic Planning and Budgeting Committee
CPO Continuous Professional Developrn- It
CTM Committee for Tutorial Matters
DoE Department of Education
ERIC Educational Resource Information Centre
LPI Learning Preference Inventory
MoE Ministry of Education
NPHE National Plan for Higher Education
NQF National Qualifications Framework
OBET Outcomes-based education and training
OSCE Objective Structured Clinical Evaluation
SAQA The South African Qualifications Authority
SAT Scholastic Aptitude Tests
SAUVCA South African Universities Vice-Chancellors' Association
SIS Structured Interactive Sessions
TFS Technikon Free State.
UFS University of the Free State.
UOFS University of the Orange Free State.
xiii
SUMMARY
Key terms: Academic achievement; cognitive ability; self-regulation; self-
efficacy; motivation; approaches to learning; study skills; learning styles;
educational strategies.
Increased access to higher education to address equity is a major
objective of The National Plan for Higher Education (NPHE) in South
Africa. This increased access necessitated more flexible entry
requirements to admit previously disadvantaged learners. These learners
are, however, inadequately prepared for higher education. Higher
education institutions should take this into account in teaching and
learning. The rationale for this study was to address the access-success
imbalance in higher education mentioned by South Africa's Minister of
Education. This research study was thus undertaken to evaluate the
impact of an interactive educational strategy in radiography education.
The research took the form of an exploratory, descriptive and quantitative
experimental study comprising of a literature review and an experimental
investigation. The literature review covered mainly two aspects: The first
aspect consisted of factors associated with academic achievement,
namely cognitive ability, self-regulation, self-efficacy, motivation,
approaches to learning, effective study skills, and learning styles. In the
second place, educational strategies were reviewed in the literature, while
interactive education was seen as an opportunity to foster the factors
associated with effective learning. Effective learning entails encouraging
self-regulation, nurturing self-efficacy, raising motivation, promoting a deep
approach to learning, teaching and assessing study skills, and
accommodating differences in learning styles when teaching. Since the
key to effective learning is rooted in the engagement of learners in active
and collaborative learning experiences, this productive interaction between
xiv
learners and facilitators - which enhances educational events and
promotes learning - was therefore explored.
The overall goal of the study was to make a contribution towards
optimising the effectiveness of education and training in the radiography
programme in the School of Health Technology at the Technikon Free
State. The aim was to explore the impact of an interactive education
strategy in radiography education on 30 second-year learners enrolled for
the modules Radiographic Practice and Clinical Radiographic Practice II
(RAD 20 at and KLD 20 at) in 2002, gauged by summative assessment
and learner perception.
The empirical study involved a Learning Preference Inventory (LPI) which
provided details on learners' learning preferences. The outcome of the LPI
directed the design of the Structured Interactive Sessions (SIS), the
intervention in which an attempt was made to address the learners'
learning preferences. The learners were divided into three study groups,
namely a formal lecture group, a self-activities group, and a self-study
group. A pre-post test model was used to quantitatively evaluate the
improvement in academic performance after the SIS intervention and
subsequently a questionnaire survey was carried out to assess learners'
perception(s) of the effectiveness of the interactive and self-directed
approach to education in radiography.
The results of the three measures, i.e. the LPI, the questionnaire, and the
pre-post test model used in the study, shared a prevalent important
component, namely the significant role of the facilitator. The LPI results
demonstrated dominance in prevalence for a teacher-structured learning
environment. The aforementioned fact is confirmed by the distribution of
test scores in the pre-test indicating that the groups with no facilitator
guidance had lower test marks than the group who received formal
xv
lectures. The learners' perception and experiences verified a preference
for facilitator-guided activities in class.
The researcher realises the limitations of the study, namely that the study
is restricted to performance after a single intervention in a controlled test
situation, while learners from one programme were used and the
contribution of only interactive education on learning, rather than
combinations of factors, was quantitatively explored. It is therefore
recommended that both quantitative and qualitative approaches, as well
as a larger and more diverse study group, would provide a more widely
applicable measurement for academic improvement after an interactive
intervention.
The findings of the present study suggest a possible link between
interactive educational strategies and academic achievement. The findings
also support the literature on academic performance in which motivation
through interaction between the facilitator and the learners plays an
important role.
xvi
OPSOMMING
Sleutelterme: Akademiese prestasie; kognitiewe vermoë; selfregulering;
selfwaarde; motivering; benaderinge tot leer; studievaardighede; leerstyle;
onderrigstrategieë .
Toenemende toeganklikheid tot hoër onderwys om gelykheid aan te
spreek, is een van die hoofdoelwitte van die National Plan for Higher
Education (NPHE) in Suid-Afrika. Hierdie toenemende toeganklikheid het
meer buigsame toelatingsvereistes genoodsaak om 'n groter getal
voorheen benadeelde studente toe te laat. Genoemde leerders is egter
onvoldoende voorbereid op hoër onderwys. Hoëronderwysinstellings
behoort daarmee rekening te hou wanneer onderrig en leer ter sprake
kom. Die rasionaal van hierdie studie was om die wanbalans met
betrekking tot toelating en akademiese sukses - waarna Suid-Afrika se
Minister van Hoër Onderwys ook verwys het - aan te spreek. Die
navorsingstudie is dus onderneem om die impak van 'n interaktiewe
onderrigstrategie in radiografie-onderrig te evalueer.
Die navorsing het die vorm van 'n ondersoekende, beskrywende en
kwantitatiewe eksperimentele studie bestaande uit 'n literatuuroorsig en 'n
eksperimentele ondersoek aangeneem. Die literatuuroorsig het
hoofsaaklik twee aspekte gedek. Die eerste aspek het uit faktore bestaan
wat geassosieer word met akademiese prestasie, naamlik kognitiewe
vermoë, sellfregulering, selfwaarde, motivering, benaderinge tot leer,
effektiewe studievaardighede en leerstyle. In die tweede plek is
onderrigstrategëeë in die literatuur in oënskou geneem, terwyl interaktiewe
onderrig as 'n geleentheid beskou is om die faktore wat met effektiewe
leer geassosieer word, te bevorder. Effektiewe leer behels die
aanmoediging van selfregulering, die kweek van selfwaarde, verhoogde
motivering, die bevordering van 'n diep benadering tot leer, onderrig en die
xvii
assessering van studievaardighede, asook die akkommodering van
verskille in leerstyle tydens onderrig. Aangesien die sleutel tot effektiewe
leer gewortel is in die betrokkenheid van leerders by aktiewe
leerondervindinge waartydens hulle moet saamwerk, is hierdie
produktiewe interaksie tussen leerders en fasiliteerders wat
onderriggebeure en leer bevorder - dus ondersoek.
Die oorhoofse doel van die studie was om 'n bydrae te lewer tot die
optimale effektiwiteit van onderrig en opleiding in die radiografieprogram in
die Skool van Gesondheidstegnologie aan die Technikon Vrystaat. Die
doel was om die impak van 'n interaktiewe onderrigstrategie in radiografie-
onderrig op 30 tweedejaarleerders te ondersoek, gemeet aan
eindevaluering en leerderindruk. Genoemde leerders het in 2002 vir die
modules Radiografiepraktyk en Kliniese Radiografiepraktyk II (RAD 20 at
en KLO 20 at) ingeskryf.
Die empiriese studie het 'n Leerdervoorkeuropname (LVO) [Learning
Preference Inventory (LPI)] behels wat besonderhede oor leerders se
leervoorkeure voorsien het. Die uitkoms van die LVO het die ontwerp van
die Gestruktureerde Interaktiewe Sessies (GIS) [Structured Interactive
Sessions (SIS)], die ingreep waartydens 'n poging aangewend is om die
leerders se leervoorkeure aan te spreek, bepaal. Die leerders is in drie
studiegroepe - 'n formele lesingsgroep, 'n selfaktiwiteitsgroep en 'n
selfstudiegroep - verdeel. 'n Voor-natoetsmodel is gebruik om die
verbetering in akademiese prestasie na die GIS-ingreep kwantitatief te
evalueer. Daarna is 'n vraelysondersoek uitgevoer met die oog daarop om
die leerders se indruk(ke) aangaande die effektiwiteit van die interaktiewe
en selfgerigte benadering tot radiografie-onderrig te evalueer.
Die resultate van die drie - naamlik die LVO, die vraelys, en die voor-
natoetsmodel wat tydens die studie gebruik is - het 'n oorwegend
belangrike komponent gedeel, naamlik die beduidende rol van die
xviii
fasiliteerder. Die LVO-resultate het die voorkeur van In oorwegend
onderwyser-gestruktureerde leeromgewing gedemonstreer. Bogenoemde
feit word bevestig deur die verspreiding van toetsresultate van die voor-
toets wat aandui dat die groepe sonder fasiliteerderleiding laer toetspunte
behaal het as die groep wat formele lesings ontvang het. Die leerders se
indrukke en ondervindinge staaf In voorkeur vir aktiwiteite in die klas wat
deur In fasiliteerder gelei word.
Die navorser besef die beperkings van die studie, naamlik dat die studie
beperk is tot prestasie na In enkele ingreep tydens In gekontroleerde
toetssituasie waartydens leerders van In enkele program gebruik is.
Verder is die bydrae van slegs interaktiewe onderrig op leer, eerder as In
kombinasie van faktore, kwantitatief ondersoek. Dit word daarom
aanbeveel dat beide kwantitatiewe en kwalitatiewe benaderinge, asook In
groter en meer uiteenlopende studiegroep, In wyer toepaslike meting van
akademiese verbetering sal voorsien na In interaktiewe ingreep uitgevoer
is.
Die bevindinge van die huidige studie dui op In moontlike verband tussen
interaktiewe onderrigstrategieë en akademiese prestasie. Die bevindinge
steun verder die literatuur aangaande akademiese prestasie waarvolgens
motivering deur middel van interaksie tussen die fasiliteerder en die
leerders In belangrike rol speel.
THE IMPACT OF AN INTERACTIVE EDUCATION
STRATEGY IN RADIOGRAPHY EDUCATION
CHAPTER 1
ORIENTATION TO THE STUDY
1.1 INTRODUCTION
In The National Plan for Higher Education (NPHE) (RSA MoE 2001) the
government is very clear on its expectations. In providing higher education
with expected outcomes and targets, for example increased equity in
access and success rates, it is also demanded that equity, quality and the
social development imperatives of South Africa in the 21st century be met
(RSA DoE 1997). To meet these demands, new entry and selection
policies were introduced in higher education institutions. The radiography
learning programme at the Technikon Free State (TFS) therefore adjusted
selection criteria to address equity and the demand for increased
enrolments.
Successful admission to the course is based on a Grade 12 certificate or
an equivalent qualification. The prerequisite subjects are Mathematics,
Physical Science and Biology or Physiology with at least 50% on standard
grade or 40% on higher grade. Prospective learners should pass both
Afrikaans and English (TFS 2001 :86). A candidate for a diploma
previously had to score at least 27 or more points on the Technikon
Scoring Scale (Swedish scale) in the Grade 12 examination in July to be
invited to undergo selection tests. To adhere to the demand of increased
2
enrolment the Technikon Scoring Scale requirements were lowered from
27 to 25 during the post transformation period. This was formalised in
2001 but had been applied informally earlier. Candidates must
successfully complete the selection process. The following measures were
included in the selection tests and used for potential determination: The
shortened Scholastic Aptitude Test (SAT) as a power test (Claassen, De
Beer, Hugo & Meyer 1991:8), a test constructed to measure academic
intelligence or scholastic aptitude and the English Proficiency Test which
measures a candidate's understanding of and proficiency in English.
The application of these new policies led to the rapid expansion of a new
population of learners in radiography education. The learners typically
have different levels of academic ability and diverse cultural backgrounds.
These diverse learners generally did not comply with the academic
success rates previously achieved. The average percentage failures
increased from 38.5% up to 1995 to 61.8% after 1995 (see Table 1.1).
Table 1.1: Enrolments versus learners who fail an academic year
Year Enrolments Failures Failure rate %
1990 23 8 34.8 Up to 1995
1991 22 6 27.3 Average
1992 26 11 42.3 percentage
1993 29 12 41.4 failure rate
1994 25 8 32.0 39.5%
1995 27 16 59.3
1996 27 19 70.4 After 1995
1997 28 20 71.4
Average
1998 27 17 63.0
percentage
1999 21 12 57.1
failure rate
2000 24 11 45.8
61.8%
2001 43 27 62.8
3
This phenomenon was also experienced on national level. Education
Minister Kader Asmal reported during a media briefing at Parliament in
February 2003 that 85% of learners who enrolled at tertiary institutions in
South Africa did not graduate; the throughput rate of 15% was too low;
and his department wanted to increase this rate by at least 5% (Stewart
2003). A study done in the Medical School at the University of Natal
ascribed the failure of learners from disadvantaged educational and socio-
economic backgrounds mainly to an inability to "bridge the gap" between
their two worlds, that of everyday life and that of higher education
(Bezuidenhout in McLean 2001 :408).
Traditionally the education approach in radiography was concomitant with
the remarks made by Turchin, Lehmann and Flexner (2000:271). They
observe that, since ancient times, the Socratic method of teaching with its
emphasis on asking learners questions and providing feedback on the
answers was popular among educators. Minton (1998:399) states that in
radiography education this culture of teaching rather than learning prevails
with teaching following a largely pedagogic style. This is an approach
frequently encountered in radiography instruction, especially in the day-to-
day clinical education of learners during experiential learning. Minton
(1998:399) argues that these strategies were effective in an era when
fewer learners were selected; where the learners were of a more
homogeneous nature; and small classes ensured adequate contact
between learners and their lecturers. Morrison (2001 :7) supports the
notion in stating that in the days when university classes contained highly
selected learners, the traditional lecture appeared to be successful, but at
present, with a more diversified learner population, many learners seem
unable to cope.
In view of the diverse cultural and educational backgrounds of the
radiography learners at the TFS the lack of academic success in the
radiography programme in this study therefore indicates that the traditional
4
methods of teaching, that is formal lectures, are no longer effective. The
diverse academic capabilities of radiography learners have been ascribed
to the fact that many are English second-language learners and received a
less than adequate secondary education that did not fully prepare them for
higher education. The use of educational strategies that will improve
learners' learning and hence academic success has become crucial. The
question to answer is: How can facilitators assist learners to learn more
effectively? Research studies provide the answer: Learners learn more
effectively when they are actively engaged in the learning process (Harden
& Crosby s.a.; Ames & Archer 1988; Wentzel 1991; Davis & Harden 1999;
Baxter & Gray 2001; Chase & Geldenhuys 2001; Gettinger & Seibert
2002).
Similarly, Barr and Tagg (1995:22) suggest that an instruction paradigm
does not teach learners to learn efficiently and effectively. They propose
that facilitators should design a learning environment that will provide
better results. They state that academic institutions should not exist to
provide instruction, but should exist to produce learning; thus forcing a
shift from teacher to learner, an advance both needed and wanted in
radiography education so as to enhance the learning process and improve
pass rates.
The National Qualifications Framework (NQF) (2000:8) confirmed the
need. It proposed that it should be the intention of any learning programme
to realise the importance of reflecting on and exploring a variety of
strategies to enable learning that is more effective. Strategies that
encourage effective learning; that are learner-centred and active learning;
the causes for underachievement; and the resolution thereof were looked
into in the literature and used as foundation for the present investigation.
An overview of the literature on academic achievement; the factors
associated with academic achievement; cognitive ability and self-efficacy;
5
self-regulated learning; motivation; approaches to learning; study skills and
learning styles follow. The value of active, learner-centred and interactive
learning in academic achievement will be addressed in the next section to
provide a background for the investigation at hand.
1.2 ACADEMIC ACHIEVEMENT
Academic achievement, which is the level of success attained in an
academic area (Dark 1998), has been the focus of extensive educational
research (Krouse & Krouse 1981 :151; Zimmerman 1990:3; Carr,
Borkowski & Maxwell 1991; Pimparyon, Poonchai, Roff & Pemba
2000:359; Ferguson, James & Madeley 2002:952; Kumar 2003:25).
Learners' characteristics, abilities, conception of learning, and orientation
to learning are concomitant determinants of academic achievement.
Linnenbrink and Pintrich (2002:313) affirm that academic enablers (non-
academic skills that contribute to academic success) - which include the
entirety of intrinsic motivation, goal orientations, social skills and self-
efficacy - are key elements to consider when reviewing academic
achievement.
1.3 FACTORS ASSOCIATED WITH ACADEMIC ACHIEVEMENT
Factors in the literature which are associated with academic achievement
(Thompson & Geren 2002:398) are, among others, the following:
• Cognitive ability (Gully, Payne, Kiechel & Whiteman 2002:147;
Linnenbrink & Pintrich 2002:314).
• Self-regulation (Zimmerman & Martinez-Pons 1988:284;
Zimmerman 1990; Leung, Lam & Hedley 2001:1072; Kitsantas
2002:109; Gettinger & Seibert 2002:350; Ruban, McCoach,
6
McGuire & Reis 2003:270; Sanz de Acedo Lizarraga, Ugarte,
Iriarte, & Sanz de Acedo Baquedano 2003:65).
• Self-efficacy (Zimmerman 1998:81; Davis & Harden 1999:130;
Pimparyon et al. 2000:363; Sobral 2001 :508; Gully et al. 2002:147;
Kitsantas 2002:103; Linnenbrink & Pintrich 2002:315).
• Motivation (Ames & Archer 1988:261; Cleave-Hogg & Rothman
1991 :456-474; Zimmerman 1998:73; Davis & Harden 1999:133;
Nasmith & Steinert 2001 :48; Linnenbrink & Pintrich 2002:314;
Kumar 2003:24).
• Approaches to learning (Entwistle in Pimparyon et al. 2000:359;
McLean 2001 :401 ; Diseth 2002:221; Gordon & Debus 2002:484).
• Effective study skills (Zimmerman 1998:73; Gettinger & Seibert
2002:350; Thompson & Geren 2002:398).
• Learning styles (Martin, Stark & Jolly 2000:531; Ferguson et al.
2002:962; Boyle, Duffy & Dunleavy 2003:268; Wigen, Holen &
Ellingsen 2003:32).
The relevance of the above-mentioned factors in the current study is
briefly touched on in the ensuing paragraphs. Since cognitive ability with
its complexity is difficult to alter, especially when contact between
facilitators and learners is limited. Hence only factors which could possibly
enhance academic achievement, and which the facilitator has an influence
over, were looked into. Interaction between the facilitator and the learner
during contact time was seen as an opportunity to foster these factors
which are to encourage self-regulation, nurture self-efficacy, raise
motivation, promote a deep approach to learning, teach study skills and
accommodate differences in learning styles.
1.3.1 Cognitive ability
Cognitive ability is considered as a factor associated with academic
achievement and is seen by Brody and Furnham in Diseth (2002:219) as a
major predictor of academic competence. Gully et al. (2002:147) add that
7
"cognitive ability" refers to the ability to integrate, process, and apply
information. Since educators believe that learners perform at a lower level
of competency than what their capabilities are, they attempt to enhance
learners' cognitive ability even though it is so complex (Sanz de Acedo
Lizarraga et al. 2003:59). The authors also suggest that any attempt to
enhance cognitive ability should include motivation through learners' active
participation in the learning process and add that cognitive ability and self-
regulation are interrelated.
1.3.2 Self-regulation
In the early 1990s educational researchers identified a process in which
learners mastered their own acquisition of knowledge and called it self-
regulated learning (Zimmerman 1990:3). Zimmerman (1998:73) describes
self-regulation as self-generated feelings and behaviour to reach
academic goals. The value of self-regulation in the present study is put
forward by Kitsantas (2002:109) who states that self-regulation and self-
efficacy beliefs positively affect academic outcomes and adds that self-
regulated learners are also self-motivated.
1.3.3 Self-efficacy
The findings of Gully et al. (2002:147) and the views of Davis and Harden
(1999:130) indicate that cognitive ability predicts self-efficacy (one's
perceived capability to perform a task). The results of Gully et al.
(2002:147) testify that ability is positively related to self-efficacy, a fact
also noted by Linnenbrink and Pintrich (2002:313) and Pimparyon et al.
(2000:359-365). The changes in the selection and access policies in
radiography education caused a wide variation in learners' cognitive ability
and therefore also their self-efficacy.
Self-efficacy is learners' beliefs about their performance capabilities in a
specific context, task or domain (Linnenbrink & Pintrich 2002:315). Davis
and Harden (1999:130) indicate that self-efficacy controls task
8
performance, determination and effort. It also influences thought patterns,
motivation and performance. A learner's own academic self-efficacy is
formed by that of the facilitator (Gordon & Debus 2002:484). Self-efficacy
as a factor associated with academic achievement was therefore seen as
a characteristic that can be improved in the radiography learning
programme.
1.3.4 Motivation
According to Davis and Harden (1999:130), taking responsibility for one's
own learning, rather than having the subject and method of learning
dictated, enriches the learning experience while presenting an intrinsic
motivation to learn. The statement that increased motivation enhances
effective learning (Ames & Archer 1988:261; Davis & Harden 1999:133;
Nasmith & Steinert 2001 :48; Kumar 2003:24), shows that if the learners in
the radiography programme are motivated, academic performance can be
improved. To find an educational strategy that motivates learners not only
became essential, but also a challenge.
1.3.5 Approaches to learning
Pimparyon et al. (2000:362) see an association between approaches to
learning and the educational environment as factors associated with
academic achievement. The authors state that it is important that
educators create an optimal educational environment that promotes a
deep approach to learning which is positively correlated with academic
achievement in contrast with a surface approach which puts learners at
risk of failing. The authors urge educators to apply interventions to address
underachievement, a statement that supports the intent of the current
investigation.
1.3.6 Study skills
Gettinger and Seibert (2002:350) indicate that learners with low academic
competence demonstrate ineffective study skills in that they playa passive
9
role in the learning process and rely on facilitators to control their learning.
Learner passivity should therefore be avoided and lecturer-learner
interaction should support the learner in obtaining effective study skills.
1.3.7 Learning styles
According to Ferguson et al. (2002:953) and Steele, Johnson, Jodi,
Thomas, Lacy and Duffy (2002:225), learning styles are also associated
with academic performance. The results presented by these authors
suggest that work on learning styles is expected to be productive if the
different learning styles of learners are accommodated in the education
process. However, using only learners' learning approach as a predictor of
academic achievement is not adequate in forecasting learners'
performance, as indicated in the previous paragraphs.
1.4 EDUCATIONAL STRATEGIES
The learning environment, which includes all the aforementioned
determinants of academic achievement, seems to be more useful in
predicting effective learning approaches. The implications include the need
for designing a supportive environment, as well as creating and
implementing interventions in the form of educational strategies to remedy
unsatisfactory elements of the environment to reach academic success
(pimparyon et al. 2000:365).
It is clear from the previous paragraphs that academic achievement
determined by the process and product of learning is complex. The use of
effective educational strategies therefore is of the utmost importance to
ensure an optimal learning milieu. Albert Einstein's (1879-1955)
philosophy: "I never teach my pupils. only attempt to provide the
conditions under which they can learn" validates the importance of
exploring educational strategies that will indeed create these conditions.
10
Since educational literature has for some time recognised the importance
of learner-centred teaching and learning where learners are active
participants in the learning process (Baxter & Gray 2001 :396), the
implementation of an active and learner-centred approach to education
seemed meaningful.
1.4.1 Learner-centred learning
Research from diverse perspectives has shown that learning is enhanced
when classroom environments encourage learner involvement, personal
responsibility, and when learners themselves are committed to
understanding and learning (Ames & Archer 1988:261). Bitzer and
Pretorius (1996:1) confirm the success of this learner-centred approach
and note that resource-based learning is an educational approach by
which learning content is made accessible to learners in ways other than
the traditional lecture. According to Bitzer and Pretorius (1996:1), the
accent is shifted from the lecturer as the conveyer of knowledge to the
lecturer as the facilitator of knowledge. Similarly, the learner as the "active
discoverer" replaces the significance of the learner as the "recipient" of
knowledge.
1.4.2 Active learning
Various researchers regard active learner participation in the learning
process as an affirmative criterion as well as an important factor for the
enhancement of learning and thus academic achievement (Harden &
Crosby, s.a.; Ames & Archer 1988; Wentzel 1991; Barr & Tagg 1995;
Baxter & Gray 2001 ; Chase & Geldenhuys 2001; Morrison 2001; Gettinger
& Seibert 2002; Kumar 2003). Boyle et al. (2003:267) state that effective
learning is characterised by an active and self-regulated approach to
learning. Davis and Harden (1999:133) verify this statement that, if the
learner is actively engaged in the learning process, the understanding and
retention of information are improved. Learner-centred learning and
learners' active involvement in the learning process is seen by the NQF
11
(2000) as a way to achieve academic success. Active learner involvement
encourages independent learning and is the foundation of an outcomes-
based education and training (OBET) curriculum. The aim of the OBET
approach is to improve the accountability of learners and to lay a
foundation for the development of a learning society (Coetzee-Van Rooy &
Serfontein 2001 :10). These views therefore suggest that, if the learners in
the radiography programme are actively involved in the learning process
and take responsibility for their own learning, academic success could be
within reach.
1.4.3 Interactive learning
Interactive learning, an educational strategy that increases learner
participation, entails an increased interchange among teachers, learners
and the lecture content. The use of interactive lectures can encourage
active learning; increase attention and motivation; give feedback to the
teacher and the learner; and increase satisfaction for both (Steinert & Snell
1999:37). Chase and Geldenhuys (2001 :1072) support this viewpoint and
identify the advantages of interactive contact sessions observed during
their survey of a class with a wide range of academic abilities. Since a
learner guide is an instrument intended to facilitate teacher-learner
interaction (Harden, Laidlaw & Hesketh 1999:249), the use thereof in this
study seemed essential.
1.4.4 Learning guides
The shift from a teacher-centred to a learner-centred approach to
education requires that learners become more accountable for their own
learning (TFS 2003:1). Since the learners in the radiography programme
needed direction and support with this approach, the learner guide had an
important function to fulfil (Harden et al. 1999:249).
1.4.5 Key solution
Owing to the work of educational establishments namely the TFS, the UFS
12
and the professional body, the Professional Board for Radiographers,
educators in radiography at the TFS have become increasingly familiar
with the concept of OBET, which is based on an active and learner-
centred approach. In search of a means to improve academic success, the
educators applied the methods advocated by the OBET approach.
However this active and learner-centred approach alone did not lead to an
improvement in pass rates. The ongoing lack of academic success was
ascribed to the fact that learners with academically deprived backgrounds
require substantial support from facilitators and do not take responsibility
for their own learning (Holsgrove, Lanphear & Ledingham 1999:99). The
use of only an active or learner-centred approach in radiography seemed
inadequate to address the educational needs of the present diverse
learner population.
According to the aforementioned literature, the academic failure
encountered in radiography has therefore the following key solution: To
address the inability of the learners to learn independently, education
should be based on an interactive educational strategy, which implies that
the facilitator directs the learning process and guides learners to become
independent learners. The need to explore the impact of an interactive
education strategy in radiography education has become pertinent. The
problem statement follows and confirms the need for the proposed
investigation.
1.5 STATEMENT OF THE PROBLEM
According to the South African Qualifications Authority (SAQA), a learner-
centred approach presents exciting opportunities for the development and
implementation of new educational tools which allow a shift from lecturer
to learner (RSA 1995). Although the new demands have forced the
radiography educators at the TFS to change the educational approach, the
13
learners failed to commit themselves to this proposed independent
learning, as revealed in the poor pass rates. A similar stumbling-block was
encountered by Holsgrove et al. (1999:99). Through their experience with
learner-centred learning in learners from diverse backgrounds, they
observed that a simple shift from teacher to learner was not possible.
Learners with academically deprived backgrounds require much more
support and encouragement to take advantage of active learning and
teacher support (Holsgrove et al. 1999:99). These authors conclude that
learning guides should be considered as an important feature in the
process of instilling an interactive mindset among learners and guiding
them towards independent learning.
Since the proposed shift from lecturer to learner was not accomplished in
the radiography programme of the TFS, it was deemed necessary to
circumvent the resistance or lack in ability of learners to take responsibility
for their own learning. The literature referred to in the preceding
paragraphs shows that, in order to improve learning, an interactive
education strategy, based on a learner guide that acknowledges learning
styles, could be of value to enhance study capabilities and thus academic
performance in a diverse learner population.
No study has investigated the impact of an interactive education strategy
in radiography education and compared interactive learning with traditional
methods of teaching (formal lectures for example). In other disciplines in
which these comparisons have been made, interactive learning has
proved to yield better academic outcomes compared to the implementation
of traditional methods. Against the background of a lack of research
evidence a need exists to validate the effectiveness of an interactive
education strategy based on a learner guide in the radiography
programme which accommodates learning style preferences as put
forward in the introduction. Given the above-mentioned problem, the
14
investigation sought to answer the following questions:
• Does the implementation of an interactive educational strategy,
which accommodates learning style preferences, based on a
learner guide, influence academic performance in a diverse learner
group in radiography education?
• Do radiography learners with diverse academic abilities and cultural
backgrounds prefer interactive teaching approaches in order to
improve their academic performance?
1.6 GOAL, AIM AND OBJECTIVES OF THE STUDY
1.6.1 Goal
The overall goal of the study is to make a contribution towards optimising
the effectiveness of education and training in the radiography programme
in the School of Health Technology at the Technikon Free State.
1.6.2 Aim
To achieve the goal, the impact of an interactive education strategy in
radiography education, gauged by summative assessment and learner
perception, was explored.
1.6.3 Objectives
To achieve the aim and the goal of the investigation in addressing the
problem statement, the following objectives were pursued:
• An extensive literature survey on academic achievement was
conducted. The determinants of academic achievement - that is
factors facilitating or constraining learners' learning, educational
strategies and innovations in the field of interactive instruction in
higher education - were looked into and were used as background
for the investigation.
15
• Learners' Scholastic Aptitude Tests (SAT) were collected to serve
as indicators of cognitive ability.
• A descriptive inventory outlined by Rezler (1974:101) was
completed to identify the learning trends and preferences of
learners.
• The information thus collected was used to develop an educational
strategy aimed at enabling learners from diverse backgrounds to
improve their academic performance.
• To determine the impact of an interactive education strategy on
learner performance, as compared with the more traditional
teaching methods, an experimental method (pre- and post-
intervention test scores) was implemented to quantify improvement
in learner performance. Learners were divided into 3 groups,
namely a formal lecture group, a self-activities group and a self-
study group whereafter all learners had the interactive education
strategy.
• A research instrument (questionnaire) was designed to determine
the participants' perception(s) of the effectiveness of the interactive
and self-directed approach to education in radiography.
1.7 SCOPE OF THE STUDY
The investigation was conducted in the study field of Health Professions
Education at a higher education level. The area of concern was the
evaluation of radiography education, with specific reference to academic
performance. Wilkes and Bligh (1999:1270) classify four general
approaches to educational evaluation, namely learner-, programme-,
institution-, and stakeholder-oriented approaches. For the purpose of the
present investigation only a single learner-oriented educational evaluation
approach was adopted.
16
Two themes in the diagnostic radiography programme for second-year
learners in 2002 in the School of Health Technology at the TFS were used
as basis for the empirical study. The lecturer responsible for academic
matters concerning second-year learners conducted the investigation.
1.8 SIGNIFICANCE AND VALUE OF THE STUDY
There is a need to question methods of teaching and learning (Pedley &
Arber 1997:11). In support of this view, Wilkes and Bligh (1999:1269)
report that educational evaluation is the systematic appraisal of the quality
of teaching and learning. It has a formative role, identifying areas where
teaching can be improved; or a summative role, judging the effectiveness
of teaching. In addition, the feedback of learners is important in evaluating
education strategies. The authors recommend that evaluation should form
an early part of the educational change process. Therefore, exploring the
impact of an interactive education strategy in radiography, served to clarify
the potential educational approach in order to improve academic
performance in diverse learners.
Features of the investigation were to articulate a theoretical perspective on
the contribution of an education strategy to academic achievement in
radiography education, as well as to identify strategies which are effective
in helping learners to succeed academically. The value of the study is in
the implementation of results in the existing radiography education
programme to optimise teaching and learning, as well as to ensure
compliance with higher education standards and demands. Diversity in the
learner population could be accommodated and guidance to self-efficacy
undertaken.
Since OBET encourages various learner-centred teaching and learning
strategies which lead to self-directed learning and, ultimatly, independent
17
learning, the study investigated the comparison between formal lectures,
self-activities and self-study.
1.9 METHODS OF INVESTIGATION
An experimental educational intervention was used for the investigation.
The following steps explain the process: A Learning Preference Inventory
(LPI) was conducted (Rezier 1974:101) to indicate the approach to the
planned educational strategy, the intervention. A learning guide was used
during structured interactive sessions to increase learner-centred learning.
The efficacy of this interactive and self-directed education strategy was
determined, based on a quantitative investigation and was compared with
formal lectures, independent self-study and self-activities.
1.9.1 Study design
The study design, a quantitative experimental study with descriptive
components, was fourfold (see Figure 1.1):
1. A Learning Preference Inventory (LPI) was conducted.
2. Before the interactive educational intervention, learners were
divided into three groups, namely a formal lecture, a self-activities
and a self-study group. Whereafter all learners received the
interactive educational strategy.
3. An experimental method was used in which the aim was to quantify
improvement in learner performance based on a standard, namely
a one-correct-answer test model, before and after an interactive
educational intervention in order to determine the impact of the
interactive educational strategy on learner performance as
compared to the more traditional teaching methods.
4. A questionnaire was designed to evaluate the learners' perception
of the effectiveness of structured interactive sessions and the
learner-directed approach to education in radiography.
18
Target group (n =30)
Learning Preference Inventory
11 st quarter grades I
I
Lectures (n=11) II Self-activities (n=11 )11 Self-study (n=8)
(No lecturer-learner interaction)
I
1 PRE-TEST 1
I
Structured interactive sessions (SIS)
(Lecturer-learner interaction)
I
POST-INTERVENTION TESTI
I IQUESTIONNAIRE I
I
SAT
Figure 1.1: Study design
1.9.2 Target group
The target group comprised 30 second-year learners enrolled in the
learning unit Radiographic Practice II (RAD20 AT) in the programme
Diagnostic Radiography in the School of Health Technology at the TFS in
2002. Participants were assigned to one of three learning conditions:
I. Formal lectures
II. Self-activities
III. Self-study
The learning material was developed in such a way as to ensure that all
19
participants could achieve identical outcomes. This was followed up with
the educational strategy, structured interactive, self-reflective, and
learning guide-oriented contact sessions (the educational intervention),
which included all the participants. The division of groups was based on
previous academic records, with each group consisting of an equal
number of high-level, average, and low-level academic performers.
Individual participants were considered as their own control.
1.9.3 Measurement
A pre- and a post-intervention test to evaluate learners' knowledge of
radiographic anatomy and radiographic procedures were used. The tests
consisted of a collection of questions from a published review guide used
in radiography programmes at tertiary academic institutions (Bontrager
1993:217). These questions were composed to have a single best answer.
Improvement in subject performance from pre- to post-intervention
sessions served as the primary endpoint, while the learners' subjective
evaluation of their experience served as a secondary endpoint.
Methodological and measurement errors were avoided (see a description
in Chapter 3, paragraph 3.5).
1.9.4 Pilot study
The questionnaire was completed by 20 third-year learners in the same
programme. Ambiguous questions were rectified and difficult terminology
changed to more understandable terms. During the main study
participants were allowed to ask for clarification of questions they did not
understand.
1.9.5 Analysis
The Department of Biostatistics at the University of the Free State (UFS)
was consulted for recommendations regarding the management of data
and the processing of results. All statistical analyses were performed by
20
the researcher. Appropriate summary statistics were calculated and
comparisons made between and within groups.
1.10 DEFINITION OF TERMINOLOGY
Terms referred to in this study are explained and extended on in the
following paragraphs:
Academic ability: Academic or cognitive ability refers to the ability to
integrate, process and apply information (Gully et al. 2002:147).
Academic achievement: Academic achievement is the success in
bringing an effort to the desired end; the degree or level of success
attained in an academic area (Dark 1998).
Academic competence: Academic competence is associated with the
knowledge and use of effective study skills (Gettinger & Seibert
2002:350). It is defined as a multidimensional concept made up of
learners' skills, attitudes, and behaviour (DiPerna & Elliott 2002:293).
Academic enablers: Academic enablers are attitudes and behaviours that
allow learners to take part in and ultimately benefit from academic
instruction in the classroom (DiPerna & Elliott 2002:293).
Academic self-regulation: Academic self-regulation refers to the
progression in which learners initiate and maintain cognition, behaviours
and affects that are focused on reaching academic goals (Zimmerman
1998:73).
Active learning: Active learning is a process in which learners become
engaged in making meaning of information when facilitators include
21
opportunities in a class where the learners are engaged in an activity in
which they use new knowledge or skills (Huang & Carroll 1997:14).
Approaches to learning: Approaches to learning refer to the association
between intent, motives and learning strategies among learners (Diseth
2002:221 ).
Educational or instructional outcomes: These are statements which
describe what learners should be able to master (Wojtczak 2002:238).
Efficacy: The ability to produce the necessary or desired result (Wojtczak
2002:238).
Facilitator: In the new educational milieu the role of the "teacher" or the
"lecturer" required revision. Facilitating learners' learning educators
become the "facilitator" of learning (Neville 1999:393).
Scholastic Aptitude Test (SAT): The SAT is a group test constructed to
measure academic intelligence or scholastic aptitude (Claassen et al.
1991 :1).
Interactive education: Interactive education or interactive pedagogy is
the process in which learners are induced or encouraged to work
cooperatively in a social environment which accommodates individual
differences (Garcia & Alban-Metcalfe 1998:176).
Interactive learning: Acting or capable of acting on each other/one
another to gain knowledge and comprehension through experience or
study (The American Heritage Dictionary of the English Language 2000).
Learner-centred education: It is an educational strategy in which it is
expected of the learners to accept responsibility for their own learning.
22
The focus is on active involvement of the learners in the acquisition of
information and skills (Division of Educational Development 1996).
Learning guide: The learning guide is a structured medium that facilitates
learning, designed to direct learners through a series of learning activities
to achieve specified outcomes (Harden et al. 1999:248).
Learning styles or cognitive styles: Learning styles refer to the
preferred way in which an individual or group learn, organise and use
knowledge to understand their environment (Anderson 2001:1) or the
manner in which information is processed (Diseth 2002:219).
Self-efficacy: It is individuals' beliefs about their performance capabilities
in a specific context, task or domain (Linnenbrink & Pintrich 2002:315).
1.11 ARRANGEMENT OF THE REPORT
The course of the investigation, the methods used to find solutions, and
the outcome of the study will be reported on as follows:
In this chapter, Chapter 1, a brief introduction and background to the study
were given.
Chapter 2, Academic performance: related factors and education
strategies, contains a report on the literature study. Academic
performance, academic competence, and factors facilitating or
constraining learners' learning are discussed. Innovations in the field of
interactive instruction in higher education, which received special attention,
are explained in detail.
23
Chapter 3, Research design and methods, provides a description of the
research methodology applied in the investigation. Theoretical aspects of
the design are discussed, the experimental instruments, The Learning
Preference Inventory, the pre- and the post-intervention test, as well as the
questionnaire used as the method to collect data receive attention; the
reasons for using the particular methods are put forward; and the course
of the study is explained.
In Chapter 4, Results and findings of the experimental study are
presented. The outcome of the study is provided, namely academic
performance and an interactive educational strategy with a learning rather
than a teaching approach.
In Chapter 5, Discussion and recommendations pertaining to the study
and in particular to the outcome are dealt with. In this chapter specific
recommendations regarding the potential use of the educational strategy
and possibilities for further research are made.
1.12 CONCLUSION
With the advantages well documented, it was evident that interactive
instruction should become an integral part of radiography education. Thus
to explore the impact of an interactive education strategy on radiography
education seemed meaningful. The next chapter, the report on the
literature, serves as a foundation for and further enlightens the issues
associated with the problem statement. The potential solutions of the
problem briefly referred to in the introduction receive special attention. An
overview of factors enhancing or hindering academic achievement and the
concomitant education strategies to promote academic performance which
follow, therefore seem appropriate.
CHAPTER 2
ACADEMIC ACHIEVEMENT: RELATED FACTORS AND
EDUCATIONAL STRATEGIES
2.1 INTRODUCTION
Educational researchers have been exploring empirical and practical
issues related to the academic advantages and disadvantages that have
resulted from the changes in higher education, i.e. increased access to
higher education through open admission and affirmative action,
commitment to diversity and the paradigm shift from teaching to learning,
to mention but a few (DeZure 2000:2). These changes have similarly
influenced learners' academic progress in radiography education and thus
it became essential to explore strategies that will improve academic
success.
The expectation that interactive instructional efforts (NQF 2000:8; Chase &
Geldenhuys 2001:1072; Kumar 2003:1) by means of a learning guide
(Harden et al. 1999:248) and the accommodation of learners' learning
styles (Ferguson et al. 2002:953; Steele et al. 2002:225) could make a
difference in learners' academic performance, as noted in Chapter 1, has
been explored in the present study. The fundamental principles related to
the impact of an interactive education strategy in radiography education
are academic performance, academic competence, factors that facilitate
or constrain learners' learning and, as a result, academic achievement. An
effort was made to define these concepts and to determine the
significance thereof in the investigation at hand. Numerous articles
published in educational journals address the aforementioned concepts.
25
2.1.1 Search criteria
The databases Academic Search Premier, Ebscohost, the Educational
Resource Information Centre (ERIC), Medline, and OVID were used to
conduct the literature search that covered the time period 1999 to 2003.
The search criteria were "academic ability, academic achievement,
academic competence, medical education, interactive education, learner
performance, and heterogeneous/diverse classes". On the basis of their
tendency to address the relevant topics, the following journals were
examined: Academic Medicine, Advances in Physiology Education, British
Medical Journal, British Journal of Educational Psychology, Educational
Psychologist, Journal of Applied Psychology, Journal of Educational
Psychology, Journal of Medical Education, Journal of Educational
Psychology, Journal of Experimental Education as well as Medical
Education and Medical Teacher. The reference sections of appropriate
articles were searched for further relevant publications. To explain the
course and foundation of this study, various perspectives from the
literature on academic achievement will subsequently follow.
2.2 ACADEMIC ACHIEVEMENT
Academic achievement, which is the extent of success reached in
education, has been the focus of widespread educational research. For
the purpose of this review, academic achievement, academic performance
and academic success are used interchangeably. In addition, it seems that
academic achievement and academic competence are interwoven, since
the possible attributes reported in the literature are similar (DiPerna &
Elliott 2002:293). "Academic competence" is defined as a
multidimensional concept consisting of learners' skills, attitudes, and
behaviour contributing to academic success (DiPerna & Elliott 2002:293).
In view of the fact that effective learning is the crux of academic
26
achievement, the nature of effective learning will be looked into to explain
academic achievement.
Behaviour as an essential part of learning is accentuated by Wentzel
(1991 :1-24) in a literature survey of both theoretical and empirical work on
social responsibility and academic achievement. The author points out that
learners' social responsibility could improve learning if positive interactions
with facilitators are promoted. The idea of academic enablers developed
from the work of the researchers Wentzel and Watkins (2002:366), as
quoted in DiPerna and Elliott (2002:293), who explored the connection
between non-academic learner behaviour and academic achievement.
These authors saw academic enablers as attitudes and behaviours that
allow learners to participate in, and ultimately benefit from, academic
instruction during contact time with facilitators. The mention of "interaction"
emerges as a potential academic enabler or, in other words, an enhancer
of learning. Referring to "interaction" as an academic enabler will be
addressed in later paragraphs.
As early as 1981 Krouse and Krouse (1981 :151) referred to under-
achievement as a complex interaction between three factors, namely a
weakness in academic skills such as reading, note-taking and taking
exams; a lack in behavioural self-control skills such as self-monitoring; and
ineffective arrangement of study time. The complexity of
underachievement mentioned by Krouse and Krouse (1981 :151) and the
role of social responsibility noted by Wentzel (1991 :1-24) as well as by
Wentzel and Watkins (2002:366), limit the impact facilitators could have on
learners' learning. Sayer, De Saintonge, Evans and Wood (2002:643)
investigated the causes of academic failure in undergraduate medical
learners and they also found that the grounds for failure are diverse and
not always academically based.
27
According to Boyle, Duffy and Dunleavy (2003:269) educational
researchers acknowledged the intricacy of learning and explored the
different aspects of learning to a greater extent. Traditional views of
effective learning were typified by the passive transfer of information from
teacher to learner (Boyle et al. 2003:268), while constructivism - which
refers to a new philosophical advance to learning - includes active, deep
and self-regulated approaches to learning. Boyle et al. (2003:270) state:
Deep learning, self-regulated learning, intrinsic motivation and a
constructivist conception of learning are regarded as preferable to surface
learning, teacher-centred learning, extrinsic motivation and an objectivist
conception of learning.
To look into these factors that influence effective learning and, as a result,
are factors associated with academic achievement seemed important and
will follow in the next paragraph.
2.3 FACTORS ASSOCIATED WITH ACADEMIC ACHIEVEMENT
Pintrich and De Groot (1990:35) investigated predictors of academic
achievement in primary education. They indicated that behaviour, among
others, is an important part of learning. Therefore effective learning, known
to be the foundation of academic achievement, was looked at. However,
the intricacy of learning was not seen as a factor easily altered.
Substantial empirical evidence indicates that not only behaviour, but also a
variety of environmental factors exist that influence learning (DiPerna &
Elliott 2002:295; Lam, Irwin, Chow & Chan 2002:234; Linnenbrink &
Pintrich 2002:313). In addition, Morrison (2001 :7) points out three factors
associated with effective learning, namely learners' academic orientation;
their level of involvement; and the extent of stimulus by learning-related
activities.
28
Even though it is not in the scope of the present study to address all of
these factors, an attempt was made to identify the factors facilitators can
control through interactive instruction during contact time with learners,
namely cognitive ability, academic self-regulation, self-efficacy, motivation,
approaches to learning, study skills and learners' learning styles or
preferences. These were considered and will be described in the
paragraphs that follow.
2.3.1 Cognitive ability
Various definitions of cognitive ability or intelligence have been presented
in previous research. For example, intelligence is the ability to adapt,
select and reform one's environment and includes the following basic
elements, namely problem-solving, verbal ability, and social factors
(Sternberg & Sternberg et al. in Claassen 1991:2). Cognitive ability or
intelligence consists of aptitudes (Gardner in Diseth 2002:220), behaviour
(Sternberg in Diseth 2002:220), involves reaction time (Kline in Diseth
2002:220), and is influenced by physiological and educational-experiential
factors (Undheim in Diseth 2002:221). Although Diseth (2002:219) states
that a combined model of intelligence is not evident, the author
distinguishes it from other concepts like cognitive style or learning style.
McLean (2001 :405) states that academic ability is influenced, among
others, by the learner's personal characteristics, the learning environment
and the kind of curriculum. The author also indicates that cultural and
political factors influence how a learner performs in a given situation.
Can academic achievement in higher education be predicted by aptitude
tests that indicate intelligence or academic ability? The question
concerning the value or answerability of this standardised ability measures
such as the Scholastic Aptitude Test (SAT) gave rise to efforts to improve
the prediction of academic achievement in higher education by evaluating
the impact of academic self-regulation on learners' learning (Claassen
1991 :120). Ruban et al. (2003:270) state that standardised measures, for
29
example the SAT, have restricted value in predicting higher education
grades. A rising tendency at all levels of education avoids dependence on
standardised measures of aptitude and achievement and places more
weight on self-regulated learning to ensure academic success (Pintrich &
De Groot 1990:36; Barron & Norman in Ruban et al. 2003:270).
2.3.2 Self-regulation
"Self-regulation can be defined as self-generated thoughts, feelings and
actions for attaining academic goals" (Zimmerman 1998:73). In addition,
the definitions of self-regulated learning have three characteristics: the use
of self-regulated learning strategies, motivation, and the reflection on
learning effectiveness by the learners themselves (Zimmerman 1990:5).
Qualitative and quantitative differences exist between high and low
academic achievers and the use of cognitive and self-regulatory study
strategies can be used as a reliable measure to predict academic success
(Gettinger & Seibert 2002:353). The dimensions and processes of self-
regulation include, among others, motivation, study method, time
management, behaviour, environmental structuring, and social help-
seeking (Zimmerman 1998:75).
Zimmerman and Martinez-Pons (1988:284) used a structured interview to
compare academically successful and regular learners' use of self-
regulatory approaches to learning in secondary school learners and found
that a strong relationship exists between learners' use of self-directed or
self-regulated learning strategies and their academic achievement. The
authors propagate that self-regulated learners are motivated, they see
themselves as self-efficacious, and they function in environments that
optimise acquisition of knowledge.
Although researchers decided on the theory and measuring of academic
self-regulation, differences in opinion on the construct exist (Ruban et al.
2003:271). According to the authors, these differences have implications
30
for interventions on learners with learning problems. The authors question
if high and low achievers use the same self-regulatory strategies when
learning and if a relationship exists between this approach and academic
achievement for learners with and without learning difficulties. Ruban et al.
(2003:275) conducted a study in which 470 undergraduate learners at a
research university in North America participated to investigate the
relationship between learners' use of self-regulated learning strategies and
their academic achievement. The authors used a structural equation
model approach and found that self-regulation has an impact on academic
achievement.
At the University of Hong Kong the authors Leung, Lam and Hedley
(2001 :1072) supported the above-mentioned findings by stating that, for
effective learning, learners must be in charge of their own learning. Davis
and Harden (1999:139) expanded on the issue of self-directed or self-
regulated learning by arguing that, if this approach leaves learners with
gaps in their knowledge and skills, the learners learn how to identify their
own learning needs and, with time, they can remedy the learning deficits
for themselves.
Kitsantas (2002:109) also compared the self-regulatory processes used in
test preparation by high and low test scorers in 62 undergraduate
psychology learners at Florida State University. The author found that high
test scorers (rnean-o.aa, ± 0.38) used more self-regulation processes
than low test scorers (rnean-u.ês, ± 0.41). The author added that self-
regulation positively affected test performance, self-regularotory skill and
self-efficacy beliefs predicted test scores and self-regulated learners were
also self-motivated.
Zimmerman in Sanz de Acedo Lizarraga et al. (2003:60) indicates that the
trend of self-regulation develops in three phases, namely enthusiasm, to
be in control of the process, and self-reflection during a learning activity.
31
Any learning activity or intervention with the aim of improving academc
performance should therefore include forethought, control and self-
reflection in order to assure self-regulation and, as a result, enhanced
cognitive ability. Sanz de Acedo Lizarraga et al. (2003:65) conducted an
experimental study on secondary education in Spain and found that an
educational model that encourages forethought, control and self-reflection
improved the use of self-regulation skills and, as a result, also academic
achievement. Their findings represent an example of how to use
educational strategies to prevent intellectual deficiencies. Zimmerman et
al. (1988:284) state that self-regulated learners plan and organise their
own learning. The authors expand on self-regulation and state that these
learners are independent, intrinsically motivated and self-efficacious.
2.3.3 Self-efficacy
Self-efficacy is defined as individuals' beliefs about their performance
capabilities in a specific context, task or domain (Linnenbrink & Pintrich
2002:315). The findings of Gully et al. (2002:147) and the views of Davis
and Harden (1999:130) indicate that cognitive ability predicts self-efficacy,
which is a person's potential to perform a task, and which serves as
motivation to learn (Zimmerman 1990:6). Gully et al. (2002:147) further
expand and state that "cognitive ability" indicates the skill to understand,
process, and relate information. Their results testify that ability is positively
related to self-efficacy, a fact also noted by Linnenbrink and Pintrich
(2002:313), Pimparyon et al. (2000:363) and Zimmerman (1998:81).
Sobral (2001 :508) conducted a study on second-year medical students at
the University of Brasilia in which the aim was to evaluate reflection on
learning in relation to measures of learning approaches and academic
achievement. Sobral (2001 :512) found that high achievers showed a high
level of perceived personal efficacy. The author expanded on the issue of
self-efficacy by stating that self-efficient learners reflect on both the
process and the content of learning, which help them to control their
32
learning and their academic performance. Self-efficacious learners also
tend to set high goals, do self-evaluation and persist under difficult
conditions in contrast with those who doubt their own ability (Kitsantas
2002:103).
Sayer et al. (2002:643) studied the causes of academic failure in
undergraduate medical learners and encouraged learners to take
responsibility for their own learning. In taking responsibility for their own
learning learners thereby promote self-efficiency and autonomy, skills that
support independent learning and as a result lead to increased motivation
and improved examination scores. The apparent inability of radiography
learners to be self-efficient in the learning process could be explained by
the experiences of Holsgrove et al. (1999:99) with learner-centred learning
of learners from diverse backgrounds. They observed that a simple shift
from teacher to learner was not possible. This explanation for poor pass
rates among radiography learners could possibly be resolved through
guidance by facilitators. This claim is confirmed by Ames and Archer
(1988:261) in their experimental study on secondary education,
academically advanced learners. They state that research from diverse
perspectives shows that learning is enhanced when classroom
environments encourage learner involvement, personal responsibility, and
when learners themselves are committed to understanding and learning.
Pintrich and De Groot (1990:35) found that higher levels of self-efficacy
correlated with higher levels of cognitive strategy and also higher levels of
self-regulation and hence academic achievement. Since self-efficacy, self-
regulation of cognition and motivation emerged in a correlation study done
by the authors as factors associated with academic achievement,
motivation was further looked into.
33
2.3.4 Motivation
Learners' failure to learn is also due to issues other than their learning
capability, for example lacking motivation (Zimmerman 1998:73). Davis
and Harden (1999:130) and Gully et al. (2002:147) state that, if learners
are actively involved in the learning process, it leads to an intrinsic
motivation to learn. Linnenbrink and Pintrich (2002:313) indicate that
motivation plays an essential role in academic competence and it is seen
as a key element in academic performance. Davis and Harden (1999:130)
share this view. They suggest that taking responsibility for one's own
learning enriches the learning experience, while presenting an intrinsic
motivation to learn.
According to Linnenbrink and Pintrich (2002:314), previous research on
achievement and learning did not integrate cognition and motivation. Only
later did researchers recognise that motivational and cognitive factors
jointly influence learning and hence achievement. These authors further
suggest that motivation can vary depending on the situation or context in
the classroom and that multiple ways to motivate learners exist. Here the
classroom environment emerges as a possible area in which learning
could be enhanced.
Cleave-Hogg and Rothman (1991 :456-474) expound on the value of
motivation. They found that the environment in which education takes
place plays an important role in learner motivation; attending non-
interactive classes is a negative discouraging factor in learning. Studies
undertaken by Chickering (1980:5) also showed that learners' progress in
becoming autonomous learners and attaining success is hindered by
lecture-centred curricula. Pike (1994) in Vaughn, Del Reyand Baker
(2001 :40) says that educators have no influence over learners' motivation,
but can only develop the environment where learners will motivate
themselves through, among others, practical application, responsibility and
active learning.
34
As recently as 2003 Kumar (2003:20) conducted an experimental study in
which his findings were that interchange between facilitators and learners
advances active learning and increases attention and motivation. Kumar
(2003:24) states that increased stimulation and motivation are the critical
ingredients for learning and are often more important for retention than
intelligence. The author's findings were based on an experimental study
conducted on first-year dental learners at an Institute of Health Sciences in
Nepal. To further expand on motivation, Boyle et al. (2003:268) state that
learners with a deep approach to learning are motivated by intrinsic
concern, while surface learners in contrast focus on memory and are
motivated only by the desire to obtain a qualification.
2.3.5 Approaches to learning
Except for behaviour and motivation previously described, the manner in
which learners approach learning also has an effect on academic
achievement. Approaches to learning refer to the association between
intent, motives and learning strategies among learners. However, there
are many factors that determine how learners approach learning, for
example the teaching approach, the instruction design, the assessment of
learners' learning and the content of the curriculum (Entwistle in
Pimparyon et al. 2000:359; McLean 2001 :401).
Diseth (2002:221) identifies mainly two approaches to learning, namely a
"surface approach" which is rote learning with the intention to reproduce
information to avoid academic failure or a "deep approach" to learning
which is based on understanding and interest in information. Gordon and
Debus (2002:484) conducted studies on how students learn and also
indicate that there are two ways in which learners approach their learning.
Some learners follow a surface approach to learning and are concerned
mainly with remembering facts in order to do well in their examinations or,
in other words, the learners aim "to meet minimum requirements with
minimum effort". Alternatively, some learners have a deep approach to
35
learning and are concerned with comprehensive learning and try to
understand the meaning behind what they learn (Gordon & Debus
2002:484; Marton & Saljo in Pimparyon et al. 2000:359). In addition, Boyle
et al. (2003:268) made the following statement: "Deep learning has been
one of the most influential constructs to emerge in the literature on
effective learning in higher education". Ferguson et al. (2002:957) through
their systematic survey of the literature on factors associated with
academic success in medical school also reported on a deep and surface
approach to learning, but in addition, reported on a strategic approach.
According to these authors a deep approach to learning is stimulated by
intrinsic motivation, career interest and personal understanding and
strategic learning is encouraged by a desire to be successful.
Alternatively, a surface appraoch to learning is motivated by a fear of
failure and these learners tend to simply memorise information.
Gordon and Debus (2002:494) in their study investigated the issue if
surface approaches can be reduced and deep approaches to learning
increased among teacher education university learners in Australia. The
results indicated that the use of deep approaches to learning increased
when teaching methods encourage the use thereof. Pimparyon et al.
(2000:361) state that a connection between approaches to learning and
the educational environment are factors associated with academic
achievement. The authors based their findings on a quantitative
experimental study conducted at a Thai nursing college in Bangkok. The
aim of the study was to assess how these learners saw their learning
environment. The relationship between their approaches to learning and
their academic achievement was reported on. According to Pimparyon et
al. (2000:361), the learning environment might motivate some learners
highly to engage in learning while, at the same time, having no positive
influence on other learners.
36
Diseth (2002:222) compared academic achievement, based on
examination grades, with approaches to learning in undergraduate
psychology learners at the university of Bergen in Norway and, in contrast
to Gordon and Debus (2002:494), found that neither intelligence nor
approaches to learning in his sample predicted academic achievement.
The differences in commitment reflect differences in learners' use of
learning approaches; some learners may learn better from some methods
and styles of teaching than others. Learners' perceptions of the learning
environment affect their choice of learning approaches, which correlate
with their academic achievement (Diseth 2002:221). However, using only
the teaching approach or the learning style as a predictor of academic
achievement is not adequate in ensuring learners' academic success
(pimparyon et al. 2000:361). Entwistle in Pimparyon et al. (2000:359)
states that suitable interventions can facilitate a deep approach to learning
and it is the responsibility of the facilitator to construct learning
experiences that provide opportunities for the development of critical
thinking.
2.3.6 Study skills
For the following discussion, the terms "study skills" and "study strategies"
are used interchangeably. Study skills include the ability to acquire,
record, organise, synthesise, remember and use information (Hoover &
Patton 1995 in Gettinger & Seibert 2002:350). Pressley and Afflerbach in
Gettinger and Seibert (2002:352) identify the following basic study skills,
namely the learner forms an overview before reading; selects and links
important information; uses prior knowledge; and changes strategies to
optimise learning.
Study skills contribute to both achievements in non-academic and
academic situations (Devine 1987 in Gettinger & Seibert 2002:350).
Several researchers as documented in Gettinger and Seibert (2002:350)
indicated that weak and restricted study skills are implemented by low-
37
achieving learners, in contrast with high achievers who make use of a
variety of study strategies in an accommodating way. Academic ability is
also associated with the knowledge and use of effective study skills
(Gettinger & Seibert 2002:350). According to the authors, capable learners
may be academically at risk because of the lack of effective study skills
and not because of the lack in cognitive ability.
The Committee for Tutorial Matters (CTM 2001b:12) state that learners
use basically two cognitive strategies of learning to direct and monitor their
own learning process, in other words, how to learn and a manner of
thinking. Furthermore, if the learner is aware of the potential advantage of
a study skill, it will be used in various settings (Gettinger & Seibert
2002:350).
To acknowledge the influence of study skills on learning seems worthwhile
and are confirmed by the following remark by Gettinger and Seibert
(2002:352): "Study skills are fundamental to academic competence.
Effective study skills are associated with positive outcomes across multiple
academic content areas for diverse learners". The authors see study skills
as an academic enabler that function as an important tool for learning;
they include a range of cognitive skills and processes that increase the
effectiveness of learning. The authors, however, indicate that learners with
low academic competence often demonstrate ineffective study skills in that
they playa passive role in the learning process and rely on facilitators to
control their learning.
Thompson and Geren (2002:398) state that facilitators playa critical role
in the early identification of learners at risk of academic failure. According
to the authors, these learners should be explicitly informed of cognitive
strategies and study skills that promote academic success. Since effective
study skills should include cognitive activities that help in the acquisition
38
and retention of information, interactive activities with facilitator guidance
to overcome these ineffective study skills therefore seemed appropriate.
Although learners were expected to develop study skills independently in
the past, educational psychologists and teachers had neglected the issue
of teaching study skills (Zimmerman 1998:73). The CTM (2001d:12)
provided a solution: According to the CTM, knowledge should be
structured to improve cognitive skills and analytic thinking. Learning
experiences should be organised in such a way that the learner is able to
demonstrate the ability to analyse, apply, synthesise and evaluate
information in order to nurture effective study strategies.
Effective study skills reduce academic failure (Gettinger & Seibert
2002:362) and, for learners to be effective, they must know when, where
and how to use these skills. The authors state that effective study skills
can be taught and facilitators should scaffold the process until the learner
has become skilled with the strategy. Although it is only one aspect of
academic failure, research on study skills instruction and ways to improve
learning should remain a high priority.
2.3.7 Learning styles
Research on learning styles has arisen along with research on effective
learning (Boyle et al. 2003:269). Wigen et al. (2003:32) and Boyle et al.
(2003:286) state that ineffective learning strategies, such as an undirected
learning style, compare negatively with academic success, while a positive
correlation between effective learning styles and academic success exists.
The manner in which learners learn is varied and is related to differences
in personality. It also changes in different situations and at different times.
These patterns have been labelled as "Learning Styles", "Learning
Strategies", "Learning Preferences" and "Approaches to Learning" (Wigen
et al. 2003:32).
39
Ferguson et al. (2002:954) conducted a systematic survey of the literature
on factors associated with success in medical school. They found that
research has mostly focused on previous academic ability and that
previous academic performance was a good but not a perfect predictor of
academic achievement. The authors report that relatively little research
has been done into the significance of learning styles associated with
success in medical education and they point out that a strategic learning
style is associated with success in medical training. Harden (2003:98)
commented on the findings of Ferguson et al. (2002:954) and emphasised
that learning styles "are believed to be significant predictors of success in
medicine".
As early as 1969, Cronbach and Snow (1969) in Keri (2002:433) assumed
that differentiating or adapting teaching to the needs of learners improves
learners' academic achievement. They argue that teaching methods place
varying demands on learners and they affect learners' learning in many
different ways. These findings strengthen those of Gully et al. (2002:152)
who found that failure to consider individual differences when designing
education programmes may lead to less positive outcomes. To strengthen
the possible approach to diverse learners, Troutman (1997-1998 :16) as
quoted in Growe, Schmersahl, Perry and Henry (2002:206) calls on higher
education institutions to build on and acknowledge cultural diversity and to
make sure that facilitators accommodate the learning styles of diverse
learner populations.
The authors Boyle et al. (2003:270) examined different learning styles in
Social Science learners at a British university. The relationship between
meaning-directed, reproduction-directed, application-directed and
undirected learning styles and academic outcome were investigated. The
authors found a statistically significant positive correlation between a
meaning-directed learning style and academic performance (r=0.23,
p<0.01). Learners should therefore be encouraged to develop a helpful
40
learning style, since it is recorded that an association between positive
learning styles and academic performance exists (Martin et al. 2000:531).
The authors used the learning style inventory of Entwistle, which was
previously used in the evaluation of medical students. This inventory
consists of three principles with four additional elements. The three basic
principles are:
• An achieving scale which is characterised by well-organised study
methods, a sense of competitiveness and a hope for success.
• A reproducing scale which represents a surface learning approach
that is extrinsically motivated and curriculum-restricted.
• A meaning scale representative of an approach that results in deep
learning and is intrinsic and academically motivated.
The four additional elements are comprehensive learning; operation
learning; a versatile approach; and learning pathologies. Martin et al.
(2000:530) assessed the relationship among clinical experience, learning
style, and test performance in first-year medical students at the University
of Leeds. The researchers found that test performance was related to well
-organised study methods and experience was associated with a deep-
learning style.
Wigen et al. (2003:32) also explored the predictors of medical students'
academic success at a Norwegian University. The researchers used the
Approaches to Studying Inventory (ASI) of Entwistle and similarly found
that constructive learning styles positively correlated with academic
success in their study. Sobral (2001 :508) conducted a study on second-
year medical students at the University of Brasilia in which the aim was,
among others, to evaluate the connection of learning approaches with
academic achievement. The author used a short version of Entwistle's
instrument which focuses on Meaning Orientation and Reproductive
Orientations, the findings of his work confirm that of Martin et al.
(2000:531 ).
41
Furthermore, since learners have different learning styles, Vaughn et al.
(2001 :40) state that educators must use a range of active learning
strategies, because learners need a variety of teaching methods to
encourage learning and to address the different learning approaches. The
authors found in their survey in a medical school in Cincinnati that learning
experiences, teaching styles and the way in which information is
managed, determine the learning styles learners use. And, most
important, is that the preferred style can change, especially when the
learner is exposed to changing teaching styles. By using a variety of
teaching methods and styles, learners are exposed to both familiar and
unfamiliar ways of learning. This variety of teaching methods and styles
cause both tension and comfort during the learning process, which
encourage more effective learning.
The inventories used by Martin et al. (2000:531), Wigen et al. (2003:32)
and Sobral (2001 :509) on learning styles are not directly comparable with
the inventory of Rezler (1974) used in this study. The aim of the Learning
Preference Inventory (LPI) conducted was not to compare certain learning
approaches to academic success, but to determine the structure of the
intervention to address learner diversity with regard to educational needs.
The inventory included the following learning situations (see Table 2.1):
42
Table 2.1: Learning preference characteristics
Learning Characteristics
situation
Abstract Preference for learning theories, principles, and general
concepts, hypothesis generation and testing.
Concrete Preference for learning specific, tangible information and
skills; practical application.
Individual Preference for learning on one's own; emphasis on self-
review and reading.
Interpersonal Preference for learning in groups and with others; values
interaction with fellow-learners and with teachers.
Learner- Preference for learning via learner-organised and self-
structured directed tasks; values autonomy and self-direction.
Teacher- Preference for learning that is directed by the teacher;
structured learning goals that are defined by the teacher.
Source: Steele et al. (2002:227)
The aforementioned factors that influence learning all share an active,
interactive and learner-centred perspective and decidedly support the use
of interactive and learner-centred approaches over passive, lecture-
centred strategies. A description of learner-centred, active and interactive
learning; the potential use; critique against; and the relevance thereof will
subsequently follow.
2.4 EDUCATIONAL STRATEGIES
DeZure (2000:2) comments in a report that "Three decades of lessons on
teaching and learning" in higer education changed approaches to teaching
and learning. The author states that many of the learner-centred and
active learning strategies advocated 30 years ago are only now taking
root. The author explains that there are at present preference for these
43
methods, because changes in higher education necessitate these
developments. An advancement that represents a shift from the lecturer to
the learner, that is one that promotes and supports an active culture of
teaching, is seen as a step forward.
Chase and Geldenhuys (2001:1071) found in their survey of learner-
centred teaching in a large heterogeneous class that the learners
subjected to interaction between facilitator and learner scored higher end-
of-term tests marks than those where only lectures were given (p=0.001).
McLean (2001 :408) in addition states that past political and historical
factors are responsible for the fact that learners are not prepared for higher
education. The author points out the need for educators to be aware of the
conception of learning these learners bring with them and that personal
involvement and more effective learning strategies must be addressed.
2.4.1 Learner-centred learning
To achieve academic success, the Academic Planning and Budgeting
Committee (APBC) of the TFS stated in April 2003 that the key to
enhancing learning depends on academic institutions to create a learner-
centred educational environment (TFS 2003:1): "The implementation of a
learner-centred approach to education is of the utmost importance". This
learner-centred learning entails a shift from the traditional teacher-centred
approach to an approach in which the emphasis is on the learners and
what they learn (Spencer & Jordan 1999:1280). The authors see learner-
centred learning as a process that actively involves the learner and they
allege that it promotes a deep approach to learning. Learner-centred
education will be explained in the following paragraph.
Learner-centred education is an educational strategy according to which it
is expected of the learners to accept responsibility for their own learning
(Division of Educational Development 1996; CTM 2001a:20). As
maintained by a Draft Planning Document of the Academic Planning and
44
Bugeting Committee (APBC) of the TFS (2003:2), learner-centred learning
is explained as a milieu that assists the searching of knowledge through
personal and interpersonal discovery. The main advantage revealed in this
document, which is very important for the present study, is that the
proposed learner-centred education addresses individual differences,
learning styles, abilities and encourages feelings of efficacy.
The following examples of learner-centred learning are put forward by the
above-mentioned document, namely combined group learning; individual
research and discovery; resource-based learning; and problem-based
learning. Problem-based learning is seen by Charlin, Mann and Hansen
(1998:323) as an educational approach and not a single instruction
method. The value if this learner-centred and active approach is based on
the fact that learners become active builders of knowledge. Davis and
Harden (1999:133) see learner-centred learning in the form of problem-
based learning as a process that forces the learners to take responsibility
for their own learning, a feature that prepares them for lifelong learning in
health care.
Since Barr and Tagg (1995:22) suggest that facilitators should design a
learning environment, which will yield better results, it is evident that the
solution is enhancing learning centres around the facilitator's ability to
create a learner-centred educational environment. Harden and Crosby
(s.a.:10), by means of a survey of 251 lecturers in the medical school at
the University of Dundee, identified the role of the lecturer in higher
education and came to the conclusion that the move to a learner-centred
approach required a fundamental shift in the role of the lecturer from
"instructor" to the "facilitator" of learners' learning.
Van den Hurk, Wolfhagen, Dolmans and Van der Vleuten (1999:808)
investigated the relationship between learning approach and achievement
at a Medical School of Maastricht University, the Netherlands. They found
45
that when learners are responsible for their own learning, they gain
autonomous learning abilities and learn to become self-directed. The
authors see self-directed learning as a process in which learners take the
first step to identify their learning needs and apply effective learning
strategies to reach the learning outcome. This independent and active
learning is stimulated by discussing problems in small groups when
unanswered questions serve as a guide for independence and self-
directed learning.
Although it seems as if the former statement is the solution to the poor
academic performance of learners in radiography, it was noted in Chapter
1 that a simple shift from teacher to learner was not possible (Holsgrove et
al. 1999:99). The authors state that, through their experience with learner-
centred learning in learners from diverse backgrounds, this shift was not
possible. This proposed shift from lecturer to learner is part of the
resistance experienced in the radiography programme under investigation
and potential alternatives were considered. Since learners with
academically deprived backgrounds require substantial support from
facilitators and do not take responsibility for their own learning (Holsgrove
et al. 1999:99) as propagated in learner-centred learning, this approach
per se was not the sole solution for academic failure. In view of the fact
that interaction between the facilitator and the learner was depicted as a
positive encounter that contributes to academic achievement (Chase &
Geldenhuys 2001:1072), active and interactive learning was looked into.
2.4.2 Active learning
"Active learning is the essence of effective studying. Good studiers are
active learners, not passive recipients of fact and details" (Gettinger &
Seibert 2002:353). Learning is a dynamic process in which the learner
should play an active role. Educational researchers found that learners
who actively take part in learning activities would learn more than students
who are passive in the learning process, an opinion also supported by
46
Butler (1992:11) and Garcia and Alban-Metcalfe (1998:177). "Active
learning", according to Boyer (2002:51), could include many "avenues" of
education and allow learners to become lively participants who can direct
their own learning. The value of active learning was highlighted (Harden &
Crosby s.a.:1 0; Ames & Archer 1988:261; Wentzel 1991 :15; Barr & Tagg
1995:15; Bitzer & Pretorius 1996:1; Davis & Harden 1999:130; Baxter &
Gray 2001 :396; Chase & Geldenhuys 2001:1071; Gettinger & Seibert
2002:352) and building on this important fact, Morrison (2001 :7) and
Kumar (2003:25) emphasise that the formal lecture creates a passive or
superficial approach to learning.
Baxter and Gray (2001 :396) also emphasise the importance of active
learner involvement in speech and language therapists in clinical
education that lead to a deep approach to learning in contrast with surface
learners who only memorise and reproduce information. Their findings
were based on learner feedback, which was positive to the more self-
directed and active learning approaches. The significance of active learner
involvement in the learning process is also emphasised by the research
findings of Dolan, Mallott and Emery (2002:648) who indicated that first-
and second-year learners in medical school who convey passive learning
behaviour are potentially at academic risk. The authors stress the need to
identify supportive interventions in future research to counteract this
passive behaviour.
Barr and Tagg (1995:23) state that the traditional "Instructional Paradigm",
which consists of formal lectures, is increasingly recognised as ineffective.
The authors urge that this instruction approach should be replaced by a
paradigm that produces learning. According to the authors, the learners
are responsible for their own learning and become "co-producers" of
learning, since they discover and construct knowledge for themselves. The
authors recommend that an effective learning theory is based on an active
and learner-centred approach and that the learning environment should
47
support the fact that both the lecturer and the learner take responsibility for
the same outcome, which is academic success. Barr and Tagg (1995:16)
point out the following: "When two agents take such responsibility, the
resulting synergy produces powerful results". The increasing importance of
learner independence in medical education has moved the "centre of
gravity" away from the lecturer towards the learner (Harden & Crosby s.a.:
3). But, on the other hand, the presence of a good lecturer may have more
positive outcomes in improving learners' achievement than other, much
publicised aspects such as class size (Harden & Crosby s.a.:3). For this
reason, interactive teaching was, among others, seen as a potential
enhancer of academic performance. This learner active and facilitator-
learner interactive approach to education therefore follows.
2.4.3 Interactive learning
The shift of responsibility from educator to learner goes hand in hand with
nurturing a culture of learning and guiding learners with a learning guide
through the process of learning (CTM 2001c:3). Interactive education or
interactive pedagogy is the process in which learners are induced or
encouraged to work cooperatively in a social environment which
accommodates individual differences (Garcia & Alban-Metcalfe 1998:176).
"Interactive learning" means that the facilitator, through interaction,
includes opportunities in a class for learners to talk, write or be engaged in
activities in which they use new knowledge or skills. Gordon (2003:543)
reports that, as far back as the 1ih century, Dr Franciscus de la Boe
Sylvius, a professor of medicine at the University of Leyden, the
Netherlands, promoted interactive teaching by using one-to-one teaching
in clinical settings. The need to address academic underachievement,
using interactive education strategies such as classroom learning within a
social context through interaction and guidance from facilitators, is
validated by Garcia and Alban-Metcalfe (1998:177), Gettinger and Seibert
(2002:350), Kumar (2003:20), and Wilke and Straits (2001 :62).
48
The beliefs of previous authors referred to in Chapter 1, namely that
learners with academically deprived backgrounds require more support
and encouragement to take advantage of active learning and teacher
support (Holsgrove et al. 1999:99), put emphasis on the value of an
interactive educational approach. Chase and Geldenhuys (2001:1072)
support this point of view and identify the advantages of interactive contact
sessions observed during their survey of a class with a wide range of
academic abilities.
More recently Kumar (2003:25), who states that interaction between the
facilitator and the learner could have positive outcomes on learning, led
the way to explore this interaction and the effect thereof on learning in
radiography education. Pimparyon et al. (2000:364) state if the aim in
education is effective and successful learning, educators should aim to
create a supportive environment and also design and put into practice
interventions to resolve unsatisfactory elements. The fact that low
academic achievers are more dependent on active facilitator guidance
sustains the importance of an interactive rather than only active
educational strategy. The belief that an interactive educational strategy
could improve the marks of low academic achievers is confirmed by the
study of Cleave-Hogg and Rothman (1991:456-474), according to which
learners were asked to indicate which factors supported and stimulated
learning. The majority of the learners mentioned the relationship between
the facilitator and the learner as the main positive influence in enhancing
learning. Harden and Crosby (s.a.:8) also indicate that learners
"traditionally expect to be taught" an approach that leads to learner
passivity. But if teachers are enthusiastic and use interactive ways, it
excites or motivates the learner.
Smits, Verbreek and De Buisonjé (2002:155) conducted a literature study
on educational interventions that included a pre-testlpost-test design. They
found evidence that interactive educational methods in medical education
49
are effective in changing performance among learners. The authors
acknowledge the value of interactive sessions, but indicate that few well-
conducted trials exist. Chase and Geldenhuys (2001 :1071), who reported
on learner-centred teaching in a large heterogeneous class with a wide
range of academic ability at the University of Stellenbosch, found that
learner interaction improved test marks in first-year medical and dental
learners. The authors found that 82% of the participants agreed that
interactive sessions was an effective way of learning. The end-of-term test
marks were also higher in the interactive session group than those who
only received formal lectures (p=0.0001).
Kumar (2003:24) states that increased attention and motivation enhance
memory and further claim that increased stimulation through interaction is
critical for learning and is more important for retention than intelligence. To
summarise, active involvement enhances the learner's height of
understanding and capability to put together and synthesise information. It
also increases retention and a motivation to learn (Ames & Archer
1988:261; Davis & Harden 1999:133; Nasmith & Steinert 2001 :48).
The value of interactive learning strategies is hence summarised as
follows: First, an active learning process results in better mastering and a
deeper understanding of subject content compared to simple
memorisation (Davis & Harden 1999:130). Second, learners' critical
thinking skills are enhanced when they are actively involved and they learn
to be more effective learners (NQF 2000). Third, since learners differ in
their preferred learning styles and abilities, the use of various learning
activities could provide opportunities for learners to encounter some
alternative way that could broaden their usual learning approach
(Ferguson et al. 2002:953; Steele et al. 2002:225). Therefore, if educators
can become skilful at using a variety of teaching approaches, the various
learner needs and styles can be accommodated (Vaughn et al. 2001 :41).
50
2.4.4. Learning guides
Spencer and Jordan (1999:1283) state that the learning guide is a
potential enhancer of interactive learning. This active involvement of
learners in the education process by using a learning guide is similarly
emphasised by Strydom (1997:6), who proposes that: "Learning packages
and materials are designed as a straight substitute for lectures", as well as
a strategy to prevent learner passivity and promote independent learning.
Forced into a self-directed environment that is unstructured, the learner
with little former knowledge on which to build needs guidance and relies
on the facilitator to construct the learning process (Neville 1999:396). The
learning guide is seen as a tool to assist both the learner and the facilitator
as confirmed by Harden et al. (1999:248), who state that a learning guide
is an instrument planned to facilitate learners' interaction with the different
components of the learning programme. Learning guides play three roles
in facilitating learning in that they manage the learning process, provide a
focus for learning activities, and are resources that make available the
necessary information concerning the learning theme. Learning is
constructed according to the learning outcomes. The learning guide
provides a foundation for either formative or summative assessment and
the implementation of learning strategies is stimulated (Harden et al.
1999:248).
Since there has been a move from a teacher-centred to a learner-centred
approach in education where it is expected of the learner to be more
responsible and also to learn independently, the learning guide plays an
essential role in guiding the learner through this process. To encourage
learners to be active, the learning guide offers an interactive facet to
learning and, as a result, enhances the learning experience. Learning
guides make a major contribution to efficient and effective teaching and
learning (Harden et al. 1999:256). The authors conclude that the key
features of learning guides are that they are essential in the education
51
process; they are informative; lead to motivation; and are interactive, with
active participation of the learner.
The CTM (2001b:4) highlights the role of the learning guide: The
outcomes-based learning guide is the product of a structured and planned
process in which outcomes and assessments are connected; the content
is integrated by means of learning strategies to facilitate learning. By using
the learning guide, learners can make the best possible use of available
learning opportunities by adjusting these opportunities to their own needs.
According to the CTM (2001b:5), the learning principles for learning guides
are that learners need structure and direction.
2.5 SUMMARY AND CONCLUSION
Low academic achievers frequently continue with little guidance or specific
educational interventions to improve their performance; their learning
problems are not attended to; and their learning environment remains
unchanged, leading to repetition of failure (Sayer et al. 2002:643). After
initiatives to advance increased access to higher education, the authors
emphasise the need for increased educational support for learners and
point out that little information about successful strategies for dealing with
academic failure is available. Growe et al. (2002:205) further summarise
the motivation for and significance of the present study: Facilitators should
face the challenge of increasing diversity and stay committed to an
understanding of education. The culturally diverse classroom should be
seen as a resource to be developed and higher education must be
prepared to meet the learning needs of culturally diverse populations.
These authors further emphasise that strategies must be designed to
educate learners in an environment that enhances learner achievement.
This last statement underscores the overall goal of the present study.
1113 5~l1i
52
Academic achievement was described in this chapter and the problem of
learner diversity briefly touched on. In summary, both experimental and
correlation research suggested a positive outcome on academic
performance if interactive instruction and the acknowledgement of different
learning styles were included in the educational approach. Although only
three articles commented on diverse learner populations, namely those by
Chase and Geldenhuys (2001:1072), McLean (2001 :402) and Gettinger
and Seibert (2002:350), these contributions elucidated a variety of potential
enhancers of academic achievement - factors which informed and
influenced the empirical approach to the present study.
From the literature review it is concluded that academic achievement is a
multifaceted concept in which academic ability, self-regulation, self-
efficacy, motivation, approaches to learning, study skills, and learning
styles playa part. Although academic achievement is complex, academic
performance could be improved if both the facilitator and the learner are
actively involved in the learning process (Bitzer & Pretorius 1996; NQF
2000; Chase & Geldenhuys 2001; Kumar 2003; Sanz de Acedo Lizarraga
et al. 2003). For that reason, if conventional lectures in radiography are
replaced by structured interactive sessions (SIS) that accommodate
learner diversity; motivate learners; provide guidance on the use of
effective study skills; encourage academic self-regulation; and promote a
deep approach to learning, the goal of this study can be reached. In other
words, help learners to become masters of their own learning. Brody
(1994:68) states that innovative instructional interactions built into the
curriculum that individualise the educational approach will improve
educational outcomes.
The next chapter, Chapter 3, entitled The research design and methods,
will explain the empirical approach and provide a description of the
research methodology that was used to achieve the aim.
CHAPTER 3
RESEARCH DESIGN AND METHODS
3.1 INTRODUCTION
In an attempt to enhance academic achievement in the radiography
learning unit at hand, the investigation used several theories from the field
of interactive learning, as described in the previous chapter. As a result
the focus was not only on active learning, but also on interactive learning,
an education strategy which implies that both the facilitator and the learner
were joined in an effort to manipulate the learning environment. The
educational intervention was thus designed to incorporate the principles of
active learning with facilitator guidance. The arrangement of these
principles and their application are discussed below.
3.2 STUDY DESIGN
This study investigated the effect of an interactive approach of teaching,
as well as learners' learning preferences and attitudes towards interactive
learning and academic performance. The study design was fourfold (see
Figure 1.1): First, a Learning Preference Inventory (LPI) was conducted
(see Appendix I) to determine the appropriate education strategy and to
arrange the structure of the educational intervention. Second, learners
were divided into three groups, namely a formal lecture group, a self-
activities group and a self-study group. Third, an experimental study
method was developed to quantify improvement in learner performance
before and after an interactive educational intervention (Appendices II and
III). Fourth, a descriptive qualitative study in the form of a research
54
instrument (Questionnaire: Appendix IV) was used to evaluate the
learners' perception of the interactive approach to education during the
intervention.
3.3 TARGET GROUP
The target group, a convenience sample, included 30 second-year
learners from the programme Diagnostic Radiography at the TFS in the
learning unit Radiographic Practice II (RAD 20 at) in 2002. All learners
participating in the study completed the themes "Skull and cranial bones"
and "Facial bones" as part of the educational offering of the School of
Radiography. Prior to this experience, the learners had been exposed to
forms of formal instruction during their first year as learner radiographers.
Interactive instructional methods were not used and were seen primarily
as a supplement to more traditional forms of instruction.
3.4 PROCEDURE
The ensuing paragraphs will describe the procedure of the study and
provide a description of the methods used. Theoretical features of the
design will be discussed, as well as the experimental instruments. The
LPI, the pre- and the post-intervention test, and the questionnaire used as
the method to collect data will receive attention. AI learning material was
in English, but discussions with the facilitator could be in Afrikaans.
3.4.1 Learning preference inventory
The educational intervention strategy was developed based on the Rezler
Learning Preference Inventory (Rezier 1974), which all the second-year
learners completed before participation in the study. Research into
learning preferences demonstrates that individuals differ in their
55
preferences and approaches to learning and that no single strategy is
optimal. The LPI reflects preferences for learning situations and
conditions. Each item consists of six words or sentences to be ranked one
to six. Each item contributed to different preferred learning situations,
divided into contrasting scales on three dimensions, namely
abstract/concrete; individual/interpersonal; and learner-structured/teacher-
structured (see Table 2.1).
3.4.2 Division of groups
The division of groups was based on previous academic records. These
records were based on the avarage marks of a formal test and Objective
Structured Clinical Evaluation (OSCE) obtained in the first semester. The
learners' names were sorted according to their average test scores
obtained. Therafter the learners were divided into three groups consisting
of an equal number of high-level, average, and low-level academic
performers (see Appendix V). The three groups were subjected to different
learning conditions which were:
• Formal lectures.
• Learning self-activities.
• Independent self-study.
Two learners assigned to the self-study group indicated that they felt
insecure to study independently and requested to be part of the formal
lecture group. The final sample sizes for each condition were 11 for formal
lectures and learning self-activities and eight for independent self-study.
The radiographic anatomy and positioning of the skull and cranial bones
were covered by all three groups.
3.4.3 Learning content
The themes covered during the study, i.e. the skull, cranial and facial
bones were part of the curriculum and relevant for the practical application
of projections during experiential learning and gained competence in the
56
clinical settings. The learning content consisted of two parts, namely
radiographic anatomy and radiographic positioning of the skull and cranial
bones. The radiographic anatomy included an anatomical overview of the
cranial bones, the sutures of the cranium, joint classifications, and an
anatomy review with radiographs. The radiographic positioning part
involved skull morphology, cranial topographic landmarks, skull positioning
lines, postioning considerations, basic and special projections, and
evaluation as well as critique of skull radiographs. All three groups used
the textbook entitled Textbook of Radiographic Positioning and Related
Anatomy (Bontrager 1997:323-384) as their primary text and were
informed by similar stated learning outcomes. The information was
developed carefully to ensure that all the learners received identical
information on the procedure and instructions of what was expected of
them. All the groups were told to spend their time as effectively as
possible and were informed that they would take a pre-test. The lecturer
for both themes and for all the sessions was the same person.
3.4.4 Formal lectures
All of the learning content was presented to the formal lecture group
(n=11) in the traditional lecture format by the researcher. The theme was
covered in a series of three-hour sessions on four consecutive days. The
lecture content obtained from Bontrager (1997:323-384) was introduced
by means of ©PowerPoint slides (see Appendix VI), which contained
anatomical sketches of relevant structures in the skull, keywords of
important facts, patient projections, and radiographs to illustrate optimal
views and radiographic images. The learners were passive observers and
no interaction was pursued. The learners were expected to memorise the
content and to prepare for the pre-test on the fifth day of the week
scheduled for the survey.
3.4.5 Self-activities
The self-activities were written exercises that the learners (n=11) worked
57
on during the same scheduled class sessions as the formal lecture group
and it covered the same learning content as the formal lecture and
independent self-study groups. The self-activities included a variety of
different types of problems, namely "Fill-in-the-blank"; short answers;
tables which had to be completed; and figures which had to be labelled
(see Appendix VII). These were all oriented towards a set of explicit
learning outcomes presented with the activities and were similar to those
of the formal lecture and the self-study groups. The activities required the
learners to extract information from the reference textbook (Bontrager
1997:323-384). The assigned group was not allowed to interact with either
the facilitator or the co-learners. The learners were expected to complete
the activities in the scheduled four days and then learn the content thereof
to prepare for the pre-test on the fifth day.
3.4.6 Independent self-study
The self-study group (n=8) received identical outcomes as the formal
lecture and the self-activity groups (see Appendix VIII). No further
guidance was provided by the researcher and no contact with other
learners were allowed. The learners were referred to the information in the
above-mentioned textbook. They were expected to work through the
theme during the same scheduled four days and then learn the content
thereof to prepare for the pre-test on the fifth day.
3.4.7 Pre-test
Pre- and post-intervention test scores measured the extent to which the
learners' academic performance increased. The pre-test was conducted
on the fifth day of the study. In the preceding four days the formal group
learners were expected to memorise the content of the formal lecture and
to prepare for the pre-test. The self-activities group was expected to
complete the activities in the scheduled four days and then learn the
content thereof to prepare for the pre-test and the self-study group was
expected to work through the theme during the same scheduled four days
58
and then learn the content thereof to prepare for the pre-test on the fifth
day. All learners wrote the same pre-test. The test consisted of a collection
of 60 questions from a published review guide commonly used by
Radiography programmes at academic institutions (Bontrager 1993:217).
These questions were written to have a single best answer. Learners were
allowed 90 minutes to complete the test.
3.4.8 Structured interactive sessions
The pre-test was followed up one week later with the interactive education
strategy, that is structured interactive sessions (SIS) which entailed self-
reflective and learner-guide-oriented contact sessions that included all the
learners. The structured interactive sessions were devised based on the
results of the LPI (see paragraph 3.4.1). The results indicated that the
majority of the learners preferred a concrete, interpersonal and teacher-
structured approach to education. "Concrete" is a preference for learning
specific, tangible information and skills and practical application. An
interpersonal preference is for learning in groups and with others, while
interaction with fellow-learners and with teachers is valued. A teacher-
structured preference for learning entails a teacher-directed approach with
learning goals and objectives that are clearly defined by the teacher
(Steele et al. 2002:227).
The educational intervention is a multidimensional approach (Butler
1992:15; Abdelhamid 1999:1) which was designed by using principles
from teaching theories with the following characteristics:
• Learner-centred learning (Chase & Geldenhuys 2001:1071; Division
of Educational Development 2002:1; TFS 2003:2).
• Problem-based learning (Barrows 1986:482; Bernard, Mann &
Hansen 1998:323; Greening 1998:12; Davis & Harden 1999:130).
• Self-directed learning (Baxter & Gray 2001 :399).
• Resource-based learning (Division of Educational Development
2000:1 ).
59
• Reflective learning (Baxter & Gray 2001 :397; Whittle & Murdoch-
Eaton 2001 :1075).
• Active learning (Boyer 2002:48).
It consisted of multiple components designed to allow for maximum
participant and facilitator interaction by using the learner guide as source
for individual activities, group activities, self-tests, simulations and
problem-solving.
The intervention, which included all the learners (n=30), covered the
theme the facial bones in a series of three-hour sessions on four
consecutive days - the same as in the three subgroups. The radiographic
anatomy and positioning of the facial bones were covered. The learning
content also consisted of two parts, namely radiographic anatomy and
radiographic positioning. The radiographic anatomy included an
anatomical overview of the facial bones and an anatomy review with
radiographs. The radiographic positioning part involved facial morphology,
facial bone topographic landmarks, facial bone positioning lines,
positioning considerations, basic and special projections, and evaluation
and critique of facial bone radiographs. All learners used the Textbook of
Radiographic Positioning and Related Anatomy by Bontrager (1997:359)
as their primary text.
The theme was introduced through a formal interactive lecture (see
Appendix IX), during which the learning outcomes and learning frame
were provided. The theme was then extended by interactive teaching,
which included several types of interactive learning exercises, activities,
case studies, simulations, reflective self-tests, small group discussions
and presentations. The overall education strategy was facilitated by
means of the use of a learning guide (see Appendix X). The learning guide
was designed to assist the learners with their learning and to ensure active
involvement. Learners were given verbal instructions and written guidance
60
on the use of the learning guide. The learning guide specified the learning
outcomes; identified learning resources; contained activities to discover
information; and provided opportunities for the learners to assess their
own progress and competence through self-tests.
3.4.9 Post-intervention test
The post-intervention test was conducted on the fifth day of the scheduled
time for the second phase of the study, which also entailed four days
during which the learning theme, namely the facial bones, was introduced
by means of structured interactive sessions, the educational intervention.
The test furthermore consisted of a collection of 60 questions from a
published review guide commonly used by radiography programmes at
academic institutions (Bontrager 1993:217). These questions were also
written to have a single best answer. The pre- and the post-intervention
tests were similar in content and format and the learners were allowed 90
minutes to complete the test.
3.4.10 The questionnaire
The questionnaire was designed to evaluate the learners' perception of
the effectiveness of the educational intervention. A set of demographic
questions and measures of individual preferences were included in the
questionnaire. The questionnaires were available in English and were
distributed in class after the tests results had been revealed; learners were
allowed to ask for clarification of questions they did not understand. They
were asked to indicate their perceptions of how successful or effective the
various teaching methods were upon their own learning. The questions, to
which the answers consisted of a "Yes" or a "No" answer only, provided
information about learners' perceptions, reactions, attitudes, feelings, and
experiences. The use of a "yes/no" answer was decided upon in order to
encourage a more objective approach to assessing the effectiveness of
the different methodologies on their own learning.
61
3.4.11 The pilot study
The questionnaire was completed by 20 third-year learners in the same
programme before it was used in the study. Ambiguous questions were
corrected and difficult terminology changed to clearer terms.
3.4.12 Scholastic Aptitude Tests (SAT)
The learners' existing official SAT scores had been obtained from the
administrator's office, collected as indicator of the cognitive ability of
learners in order to determine possible associations between the SAT, the
pre- and the post-intervention test scores.
3.5 METHODOLOGICAL AND MEASUREMENT ERRORS
A brief overview of how methodological and measurement errors were
counteracted, follows:
• The researcher's preferences for methods of instruction might have
influenced the approach to education. An LPI was used to gather
additional information to identify possible learning style differences
that might have influenced academic performance among learners
and thus to select the most appropriate education strategy.
• The investigation was conducted in a relatively short period of time
(three weeks) to exclude the influence of the development of
knowledge, skills, and efficacy regarding the themes covered.
• Objective test questions and answers (one correct answer only)
ruled out variations associated with the observer.
• Different knowledge and test levels between pre- and post-
educational intervention were addressed by using standard learning
material and internationally used self-tests.
• Completing the pre-test might have improved post-intervention test
scores. Pre- and post-intervention tests were conducted three
weeks apart to rule out the retention of interrelated knowledge.
62
• Considering each individual participant as his/her own control might
have led to an invalid baseline being determined by previous test
scores. This measurement error was excluded by using the
learners' SAT scores to confirm academic ability.
• The research findings cannot claim to be representative of other
settings. A comprehensive study and comparison of the relevant
literature in Chapter 2 support the findings.
• The questionnaire might be inadequate and might have omitted key
areas. Piloting the questionnaire to a different group (to avoid
sensitising the learners) indicated possible shortcomings and these
were rectified.
3.6 ANALYSIS
The Department of Biostatistics at the UFS was consulted for
recommendations regarding the management of data and the processing
and presentation of the results. All statistical analysis was conducted by
the researcher, using a statistical package for Windows, namely Statistica
Version 5.0 (Stat Soft Inc. 2001) and SPSS 11.0.0 (SPSS Inc. 2001). All
numerical variables were presented as a mean with standard deviation
and median. Categorical variables were summarised using frequencies
and percentages. Significant changes in the pre- to post-intervention test
scores within the different study groups were measured by means of a
paired difference t-test. The ANOVA method (Analysis of Variance) was
used to compare the pre- and post-intervention test scores of the three
subgroups. An ANOVA was also used to compare the improvement in
test scores between the three different intervention groups. Correlation
coefficients were calculated to determine the strength of association, if
any, between numerical variables. Tests for normality and homogeneity of
variances were conducted.
63
3.7 ETHICAL ASPECTS
Informed consent was obtained from all the learners. On the consent
forms (see Appendix XI) the learners gave permission for the access of
their official ASAT scores from the administrator's office and that their test
marks might be used as a measure to assess improvement in academic
achievement. Learners were assured that all information collected would
be treated confidentially. The results and benefits thereof were shared with
the learners. The Ethics Committee of the Faculty of Health Sciences at
the UFS reviewed the protocol and gave consent for the investigation to
be conducted (see Appendix XII, ETOVS 39/03). All efforts were made to
comply with the standards set by Joubert, Bam and Cronjé (1999:62)
regarding the use of correct and scientifically acceptable methods, thereby
ensuring that feedback and reporting on the study were honest, frank and
sensitive.
3.8 CONCLUDING REMARKS
In this chapter the study design, the methods as well as the process of the
experiment were addressed. Theoretical aspects of the design were
discussed, while the experimental instruments, the LPI, the pre- and the
post-intervention test, as well as the questionnaire used as the method to
collect data received attention. The reasons for using these particular
methods were briefly touched on in Chapter 1 and a more complete
discussion will follow in Chapter 5.
In Chapter 4, the results and findings of the study will be presented and
the outcome of the educational interventions will receive special attention.
CHAPTER 4
RESULTS AND FINDINGS
4.1 INTRODUCTION
In this study a group of learners was subjected to an educational
intervention. Learners were subjected to a formal test before and after the
SIS. The test scores were subsequently used as a quantitative indicator to
evaluate and compare the effectiveness of each intervention. In addition, a
questionnaire was used to evaluate the experience of each learner as a
subjective indicator of the separate interventions.
In this chapter results will be reported in three different sections: Learning
preference inventory observations; pre- and post-test scores; and
questionnaire results of perceived enhancers or constraints of academic
achievement. Data will be presented by means of tables and figures.
4.2 STUDY GROUP
The study population consisted of 30 learners with a mean age of 20
years. The age of the learners ranged between 18 and 22 years. The
group mainly consisted of females (n=25, 83% of the total group). The
majority (56.7%, n=17) of the learners were White, 40% (n=12) Black, and
3.3% (n=1) Coloured. Reports on learners' home language (mother
tongue) indicated that 53.3% (n=16) spoke Afrikaans, 6.7% (n=2)
English, 30% (n=9) Sotho, and 10% (n=3) some other African language.
The learners came from different geographic areas where they had
completed their school education, namely 63.3% (n=19) from the Free
65
State, 16.7% (n=5) from the Northern Cape, and 20% (n=6) from other
provinces. Forty-three percent (n=13) of the learners reported that they
came from traditionally Black schools in and around Bloemfontein (see
Table 4.1).
Table 4.1: Background information on the study population
Number % of total group
Gender
Male 5 16.7
Female 25 83.3
Race
Black 12 40.0
White 17 56.7
Coloured 1 3.3
Language
Afrikaans 16 53.3
English 2 6.7
Sotho 9 30.0
Other 3 10.0
School
White 17 56.7
Black 13 43.3
Distribution
Free State 19 63.3
Northern Cape 5 16.7
Other 6 20.0
4.3 LEARNING PREFERENCE INVENTORY (LPI)
The next section illustrates the learners' learning preferences and the
related ranking thereof. The LPI reflects preferences for learning situations
66
and conditions. Contrasting scales are employed on three dimensions,
namely abstract/concrete, learner-structured/facilitator-structured, and
individual/interpersonal (also see Chapter 3, Figure 3.1). Results with
regard to the ranking of learning preferences in the group of 30 learners
are displayed in both Figure 4.1 and in Table 4.2.
60
50
Ul
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o - "..",
Abstract Concrete Teacher- Student· Interpersonal Individual
structured structured
Preferred learning condition
Figure 4.1: First learning preference
Fifty-six percent (n=17) of the learners reported that a teacher-structured
approach in education was their first learning preference. The well-
organised, facilitator-directed classes were their first choice as potential
factor that improved learning (see Figure 4.1). This involves ciear
expectations, assignments and goals defined by the facilitator. All other
learning preferences had 16.7% or less of the learners choosing that
preference as first choice. Nearly half (43%, n=13) of the group indicated
that their second preference was a concrete teaching approach, which
entails the learning of tangible, specific, practical tasks and skills (see
Table 4.2). The individual category was also chosen as a second
preference by 36.6% (n=11) of the group. This involves a preference for
learning or working alone, with an emphasis on self-reliance and tasks.
67
Abstract learning, the learner -structu red category, as well as the
interpersonal category featured throughout as the least preferred method
of learning with median rankings of 4 or 4.5.
Table 4.2: Ranking of learning preferences
LPI ranking (n=30) 1SI 2nd 3r!! 41h Slh 61h Median
Abstract (AB) 0 1 5 9 11 4 4.5
Concrete (CO) 5 13 9 3 0 0 2
Facilitator-structured (TS) 17 3 5 3 1 1
Learner-structured (ST) 3 2 6 5 8 6 4
Interpersonal (lP) 3 4 2 6 7 8 4.5
Individual (IN) 2 11 5 5 4 2 3
4.3.1 Association between SAT range and first learning preference
The majority of learners in the high SAT range (73,3%, n=11) preferred a
teacher-structured approach while only 1 out of 8 learners (12,5%) in the
low SAT range chose this approach as their first choice. In the average
SAT range 5 out of 7 learners (71.4%) also made the teacher-structured
approach their first choice. Three out of 8 learner (37.5%) in the low SAT
range preferred an inter-personal approach to learning 4 (see Table 4.3).
Table 4.3: SAT range and first learning preference
First learning preference
SAT range (n=30) TS CO ST lP IN AB
0-49% (n=8) 1 2 1 3 1 0
50-65% (n=7) 5 1 1 0 0 0
66-100% (n=15) 11 2 1 0 1 0
68
4.4 PRE-TEST SCORES
The mean of the pre-test scores for the group as a whole was 51.5%.
Table 4.4 also shows that the mean pre-test score of the formal lecture
group (mean=59.4%) was significantly higher compared to the self-activity
group (mean=42.7%, p=0.007). There was no significant difference
between the mean pre-test scores of the formal lecture group compared to
the self-study group (median=51.7%, p=O.271). Therefore, the individual
subgroup scores indicate that independent self-learning, i.e. self-activities,
were significantly less effective than the formal lectures.
Table 4.4: Test scores before and after the intervention
Pre-test scores Post-intervention test scores
n Mean%Median Standard Mean% Median Standard
% deviation deviation%
%
Group as 30 51.5 51.5 15.2 70.4 71.5 9.6
a whole
Formal 11 59.4 59.0 11.4 72.4 71.0 7.4
lectures
Self- 11 42.7 40.0 14.3 66.5 61.0 11.4
activities
Self- 8 52.6 51.7 14.4 72.9 71.5 10.3
study
4.5 POST-INTERVENTION TEST SCORES
Mean test scores for the group as a whole increased significantly (see
Table 4.4) from the pre- to the post-intervention test (from 51.1 ± 15.2% to
70.4 ± 9.6%, P < 0.001). The post-test scores of both the self-study group
(mean=72.9%) and the formal lecture group (mean=72.4%) tended to be
69
higher when compared to the self-activity group (mean=66.5%). This
difference was not statistically significant.
Improvements in test scores (see Table 4.5) from pre- to post-intervention
were significant within all three learner groups (p=0.001 for the formal
lecture group; p<0.001 for the self-activities group; and p=0.002 for the
self-study group). The correlations between pre-intervention scores and
changes from pre- to post-intervention test scores are provided in Table
4.6 and they support the above-mentioned findings.
Table 4.5: Descriptive statistics of the improvement in test scores
n Mean Standard p- 95% Cl of the
improvement% deviation value* difference
Group as 30 18.9 11.3 <0.001 14.7; 23.1
a whole
Formal 11 13.0 9.1 0.001 6.9; 19.1
lectures
Self- 11 23.8 11.2 <0.001 16.3; 31.3
activities
Self-study 8 20.3 11.8 0.002 10.4; 30.1
*Paired Samples t-test
However, in order to assess the true effect of the intervention on the
outcome of test scores in the different intervention groups, it is necessary
to compare the magnitude of change or improvement in test scores
between the respective learner groups. The improvement in pre- to post-
intervention test scores for the self-activities group (23.8 ± 11.2%) is
significantly higher compared to the improvement in the test scores of the
formal lecture group (13.0 ± 9.1%). The improvement in pre- to post-
intervention test scores for the self-study group tended to be higher
compared to the formal group. However, this difference was not
significant. The improvement in test scores within the self-activities group
70
compared to the improvement of test scores within the self-study group
also fell short of statistical significance.
Table 4.6: Correlations between changes from pre-intervention to
post-intervention test scores
Study group n Correlation Significance
Group as a whole 30 0.644 <0.001
Formal lecturers 11 0.611 0.046
Self-activities 11 0.639 0.034
Self-study 8 0.592 0.122
4.6 SCHOLASTIC APTITUDE TEST (SAT)
Existing official scholastic aptitude tests scores (SAT) were obtained as an
indicator of the cognitive ability of learners (see Table 4.7). The group as
a whole had a mean SAT score of 64.4% (standard deviation=26.0%). The
self-study group had the highest mean SAT score (74.0 ± 20.6%). This
high score is ascribed to the two learners with low SAT scores (27% and
34%) who had requested not to be part of the self-study group. These
candidates were then included in the formal lecture and self-activities
group.
Table 4.7: SAT scores
Study group n Mean% Median% Standard deviation%
Group as a whole 30 64.4 64.5 26.0
Formal lectures 11 63.3 63.0 28.4
Self-activities 11 58.5 55.0 27.3
Self-study 8 74.0 72.5 20.6
71
4.6.1 Associations between the SAT and the pre-test scores
Table 4.8 reflects the association between the SAT and the pre-test
scores. The self-study group had the highest mean SAT score (74.0 ±
20.6%), while the mean pre-test scores (52.6 ± 14.4%) were second to
that of the formal lecture group (59.4% ± 11.4). The formal lecture group
had the second-highest mean SAT score (63.3 ± 28.4%), but obtained the
highest mean pre-test scores (59.4 ± 11.4%). The self-activities group had
the lowest SAT scores (58.5 ± 27.3%) and obtained the lowest mean pre-
test score (mean=42.7% ± 14.3%).
Table 4.8: SAT and pre-test scores
Formal lectures Self-activities Self-study
(n=11 ) (n=11) (n=8)
SAT Pre-test SAT Pre-test SAT Pre-test
Mean% 63.3 59.4 58.5 42.7 74.0 52.6
Standard deviation% 28.4 11.4 27.3 14.3 20.6 14.4
Median% 63.0 59.0 55.0 40.0 65.3 51.7
4.6.2 Associations between the SAT and the post-intervention test
scores
Table 4.9 reflects the association between the SAT and the post-
intervention test scores. The self-study group with the highest mean SAT
scores (74.0 ± 20.6%) obtained the highest mean post-intervention test
scores (72.9 ± 10.3%). The formal lecture group with the second-highest
mean SAT scores (63.3 ± 28.4%) obtained the second-highest mean post
-intervention test scores (72.4 ± 7.4%). The self-activities group with the
lowest mean SAT scores (58.5 ± 27.3%) obtained the lowest mean post-
intervention test scores (66.5 ± 11.4%).
72
Table 4.9: SAT and post-intervention test scores
Formal lectures Self-activities Self-study
(n=11) (n=11) (n=8)
SAT Post-test SAT Post-test SAT Post-tes'
Mean% 63.3 72.4 58.5 66.5 74.0 72.9
Standard deviation% 28.4 7.4 27.3 11.4 20.6 10.3
Median % 63.0 71.0 55.0 61.0 65.3 71.5
The mean SAT, pre-test and post-intervention test scores are displayed in
Figure 4.2.
t:lI SAT o Pre-test • Post-test
80
70
~ 60
~ 50
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(/)
.$ 30-
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Q)
I- 20
10
0-
Formal lectures Self-activities Self-study
Figure 4.2: SAT, pre-test and post-intervention test scores
4.6.3 Correlations between SAT, average test scores, pre- and post-
intervention test scores and improvement from pre- to post-
intervention test scores
The strength of correlation between the improvement in pre- to post-
intervention test scores SAT, average test scores (ATS) and pre- and
post-intervention test scores is reported in Table 4.10.
A significant negative correlation was measured between SAT and the
improvement in test scores from pre- to post-intervention in the formal
73
lecture group. Furthermore, the negative correlation between the average
test scores and the improvement in test scores of the group as a whole
and the formal lecture group was significant. A significant negative
correlation was also measured between the pre-intervention test scores
and the mean improvement in test scores of all the study groups.
Table 4.10: Correlations between SAT, ATS, pre- and post-
intervention test scores and improvement from pre- to
post-intervention test scores
Variable Improvement in test scores
Group as Formal Self- Self-
a whole lectures activities study
SAT r# -0.274 -0.624* -0.109 -0.153
Significance 0.142 0.040 0.749 0.717
ATS r -0.381 * -0.692* -0.146 -0.452
Significance 0.038 0.018 0.669 0.261
Pre-test r -0.743** -0.795** -0.624* -0.707*
Significance 0.000 0.006 0.040 0.050
Post- r 0.033 0.043 0.203 0.152
test Significance 0.863 0.899 0.550 0.720
Pearson correlation
** Correlation is significant at the 0.01 level (2-tailed)
* Correlation is significant at the 0.05 level (2-tailed)
4.6.4 Association between mean % increase in test scores and SAT
range
Classification of SAT scores into three categories based on low (0 to
49%), average (50 to 65%) and high academic aptitude (66 to 100%) was
used to compare the association between mean percentage increase in
test scores and SAT range. The mean increase in test scores is illustrated
in Table 4.11 and in Figure 4.3. In the group as a whole learners in the low
and average academic competency group showed a higher increase in
test scores (mean=16.3% and 21.5%) than the higher competency group
(mean=11%). The formal lecture group showed the highest increase in
74
test scores (mean=23.7%) in the low SAT range, while the average SAT
range in the self-activities and self-study groups showed the highest
increase (mean=34.5% and 23.0%) in test scores. The high SAT range
showed the least increase in test scores in the group as a whole
(mean=11.0%) and the formal lecture group (mean=9.2%). The numbers
in the subgroups are small, however, and the statistical value is therefore
limited.
Table 4.11 :Association between mean increase in test scores and
SAT range
Mean increase from pre- to post-test score in%
SAT range Group as a Formal lectures Self-activities Self-study
in% whole (n=30) (n=11) (n=11) (n=8)
0-49 16.3 (n=8) 23.7 (n=3) 21.5 (n=4) 19.0 (n=1)
50-65 21.5 (n=7) 8.7 (n=3) 34.5 (n=2) 23.0 (n=2)
66-100 11.0(n=15) 9.2 (n=5) 21.4 (n=5) 19.4 (n=5)
110-49% .50-65% 066-100%
35
30
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51
o .
Whole group Formal Self-activities Self-study
(n=30) lectures (n=11) (n=11) (n=8)
Figure 4.3: Association between mean increase in test scores and
SAT range
75
4.7 QUESTIONNAIRE
The learners reflected on their perception of the effectiveness of the
structured interactive sessions (the intervention) in the questionnaire. The
questionnaire contained a biographical section, eliciting responses
regarding factors such as gender, age, home language (mother tongue),
and demographics (see paragraph 4.1). For the remainder of the
questionnaire learners had to indicate the extent to which the respective
teaching approaches influenced their learning.
Information obtained from the questionnaires indicated that the
enhancement of learning was mostly due to the practical nature of, and
active participation in, facilitator-structured activities. The questionnaire
distributed at the end of the study required the learners to indicate their
agreement with a series of statements on a "Yes" or "No" basis. The
statements relevant to the teaching method; the role of the lecturer; study
methods; general comments regarding their experience with the
intervention; and the responses of the 30 learners will subsequently be
discussed.
Results from the questionnaire indicate factors that affect learning in one
way or another. Factors that were reported to influence learning positively
by means of improving academic performance to a large extent are
provided in the following paragraphs.
4.7.1 Teaching methods which improved marks
Learners were asked to choose the teaching method that would improve
their marks (see Table 4.12). The majority, 93.3% (n=28) and 73.3%
(n=22) of the learners reported that lecture interactive activities in class
and individual assignments respectively were the prominent factors that
improved their marks. Half of the learners, 53% (n=16), mentioned that the
use of only formal lectures had influenced their academic performance.
76
More than 60% (n=18) of the learners reported that group activities,
independent self-study and group assignments in class could improve their
marks, while 60% (n=18) mentioned that independent self-study was not a
teaching method that would improve their performance.
Table 4.12:Teaching method which improves learning experience
Teaching method that will improve Learners (n=30)
their marks
Yes No Un-
% % %
(n) (n) sure
Formal lectures 16 53.3 12 40.0 2 6.7
Independent self-study 10 33.3 18 60.0 2 6.7
Lecture interactive activities in class 28 93.3 1 3.3 1 3.3
Group activities 18 60.0 10 33.3 2 6.7
Independent individual activities 19 63.3 9 30.0 2 6.7
Fellow-learner presentations 12 40.0 16 53.3 2 6.7
Individual assignments 22 73.3 7 23.3 1 3.3
Group assignments in class 19 63.3 8 26.7 3 10
4.7.2 The role of the lecturer
In the questionnaire items that examined the importance of lecturer input
as constituent to increased marks 96.7% (n=29) and 100% (n=30) of the
learners responded by pointing out that the lecturer's role is to provide
information and knowledge and notes respectively and also to promote
interaction during formal lectures (96.7%, n=29). Sixty percent (n=18) of
the learners reported that their marks would have increased if the lecturer
had guided and structured self-study. The majority of the learners, 80%
(n=24), mentioned their preference for lecturer involvement and all the
learners indicated that they had learned more when the lecturer was active
in the learning process (see Table 4.13).
77
Table 4.13:The role of the lecturer
Lecturer importance to Learners (n=30)
increase marks
Yes % No % Unsure 0/0
Providing information and 29 96.7 1 3.3 0 0
knowledge?
Supplying notes? 30 100.0 0 0.0 0 0
To guide and structure self- 18 60.0 10 33.3 2 6.7
study?
To promote interaction during 29 96.7 1 3.3 0 0
formal lectures?
The lecture participation 24 80.0 5 16.7 1 3.3
influences your marks?
Do you prefer the lecturer to be 1 3.3 29 96.7 0 0
only a facilitator (not active)?
Do you learn more if the lecturer 30 100.0 0 0.0 0 0
is active in the learning process?
4.7.3 Preferences for study methods
The learners reported that they used the following methods when studying:
The whole group reported that they used lecturers' notes, while 83.3%
(n=25) read through information a few times. The majority of the learners
(76.7%, n=23) made summaries and more than 60% (63.3%, n=19) studied
only for tests or exams. Studying in groups was perceived by only 26.7%
(n=8) as a preferred method of studying (see Table 4.14).
78
Table 4.14: Preferred methods of study
Study methods Learners (n=30)
Yes % No 0/0 Unsure %
just read through information 3 10.0 26 86.7 3.3
in your textbook once?
Read through information in 25 83.3 5 6.7 0 0
your textbook a few times?
Make summaries? 23 76.7 7 23.3 0 0
Draw mind maps of important 12 40.0 18 60.0 0 0
information?
Prefer to use just lecturers' 9 30.0 20 66.7 3.3
notes?
Use lecturers' notes as well as 30 100.0 0 0.0 0 0
other methods?
Like to study in groups? 8 26.7 22 73.3 0 0
Study directly after lectures? 10 33.3 20 66.7 0 0
Study only for tests or exams? 19 63.3 11 36.7 0 0
4.7.4 Preference for assessment methods
Formal examinations and tests were the learners' (96.7%, n=29) preferred
method of assessment, followed by assessment through assignments
(80%, n=24) and OSCEs (73.3%, n=22). More than 60% (63.3%, n=19) of
the learners preferred self-demonstrations and self-presentations as
preferred method of assessment. Orals and integrated tests (16.7%, n=5)
were least preferred (see Table 4.15).
79
Table 4.15: Preferred methods of assessment
Assessment methods Learners (n=30)
Yes % No % Unsure %
Formal examinations 29 96.7 0 0.0 1 3.3
Formal tests 29 96.7 3.3 0 0
Integrated tests 5 16.7 25 83.3 0 0
Practical exams at the TFS 19 63.3 11 36.7 0 0
Practical exams in Practice 11 36.7 19 63.3 0 0
Assessment through assignments 24 80.0 6 20.0 0 0
OSCEs 22 73.3 6 20.0 2 6.7
Orals 5 16.7 25 83.3 0 0
Fellow-learner assessment 10 33.3 20 66.7 0 0
Through self-demonstrations 19 63.3 11 36.7 0 0
Through self-presentations 19 63.3 11 36.7 0 0
4.7.5 General factors associated with learning
A total of 73.3% (n=22) of the group reported that outside factors existed
that influenced their learning performance (see Table 4.16). The feedback
of the learners on the worth of interactive activities in class was seen as a
positive and an encouraging factor to improve learning. Eighty-three
percent (n=25) of the learners indicated that they learned more from
reflective activities in class than just formal lectures. The group as a whole
reported that interactive lectures promoted their insight and understanding
of a subject. In addition 83.3% (n=25) of the learners pointed out that self-
activities improved their learning experience. In contrast, two- thirds of the
learners reported negative responses to independent self-study.
80
Table 4.16:General factors associated with learning
Learners (n=30)
Yes % No % Un- %
sure
I am satisfied with my career choice 28 93.3 1 3.3 3.3
Own a relevant Merrill or Bontrager 27 90.0 3 10.0 0 0
textbook
Use the library to obtain additional 17 56.7 13 43.3 0 0
information
Use the library to obtain just the 17 56.7 13 43.3 0 0
necessary information
Outside factors exist that influence 22 73.3 7 23.3 3.3
my learning
I am satisfied with my marks 9 30.0 21 70.0 0 0
The lecturer play an important role in 29 96.7 0 0.0 1 0
my learning process
The Year organiser helps me to plan 20 66.7 9 30.0 1 0
my learning
The learning guide is an important 30 100 0 0.0 0 0
source of knowledge
I prepare for lectures 11 36.7 17 56.7 2 0
I often postpone learning 15 50.0 15 50.0 0 0
I prefer independent self-study to 11 36.7 19 63.3 0 0
interactive lectures
I learn more from reflective activities 25 83.3 5 16.7 0 0
in class than from formal lectures
Interactive lectures promote my 30 100 0 0.0 0 0
understanding of the subject
I like to take part in class discussions 23 76.7 7 23.3 0 0
I feel isolated during independent 10 33.3 20 66.7 0 0
self-study
Activities improve my learning 25 83.3 5 16.7 0 0
experience
The lecturer must be a role model in 30 100 0 0.0 0 0
the learning
81
4.7.6 Experience with teaching methods
The learners were asked to reflect on their experiences as far as the
different teaching methods were concerned. In these specific items
learners were requested to rank the importance of a specific teaching
method as a possible factor that could improve their marks, using (1) as
the most important; (2) as the second-most important; etc. Forty percent
(n=12) of the learners reported lecturer demonstrations as the most
important factor that could improve their marks (see Table 4.17). All other
teaching methods had 26.7% (n=8) or less of the learners choosing them
as possible factors that influenced their marks as a first choice. None saw
peer presentations as a factor that could improve their marks. Contact
sessions with a variety of activities and lecturer demonstrations were the
teaching methods most positively experienced with a median ranking of 2.
Table 4.17: Experience with teaching methods
Teaching method that improves marks Learners (n=30)
Ranking Me-1st 2nd 3rd 4th s" 6th dian
Independent self-study 4 3 5 7 4 7 4
Formal lectures without interaction 8 6 6 5 2 3 3
Contact sessions with a variety of activities 8 9 3 5 4 1 2
Group discussions 2 4 10 2 6 5 3
Peer (fellow-learners') presentations 0 2 4 9 4 11 4.5
Lecturer demonstrations 12 10 4 3 0 1 2
4.7.7 Personal factors influencing learning
Personal factors influencing learners' learning were reported on as follows
(see Table 4.18): According to 56.7% (n=17) of the learners the cost of
textbooks was not a factor hindering learning. Insufficient study-time was
reported by 83.3% (n=25) of the learners; poor time management by
63.3% (n=19); poor concentration by 60% (n=18) and outside factors by
50% (n=15) as factors that influenced their learning. Seventy percent
82
(n:::21) experienced study stress, while 50% (n:::15) experienced work-
related and personal stress. Financial burdens were an issue in learning
reported by 63.3% (n:::19) of the learners and 10% (n:::3) indicated that
other factors existed that influenced their learning.
Table 4.18: Personal factors influencing learning
Learners (n=30)
Personal factors Yes % No % Unsure 0/0
Cost of textbooks 13 43.3 17 56.7 0 0
Insufficient study time 25 83.3 4 13.3 3.3
Poor time management 19 63.3 11 36.7 0 0
Poor concentration 18 60.0 12 40.0 0 0
Outside factors 15 50.0 15 50.0 0 0
Experiencing study stress 21 70.0 9 30.0 0 0
Experiencing work stress 15 50.0 15 50.0 0 0
Experiencing personal 15 50.0 15 50.0 0 0stress
Financial burdens 11 36.7 19 63.3 0 0
Others 3 10.0 27 90.0 0 0
4.8 SUMMARY
The LPI results indicated that teacher-structured and concrete approaches
to teaching were preferred by most of the learners, while abstract learning
featured throughout as the least preferred method of learning. The post-
intervention test scores for the group as a whole and within all three
learner groups increased significantly from the pre- to the post-intervention
test. The improvement in pre- to post-intervention test scores for the self-
activities group is significantly higher compared to the improvement in the
test scores of the formal lecture group.
83
Reports on the teaching method that will improve academic performance
"lecture interactive activities" in class were seen as the most dominant
factor that influenced the learners' marks. The whole group saw the role of
the lecturer as an important factor to improve marks if the lecturer actively
took part in the learning process and guided and structured self-study. The
study method that the learners preferred was to use lecture notes to study.
Independent self-study, group discussions and peer presentations were
reported to be less important in playing a role in academic performance.
Formal examinations and tests were preferred by the learners as methods
of assessment. An interactive approach to education was associated with
improved test scores with a high acceptability of interactive learning by the
radiography learners.
CHAPTER 5
DISCUSSION AND RECOMMENDATIONS
5.1 INTRODUCTION
In view of the fact that increased diversity in higher education occurs, it
has become critical to address the needs of non-traditional learners,
especially the low-achievers (Henderson in Ruban et al. 2003:270).
In an attempt to address this issue and answer the question "How can
learners be encouraged to become more effective learners?", the impact
of an interactive education strategy on radiography education was
explored. The above-mentioned question forms the essence of this
endeavour and the answer was searched for in the literature as well as in
the outcome of this study. This chapter is a discussion of the main findings
from both the literature and the research done. Salient points will be
argued and connections between the reviewed literature and the results of
the present study will be presented. Specific recommendations regarding
the potential use of the educational strategy, possibilities for further
research and the limitations of the study will receive attention.
As mentioned in Chapters 1 and 2, academic enablers (non-academic
skills which contribute to academic success) which influence academic
achievement include the entirety of intrinsic motivation, goal orientations,
social skills, as well as self-efficacy, to name but a few (Linnenbrink &
Pintrich 2002:313). Owing to the complex nature of academic competence
and the time constraint of academic schedules, the influence which
facilitators could have on the whole continuum of learners' academic
achievement is limited. However, considering the relevant literature which
suggests that instructional efforts could make a difference to learners'
85
academic competence, interactive instructions were considered to
promote academic achievement and were therefore investigated. The
concerns with regard to how valid and appropriate the findings are in
addressing the lack of academic success in the radiography programme,
will receive attention in the next paragraph.
5.2 VALIDITY OF THE STUDY
The remark "Educational research has recently been described as
unhelpful in answering real life questions", made by Jolly (2001 :920),
addresses not only the internal and external validity of this investigation,
but also questions the value or significance thereof in the intended
programme. Internal validity is defined by Jolly (2001:920) as the capacity
to be able to state explicitly that the effects demonstrated within the study
are ascribed to the manipulations made by the researcher and not existing
external factors, while the external validity is the "generalisability" of the
results of the educational research. To exclude these limitations, the
current experimental conditions, the intervention, as well as the pre-post
test control group approach to the study were therefore designed
specifically to represent teaching and learning patterns that mimic
everyday radiography education. This allowed the current investigator to
extrapolate findings to real life conditions and to see interactive instruction
as an effective education approach to improve academic success. The
study methodology that follows explains the approach to the study and
interprets the results in terms of the literature.
5.3 STUDY METHODOLOGY
Research in medical education is no longer in its early stages and, to a
large extent, it has added to the understanding of the learning process
86
(Norman 2002:1562). The study of the relevant literature covered in
Chapter 2 helped the researcher to develop an insight into factors
associated with learning and the literature further assisted in structuring
the study design described in Chapter 3. Kumar (2003:24), who states that
learners are in a position to judge instructional effectiveness, further
supports the course and outcome of the current experiment.
The approach to the present study was based on the remarks of Kumar
(2003:24) that the performance in examinations is the traditional test for
evaluating success in education. Although the author propagated an
objective measure for education effectiveness, it was not used in this
investigation. To validate the findings on interactive lecturing techniques,
only a questionnaire as a measure to assess learners' perception of the
approach was used. Kumar argued that performance was not used to
measure the effectiveness of the strategy because learners had different
abilities. To exclude performance as an objective measure on the grounds
of learners' diversity seemed irrelevant. The reasons for the specific
methods that were used during the investigation will be explained in the
following paragraphs and are supported by the literature.
5.3.1 The Learning Preference Inventory (LPI)
Anderson (2001:1) urges educators to realise the importance of learning
styles and to relate them to the diverse needs of learners. The author also
asks if instructional methods should be adjusted to accommodate learning
styles. The present study shows the importance thereof. The structured
interactive sessions included a combination of educational methods. It
could thus be argued that the variety in instruction used during the
intervention provided a preferred style of learning to the learners and, as a
result, led to the improved post-intervention test scores of the diverse
learners.
87
The outcome of the LPI as reported on in Chapter 4 is of notable value,
since the results thereof, the pre-test and the post intervention test scores,
as well as the questionnaire shared the same teacher-structured
interactive dominance. The results suggest that interventions aimed at
improving academic achievement need to address learners' learning
styles. Ferguson et al. (2002:955) capture the importance of learning
styles. They state: "Learning styles cover both motivation for learning and
the processes by which the student approaches the task of learning." The
authors also suggest that learning styles can be changed and that
educators should teach learners to use the most effective style.
It is thus recommended that knowledge of the learning style preferences of
learners, along with their implications for academic performance, may give
facilitators insight into teaching and learning approaches and thus allow
them to modify non-productive teaching methods and strengthen
beneficial ones.
5.3.2 Choice of content
The choice of content for the two themes used during the investigation, i.e.
the cranial and the facial bones, was carefully considered. The two themes
were different in content, but similar with regard to the quantity of
information; the level of difficulty; and the level of knowledge needed to
write the pre- and the post-intervention tests. The parallel content allowed
the comparisons which were made during the analysis of the data.
5.3.3 The division of groups
Since the aim of the OBET approach is self-directed and independent
learning the learners were divided into the formal lecture, self-activities,
and self-study groups. This division allowed the comparison between
learner-centred education and the more traditional approach to education,
which is the formal lecture. Learners' active involvement in the learning
process is seen by the NQF (2000) as a way to achieve academic
88
success, therefore the SIS intervention group allowed active learner
involvement and encourages independent learning.
5.3.4 The intervention
The researcher's preferences for methods of instruction during the
structured interactive sessions were counteracted in using the results from
the LPI to gather additional information to identify possible learning style
differences that might influence academic performance among learners. In
an attempt to improve the quality of educational research, Murray
(2002:111) claims that experimental interventions are complex and it is
often difficult to identify which component of the intervention is responsible
for which result. It is recognised that, since the interactive education
intervention explored in the current investigation was as complex as
indicated, no attempt was made to suggest any specific component in the
education strategy that led to the positive outcome observed.
Treloar, McCall, Rolfe, Pearson, Garvey, & Heathcote (2000:708) propose
that interventions aimed at enhancing academic achievement face the
challenge of providing optimal learning environments for learners from
diverse backgrounds. This investigation explored interactive education as
a potential strategy in reaching the ideal learning environment, since the
target group consisted of learners from diverse backgrounds. It is therefore
suggested that the multidimensional approach of the structured interactive
sessions addressed the variety of learning needs of the learners and
resulted in test score improvement. Kumar (2003:25), who claims that
stimulation through interactive education and motivation to learn is more
important for retention than intelligence, confirms the argument. Vaughn et
al. (2001 :39) also used a combination of various teaching approaches to
motivate learners with different learning styles to enhance and strengthen
the learning process. The authors found the multidimensional approach a
useful teaching-learning model.
89
It is understood that interactive education strategies rely on an
understanding of the theory of teaching, as well as knowledge of current
research on the effectiveness of instruction strategies - matters that were
searched for in the literature (see Chapter 1). The pedagogic shift from
teacher to learner is widely propagated in educational literature (see
Chapters 1 and 2). However, no clear distinctions were made in the
literature as to exactly which strategy would be ideal to make the shift.
Learner-centred or self-directed strategies, which have been developed,
include problem-based learning; resource-based learning; task-based
learning; reflective learning; and autonomous learning. From the
perspectives gained in the present study, it is suggested that a
combination rather than only one strategy be used to optimise learning.
Vaughn et al. (2001 :43) explored a strategy in which their aim was to
address learning style preferences. The authors state that the success of
such a strategy depends on the educators' sensitivity to learners' individual
learning style preferences; their ability to assist learners in identifying their
learning strengths and weaknesses; and to use a variety of teaching
methods to help learners to reach their academic goals. A variety of
opportunities should therefore be available to the learners to address their
individual differences, as noted in paragraph 5.3.1. In other words, a
mixed approach could best benefit the diverse learner population. A
learning guide is seen as a potential tool that structures this combined
educational approach. A brief discussion of the use and value thereof
follows.
5.3.5 The learning guide
The learners in the current study reported that the learning guide helped
them to plan and structure their learning and they also see it as an
important source of knowledge. The importance of the learning guide is
put forward by Spencer and Jordan (1999:1282). They see the learning
guide as the main tool by which facilitators could support self-directed
90
learning and, at the same time, ensure active involvement of learners. A
point of view shared by the current researcher is that the learning guide as
a structured medium facilitates learning. It is designed to direct learners
through a series of learning activities to achieve specified outcomes
(Harden et al. 1999:248). The learning guide is therefore seen as an
important education strategy to structure both the process of learning and
the approach to teaching, since it forces both the learner and the facilitator
to stay active in the teaching-learning process. The shift from a teacher-
centred to a learner-centred approach to education requires that learners
become more accountable for their own learning (TFS 2003:1). Since the
learners in the radiography programme needed direction and support with
this approach, the learner guide had an important function to fulfil (Harden
et al. 1999:249).
5.3.6 The pre- and the post-intervention tests
Objective test questions and answers in the pre- and the post-intervention
tests ruled out variations associated with the observer. The questions did,
however, not address the higher cognitive levels of analysis, synthesis and
evaluation, which made the pre-post test evaluations more objective.
Although objectivity was reached, the content lends itself to the
assessment of knowledge retention only.
5.3.7 The questionnaire
It was clear that the majority of the learners had gained more learning
experience in this interactive education approach than through traditional
classroom teaching. Results obtained from the questionnaire showed that
individuals were receptive to this method of instruction and found these
interactions to be good at stimulating their learning interest.
As a measuring tool, the questionnaire served its purpose in identifying
areas which the learners found to be enhancers or constraints to learning.
The outcome thereof, however, only allowed for quantitative and not
91
qualitative results. Including open-ended questions or interviews in the
measure could have improved the validity of the questionnaire as a
research tool. The questionnaire items also forced the learners to focus
only on those factors included in the questionnaire as potential enablers or
constraints to learning.
5.4 LIMITATIONS OF THE STUDY
The investigation was largely successful in achieving its overall goal and
supporting the goal of the academic institution, which is to promote and
enhance educational (teaching and learning) success and development
with a view to maintaining and promoting the quality of education and
training. The intervention, using quantitative methods, helped in the
collection of useful information on how teaching and learning could be
improved. However, a number of limitations must be considered in
interpreting the results of the study. First, the study was restricted to
performance in a controlled test situation. Second, the small sample size -
which was a convenience sample - and the fact that learners from one
programme were used, limited the claim that these findings could be
representative of other settings. A larger and more diverse sample would
have provided a more widely applicable measurement for academic
improvement. Third, the results reported here are based on a single
intervention. It is possible that a different approach covering different
content would have yielded different results.
The pre- and the post-intervention test measurement of gain in knowledge
may be acceptable for a targeted intervention, but when the aim of an
educational intervention is to assess attitude, behaviour or the acquisition
of skills, this approach is too simplistic (see paragraph 5.3.6). The positive
outcome of the investigation is also only relevant on the level of the
intervention and extensive application of the interactive strategy alone
92
could prove whether the intervention had the potential to benefit the
radiography learning programme as such.
A further limitation to the current empirical study regarding the impact of an
interactive education strategy is that the investigation primarily explored
the contribution of only interactive education on learning, rather than
combinations of factors enhancing or hindering academic achievement.
Murray (2002:111) emphasises that, in order to evaluate complex
interventions in medical education, both quantitative and qualitative
approaches are essential. Although the current investigation made use of
both a pre-post test model and a questionnaire to evaluate improvement
and perception of the intervention, the questionnaire did not allow for
qualitative results mentioned in paragraph 5.3.7. This is seen as a limiting
factor, since it resulted in both the measurements (test results and
perceptions) being quantitative. It is therefore recommended that future
studies in this area should allow for the inclusion of qualitative measures to
improve the validity of research and uphold the value thereof. In future, a
combination of methods, including both open-ended questions and
interviews, would offer a better approach.
The likelihood of a "Hawthorne effect" is high. Since the learners knew that
the test scores were used to make a comparison, they might have put in
more effort to perform. Despite these limitations, the information gained
from the study suggests how learners learn and what they perceive as
possible factors that can improve their marks. Wilkes and Bligh (1999:
1271) claim that, if one knows how learners learn, it is as meaningful as
what they learn and that realising how they learn can contribute much to
enhancing what they learn. Learning being the core of the current
investigation was thus elucidated.
Over and above the limitations mentioned, the results of this investigation
yield a number of interesting findings of relevance to radiography
93
educators: First, learners are still dependent on facilitator guidance and
expect facilitators to structure the learning process. Second, since the
learners who had participated in this investigation were from diverse
settings, the mixed approach of the structured interactive sessions
accommodated the diversity in learning styles in some way or another.
5.5 FINDINGS
Interactive education will neither eliminate the poor throughput rates
experienced in radiography education, nor will it be perfect, but this
method of teaching has a number of apparent strengths. The traditional
format of one-ta-one teaching is retained, while the facilitator has the
opportunity to participate actively in defining activities and questions. From
the available evidence, the importance thereof was explicit in the findings
of the learners' perception and expectation demonstrated in the results
from the questionnaire. Of the 30 learners, 93.3% (n=28) indicated that the
"Lecture interactive activities in class" was their preferred method of
teaching. The role of the lecturer was seen as the promoter of interaction
during lectures and 24 out of 30 learners (80.0%) stated that active lecture
participation positively influenced their marks (see lecture interactive
activities, to promote interaction during formal lectures and lecture
participation influence marks, in Chapter 4, paragraphs 4.7.1 and 4.7.2).
Radiography learners are used to a rigid didactic teaching structure and it
is likely that their lack of willingness to take part independently in self-study
and self-activities reflected unfamiliarity and anxiety as far as this teaching
approach was concerned.
That the lecture has a place in radiography education is certain, since
learners in radiography are still dependent on lecturer guidance, as is
evident from the LPI and the questionnaire results. As a result of previous
reports from the literature, the future of the traditional lecture was a matter
94
of concern. Morrison (2001 :7) states that, in the days when university
classes contained highly selected learners, the traditional lecture
appeared to be successful, but at present, with a more diversified learner
population, many learners seem unable to cope. Minton (1998:399)
supports this notion by indicating that formal lectures were effective in an
era when fewer learners were selected; where the learners were of a more
homogeneous nature; and small classes ensured adequate contact
between learners and their lecturers. It was thus expected that the
traditional didactic lecture in the current investigation would come forth as
being perceived as the least effective teaching/learning tool when
compared with other methods used in the study.
However, what is noteworthy, is that the formal lecture is popular and was
perceived as being effective. The majority of the learners indicated that the
tradition of the lecture was acceptable and it was seen as an effective
learning mechanism if the learner was actively engaged. These responses
were consistent with the frequent verbal comments offered by the learners
throughout the study, expressing uncertainty about the self-activities and
independent self-study. The feeling of uncertainty was generally
associated with a sense of doubt that they would not adequately interpret
the learning content and they missed the reinforcement of the lecturer
being active in the teaching process. Thus the learners were more
comfortable with the traditional lecture format than with the independent
self-activities and self-study as teaching methods to increase academic
performance, but lecture involvement in interactive class activities was
their method of choice. The variations on the lecture format are merited.
Butler (1992:15) supports this view by suggesting that the "mixed" lecture
can be stimulating, inspiring and an effective learning instrument.
The results of the three measures, i.e. the LPI, the questionnaire, and the
pre-post test model used in the intervention, shared a prevalent important
component, namely the significant role of the facilitator. The LPI results
95
demonstrated dominance in preference for a teacher-structured learning
environment (see Chapter 4, paragraph 4.3). The aforementioned fact is
confirmed by the distribution of test scores in the pre-test indicating that
the groups with no facilitator guidance had lower test marks than the group
who had received formal lectures (see Chapter 4, paragraph 4.4). The
learners' perception and experiences verified preference for facilitator
guided activities in class (see Chapter 4, paragraphs 4.7.1 and 4.7.2). This
phenomenon affirms the findings of Treloar et al. (2000:708) in their
research on the factors affecting progress in medical schools. They claim
that problem-based learning, which promotes independent learning
through group and self-directed learning, may be unsuited for diverse
learners, because they rely on verbal interaction and group interactive
learning. These learners reported that a lack of guidance resulted in
anxiety, inefficiency in learning, and gaps in knowledge.
The previous comment emphasises the need of learners that facilitators
should be an integral part of the learning process and that a shift from
lecturer to learner as proclaimed by the literature is not a paradigm easily
reached. This observation could explain the learners' incapability or
unwillingness to act as independent learners in the radiography learning
programme stated in Chapter 1.
5.6 RECOMMENDATIONS
The present study is an exploratory, quantitative investigation that does
not claim to be representative of other settings. The intention of the study
was to explore an interactive education strategy to enhance learning and
therefore academic achievement. The process of learning is complex - as
mentioned in Chapter 2 - with many variables, for example academic
ability, self-regulation, self-efficacy, motivation approaches to learning,
study skills and learning style preference, to mention but a few. Therefore,
96
the findings cannot be made applicable to other settings. Studies involving
larger cohorts of learners from both experimental and control groups to
assess the impact of an interactive intervention on learners' learning
should be pursued to substantiate the findings of this study. However,
extended studies could rouse ethical concerns on offering all learners
equal access to a potentially beneficial educational strategy.
The study was limited in that it relied only on learners' feedback in the form
of tests and a questionnaire. Further research could test the effectiveness
of the intervention (SIS) in improving learners' academic performance,
relying on a direct analysis of the quality of learning using a pre- and a
post-intervention test, randomised control group design. However, issues
of treatment conformity and ethical concerns about providing all learners
equal access to a potentially beneficial educational approach would
complicate such a study.
Learners could, in addition, be asked to individually make a list of criteria
(or a model) of factors that improve learning before and after the
intervention to determine whether they were able to identify a wider range
(or more refined set) of criteria as a result of the intervention. This
approach would also allow for closer inspection of the way that learners
think about interactive learning and, could therefore simultaneously
enhance the educational value of the intervention while gathering research
data. Finally, learners' ratings of the value of the educational strategy
could be obtained through a brief interview which could add a qualitative
outcome to the study and, as a result, improve the validity of the study.
Possible areas for future research include replicating these results to verify
the validity and investigations on interventions for learners who fail to
succeed academically. The researcher, however, suggests that the choice
of teaching must continue to be based on the union between learning unit
goals and learners' needs.
97
5.7 IMPLICATIONS OF THE RESEARCH STUDY
The results from this study will assist the institution to modify the learning
environment to foster desirable approaches to learning that will enhance
academic achievement. Interactive learning may not be ideal as the only
instrument to enhance academic performance, yet it could still be a
valuable educational tool when used in combination with other teaching
techniques. A further long-term effect of this interactive approach to
teaching is that learner radiographers are guided towards autonomous
learning. Autonomous learning is the first step to lifelong learning, a
responsibility that heavily depends on the practising radiographers'
responsibility to take part in and take advantage of mandatory continuous
professional development (CPO).
It is realised that much thought is still needed as to which of the many
learner-centred approaches should be adopted; how they can be
implemented in different settings; and what resources and staff are
needed to support the strategy. The main implication of accepting
structured interactive sessions as a general mechanism for improving
learners' learning is the increase in preparation time. Since each learner
receives three to six sheets of paper for the learning guide containing the
interactive activities for each session, the interactive educational approach
also has higher cost implications than the formal lecture approach.
This study offers a preliminary description of and reflection on an
educational strategy conducted with learners to enhance academic
performance. This activity suggests one way to "scaffold" learners' ability
to manage their own learning, a vital aspect of learner-centred learning.
Further research could focus on other educational methods of enhancing
learning. Such descriptive reports, even at preliminary stages, may be
useful to facilitators and others who work with diverse learner populations.
98
5.8 SUMMATIVE PERSPECTIVE OF THE RESEARCH STUDY
The research that was undertaken mainly concentrated on improving
academic achievement. The factors associated with academic
achievement received attention and the predictive power and/or value of
these factors with regard to academic success were derived from a
comprehensive study of the literature. The interconnection between these
factors also became clear, since authors - as mentioned in Chapters 1 and
2 - who had investigated specific causes for underachievement, identified
this interdependence. Motivation is seen as the most dominant factor in all
of the factors described, since it is perceived as more important than
cognitive ability to improve retention of knowledge. In addition, motivated
learners tend to be more self-efficient and self-regulated; they have a deep
and strategic approach to learning; and also use more effective study skills
while motivation furthermore plays a significant role in the use of effective
learning and study strategies.
An optimal educational strategy being the core of the study therefore
should first of all address motivation. Structured interactive sessions (SIS),
which imply that both the facilitator and the learner are active in the
learning process, construct a platform to motivate learners. This
educational approach also scaffolds the process of effective learning
through a teacher-structured instruction design and a concrete approach
to teaching. Additionally, learning assessment through self-evaluation and
self-reflection is also a potential enhancer of motivation. Allowing
integration in the curriculum and, finally, accommodating learner diversity
in the curriculum design furthermore sets the stage for academic success
(see Figure 5.1).
99
Figure: 5.1: Summative perspective of the research study
~
ACADEMIC ACHIEVEMENT .
-..+.. "
Factors associated with academic achievement
•
I t + t _iCog.n.itive ~ .. I Self- I Study ... .. Learning Iability I"" ""I efficacy I skills I'" ....1 style• + ~~
,
EFFECTIVE LEARN!! ~G ~
a .... ~ ,,~
I .... ~
Self-regulation Learning approach
! ! ~.._t_ ~t __y
Self-regulated Self-reflection Deep Surface Strategic
learning strategies on learning approach approach approach
I Motivation.... ,... I
«. .... Ii" "
Instr±'tion Te~a·.c.IOg1+ =0/ Le~.n9 w currtlum ,approach assess.ment de,si.gn ,defQ:mió' :ij'
Didactic versus Concrete approach
..• Self-evaluation and
Address
learner-centred to instruction self-reflection diversity
..1111 ~ M:
,
,
I Facilitator L Structured
...-
.1 Learner
'1nteractive SeSfion; Ii' ~:;:
:li bplii ~
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;:::i: EDUCATION'~ STRATEGY
.'.~.'
*~ ÁCADEMftl~UCCESS% .. ~~ . fillW:~ ill ~~;% s-
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100
The aforementioned findings therefore propose that an educational
intervention, designed to improve academic achievement, should involve
interactive lectures that encourage active learning; increase attention and
motivation; give feedback to the teacher and the learner; and increase
satisfaction for both (Steinert & Snell 1999:37).
In addition to using different educational approaches to facilitate the
learning process, the intervention provides the following advantages:
1. By combining different educational strategies to facilitate the
learning process, the intervention can be used as an interactive
educational model that provides a theoretical base for radiography
education, since learners generate the information themselves in
response to the activities.
2. It further gives the learners the opportunity for self-discovery, which
leads to a motivation to learn.
3. The group activities promote cooperative learning, an approach that
facilitates teamwork in the profession.
4. This interactive approach results in "deep" rather than rote learning
since the learner - through active involvement - generates
information.
5.9 CONCLUSION
The overall goal of the study was to make a contribution towards
optimising the effectiveness of education and training in the radiography
programme in the School of Health Technology at the Technikon Free
State. The information collected was used to develop an educational
strategy which will enable learners from diverse backgrounds to improve
their academic performance. Since there is a lack of research evidence on
101
the extent and effectiveness of interactive instruction in radiography
education, the problem statement of the study seems important and the
results presented in this study suggest that the majority of learners in the
target group experienced educational benefits.
Higher education in South Africa has been forced to respond to the
massification of education (Makoni 2000:98). This resulted in the
increased access of previously disadvantaged learners to the TFS. As
mentioned in Chapter 2, moving away from the didactic teacher-student
model is claimed by various educational researchers to be the way forward
in addressing the access-success imbalance mentioned by Minister Kader
Asmal in February 2003 who stated that the majority of learners who
enrolled at tertiary institutions in South Africa did not graduate. The draft
planning document of the APBC of the TFS, submitted in April 2003 (TFS
2003:1), claims that the key to learning improvement is embedded in the
engagement of learners in active and collaborative learning experiences.
This productive interaction between learners and facilitators extends
educational events which promote academic achievement. This
commentary in the document supports the importance of the effect and
results of the current investigation, since it promotes the fundamental
principle on which the aim, goal and design were based.
The TFS claims that a "superior learner-centred educational environment",
determined by the productive interaction between learners and academic
staff, should be the future approach to teaching and learning. The current
study already explored the potential benefits thereof in 2002 and the
findings are therefore in accord with the trend that learning rather than
instruction should be "at the heart of higher education". The approach
urged by Barr and Tagg (1995:13) that educational institutions exist not to
give instruction, but to produce learning, is therefore merited. The authors
state that, in an instruction paradigm, a specific methodology determines
102
the limitation of what educators can do in contrast to the learning paradigm
where learner learning and achievement set the limit.
Since OBET places increased demands on learner-centred learning and
learner independence where it is expected from the learner to be more
self-regulated, self-regulation has come forward as a key variable to shed
light on academic achievement. The theories and processes of self-
regulation were made known qualitatively and evaluated quantitatively.
They were found to be highly predictive of academic motivation and
achievement (Zimmerman 1998:84). From the perspectives gained in the
investigation, it is concluded that, although active learner participation is
valued to solve academic failure, the findings of the study also suggest
that a shift from facilitator to learner could not be reached easily. This fact
was mentioned in Chapter 1, namely that learners from diverse and
academically deprived backgrounds require more support and
encouragement in taking advantage of active learning and teacher support
(Holsgrove et al. 1999:99) - a fact also noted by the CTM (2001b:15):
"Learners might initially require more support and consultation
opportunities before they master self-directed learning".
The aim of the study was to explore the impact of an interactive education
strategy in radiography education, measured by summative assessment
and learner perception. In reaching the aim and objectives, the intervention
is considered to have a positive outcome derived from the results of the
current investigation. As a result, this interactive approach according to
which the facilitator and the learner actively take part in the learning
process, rather than just a learner-centred approach to education, was
found to be of value. It should thus be pursued in the future. These results
could also have application to other learning programmes, particularly
those that face the challenge of providing an optimal learning environment
for learners from diverse backgrounds.
103
Increased access to higher education to address equity is a major
objective of the NPHE (RSA MoE 2001). This increased access
necessitated more flexible entry requirements to admit previously
disadvantaged learners. These learners are, however, inadequately
prepared for higher education. According to McLean (2001 :408) past
political and historical factors are responsible for the fact that these
learners are under prepared and, as a result, their academic development
is obstruct. The South African Universities Vice-Chancellors' Association
(SAUVCA) insists that institutions take this into account in teaching and
learning (SAUVCA 2002:6). Therefore the mere expansion of access to
higher education must be broadened to embrace the idea of access to
academic success.
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118
APPENDICES
119
A. MEASUREMENT
120
APPENDIX I
Learning Preference Inventory (LPI)
(Rezier 1974: 101)
APPENDIX I
LEARNING PREFERENCE INVENTORY (LPI)
Rezler (1974:101)
This inventory gives you the chance to indicate those conditions or situations which
most facilitate your learning (improve your marks). It is not a test; there are no right or
wrong answers. The aim of the Inventory is to describe how you learn, not to evaluate
your learning ability.
The Inventory has two parts.
In Part I there are six sets of six words listed.
In Part II there are nine items each of which contain six statements.
Instructions for answering Part I
Record all of your answers on the Answer Sheet for Part I
Read all six words carefully in Column A and rank order them.
Write 6 for the word in Column A that best promotes your learning; write 5 for the word
that promotes learning the next best, and so on, until you write 1 for the word that
promotes learning the least of all.
Be sure to assign a different rank to each of the six words in Column A and continue
the same procedure for the remaining column until all words are ranked.
The following example illustrates the ranking procedure:
Rank the following colours in the order in which you prefer them:
Column A
a. Yellow
b. Green
c. Blue
d. Red
e. White
f. Black
Answer sheet:
Column A
a. .6
b. 3
c. ~
d. 5
e. 2
f. 1
You are to rank the responses and mark answers to each word in Part I
(Columns A through F) in the same way.
Rank each word; please do not omit any.
Be sure to assign a different rank to each of the six words in each column.
LEARNING STYLE INVENTORY Part I
Promotes learning most for you 6.
Promotes learning second-best 5.
Promotes learning third-best 4.
Promotes learning fourth-best 3.
Promotes learning fifth-best 2.
Promotes learning least for you 1.
ColumnA Column S Column C
a. Factual a. Self-instructional a. Sharing_
b. Teacher-directed b. Myself b. Doin_9_
c. Teamwork c. Hypothetical c. Guided
d. Reading d. Interpersonal d. Self-initiated
e. Self-evaluation e. Teacher defined e. Thinking
f. Theoretical f. Practical f. Solitary
Column .D. Column E Col.umn F
a. Teacher structured a. Scientific a. Individual
b. Concrete b. Assigned b. Applied
c. Writing c. Skill-oriented c. Supervised
d. Reading d. Personal d. Autonomous
e. Group e. Self-designed e. Abstract
f. Self-directed f. Team-oriented f. Interactive
Colum'n"A "" .es-!:,. # ColumnS . '0 i:ColurT\" C;_ ..£
(26) a. (32) a. (38) a.
(27) b. (33) b. (39) b.
(28) c. (34) c. (40) c.
(29) d. (34) d. (41) d.
(30) e. (35) e. (42) e.
(31) f. (36) f. (43) f.
(44) I-a_-.------I (50) a. (56) a.1------1 t-------i
(45) I-b_-.------I (51)t-b_.----I (57)t-b_.__ --I
(46) I-c_-.------I (52) I-c_-.------I (58) I-c_-.---I
(47) I-d_-.------I (53)t-d_.__ --I (59) d.t-------t
(48) e. (54) e. (60) e.
I-------f I-------f I-:------i
(49) f. (55) f. (61) f.
LEARNING STYLE INVENTORY PART II
6 = Promotes learning most for you
5 = Promotes learning second-best
4 = Promotes learning third-best
3 = Promotes learning fourth-best
2 = Promotes learning fifth-best
1 = Promotes learning least for you
1. Read the following six statements and then rank them in terms of how
well they describe the teachers in whose classes you have done the best.
a. The teacher gave many practical, concrete examples.
b. The teacher let me set my own goals and try different approaches
to reach them.
c. The teacher encouraged me to work by myself.
d. The teacher was friendly and outgoing.
e. The teacher made the relationships between different thoughts clear.
f. The teacher made clear and definite assignments,
and I knew exactly what was expected.
12. Number the fOllowing work in the:order in which they would interest you.
a. Work that would require cooperation among team members.
b. Work with specific and practical ways of handling things.
c. Work that would let me do things on my own.
d. Work that would permit me to deal with ideas rather than things.
e. Work that I could plan and organise myself.
f. Work that would be clearly defined and specified by my supervisor.
3. Rank the following in terms of thiir effects on how hard you work and how
much you accomplish in a class. ,\
a. I can set my own goals and proceed accordingly.
b. I can address myself to a concrete, practical task.
c. I have an opportunity to discuss or work on something with other students.
d. I can examine different schools of thought.
e. I understand what is expected and how it will be evaluated.
f. I can accomplish most tasks by myself.
4. The evaluatlon of student performance is a part of nearly all courses.
Rank the following in terms of how you feel about such evaluation.
a. It should be assembled from questions provided by students.
b. It should focus on individual performance.
c. It should consist of a written examination dealing with written concepts.
d. It should consist of a practical examination dealing with skills.
e. It should be consistent with clearly specified requirements.
f. It should not interfere with relationships between teacher and student.
5. Rank the following in terms of their general value to you as
ways to learn.
a. Study a textbook.
b. Engage in an internship or practicum.
c. Prepare a class project with other students.
d. Search for reasons to explain occurrences.
e. Follow an outline prepared by the teacher.
f. Prepare your own outline.
6. Rank the following in terms of how much they would attract
you to an elective class.
a. Good personal relationships between teacher and students.
b. Clearly spelled-out standards and requirements.
c. Emphasis on practising skills.
d. Emphasis on individual study.
e. Opportunity to determine own activities.
f. Emphasis on theoretical concepts.
7. Consider the following in terms of their general effect on how well
you do in a class.
a. I can study on my own.
b. I can work with something tangible.
c. I can focus on ideas and concepts.
d. I can organise things my own way.
e. I can work with others.
f. I can work on clear-cut assignments.
8. Rank the'foUowing in the order in whic~ you think tea.chers should
posse,s these characteristics-or skills:~\ WiP tllF
a. Getting students to set their own goals.
b. Getting students to demonstrate concrete skills.
c. Involving students in generating hypotheses.
d. Preparing of self-instructional materials.
e. Relating well to students.
f. Planning all aspects of courses and learning activities.
9. Rank the'fQUo'wing in terms of how much they generaHy help you
learn and4rf)member. Cl~::1~1~ y: W<
a. Studying alone instead of studying with fellow-students.
b. Performing a specific task.
c. Having a knowledgeable teacher discuss the theory upon which
a practice is built.
d. Determining your own approach and proceeding accordingly.
e. Joining a student group to study together and share ideas.
f. Getting an outline of the course from the teacher and a clear
understanding of what will occur in the course
LEARNING STYLE INVENTORY ANSWER Sheet PART II
Item 1 Item2 Item 3
(26) a. (32) a. (38) a.
(27) b. (33) b. (39) b.
(28) c. (34) c. (40) c.
(29) d. (35) d. (41) d.
(30) e. (36) e. (42) e.
(31) f. (37) f. (43) f.
Item4 Item 5 ItemS
(44) a. (50) a. (56) a.
(45) b. (51) b. (57) b
(46) c. (52) c. (58) c.
(47) d. (53) d. (59) d.
(48) e. (54) e. (60) e.
(49) f. (55) f. (61) f.
Item7 ItemS Item9
(62) a. (68) a. (74) a
(63) b. (69) b. (75) b
(64) c. (70) c. (76) c.
(65) d. (71) d. (77) d.
(66) e. (72) e. (78) e.
(67) f. (73) f. (79) f.
SUMMARY SHEET
Use this page to summarise your scores.
Each of the numbers in Parts I and II below corresponds to items in
the Questionnaire. For each item, write the rank (from 1-6).
After filling in your ranks, total them separately for Parts I and II.
At the bottom of the page, combine the totals of both parts. To check the
accuracy of your calculations, the bottom total of 6 columns should be 315.
PARTI
AB CO TS SS lP IN
(31 ) (26) (27) (30) (28) (29)
(34) (37) (36) (32) (35) (33)
(42) (39) (40) (41 ) (38) (43)
(48) (45) (44) (49) (47) (46)
(50) (52) (51 ) (54) (55) (53)
(60) (57) (58) (59) (61 ) (56)
Part I
Subtotal: 1..._._ ~ __ ~ __ __,, __ __,, __ ----&__ ___. = 126
PART II
AB CO TS SS lP IN
(30) (26) (31 ) (27) (29) (28)
(35) (33) (37) (36) (32) (34)
(41 ) (39) (42) (38) (40) (43)
(46) (47) (48) (44) (49) (45)
(53) (51 ) (54) (55) (52) (50)
(61 ) (58) (57) (60) (56) (59)
(64) (63) (67) (65) (66) (62)
(70) (69) (73) (68) (72) (71 )
(76) (75) (79) (77) (78) (74)
Part "
Subtotal: I = 189
TOTALS:~----~----~----~--~~--~----~
.__----~------------~----------------~= 315
Description of categories:
Abstract (AB): preference for learning theories, general principles,
concepts, and generating hypotheses.
Concrete (CO): Preference for learning tangible, specific, practical
tasks and skills.
Teacher-structured (TS): Preference for well-organised, teacher-directed
classes with clear expectations, assignments, and goals defined
by the teacher.
Student-structured (SS): Preference for learner-generated tasks,
autonomy and self-direction.
Interpersonal (lP): Preference for learning or working with others;
emphasis on harmonious relations between students and teacher
and among students.
Individual (IN): Preference for learning or working alone, with emphasis
on self-reliance and tasks which are solitary, such as reading.
121
APPENDIX II
Pre-Intervention test
(Bontrager 1993:237)
APPENDIX II
PRE-INTERVENTION TEST
SKEDELISKULL
SKOOL vir GESONDHEIDSTEGNOLOGIE
SCHOOL of HEAL TH TECHNOLOGY
ONDERRIGPROGRAM: Radiografie
VAK: Radiografiese Praktyk II
KODE: RAD 20 at
INSTRUCTIONAL PROGRAMME: Radiography
SUBJECT: Radiographic Practice
CODE: RAD 20 at
DOSENT/LECTURER: S.M.Brussow
DATUM/DATE: 2002-05-17
TYD/DURATION: 120 min.
MAKSIMUM PUNTE/MAXIMUM MARKS: 142
INSTRUKSIES/INSTRUCTIONS: Beantwoord al die vrae/ Answer
aI/ the questions
Naam/Name: _
Student Nr.: _
1. The calvarium is formed primarily by the following four cranial
bones:
A.
B.
C.
D.
2. The following four cranial bones primarily make up the "floor" of the
cranium:
E.
F.
G.
H. 8
Matching: (You may indicate more than one choice)
3. Auricle A. Gonion
4. External occipital protuberance B. Nasion
5. Prominence between eyebrows C. TEA
6. Centre of triangle of chin D. Infraorbital margin
7 Groove above eyebrows E. Pinna
8. Depression at bridge of nose F. Supraorbital groove
9. Top of ear attachment G. Acanthion
10. Medial junction of eyelids near nose H. EAM
11. Superior rim of orbit I. Inion
12. External landmark-petrous ridge J. Vertex
13. Inferior rim of orbit K. Inner canthus
14. Midline of junction of upper lip-nose L. Supraorbital margin
15. Lateral portion of orbital rim M. Mental point
16. Landmark-highest level of facial bones N. Infraorbitomeatal line
External landmark corresponding to
17. O.Orbitomeatalline
highest level of facial bone mass
18. Reid's base line P. Glabella
19. Line between outer canthus and EAM
20. Most superior portion of cranium
21. Bump at lower posterior cranium
22. External landmark-floor of cranium
20
Matching: (Match the following with the correct cranial bone)
23. Lies primarily under floor of cranium Temporals (T)
24. Houses organs of hearing Parietals (P)
25. Crista galli Frontal (F)
26. Styloid process Occipital (0)
27. Sella turcica Sphenoid (S)
28. Inion Ethmoid (E)
29. Mastoid process
30. Dorsum sellae
31. Pterygoid process
32. Zygomatic process
33. Labyrinths
34. EAM
35. Perpendicular plate
36. Turbinates
37. Foramen magnum
38. Cribirorm plate
39. Orbital plate
40. Lesser wing
41. Glabella
42. Petrous pyramids
43. Clivus
44. Lateral conylar portions
45. Foramen rotundum, ovale and spinosum
23
46. Fill in the following according to the drawings:
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
Q.
R.
S.
Fig. 11·8
T.
u.
v.
W.
X. 24
47. Indicate the number of adjoining cranial bones with which each of
the following bones articulate:
A. Frontal C. Occipital E. Sphenoid
B. Each parietal D. Each temporal F. Ethmoid
48. Complete the following for the correct shape classifications and the
degrees of angle between the petrous pyramids and the midsagittal
plane:
A. Average shaped head (a) (b) __ degrees.
B. Long narrow head (a) (b) __ degrees.
C. Short broad head (a) (b) __ degrees.
49. Describe how you would locate the sella turcica from external
landmarks
50. What are the two lines or planes which should be checked carefully
to insure a true lateral skull position?
A.
B.
51. List the additional terms commonly used to describe the following
projections of the skull:
A. PA, 15 caudal angle _
B. AP axial ---------------------
C. Basilar _
52. Describe how to locate the correct central ray location for a lateral
skull if the entire cranium is to be centred to the film.
53. How can a person determine by critiquing radiographs if the correct
angle of the central ray was used for the following projections of the
cranium:
A. Pa Caldwell? ----------------------------------
B. AP axial for sella turcica (30 caudal to IOML)? __
C. AP axial for sella turcica (37 caudal to IOML)? __
D. Submentovertex? _
54. For an AP axial (Towne) projection as part of a routine skull series,
which line of the skull should be perpendicular to the film if:
A. A 30 caudal angle is used? __
B. A 37 caudal angle is used? __
55. On a submentovertex projection, the __
line must be parallel to the plane of the film.
56. List the structures best demonstrated on the following cranial
projections:
A. Submentovertex -------------------------------
B. AP axial (30°) _
57. Which two projections best demonstrate the petrous pyramids
(ridges)?
A.
B.
58. What single projection best demonstrates the sella turcica and
clivus?
59. Which projection best demonstrates the internal auditory canals?
32
60. Label the following radiographs:
II
III IV
35
122
APPENDIX III
Post-intervention test
(Bontrager 1993:261 )
APPENDIX III
POST-INTERVENTION TEST
GESIGSBENE/FACIAL BONES
SKOOL vir GESONDHEIDSTEGNOLOGIE
SCHOOL of HEAL TH TECHNOLOGY
ONDERRIGPROGRAM: Radiografie
VAK: Radiografiese Praktyk II
KODE: RAD 20 at
INSTRUCTIONAL PROGRAMME: Radiography
SUBJECT: Radiographic Practice
CODE: RAD 20 at
DOSENT/LECTURER: S.M.Brussow
DATUM/DATE: 2002-05-17
TYDIDURATION: 120 min.
MAKSIMUM PUNTE/MAXIMUM MARKS: 157
INSTRUKSIES/INSTRUCTIONS: Beantwoord al die vrae/ Answer
all the questions
Naam/Name: _
Student Nr.: _
A.
1. Identify the labelled anatomy and list the name of which bone it is
part where indicated
Anatomical part Facial/Cranial bone
A.
B.
C.
D. L
E. K
F. J
G.
H
H. G
I.
F
J.
K.
L.
2. Fill in the names of the three openings of the orbits.
A.
B.
C.
3. The small root of bone forming the lateral wall of the optic canal,
important in radiology, is the _
A. Maxillae
B. Zygomatic bones
C. Lacrimal bones
D. Nasal bones
E. Mandible
F. Vomer
G. Palatine bones
H. Inferior nasal conchae
Matching: Match the correct facial bone(s) for the following:
4. bony nasal septum
5. frontal process
6. nasion
7. maxillary sinuses
8. form the three facial cavities
9. alveolar process
10. zygomatic process
11. malar bones
12. largest immovable bone
13. tear ducts
14. palatine processes
15. zygomatic arches
16. largest facial bone
17. anterior hard palate
18. posterior hard palate
19. turbinates
20. anterior nasal spine
21. coronoid process
22. The two common types of fractures involving the orbits are:
A.
B. 21
23. Identify the names of the bones and the openings as labelled on
this drawing of the orbit.
A.
B C
B.
c.
E
D. A
E.
F
F.
G.
G
H.
H
I. Medial Laleral
J.
K.
24. Which two structures make up the bony nasal septum?
A.
B.
25. What is the name of the projection describing the PA Waters
position? _
26. What anatomical part is best demonstrated on the following?
A. Waters -----------
B. Modified Waters
C. Rhese position _
27. Which two anatomical parts or areas should be superimposed in an
optimal modified parietoacanthial projection? (a) and
(b). _
28. Which two anatomical parts or areas should be superimposed in an
optimal Waters position? (a) and (b) _
29. List the name of the position taken in place of the Waters for the
patient with possible spinal injuries who cannot be turned prone,
and describe how it would be done -------
30. How can rotation be determined on a radiograph taken in either the
Waters or modified Waters positions? 23
31. List the degrees of angle between the orbitomeatal line and the
plane of the film for:
A. Waters position degrees
B. Modified Waters position degrees
32. For an oblique axial position for the right zygomatic arch, the __
line is perpendicular to the central ray and the head is rotated
__ degrees towards the affected side.
33. Complete the following for the special projection to demonstrate the
optic foramina as demonstrated by the drawings in Figs.12-9 and
12-10.
A. The correct name for this projection.
B. The popular common name for this projection.
C. As a starting reference position, name the three "points"
which should be touching the table. __ , __ and __
Fill in the correct angles from the following drawings:
D. degrees
E. degrees
0
Fig. 12-9
C.R.
F. degrees ,
I
G. degrees ,I
G
Fig. 12-10
H. Name the positioning line that is parallel to the central ray.
I. The position demonstrated in Fig. 12-9 will demonstrate the
(a) _ (RIL) optic foramen within the (b) _Quadrant of the
orbit.
34. A good submentovertex projection requires that the central ray be
at right angles to the line. 17
35. Complete the following for an AP axial projection (Townes) for the
zygomatic arches:
A. Central ray should enter head at _
B. Tuck the patient's chin, bringing the --- line
perpendicular to the film.
C. The central ray should be angled __ degrees __
(caudal or cephalad).
36. The correct central ray for a reverse Waters is to the _
37. In a Waters position, the line should be perpendicular to
the plane of the film.
38. A. The triangular area of the mandible projecting anteriorly
is called the ------
B. The centre of this triangle is the _
39. The (a) of the mandible fits into the __ fossa (b) of
the (c) bone to form the (d) joint,
abbreviated (e) _.
40. Fill in the following anatomy:
ABC 0
A.
B.
C.
D.
E.
F.
G.
H.
I.
41. What is the centering point for the PA projection of the mandible?
42. Describe how you would position for an axiolateral oblique mandible
for the right mandibular body _
43. For an axiolateral or oblique mandible the central ray is angled
__ degrees (caudal or cephalad).
44. What is the name of the basic projection which demonstrates the
mandibular rami and lateral portion of body? 27
45. What projection best visualises the upper rami and condyloid
processes of the mandible? _
46. Name the two basic positions/projections for radiographing the
temporomandibular joints (include the common name for each.)
A.
B.
47. Why are temporomandibular radiographs taken bilaterally and in
both the open and closed mouth position? _
48. Should the open and closed positions be attempted in TMJ
radiography if the patient has a possible fracture of the mandible?
49. Positioning for the axiolateral oblique (Law) position requires a
double degree angle. (Head rotation and CR angie.)
50. Positioning for an axiolateral (Schuller) position requires a _
degree (caudal or cephalic) CR angle with the head in a true lateral
position. 10
B. Review of anatomy on radiographs
Identify the following anatomical parts on radiographs attached p. 9:
- greater wings of the sphenoid - orbital roofs
- sella turcica - zygoma
- mandible - inferior rim of orbit
- maxillae - nasal septum
- zygomatic arches - anterior nasal spine
- orbital rim - nasal Ixfties
- optic foramen - mandibular rami
- temporomandibular joints - condyloid processes of mandible
- coronoid process of mandible - temporomandibular fossae
- petrous ridges
c. Review of topographical landmarks and positioning lines
Locate the following:
1. Midsagittal plane
2. Interpupillary line
3. Zygoma
4. Outer canthus
5. EAM
6. Mentomeatal line K
7. Acanthion
8. Orbitomeatal line
9. Infraorbitomeatal line
10. Glabelloalveolar line
11. Mandibular symphysis
12. Angles of the mandible
13. Glabella
14. Zygomatic arch
15. Zygomatic prominence
16. Three-point for Rhese method
17. Superciliary arch
17
Radiographs (B)
Lateral Parietoacanthial
PA Caldwell Submentovertex
Rhese oblique Schuller method
123
APPENDIX IV
Learner questionnaire
APPENDIX IV
LEARNER QUESTIONNAIRE
This questionnaire is developed to determine which factors can improve
your marks.
This questionnaire is anonymous to afford you absolute freedom in
your answers.
Please provide frank and honest answers. Answer all questions.
Please indicate with an "X" in the block next to the appropriate answer.
[1. DEMOGRAPHICS
1.1 What is your gender?
I'~ë~a'~""-"----"-''''''''''''''''-'' .------ --- - - ---.--.-.- .-. --H
1.2 To which population group do you belong?
I~~
1.3 Your age:
'2210""""'-· ..,"".,.,..·.._--"', ..,"'.,.- ,..·..,-"'"""""',., "..,--,- - ..- .._ ..- - _ -- - ..- ,-- -- - -_ r---
22 - .-.- .-. -,-- -- ..-- -.-.,.- ,-._. - -.-- - - ,-- ,-- - 'r---
23- ---.--- - -.-..-._ ..-,- ---.- - - '- ,- _ - ,- - r---
-.-. - --,- - ,.,. -----,- , -- , ,- ,- , -'_ r---
older
1.4 What language do you speak at home most often?
'EAnfrgï'klisaharis .-.-- ·-, ·-.-._· · ·..__ · - .._ - ,-- - ,- _ ""'''r--
'Sëttï'ë)·-- .·.-'- ·..--·- ..-.._ ,-...... .. __ -- - - ..- _ ..-- ..-.-_ _'- r--
,-----.-, --'-.-.'-----'-·-r------....L----i
Other (Specify): I
1.5 Name the school and area where you completed your high school training.
ITown: School:
12. TEACHING METHOD
Which of the following will improve your marks? Yes No
2.1 ,~,?E,~,,~~),~,~!,~.,E.~,,~i,,~,~gI,,~,,~~..r.~,.~.p,~_~~.p.,,i~,~!.g:..~ ,"",.,.". " ""'""',,, t--+--I
2.2 ,!.~.~.p~.~,~,~,~,~,~,_~,~,."I.,!:,~",!_~_,~_."Y..'_..:_ ,_ ".".".",.,','''''"" " , 't---+---1
2.3
,L_e-ct,u-r.e".'-in, te-r.-a.cti-ve_act,ivi-t.i-.e.-.s--i,n-,c-la--s_s. --- -- ..·- ,-.-.· ·--_ .-.t--+---1
2.4 Grgup activities.
,.-,.-.- .-..,---- -t---t---1
2.5 Independent individual activities.
2.6 Fellow-learner presentat-ion~s.-------'--
2.7 Individual assignments.
2.8 Group assignments in class.
13. ROLE OF THE LECTURER
Is the lecturer important to you to increase your marks? Yes No
3. 1 .~. Eovi~ ing~!~r~~.!.i.c::>.~. _':l~~ ~.~.9~~~.~~.~.:_ - - _ -1--_+-..,
3.2 §..~.Ee!YJ.~.~_~c::>~~.: _ _ 1--_+-..,
3. 3 "!:..~~_l.:i.l~.~~.r.:!~.~..~. .~~.~.:..~~~_~I!:..s...~.~_~..Y.: -- - - - -~-+_--i
3.4 .:!'..?e!~!:!.'!.?teJnte_~~!! .<. ?~._. ~.~. L~9_.!.?.!.~.~J~~c.~:~~~-.- .-. - +----+--i
3.5 .T..~.I.~. .~!.~.:..~ p.~.~.i.~.!.e.~.!.!i.<~?!.I~.~~.~g~ y.?.~..~. ~.?.~. ~..~:. +----+--i
3.6 .1. ??y~.~eE.~. !~L.~.~ I.~.~.!.~.:..~~..?:..!?. ~~ ~~..!!..~~~~~.I.?~.~.?_ _ __ I--_+--i
3.7 Do you learn more if the lecturer is active in the learning process?
14. STUDY METHODS
Do you use the following study methods? Yes No
4.1 .~.~..s. t rea.9 through information in your text book once. .. - .-.- -.1---+---1
4.2 .~~.?.d t~.r.0u9h infor~ation in y'..?urtext book a few times. . ..-... --+---+--i
4.3 .M..a.k._e...s.u..m..m.-.a-.r.i-e..s- . -.- - - -- -- .-..- -- - - -t---+---l
4.4 .1?!.~~.~. .~. r:!~_.~.~~?! !.!:!.'!.P.?.rr.t:a!!..i.f.:l ..!?~~.?~.?.!:'...-: -- - _ _ - 1--_+-..,
4. 5 .~. .~~.!?!~~..~.~...J.!.~~..~<?! ..!.~T~.:?..:!'..~.:.~ 1---+---1
4.6 .U..s-.e.-..le..c.t.ur-e-rs- note-s- w-i-th--other m-ethods-.-.----- -- - ---.1---+---1
4. 7 .~.i_k.~.!..~.~tudy.~Wo~E~· -- - - +----+--i
4. 8 .§..!.~. .Y.~.!..:..~.~!.I~.Y!!. .~.I:..~.~.!.~E~.~.: _ +----+_-1
4.9 Study only for tests or exams.
15. ASSESSMENT METHODS
Which of the following assessment methods do you prefer? Yes No
5.1 .F.o..r.m..a.l...e.x.a..m..in..a.t.io..n.s........_................_........................................1..-..-.-.+...-.-.-..1...............
5.2 .F.o..rm..a..l ..t.e-.s.t.s........-.-...-..-........-......-- - --- - - +---f---i
5.3 ~nte9!:ate':!.....!..es_ts(all.~. ~bjects ir:!.....<?.tneest). --- - -1--_+-..,
5.4 ..':ra.~. !!~?J.ex~m~_~~~ Radio~ ra phic labora.!!?ry .-- ._. - -- .-. .-+--+---l
5.5 .p~~.!!.gal .~..~~~.~ ..i.E..l.!.~..~_RadiO'.!.<?9..Y......I?~...E?.rtmenUPr.a.c_t!~._ t--+---l
5.6 .~~~.~:'.~.~.~D.!.~.~?~.9..~.~.~.9.i..~.~.~.~.!~.:................................................................. 1---+-..,
5.7 .O.-S.-.CEs. - - - - - -- - _- .-. - - ---'1---+-..,
5.8 Orals.
5.9 .F.e..l_l.o.-w..-.le.-.a.r.ner a-ssessment. - - - -- - - ---- 1--_+-..,
5.10 Ihr.<?_l9:.l.!:! ?_elf-d~m?!:l_~!.t:ations._. .._... __ ._. _. -+---+---1
5.11 Through self-presentations.
16. GENERAL
Which of the following statements are true? Yes No
6.1 .!. ':lm~?tisfi~~..Y.Vith !:!.'!Y_.~.e?.eEL~ .~._o.i.~c. :._._._.__ ._. . _ _.t---+---l
6.2 Own a relevant Merrill or Bontrager textbook.
1-" ..-. ...-. ....-.-.-- ...-.. ..-.-------- ..- ....-..---t--+---l
6.3 .~. .s..e t~~.~brary to .?. ~!.~.~addition.al informati<?.~. .._... ..... 1--_+-..,
6.4 Use the library to obtain just the necessary information .
6.5 .Q.~~!~.!.~c!c::>rs~.~is!..!...~.~!J~!!_lJ..~~.gm~Y..J..~.~.!..r~..~,Lper!?.r.~.~.~.~..~._.:..._. +--_+-..,
6.6 .I..?..m sat~~fied with my_~arks. ...._._.._...... .1....----1.._-1
- - - - .-. -.- - - -.-.-.----- -- - -- - -.,.-----r----,
6.7 The lecture.r play a.n. important role in my learnin~ process.
6.8 The Year Organise..r:...~elps me to plan my learninf:l.
6.9 T~.~ ~~.~. .~J~.(;J9.~i9.~. ~~.....9 ~ ~E~.r..:!.~.~...!..r~c~~of know.I.~. .9...9.:.~_. ._ _ - t---+--j
6.1 0 LP.E~P..9~...~....!.<?.~I.~.~!~.~.~~.:._._ _ " " " "- t---+--j
6. 11 .1.?~.~.~P?~.!.P.~..~.~I.~.~.. ~.~~.9.: _._ _ _ +---+_-j
6. 12 Lp.~~.!.~~.~.~P~.r..:~.!9.~. .!~elf -st.~.~Y~. .oin~r.ac~~~.~._I.ec~~~.~.:......_ ._. ._ t---t-_--i
6. 13 !~.~!..~_0~~ !..~~.9!!...l~.~ivietis i!..l~I.9. ...~.~.!.~9..J...r..~: ..~!.~~!!.9..l.!..!.~.~. !~~e~.:. t---t----i
6. 14 .~. nt~~~.cti':'..~~~~.!.~f~..P~.r.?~.~t~~X ~r.:!.~.~E.~.~~.r..:5.!9>.!i~r.:~.9_~~~.!...:i.~.~+---+_-i
6.1 5 .~.~..i.~!? !~.~.p..9..~.~i.~ ~.I.~.~.9~.J~~.~.}.o~~~ _ _ _._ _ +---+--i
6 .16 L!..~..I i.~..!..!.a.~. .9.9..!:l.~~.'~:.19_9.~p~.9.~.ent ~~~:stud .L. - - --- t---t-_--i
6.17 ~~!i.y!~.i.~~~.p.~ov.~. .~...Y....!~~.~~Jr.:.~~.~..P!.}~.r.:!.~~._. _ -- --- - - -t--+-----i
6.18 The lecture must be a role model in the learning setting.
17. EXPERIENCE
Finally I would like your comments and experiences
with regard to teaching methods.
Which teaching method will improve your marks the most?
Rank the following teaching methods by filling in a number in the
block provided with (1) as the most important, (2) as the second-
most important, (3) as the third-most important, and so on.
(Only use a number once) Rank: 1, 2, 3, 4, 5 & 6
7.1 ..I_n_de_pe__nde_nt -self-study _(a_u.._tonomo_u_s _lea_rnin_g)_. .._ _ __ .._ _ -
7.2 ..F.......o_rmal lectures without int_eraction _. _ _ _ __ _._ -
7.3 ..C.......o......n.....t...a......c.....t.............s.....e......s.....s.....i...o.....n......s................w...... ith_.a_va_riety of activities ." _ _ .._ _ -
7.4 ..G........r...o.._up dis_cussion_s _. _ _ _ ".._ _ _ _ _-_ _._-._ ..__ _ .._ -
7.5 ..P.......e......e.. _r.._(f_e_llow_-lear_ners)_ __pres_e_nt.a-tio_ns_. _ .._._ _ _-_ _ _ _ .._ -
7.6 Lecturer demonstrations.
Is. PERSONAL
Which of the following statements are true in connection
with factors influencing your learning? Yes No
8.1 Cost of textbooks.
8.2 .~. .r.:!.~~.!!~ien!!t.~.~ !? ~~.~..9.y.: _ _ _ - -.-- +---+--i
8. 3 .~. <??~!~~~_~....~ .~~.~(.~~~.I~n..:! __ _ _ - - +---+--i
8.4 .P.-o..o.r-.c-.o-ncentra-tion_ .- -- --.---- - ----.- -+-+-----i
8.5 Outside factors.
8.6 Exp~rien~ .~. JL~!.~9...Y..._~tres~ _
8. 7 .~. ~P.~.!~.~~.~!.~.~9~!...~E. ~!.9...!.~.9..-s~~~_~.._: _ _ _ _+__ --+_~
8. 8 .~. .~. P~~~~.~.i.~.9P~!.~.~r.!.~~! !~~~~.: _ __._. ___ _ +---+--i
8.9 DFina8.10 tïïnecirasl :-b-u-r-de.n.-s.·...·.- .-..-
Specify: I
124
B. STUDY DESIGN
125
APPENDIX V
Division of learners and test scores
APPENDIX V
DIVISION OF LEARNERS AND TEST SCORES
O'rvr..sion accor d'mg t0 average tes t scores *
Learners "Test Formal lectures Self-activities Self-study
scores ASAT Pre-test Post-test ASAT Pre-test Post-test ASAT Pre-test Post-test
1 51.5 63.0 43.0 52.0
2 46.0 58.0 54.0 66.0
3 48.5 66.0 33.0 59.0
4 50.5 86.0 55.0 71.0
5 39.5 34.0 38.0 51.0
6 43.0 27.0 51.0 76.0
7 50.0 37.0 47.0 66.0
8 77.0 98.0 80.0 85.0
9 71.5 91.0 68.0 81.0
10 86.0 96.0 75.0 85.0
11 47.0 25.0 37.0 63.0
12 67.5 68.0 62.0 74.0
13 64.0 81.0 69.0 66.0
14 58.0 91.0 64.0 81.0
15 69.5 81.0 51.0 73.0
16 59.5 90.0 56.0 78.0
17 62.0 87.0 55.0 69.0
18 56.5 55.0 25.0 75.0
19 67.0 63.0 64.0 66.0
20 67.0 92.0 50.0 83.0
21 78.0 97.0 67.0 78.0
22 61.5 50.0 59.0 71.0
23 55.0 25.0 52.0 72.0
24 47.0 50.0 40.0 59.0
25 52.0 63.0 39.0 76.0
26 47.0 34.0 41.0 58.0
27 59.0 97.0 74.0 87.0
28 83.5 32.0 32.0 61.0
29 57.5 77.0 33.0 72.0
30 36.5 18.0 30.0 57.0
Count 30.0 11.0 11.0 11.0 11.0 11.0 11.0 8.0 8.0 8.0
Mean 58.6 63.3 59.4 72.4 58.5 42.7 66.5 74.0 52.6 72.9
Max 86.0 98.0 80.0 85.0 96.0 75.0 85.0 97.0 74.0 87.0
Min 36.5 25.0 37.0 63.0 18.0 25.0 51.0 37.0 33.0 52.0
Std 12.7 28.4 11.4 7.4 27.3 14.3 11.4 20.6 14.4 10.3
126
APPENDIX VI
Study group I: Formal lectures
Figures and radiographs from Merrill's Atlas of Radiographic Positions and
Radiologic Procedures (Ballinger & Frank 1999:231), Radiographic
Positioning and Related Anatomy (Bontrager 1997:323) and Radiographic
Positioning and Related Anatomy: Workbook and Laboratory Manual
(Bontrager, K.L. 1993).
Skull
Flour. Md radiogrepn. c:ourt .. y of BfIIH~ & "nlnk !Mml. "'tIM of
R"~1e PosHlons .nd Rfldlok9c PToctdUI'M and 8otItr~
R~phlc Poe.IUo"I~.net A.IaI" An.om)'.
Pathology Skull series
Fractures
Linear
Depressed
Basal skull
Neoplasm
Metastases
Osteolytic
Osteoblastic
Multiple Myeloma
Pituitary adenomas
Paget's disease
OF 0° Skull
Structures Part position
• Frontal bone • Nose & forehead
• Crista galli • OMUBaseline
• Frontal sinus • No rotation
• Ethmoid sinus • No tilt
• Petrous ridges • MSP~
• Sphenoid wings • CR~
• Dorsum sellae • Exits 7Glabella
OF 0° Skull Evaluation criteria
Structures
Frontal Bone, Crista Galli, lAM,
Frontal sinus, Petro us ridges,
sphenoid wings, dorsum sellae
• Entire skull INo rotation
• Petrous pyramids 90rbits
• ObI.Orb.line=skuli margin
• P & A clinoids superior
ethmoid
PA axial 15° PA 15° Skull
Structures Part position
• Frontal bone Nose & forehead
Crista galli OML~
• Frontal & ethmoid • No rotation
• Petrous ridges • No tilt
Sphenoid wings MSP~
• Foramen rotundum • Baseline
• Sup. Orb fissures • CR 15° ext nasion ~""
• lAM
• Orbital margin
PA 15° /25° - 30°
Evaluation criteria AP axial 300 Towne
Structures Structures
• Frontal bone, Crista galli, Frontal & Ethmoid
sinus, Petrous ridges, Sphenoid wings, • Occipital bone
Foramen rotundum, Sup. Orb • Petrous pyramids
Orbital margin • Foramen magnum
• Entire skull, No rotation/tilt:
- Obl.orbital margin=lat.skull 7 Dorsum sellae
- Sup. Orb.tis. = Post. clinoids
Petrous ridge 71/3 orbit
• Colli: margin of skull
• Nasion in centre
AP axlaf Towne
Part position
MSP&OML~
• OML ~ CR 30°
• IOML ~ CR 37°
• No rotation / tilt
• EB 6cm 1
Glabella
Evaluation criteria Lateral Skull
• Entire skull Structures
• No rotation:/I
Foramen Magnum • Total cranium RIL
and lat.marg.skull • Sella turcica
• Petrous ridge
superior to mastoids • A & P clinoids
• Petrous ridges • Dorsum sellae
symmetrical • Wings of
• Dorsum sellae & sphenoid
Post. clinoids inside
Foramen magnum
Lateral skull
Part position
• True lateral
Glabelle/Nasion =
Occ.protuberance
• No rotation/tilt
• MSP db
• Baseline / GAL
• CR 5cmn EAM
Evaluation criteria Submentovertex
• Entire skull Structures
• No rotation/tilt • Occipital bone
Mand. Rami, EAM • Foramen magnum
Orbital roofs ~ • Foramen ovale
• Foramen spinosum
Sella turcica ~ • Mandible
A & P clinoids • Sphenoid & Ethmoid
Dorsum sellae • Mastoid
Wings of sphenoid • Hard palate
• GAL II to film edge • Petrous ridge
Submentovertex SMV
Part position
• Hyper extension
Glabelle/Nasion =
Occ.protuberance
• No rotation / tilt
• Mspdb
• Baseline~
• CR2cm TI EAM
• IOML
Evaluation criteria Trauma Skull
Entire skull • Lateral without
No rotation/tilt head
• Mandible Condyles manipulation
anterior to petrous ridges
• Mand. Symph. frontal • MSP II
bone4? ·IPL6
• Mandibubalar= border
Foramen ovale visible • CRr?
• Foramen spinosum • EB 5cm 1 EAM
visible
Trauma Skull AP 0° to OML
• Lateral after
Cervical injury has • AP
been ruled out • MSP EB to film
• MSP II • CR lito OML
• IPLdb I 10-15°
• CRU> • EB Glabella
• EB 5cm 1 EAM • CR EB IR
AP 15° to OML AP Axial Towne
Reverse Caldwell
• AP
• AP • MSP EB to film
• MSP E9 to film • JCR 30° to OML
• CR 10-15° to OML • Superciliary arch
• E9 Nasion • CR EB IR & EAM
• CR E9 IR 8ontr ..... K.L. 1ttl. R~k I'NIdottIng ..RH"_ AnMomy. WorlDoolt' MWILMOBfOIy""_'_ Vol
1.3rded.U.s .... :IILCMIIILIItIooAy.Zl1-2t1.
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R~ PNIfJon. w Radlllolo(llc ,..,. ...
tid. u.s ...... St lou": MoMy. n103(17.
127
APPENDIX VII
Study group II: Self-activities
Activities, figures and radiographs from Radiographic Positioning and
Related Anatomy: Workbook and Laboratory Manual. Vol. 1, 3rd ed.
U.S.A: St Louis. Mosby. (Bontrager1993:217 -268).
APPENDIX VII
STUDY GROUP II: SELF-ACTIVITIES
SKULL
1. INTRODUCTION
Radiographic examinations involving the skull are usually considered
among the most difficult of all examinations. The skull is a very compact
structure involving many small but important bony or superimposed by
other structures of the skull. This makes it very difficult to visualise many of
these bony structures on radiographs.
The anatomy of the skull, including both the cranial and facial bones, is
very detailed, especially those crania bones making up the "floor" and
lower "walls" of the cranial vault. To visualise many of these structures
requires controlled use of displacement radiography. This requires either
certain rather precise angulations of the central ray or specific obliques of
the skull. An example of this is an axial AP projection of the skull which
specifically demonstrates the occipital bone and the petrous pyramids of
the temporal bone. This projection requires a very precise 30 degree
caudal angle to the orbitomeatalline, a special positioning line of the head.
This central ray angulation projects the facial bone mass caudally so it will
not superimpose the specific structures being demonstrated on this
projection. The same is true for visualising the facial bones without
superimposition by the dense petrous pyramids.
Good skull radiography is a definite challenge and requires much effort
and study before it can be mastered. The detailed anatomy of the skull is
presented in such a way in the textbook that it will allow you to learn the
anatomical terms for all of these structures as well as relationships to other
internal as well as external structures and landmarks.
2. LEARNING OUTCOMES
After you have successfully completed all the activities, you will be able to:
2.1 List and locate all surface landmarks and localising lines described
in this theme.
2.2 Identify the external landmarks, which correspond to the level of the
floor of the anterior cranium and the level of the petrous ridge.
2.3 List the eight cranial bones and identify the four bones composing
the calvarium or "skull cap" and the four making up the "floor" of the
cranium.
2.4 Describe the relative locations or positions of the eight cranial
bones and identify on drawings and radiographs the various
portions or parts of each cranial bone as described in this theme.
2.5 List and identify on drawings and radiographs the sutures of the
skull including the areas of the six fontanels or "soft spots" on
newborns.
2.6 List the number and the names of specific adjoining cranial bones
with which each cranial bone articulates.
2.7 List the three terms describing the common shape classifications of
the cranium and identify the approximate angles of the petrous
pyramids for each classification.
2.8 Describe the correct angle (caudal or cephalic), the degrees of
angle and the line used to determine this angle on a PA Caldwell,
and an axial AP projection.
2.9 For a submentovertex projection, identify the line, which should be
as near parallel to the plane of the film as possible and describe the
relationship of the central ray to this line.
2.10 Position a model and/or phantom for each of the basic and optional
projections as described in the textbook. Include the three different
ways for taking each projection which are:
(a) on a routine radiographic table;
(b) on a vertical head unit or erect table or grid film holder;
(c) modifications for severely injured patients.
2.11 Critique skull radiographs based on evaluation criteria provided in
the textbook.
2.12 Discriminate between radiographs which are acceptable and those
which are unacceptable due to exposure factors, collimation or
positioning errors.
3. SOURCES
Bontrager, K.L. 1993. Radiographic Positioning and Related Anatomy:
Workbook and Laboratory Manual. Vol. 1, 3rd ed. U.S.A: St Louis. Mosby.
217-268.
Bontrager, K.L. 1997. Radiographic Positioning and Related Anatomy. 4th
ed. U.S.A., St Louis: Mosby. 323-358.
Ballinger, P.W. & Frank, E.D. 1999. Merrill's Atlas of Radiographic
Positions and Radiiiologic Procedures. 9th ed. U.S.A., St Louis: Mosby.
231-307.
4. ACTIVITIES
Activity 1
Topographical Anatomy and Landmarks, Lines and Planes of the skull.
The following review exercises should be completed only after careful
study of the associated pages in the textbook.
1. Fill in the total number of bones for:
A. Cranium
B. Facial bones
2. Describe the location of the following topographical landmarks of
the cranium:
A. Glabella
B. Acanthion
C. Mental point
D. Superciliary ridge (arch)
E. Supraorbital groove
F. Nasion
G. Angle (gonion)
H. Vertex
I. Inion
3. Which of the above landmarks corresponds to the level of the floor
of the anterior fossa of the cranium?
4. Fill in the correct term describing the following five landmarks
relating to the eye or rim of orbit:
A. Medial junction of two eyelids _
B. Lateral junction of the two eyelids. _
C. Superior rim of orbit _
D. Inferior rim of orbit ------------------------------
E. Lateral aspect of orbital rim, _
5. Fill in the correct term or a second term for the following landmarks:
A. EAM
B. TEA
c. SOM
D. 10M
6. The orbit is (a) in shape and extends
(b) (anteriorly or posteriorly) from the base.
7. The circular rim of the orbit, which can be palpated, is actually
the of the orbit.
8. What is the external landmark corresponding to the petrous ridge?
9. Fill in the correct term describing the following planes and lines:
A. Divides the body into right and left halves _
B. Describes the imaginary line drawn between the pupils of the
eyes __
C. The line connecting the glabella to the EAM _
D. The line connecting the outer canthus of the eye to the EAM
E. Describes the line between me infraorbital margin and the
EAM _
F. The line between the acanthion and the EAM ----------
G. The line between the "chin" and the EAM _
H. The line between the glabella and the anterior aspect of the
alveolar process of the maxilla _
10. Reid's base line, or just base line is also used occasionally to
describe the --------------------------------------_
11. Which line should be perpendicular to the film on a true lateral
skull? _
12. Which body plane of the head must be parallel to the plane of the
film on a true lateral skull? ------------------------------
Activity 2
Anatomy of the skull
1. What is the correct anatomical term describing the skull cap?
(a) _
What are the names of the four bones making up this portion of the
skull? (b) right and left (c) and
(d) _
2. What are the names of the additional four cranial bones which
primarily make up the floor of the cranium? The right and left
(a) , the (b) , and the (c), __
3. The frontal bone can be divided into two portions, the vertical or
(a) portion and the horizontal or
(b) portion.
4. The ridge of bone under each eyebrow is called the
5. The portion of the frontal bone forming the superior aspect of each
orbit is the _
6. Two bones which primarily make up the walls of the calvarium or
skull cap are the right and left _
7. The widest portion of the skull is found between the
_________ of the two bones described in question
number 6.
8. Answer the following questions on the joints or articulations of the
skull (excluding the temporomandibular joint, TMJ):
A. The correct anatomical term for these joints? _
B. Structural classification of these joints?
C. Functional or mobility classification of these joints? _
D. Are these movable or immovable joints? _
E. Separates the frontal from the two parietais. _
F. Separates the two parietais. _
G. Separates the two parietals from the occipital bone. _
H. Separates the parietals from the temporals. _
I. The anterior end of the sagittal suture is called the
J. The posterior end of the sagittal suture is called the _
K. The areas described in Parts I and J are "soft spots" in new
borne and are called the anterior and posterior
L. The "soft spots" located at the sphenoid angle of the parietal
bone on each side of the head are called
(a) , on an adult this point (which can
be used for specific cranial measurements) is called the
(b) _
M. The second lateral "soft spot" located at the mastoid angle of
the parietal bone on each side is called the
(a) and on an adult is called the
(b) _
N Which of die six "soft spots" of the cranium is the largest and
doesn't close until about 18 months of age?
O. What are the small irregular bones called which sometimes
develop in adults at the "soft spots?" _
9. The posterior and somewhat inferior portion of the calvarium is
formed by the single bone.
10. The large hole or opening in the bone described in question 9 is
called the _
11. The two oval convex articular surfaces on each side of this large
opening at the base of the skull are called (a), _
or (b) _
12. The articulation between the skull and cervical spine is called the
-------' ioint.
13. Identify the labelled parts of the following drawings:
B
A.
B.
C. o
D. E
E.
F
F.
G.
H.
I.
J.
K.
L.
M.
N
14. The two lateral condylar processes are part of the
bone. (Hint: these processes help
make up a joint involving the skull.)
15. The bones house the organs of hearing and balance.
16. The _bone is the primary anchor bone for all eight cranial bones.
17. The bone lies primarily below the floor of the cranium.
18. The thin "wall" portion of the temporals is called the _
portion (similar to name of the suture at upper border of temporal).
19. The temporal bone contains a process of bone called the (a) __
process, which meets another process of a facial bone to make up
a prominent arch of bone called the (b) _
20. The temporal bone contains a fossa called the _
fossa, which helps form the only diarthrodial, or freely movable joint
of the skull.
21. A slender process of the temporal bone projecting downward is
called the process.
22. The thick portion of the temporal bone directly posterior to the EAM
which contains air cells is called the (a) portion, which
has a small, somewhat "blunt" process or tip projecting downward
called the (b) _
23. The petrous portions of the temporal bones are the thickest and
most dense bones in the skull and are sometimes also called the
(a) or . The upper edges of these portions
are often called the (b) _
24. The central depression of the sphenoid which looks like a saddle is
called the (a) which protects the important
(b) gland.
25. The back of this "saddle" is called the (a) , which
contains two small ear-like projections of bone called the (b)
26. The two small, ear-like projections anterior to the "saddle" are
called the (a) , which are attached to a pair of triangular
shaped and nearly horizontal projections of the sphenoid called the
(b) _
27. The shallow depression just posterior to the dorsum sellae, which
forms a continuous groove to the foramen magnum and provides a
base of support for the pons portion of the brain, is called the
28. The sphenoid bone contains four processes projecting downward:
A. The two more lateral and somewhat flat processes are called
B. The two medial and more pointed processes are called the
c. The two hook-like projections extending from the medial
processes are called the _
29. The three pairs of small openings (for nerves and blood vessels) in
the greater wing of the sphenoid are the (a) _
(b) and (c) _
30. The sphenoid articulates with ------ other cranial bones.
31. Answer the following questions regarding the ethmoid bone:
A. The small horizontal portion located in the ethmoid notch of
the frontal bone is the -----------
B. The superior projection, which has an appearance of a
rooster's comb, is the __
C. The portion projecting downward in the midline to help form
the bony nasal septum is the _
D. The two lateral masses, also called the lateral._-----
contain air cells and are suspended inferiorly from the under-
surface of the horizontal portion of the ethmoid.
E. Extending medially and downward from these lateral masses
are thin, scroll-like projections called the superior and middle
(a) , sometimes called (b), _
F. The ethmoid articulates with two cranial bones, the
(a), and (b) _
32. Full in the following from the labelled drawings:
A.
B.
8
C.
D. A
E.
F.
G.
H.
I.
J. .J
K.
L.
M.
N.
o.
P.
Q.
R. a
s. R
T. __________ 8
u.
v.
w.
x. y
w
Y.
z.
a.
b.
33. The frontal bone articulates with four cranial bones, the right and
left (a) , the (b) and the (c) _
34. The parietal articulates with five cranial bones: (a) , (b) _
(c) , (d) , and (e) _
35. The occipital articulates with six bones: right and left (a) _
right and left (b) , the (c) , and the (d) _
36. A lateral measurement of the cranium should be made in the area
of the largest diameter which is between the two
(a) , which averages b) centimetres.
37. The antero-posterior measurement should be made between the
(a) and the (b) , which
averages (c)_. _ centimetres.
38. Fill in the correct shape classifications and the approximate angle
between the petro us pyramids and the midsagittal plane for the
following:
A. Average shaped head ____ degrees
B. Short broad head ____ degrees
C. Long narrow head ____ degrees
Activity 3
Positioning of the Cranium and Sella Turcica
1. List the three basic and the one optional projection most commonly
included in a skull series. List second terms where more than one
term is commonly used.
Basic: A.
B.
C.
Optional: D.
2. When positioning for a lateral skull projection, which line should be
placed perpendicular to the side of the table?
3. Indicate which way the 24 x 30 cassette should be placed
(crosswise or lengthwise) on the following projections taken on a
radiographic table:
A. Lateral -------------
B. PA or Caldwell --------------------
C. AP axial _
D. Submentovertex ------------
4. What are the two lines, which snould be checked carefully to insure
a true lateral skull position? Indicate if these should be parallel or
perpendicular to the plane of the film.
A.
B.
5. Describe the central ray location for the following two methods
commonly used in centring for a lateral skull projection.
Centre entire cranium to film: _
Centre sella turcica to film:
6. There is a _ degree difference between the OML and the IOML.
7. In checking a lateral skull radiograph for possible rotation or tilt,
what four pairs of anatomical structures should be directly
superimposed?
A. C. B. D. _
8. Fill in the correct lines and/or planes, which should be perpendicular
to the film on the following positions or projections:
A. Lateral: line
B. PA Caldwell: (a) line and (b) plane
C. AP axial: (a) line and (b) ______ plane
9. Fill in the correct angle, number of degrees and the correct line
used to determine this angle on the following:
Caud./Ceph Angle Line
A. PA Caldwell (a) (b) (c)
B. Reversal of Caldwell-trauma (a) (b) (c)
C. AP axial (a) (b) (c)
10. For an AP axial projection, the central ray should be angled
(a)__ degrees caudal if the orbitomeatal line is perpendicular to
the film and (b)__ degrees if the infra-orbitomeatal line is
perpendicular.
11. The dorsum sellae and posterior clinoids are projected into the
foramen magnum on which sella turcica projection(s)? _
12. The dorsum sellae and posterior clinoids are projected just superior
to the foramen magnum, superimposing the occipital bone, with the
_______ sella turcica projection.
13. What two intracranial structures are demonstrated in profile on a
true lateral skull? (a) and (b) _
14. Complete the following for a submentovertex projection of the skull:
A. The patient should be positioned so the __ line is parallel
to the plane of the film.
B. The central ray must be perpendicular to the line.
C. If the correct line was perpendicular to the central ray, then
the condyles of the mandible will be projected
(a) (anterior or posterior) to the (b) _
15. The projections best demonstrating the following:
A. Sella Turcica (a) and (b) _
B. Petrous Pyramids (ridges) (a) and (b) _
16. The internal auditory canals are best demonstrated on which
projection? _
17. Which trauma skull projection is essential for visualising inner
cranial air/fluid levels? _
Radiographic positioning laboratory exercises
For this section you need another person or an articulated phantom to act
as your patient. Practise the following until you can do each of them
accurately and without hesitation. It is important to achieve both accuracy
and speed in radiographic positioning. Include the following parameters as
you simulate the basic positions or projections listed:
• correct choice of source image receptor distance
• correct size and type of film holder
• correct location of central ray
• correct centring of part to film
• correct placement of Rand L markers
• accurate collimation
• proper use of immobilising devices when needed
• proper use of positioning aids as needed
• approximate correct exposure factors
• correct instructions to your patient before and during exposure.
1. Table top lateral and PA Caldwell projections.
2. Table top AP axial and submentovertex projections.
3. Erect (with head unit if available or with erect table or other erect
grid-film holder), lateral, PA Caldwell, AP axial and submentovertex
projections.
4. Severely injured patient who cannot be moved from a supine
position on a stretcher. (A cross-table lateral cervical spine has
ruled out spinal injury.) Take a cross-table lateral projection, AP
projection to replace routine PA Caldwell and AP axial (Towne)
projection.
5. Special projections for sella turcica (erect or table top).
6. Cross-table lateral projection.
7. AP Axial (Towne) and modified AP to replace PA Caldwell on
severely injured patient.
8. Tabletop lateral and PA Caldwell projections.
9. Submentovertex projection (disarticulated skull phantom only).
REFERENCES
Bontrager, K.L. 1993. Radiographic Positioning and Related Anatomy:
Workbook and Laboratory Manual. Vol. 1, 3rd ed. U.S.A: St Louis. Mosby.
217-268.
Bontrager, K.L. 1997. Radiographic Positioning and Related Anatomy. 4th
ed. U.S.A., St Louis: Mosby. 323-358.
Ballinger, P.W. & Frank, E.D. 1999. Merrill's Atlas of Radiographic
Positions and Radiiiologic Procedures. 9th ed. U.S.A., St Louis: Mosby.
231-307.
128
APPENDIX VIII
Study group III: Self-study
APPENDIX VIII
STUDY GROUP III: SELF-STUDY
SKULL
LEARNING OUTCOMES
• List and locate all surface landmarks and localising lines described
in this theme.
• Identify the external landmarks, which correspond to the level of the
floor of the anterior cranium and the level of the petrous ridge.
• List the eight cranial bones and identify the four bones composing
the calvarium or "skull cap" and the four making up the "floor" of the
cranium.
• Describe the relative locations or positions of the eight cranial
bones and identify on drawings and radiographs the various
portions or parts of each cranial bone as described in this theme.
• List and identify on drawings and radiographs the sutures of the
skull including the areas of the six fontanels or "soft spots" on
newborns.
• List the number and the names of specific adjoining cranial bones
with which each cranial bone articulates.
• List the three terms describing the common shape classifications of
the cranium and identify the approximate angles of the petrous
pyramids for each classification.
• Describe the correct angle (caudal or cephalad), the degrees of
angle and the line used to determine this angle on a PA Caldwell,
and an axial AP projection.
• For a submentovertex projection, identify the line, which should be
as near parallel to the plane of the film as possible and describe the
relationship of the central ray to this line.
• Position a model and/or phantom for each of the basic and optional
projections as described in the textbook. Include the three different
ways for taking each projection which are:
./ on a routine radiographic table;
./ on a vertical head unit or erect table or grid film holder;
./ modifications for severely injured patients.
• Critique skull radiographs based on evaluation criteria provided in
the textbook.
• Discriminate between radiographs, which are acceptable, and
those, which are unacceptable due to exposure factors, collimation
or positioning errors.
129
c. INTERVENTION
130
APPENDIX IX
Interactive lecture
Figures and radiographs from Merrill's Atlas of Radiographic Positions and
Radiologic Procedures (Ballinger & Frank 1999:309) and Radiographic
Positioning and Related Anatomy (Bontrager 1997:359).
Facial Bones Facial Bones
-'~'-"_
.'t-"\.". "_,, ---_-_ .._-_., ..__
'. .//''' ~"\,
"
F.. ,....nd Radf09r.ph. eourt .. y of a.l1I~ & FrlNlk...m .. Au.. of
R1Idk>gr.hlc PlKltkln. and Rltdiotoglc Pr~r .. end 8ontr-u_
R~apf'llc Pollltioning .. d R.... ed ANtomy.
Projections Lateral Facial bone
Structures
• Facial bones
• Wings of ~
sphenoid ~
• Sella turcica
• Zygoma
• Mandible
OML vs. MML Erect vs. Supine AP vs. PA
Lateral Facial bones Evaluation criteria
Part position • ZygomasEB
• Side of interest • No rotation & tilt
• True lateral • Mandibular Rami,
• Nasion=Occ.prot. ~ EAM
• No rotation/tilt orbital roofs <{?
• MSP/I Sella turcica
• Interpupilary 4b ~NW"'''''" _ .\ Maxillary region
• CR % outer canthus EAM (Zygoma)
Parietoacanth ial Parietoacanth ial
Structures Part position.
• Inferior orbital rim • Chin
• Zygomatic bones • MML
• Zygomatic arches • OML = 37°
• Nasal Septum • No rotation/No tilt
• Maxillae • MSP~
• Anterior nasal • CR ~ Acanthion
spine
Acanthion
Evaluation criteria Mod. Parietoacanthial
• Inferior Orbital Rim Structures
• Petrous ridge .n. • Orbital floors &
Maxillary sinuses Rims
• Entire skull • Zygomatic bones
• No rotation: • Zygomatic arches
septum=skull margin • Nasal Septum
• Inferior Max.sin. free
from alveolar • Maxillae
processes • Ant. nasal spine
Mod. Parietoacanthial Evaluation criteria
Part position • Inf. Orb. Rim
• Nose & Chin filmEB
• LML~ • Petrous ridge .n.~Maxillary sinuses
• OML = 55°
• No rotation/tilt • Entire skull
• ~ orbital floors
• MSP~
• CR ~ Acanthion • No rotation-Nasalseptum = orbital
margin
Acanthion
PA axial 15°(Caldwell) PA axial (Caldwell)
Structures Part position
• Maxillae • Nose & forehead /""
• Nasal Septum
• Zygomatic bones : ~~;o:!n/ tilt (
• Ant. Nasal spine • MSP~ \:' .
• Cassette EB nasion ~~ ....
• 30° - Orbital rim • CR 15° ext nasion _~
Nasion
Evaluation criteria Nasal Bones R+L
• No rotation-Crista Structures
galli=skull margin
• Nasal bone
• Petrous ridge lower
1/3 orbit • Soft tissue
• Frontal sinus lj
Fronto-nasal suture
• Sup. Orb. Fiss.
Orbits =
Nasal Bone Evaluation criteria
Part position • Nasal bone EB
• Side of interest • No rotation
• True lateral • ~ Nasal bone
• Nasion=Occ.prot. & soft tissue
• No rotation/tilt
• MSPII
• Interpupilary ~
• CR 1.25cm n nasion
Nasal Supero-inferior Nasal Supero-inferior
Structures Part position
• Nasal bone • Chin
• Soft tissue • GAL~ film
• OML = 37°
• No rotationlNo tilt
• MSP
• CR ~ GAL (skim) L
Evaluation criteria Zygomatic arches SMV
• Nasal bone EB Structures
• No rotation
• ~ Nasal bone • Bilateral
& soft tissue zygomatic arches
• Glabella & Zygomatic bo
alveolar line not
over nasal
septum Temporal bone
Zygomatic arches SMV Evaluation criteria
Part position Entire skull
• Hyper extension No rotation & tilt
• Glabelle=Occ.protub • Zygomatic arches lateralof zygomatic & temporal
• No rotation/tilt bones
• MSP~ • Mand. Symph.
• IOML II superimposes ant.
••
frontal bone
• CR4c~and.
& • Zygomatic archessymph. % symmetrically
Zygomatic arches
Zygomatic arches Zygomatic arches
ObI. Part position
Inferosuperior • Hyper extension
(Tangential) • Rotate head 15°
Structures • Tilt head 15°
• Single zygomatic • IOML 6
arch • CR6to IOML
• Trauma -Flat or • EB to Zygomatic
depressed arch of interest
Evaluation criteria Zygomatic arches
• Zygomatic arch EB AP axial 30° (Modified Towne)
•~ zygomatic arch
• Zygomatic arches Structures
without • Bilateral
superimposition Zygomatic arches
of parietal or
mandible
Zygomatic arches Zygomatic arches
AP axial 30° (Mod"tied Towne)
Part position AP axial 300 (Modified
• OML~ \ '-wo "," Towne)
, \...... ' -
• No rota • Zygomatic arch EB.oti.on/tilt ,/ ,\.', \ > {~;~': ,
• MSP~ ',:t!" ~ ,;,p : '- • " zygomatic arch
• CR 30° caudad to t,:t ' -, • Zygomatic arches<" "
OML~ Cv-, - ~mandible
• 37° to IOML ~-..",~ • Zygomatic arches
• EB 2,5 cm superior to symmetrical
Glabella
Parieto-Orbital (Rhese) Parieto-Orbital (Rhese)
Structures Part position
• Cross section of • Nose chin & I~-
each optic canal cheek ,~ $I
• Non-distorted • MSP 53° angle I
view of optic • AML~ \,~,_
foramen • CR to EB
downside orbit
• CR to film Orbit
downside orbit
Evaluation criteria Axiolateral Mandible
• Optic foramen EB Structures
lower outer
quadrant of orbit • Mandible rami
• Optic foramen • Body & mentum
to collimated field
• Orbital margins in
collimated field
.~ Visualise optic
foramen
Axiolateral Mandible Evaluation criteria
Part position ~ • Mandible EB
• Side of tnterest=> • Opposite mand.
• True lateral not over ramus
-ramus 30° • Ramus free of
-body 45° Cerv.sp.
-mentum 10-15° • Condylar and
general survey coronoid visualizes
• CR 25° cephalad • ~visualize
• CR pass through m)mdibular area of
mandible interest
PA/PA Axia;l'.'.~..~MandibleStructures PA/PA Axial
• PA ~• . .?? Part position
• Mandibular rami .i~ . • Forehead & Nose
• Lateral portion of body r • OML~
• PAAxial • MSP~
• Proximal rami • PA-CR exit -lips
• Lateral aspects of body • PA Axial 20-25° Acanthion
• Elongated view of exit-Acanthion
condyloid processes
EvaluationIcr#iter.·~ia Mandible• Include TMJs' . AP axial 30°
• Mandib!e without '~""'; (Towne)
• ~~~~~~~a~~~~~~:~s ~ ~.~ Structuresr
• Condyloid
• PA Axial TMJ & processes of
condyles visible mandible
mastoids • Temporo
• Condyloid processes mandibular fossae
well visualize
Zygomatic arches Zygomatic arches
AP axial 35°
(Modified Towne)
Part position
'OML~
'No rotation/tilt
'MSP~
'CR 35° caudad to
OMU37° to IOML
• EBto Glabella ~ EAM
Evaluation criteria Zygomatic arches
• Condyloid processes Part position
symmetric ~r • Prone
• TM fossae I • Nose & chin on film
visualise zygomatic ,. ~~.
arch • MSP~
• TM fossa mastoids • 23-38° caudal
• ~ Condyloid • Enter vertex
processes & • 112 Zygomatic arches
TM fossae visible
Mandible SMV Mandible SMV
Structures Part position
• Entire Mandible • Hyper extension
• Coronoid : ~o~~~tion/tilt ;l r •.\ .
• Condyloid
processes • MSP ~ ~" ,::
• CR 1/2L e of mandible; l'i.,·,. ~~~• CP 4cm inf. to " _._.~:_~; .ti
mand.symph.
• CR~ IOML
Evaluation criteria Additional
• Entire Mandible
• No rotation/tilt
• Condyles anterior to
petrous ridges
• Mand. Symph. frontal
bone~
• Mandibubal=border
• Mandibular coronoid
processes lateral
TMJs TMJs
AP axial 30° AP axial 20°
(Modified Towne) (Modified Towne) ,
Structures Part position
·Condyloid processes OML~
;' \,'
·TM fossa • No rotation/tilt ': \
• MSP~ ,
• CR 20° caudad to ~ ...
\
" \.
OML/42° to IOML
TMJ
Evaluation criteria Axiolateral TMJs
• Condyloid Structures
processes • TMJ closest to
& TM fossa film
• Mandible - no • Bilateral ¢
rotation • Open & closed
mouth
Axiolateral TMJs Evaluation criteria
Part position • TMJ EB. to film
• Side of interest • TMJ anterior to
EAM
• Nasion=Occ.prot.
• No rotation/tilt • Open & closed
• MSP II • no motion
• Interpupilary ~ • ~ visualise TMJ
BOfIt..-g .. , K.L. ,M3. Rltdlo"aphk PoMtIoMt(l.nd R.,ed AlNtonrr. Worlrboooff
• CR 25-30° caudad .ndt.OOnltoryAlMtl-'. Vot 1, W ed. u.s ....: StLoul .. Mo.oy.211~",
~, KL 1"7. RedIogrepl* ~ and R.Mfttd AnMomy. 4th ed.
• CP 1,3 ant & 5cm U.s.A., St Lou'-: Mo4by. a;tJ.311.Schuller Method
sup. of EAM ~, P.W.&. Fruk. E.D. 1,", ",."... A'" 0/ ~ I'NIIJoM andRedllolOflk Proc«I_ ...... U.aA. St LovioI: a.to.by. 2l1 ... 7.
131
APPENDIX X
Interactive learning guide
Activities from Radiographic Positioning and Related Anatomy: Workbook
and Laboratory Manual. Vol. 1, 3rd ed. (Bontrager 1993:261-266).
APPENDIX X
INTERACTIVE LEARNING GUIDE
School of Health Technology
RADIOGRAPHY
Technikon Free State
Learning Guide
Radiographic Practice RAD 20 at
Theme: Facial Bones 3 credits
May 2002
S.M. Briissow
©
Unit I
Bontrager p. 341 / Merril p. 292
FACIAL BONES
1. INTRODUCTION
Radiography of the facial bones requires a good understanding of the
anatomy of these 14 separate bones. The facial skeleton is difficult to
radiograph, not only because of the complexity of these bones, but also
because they are situated directly anterior to very dense cranial structures.
For example, how could the maxillary bones comprising the upper jaw be
visualised on a frontal projection, since the very dense petrous pyramids
are located posteriorly and at the same level as these bones? A certain tilt
of the head will cause the facial bones to be thrown up just enough so they
will be projected on the radiograph slightly higher than the petrous
pyramids. Thus it is especially important that you not only know the
specific anatomy of the facial bones, but also know the relative positions of
each specific part of these bones in relationship to other cranial structures.
The orbits or bony cavities of the eye sockets contain small openings for
nerves and blood vessels and certain types of pathology or abnormalities
involving these openings or foramina can only be diagnosed on
radiographs. This again requires a thorough understanding of the shape
and structure of the bony orbits in order to be able to direct the central ray
precisely through these foramina to visualise them on film. On patients
these skeletal structures are covered with skin and other tissues and you
must learn and understand this anatomy to the extent that you develop "x-
ray sight" and know and be able to "see" and locate these skeletal
structures.
It is also very difficult to recognise specific facial and cranial anatomy on
radiographs because they often superimpose each other. Even many
experienced technologists have difficulty with this. You should take special
note of the labelled radiographs in this chapter and learn to look for certain
more obvious structures and relate other less obvious structures to them.
This will require that you study actual radiographs, which are not labelled
in the lab and identify all structures identified on the radiographs in the
textbook. You will also need to practise each projection and position
described in this chapter and evaluate resultant radiographs for proper
patient positioning, technical factors, and the visualisation of specific
needed anatomy.
2. LEARNING OUTCOMES
After you have successfully completed all the activities you will be able to:
1. List the 14 facial bones (with correct spelling).
2. Identify both on drawings and radiographs, anatomical parts of each
facial bone as defined in the textbook.
3. Identify the two anatomical names for the "cheek" bone.
4. List the names of specific cranial and facial bones with which each
facial bone articulates.
5. Identify the temporomandibular joints (on radiographs) and
discriminate between those taken in the open mouth position and
those taken in a closed mouth position.
6. Describe the shape and the position of the bony orbits within the
skull. Identify the angle formed between the cone-shaped orbits and
the orbitomeatal line and between the cone-shaped orbits and the
midsagittal plane.
7. List the seven bones making up the orbits and identify which are
facial bones and which are cranial bones.
8. Identify on a dry skull each of the seven bones comprising the orbits
as well as the three openings of the orbits.
9. List the two basic projections or positions for a routine facial bone
series and the optional position for the "floor" of the orbits.
10. Describe the difference between the routine Waters and the
modified Waters positions and describes what anatomical
structures are best demonstrated on each.
11. List the two basic projections or positions taken for a routine
zygomatic arch series and the three optional positions or
projections.
12. List the two basic projections or positions for a routine mandible
series. Describe the differences in positioning for the axiolateral to
best visualise the ramus, the body, or the mentum.
13. List the optional projections or positions, which best demonstrate
the following specific parts of the mandible: (1) the upper rami and
condyloid processes; (2) the mentum; and (3) the u-shaped outline
of the body and mentum.
14. List the two possible projections for the visualisation of the
temporomandibular joints and identify the reason for preceding TMJ
radiography with routine mandible radiographs. Identify the reason
for examining the TMJs bilaterally and in both the open and closed
mouth positions.
15. Identify the special position commonly used to demonstrate the
optic foramen. Describe the positioning line, which must be parallel
to the central ray, and the degrees of angle between the midsagittal
plane and the tabletop.
16. Position on a model and/or phantom each of the basic and optional
projections as described in the textbook. Include the three different
methods for taking each projection which are: (a) on a routine
radiographic table; (b) on a vertical head unit or erect table or grid
film holder; and (c) modifications for severely injured patients.
17. Critique assorted facial, mandible, and orbital radiographs based on
evaluation criteria provided in the textbook.
18. Discriminate between radiographs which are acceptable and those,
which are unacceptable due to exposure factors, collimation or
positioning errors.
Prerequisite
An understanding of the surface landmarks and the localising lines
as described in the skull guide, as well as the anatomy and
positioning of the cranium is essential prior to beginning this theme
on the facial bones.
3. SOURCES
Bontrager, KL 1993. Radiographic Positioning and Related
Anatomy: Workbook and Laboratory Manual. Vol. 1, 3rd ed. U.S.A:
St Louis. Mosby. 217-268.
Bontrager, KL 1997. Radiographic Positioning and Related
Anatomy. 4th ed. U.S.A., St Louis: Mosby. 323-358.
Ballinger, P.W. & Frank, E.D. 1999. Merrill's Atlas of Radiographic
Positions and Radiiiologic Procedures. 9th ed. U.S.A., St Louis:
Mosby. 231-307.
4. THEME OUTLAY
At the beginning of this theme I would like to provide you with a
bird's eye view in the form of a summative chart
Radiographic Anatomy
Facial bones (14) I·,
" ..~,~-
.. ~.~~-M- axillae .. !
Zygoma
Lacrimal
Nasal
Inf cinchae
Palatine
Vomer
Mandible
Basic and Special Projections IJ
~ ,~-",.,w--~.""'=ïrl .r._. -_-_-__,.__-_ -_-_-_~_--_-._..-._.-·l·i- ..r--_. _-_.- - __ - ... I
l
Facial Bones Nasal Bones I, Zygomatic arches
Basic Basic I Basic I
Lateral Lateral ! SMV ~
Parietoacanthial (Waters) Parietoacanthial (Waters) ObI. Inf.Sup (Tangential) li
PA (Caldwell) Special
Special PA (Caldwell) ~:e~!~1 (Mod.Towne) "I
Modified Parieto- Superoinferior (axial) Parietoacanthial (Waters) i
Acanthial Lateral .~
(Modified Waters) J I j
,. _H
Optic Foramina Orbits Mandible I""""" TMJs 1;
Basic Basic Basic Basic
Rhese M. Parietoacanthial Axiolateral AP axial (M.Towne) 't
Waters i Modified Waters Cross table Special ,t
PA (Caldwell) I (trauma) .: Axiolateral 150obl. t
Special PA 0° & 20-250 caphalad Axiolateral "
Parietoacanthial AP axial (Towne) I Tomography
(Modified Waters) I special .]•.J SMV I Panorex..... ..... t
.. ()
~~~ /t will take you about 60 minutes to camp/ete Activity 5.
5. ACTIVITIES
PART I RADIOGRAPHIC ANATOMY
LINK! ~ Specified learning outcomes 2.3
~.
Learning outcomes 1-8
Review Exercise A
Anatomy of Facial, Nasal, Mandibular, and Orbital Bones
1. List all of the facial bones and indicate if they are single or paired
bones.
Facial bones Single or paired
A. ___
B. ___
C. ___
0. ___
E. ___
F. ___
G. ___
H. ___
2. Complete the following:
A. A second anatomical name for the zygomatic bone is .
B. The largest facial bone is the _
C. The largest immovable facial bone is the
D. Which facial bone assists in forming the mouth, nose, and
orbital cavities? _
E. The inferior aspect of the body of the maxilla is called the
F. The pointed process of the maxilla located at the acanthion
is called the _
G. The parts of the maxilla, which help form the roof of the
mouth, are the right and left _
3. Each maxilla articulates with two cranial bones, (a) __
and (b) _
4. List the four separate facial bones, which make up the hard palate:
A. C. _
B. _ 0. __
5. The zygomatic arch is formed by the (a) and (b)
_________ bones.
6. The zygomatic prominence is a positioning landmark and refers to
the most prominent portion of the bone.
7. Each nasal bone articulates with which two cranial bones?
A. _
B. _
8. The pair of small facial bones closely associated with the tear ducts
is the _
9. An incomplete joining of the two palatine processes of the maxillae
results in a condition called -----------
10. The upper teeth are embedded in cavities along the inferior edge of
the (a) _ process of the (b) bones.
11. The large air-filled cavities located in the body of the maxillary
bones are called _
12. The process of each maxilla projects upward along
the lateral border of the nose.
13. The surface landmark located at the point of junction of the frontal
bone and the two facial bones forming the bridge of the nose are
the ---------------
14. List the three pairs of scroll-shaped bones located in the nasal
cavity, and identify the cranial or facial bone each is associated
with.
A. __
B. __
C. __
15. A second name for the above three pairs of bones is _
16. The superior portion of the bony nasal septum is formed by the
(a) ofthe (b) . and the inferior
portion by the (c) _
17. Identify the anatomy from the labelled drawings and list the name of
the bone for which it is a part.
Anatomical part Name of facial or cranial bone
A.
B.
c.
D.
E.
F.
G.
H.
I.
J.
18. The two halves of the mandible join to form a single bone at
approximately year(s) of age.
19. The Latin word for the chin is -----------
20. True / False:
A. __ The symphysis of the mandible extends along the
complete vertical portion of the mid anterior mandible.
B. __ "Mental protuberance" refers to the lower anterior
mandible which projects forward, the centre of which is the
mental point.
C. __ "Symphysis menti" is another term for the symphysis of
the mandible.
21. Matching:
A. __ part of mandible A. coronoid process
B. part of scapula B. coracoid process
C. part of proximal ulna
22. Label the following drawings of the mandible:
A.
B.
C.
D. (VjJ-E
1 .~
E. ~n:cd .~(,
F.
G. . f ~_;j-G
H
H.
I.
J.
K.
L.
M.
N.
O.
P.
23. A. What is the name of the only synovial/diarthrodial joint of the
skull?
B. What movement type(s) is this joint?
24. There are two types of fibrous/synarthrodial joints of the skull.
These are the (a)
______________ of the cranial bones, and the special type of joint
involving the teeth and the mandible and maxillae of the subclass
termed (b) __
25. The condyles of the mandible move (a) (b)
___ (front or back) edge of the (c) (forward or
backward) to the as the mouth is opened.
26. Fill in the secondary term for the following parts of the mandible:
A. Angle _
B. Condyle _
27. Each orbit is (a) shaped and is composed of parts of (b) (number)
bones.
28. With the orbitomeatal line situated parallel with the floor, each orbit
projects superiorly at a (a) degree angle, and toward the
midsagittal plane at (b) degrees.
29. A small opening termed the is located at the
----- of each orbit.
3D. Fill in the names of the seven bones which form the orbit as
indicated in this drawing:
A. __ Medial Lateral
B. __
C. __
D. __
E. __
F. _
G. _
31. Fill in the name of the openings and the one structure (B) in the
posterior orbits as indicated in this drawing:
A. Medial Lateral
Il
B. __
C. __
D. _
32. Two fractures involving the orbit are known by their descriptive terms
as (a) and (b) fractures.
PART II. RADIOGRAPHIC POSITIONING
Positioning of the Facial and Nasal Bones, Mandible and Orbits
Textbook: pp. 354-387
1. Based on the national survey (as quoted in textbook), list the most
frequently performed (basic or routine) positions or projections for
the following:
A. Routine facial bones (a) (b)
B. Facial bones on a severely injured trauma patient who cannot
be turned into a prone position
(a), _
(b), _
C. Routine nasal bones (a) (b)
D. Routine zygomatic arch (a) (b)
E. Position best demonstrating optic foramina _
F. Best demonstrates "blow-out" fractures of orbits
G. Routine mandible (a) (b) _
H. Routine temporomandibular joint (a) or (b) _
2. To prevent head rotation on a lateral facial bone radiograph, the (a)
______ plane is aligned (b) to the film
and the (c) Iine is aligned to (d) _
to the film.
3. The projection is another name for the
Waters projection.
4. The petrous ridges should be projected directly below the (a)
_________ in a Waters position, and projected into the
lower half of the maxillary sinuses or below the (b)
_______ in a modified Waters position.
5. True or false: For a PA Waters, the distance from the tip of the
nose to the table top is a good positioning method for determining
the correct angle between the orbitomeatal line and the film plane
6. In the Waters position, the (a) line
should form a (b) __
degree angle with plane of the film, and a (c) __ degree angle in
a modified Waters.
7. In the Waters or reverse Waters position, the _
line should be parallel to the central ray and perpendicular to the
plane of the film.
8. In the Waters position, the central ray should exit at the
9. In addition to using a small focal spot, a (a) film
holder should be used to obtain optimal detail for a lateral nasal
bone radiograph. The kVp range used should be (b) _
10. A good basilar or submentovertex projection requires that the
central ray be at right angles to the _
line, which is abbreviated as _
11. For the oblique axial position of the zygomatic arch, the head is
turned (a) _ degrees toward the side being examined, and the
midsagittal plane is tilted (b) __ degrees.
12. Complete the following for an AP axial projection (Towne position)
for the zygomatic arches:
A. The central ray is directed (a) _ degrees (b) _
(caudal or cephalic) to the (c) line.
B. If the infraorbitomeatal line is placed perpendicular to the
film, the central ray angulation should be increased to__
degrees.
13. Indicate the correct central ray location and angulation (indicate as
perpendicular if no angle) for the following:
Central Ray Location Central Ray Angulatin
A. Lateral facial bones
B. Reverse Waters
C. Lateral nasal bones
D. Townes for zygomatic arches
E. Axial obliques for bilateral zygomatic arches _
F. AP axial projection of mandible
G. Axiolateral oblique position of
temporomandibular joints
14. Complete the following for the Rhese position:
A. As a starting reference position, the three parts of the face,
which should be touching the tabletop, are the _
----- and --------
B. The line should be perpendicular to the
tabletop and parallel to the central ray.
C. The head should be rotated __ degrees from the PA
position, which results in a _ degree angle between the
midsagittal plane and the tabletop.
D. This position will project the optic foramen into the
______________ quadrant of the orbit being examined.
15. What projection or position is most useful in visualising the
condyloid processes and temporomandibular fossae?
16. Aligning the plane perpendicular to the plane
of the film for a PA mandible will prevent rotation.
17. True or false: For the routine PA projection of the mandible, a 15-20
degree caudal angulation is needed.
18. In the axiolateral projection (oblique position) of the mandible, name that
portion of the mandible, which would be best demonstrated, using the
following head rotations.
A. 30-degree rotation _
B. True lateral (no rotation) _
C. 45-degree rotation _
19. Why must the chin be extended when doing the axiolateral projection of
the mandible?
20. For the axiolateral position a cephalic angle of approximately __
degrees is needed to visualise the affected mandible without
superimposition of the opposite mandible.
21. For a panorex of the mandible, the (a)
____________ line is aligned parallel with the (b)
22. A. The common name for the axiolateral position for the
temporomandibular joints is the method.
B. This position requires the head to be in a true lateral position and
the central ray to be angled __ degrees (caudal or
cephalad).
23. A. The axiolateral oblique position of the temporomandibular Joints
is commonly referred to as the method.
B. This requires that the head be rotated (a) __ degrees toward
the film and the central ray angled (b) _ degrees _
(caudal or cephalad).
Facial bone Radiography is one of the areas in which a sound
knowledge of the relevant anatomy is of the utmost importance -
it will enable you to be a far more competent and skilled
radiographer.
Feedback and answers to your activities and self-tests will be
provided to you during contact sessions as indicated on your time
tables.
riJ
It will take you about 60 minutes to complete this activity
PART III. RADIOGRAPHIC PROCEDURES
LINK! Exit level outcome 1 - 3 p. 9 of Year Organiser
Specified learning outcomes 1.1-3.7 0
Learning outcomes 9-18 l!!f
Part A of this learning activity exercise needs to be carried out in a
radiographic laboratory
A. Positioning exercise
For this section you need another person or an articulated phantom to act
as your patient. Practice the following until you can do each of them
accurately and without hesitation. It is important to achieve both accuracy
and speed in radiographic positioning. Place a check by each position
when you feel you are competent.
Include the following parameters as you simulate the basic positions or
projections listed:
• correct choice of source image receptor distance
• correct size and type of film holder
• correct location of central ray
• correct centring of part to film
• correct placement of Rand L markers
• accurate collimation
• proper use of immobilising devices when needed
• proper use of positioning aids as needed
• approximate correct exposure factors
• correct instructions to your patient before and during exposure.
1. Erect (with head unit if available or with erect table or other erect
grid-film holder), lateral and Waters positions for the facial bones.
2. Severely injured patient who cannot be moved from a supine
position on a stretcher. (Spinal injury has been ruled out by cross
table lateral cervical spine.) Take a cross table lateral and a Waters
position.
3. Head unit or tabletop lateral and Waters positions for nasal bones.
4. Head unit or tabletop submentovertex projection for zygomatic
arches.
5. Head unit or tabletop parieto-orbital projection of the optic foramina.
6. Head unit or tabletop modified acanthioparietal projection for the
orbits.
7. Head unit or tabletop axiolateral and PA projections of the
mandible.
8. Head unit or tabletop axiolateral oblique position (Law Method) of
the temporomandibular joints.
9. Special acanthioparietal projection to demonstrate the "floor" of
orbits.
Optional: Using either a sectional or fully articulated phantom, produce a
diagnostic radiograph for the following;
1. Parietoacanthial and acanthioparietal projections.
2. Parieto-orbital projection.
3. Axiolateral (oblique) projection of the mandible.
4. Axiolateral oblique position (Law Method) of the
temporomandibular joints.
5. Rhese method of the orbit.
6. Nasion inferior-superior.
7. TMJ
Tip:
You should gain experience of radiographic facial bone procedures by
performing the different projections on a phantom or in practice during
experiential training.
Film critique and evaluation
Critique each radiograph based on evaluation criteria:
Criteria guidelines:
a. Correct film size and correct orientation of part to film?
b. Correct alignment and/or centring of part to film?
c. Correct collimation and CR location?
d. Pertinent anatomy well visualised?
e. Motion?
f. Optimal exposure (density and/or contrast)?
g. Patient ID information and markers?
h. Radiographs.
1. Lateral
2. Parietoacanthial
3. PA Caldwell
4. Submentovertex
5. Rhese oblique
6. Schuller method
Identify the following anatomical parts:
- sella turcica - zygoma
- mandible - inferior rim of orbit
- maxillae - nasal septum
- zygomatic arches - anterior nasal spine
- orbital rim - nasal bones
- optic foramen - mandibular rami
- temporomandibular joints - condyloid processes of mandible
- coronoid process of mandible - temporomandibular fossae
- petrous ridges
C. Review of Anatomy on Radiographs
Use those radiographs provided a lateral, parietoacanthial, PA Caldwell,
submentovertex, Rhese oblique, Law, and Schuller methods
Lateral Parietoacanthial
PA Caldwell Submentovertex
Rhese oblique Schuller method
D. Review of Topographical Landmarks and Positioning Lines
(as used for facial, mandibular, and orbital bone positioning).
Locate the following on another person:
1. Midsagittal plane
2. Interpupillary line
3. Zygoma
4. Outer canthus
5. EAM
6. Mentomeatal line
7. Acanthion
8. Orbitomeatalline
9. Infraorbitomeatal line
10. Glabello-alveolar line
11. Mandibular symphysis
12. Angles of the mandible
13. Glabella
14. Zygomatic arch
15. Zygomatic prominence
16. Three-point landing for Rhese method
17. Supercilliary arch
6. ASSIGNMENT
1. Practise and be able to demonstrate projections 1 to 9.
2. Hand in the projections 1 to 4 on the lower part of the page.
3. Complete the atached table in connection with the facial
bones.
This assignment needs to be carried out in a radiographic practice/
department
For this section you need a patient or an articulated phantom to act as
your patient. Practise the following until you can do each of them
accurately and without hesitation. It is important to achieve both accuracy
and speed.
1. Erect (with head unit if available or with erect table or other erect
grid-film holder), lateral and Waters positions for the facial bones.
2. Severely injured patient who cannot be moved from a supine position
on a stretcher. (Spinal injury has been ruled out by cross table lateral
cervical spine.) Take a cross table lateral and a Waters position.
3. Head unit or tabletop lateral and Waters positions for nasal bones.
4. Head unit or tabletop submentovertex projection for zygomatic
arches.
5. Head unit or tabletop parieto-orbital projection of the optic foramina.
6. Head unit or tabletop modified acanthioparietal projection for the
orbits.
7. Head unit or tabletop axiolateral and PA projections of the mandible.
8. Head unit or tabletop axiolateral oblique position (Law Method) of the
temporomandibular joints.
9. Special acanthioparietal projection to demonstrate the "floor" of
orbits.
7. PRESENTATION
In groups of two prepare a clinical demonstration of the abovementioned
projections.
The skills you have developed in this theme are:
NQF generic outcomes
~ -problem-solving
-teamwork
-organisation
-the effective use of science and technology.
8. DRAW UP A TABLE: FACIAL BONES
132
D. ETHICS
133
APPENDIX XI
Consent form
APPENDIX XI
CONSENT FORM
vr1:;Jr~bj]t1~r~/jJ~ta
CONSENT TO USE MY ACADEMIC PROFILE
NAME: _
• I certify that the lecturer has explained and informed me of the
nature of the proposed study.
• I consent to the use of my academic profile and marks as
necessary to compare relevant marks in a search of a
teaching strategy to enhance my academic performance.
• All collected information will be handled confidentially.
• Feedback in connection with the results of the study will be
provided.
Signature: _
Date: ----------
134
APPENDIX XII
Ethics committee approval (ETOVS nr 39/03)
APPENDIX XII
ETHICS COMMITTEE APPROVAL
UNIVERSITEIT VAN DIE VRYSTAAT
UNIVERSITY OF THE FREE STATE
Direkteure FlIklllteitliU.dmini~lrasi" Direelor: Fandty AdlllinMrlltij)1l
Fakulteit (;esondheids\\el~J1..~kalll)t Faculty of Hj';tllb Sdl"llff'i
~; 339 BLOEMFONTEIN 9300 -: 339 BI.OEMFONTEIN 9300
RFPU81.1EK VAN SUln·AFRIKA REPUBLIC OJ: SOUTH Af"RICA
'fr' (051) 405 3013i 4012847 'tt ((iSI) 405 3013 I 401 ~il47
....... (051) 444 3103 ...... (05) 444 310:>
'~: gfldklU'rr.9<llJO\'s.ac.za :"::;,gnukl@m~.lIovs ac lJ
Re$~c!rch Dh·ision
'",,,m.l POSISox G40
WiQS,) 4053654
2CC3·03 20
HS SI'-1IlRGSSOW
C/O PROF M"'l NE.L
DIVISION OF E.DUCA TlONAL DEVELOPMENT
IN rERNAL POST BOX G 14
UFS
Dear Hs Brussow
ETOVS NR 39i03
REStARCHEIl: MS SM IlIUi$SOW
PROJECT TITLEl THE IMPACT OF AN INTERACTIVE EDUCATION STRATEGY IN
RADIOGRAPHY EDUCATION.
You are hereby Informed chat the Erhlcs Cornmluee approved the abovemenuoned study during their m~(>tlng
held on the l Bth March 2003.
Your euenuon is kindly drawn to the following:
". Failure to submit a progress report not later than one yeJr after approval of the project may result In the
terrnlnation of the study.
". That Jil exrenuons, amendments, serious adverse events, termination of a study ere have to be reported to
the Ethics Ccmmlrtee
';. These documents have been accepted as complying wlch the Ethlcs Standards tor Clinical Rcseerch based
on FDA, ICH GCP and Declaration of Helsinki guidelines
;,.. Trmslauons of the Subject lnformauon Leaflet and Consent Form have [0 be subrnltted prior 10
commencement of a study,
Will you please quote the Erovs number as indle.md above In subsequent correspondence, reperts and
enquiries.
Yours fJ~thfuUy /1 ' f/"'
() il/ ' !
.,
For D~Ut{!(\é~1OR: MEDICINE ADMINISTRATION
--"..)