Exploring health sciences students’ experiences of feedback in a problem based learning tutorial : a case study in an African Medical School

Mubuuke, Aloysius Gonzaga (2018-03)

Thesis (DMed)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : Problem Based Learning (PBL) has been widely adopted by medical educators across the globe since its inception at McMaster Medical School in Canada. It is a student-centered instructional approach in which learners collaboratively solve problems and reflect on their learning experiences. PBL involves designing tasks as triggers for learning, and setting them in a context that may be relevant in the real world. Students work in small groups also known as tutorial groups supported by tutors, with the emphasis being student centered rather than teacher centered. This enables students to take charge of their own learning, conduct research, integrate theory and practice, and also apply knowledge and skills while developing solutions to a presented learning task. In such a setting, students construct their own knowledge and regulate their own learning activities in order to achieve the intended learning outcomes. Tutor feedback is an important aspect of the PBL tutorial process. This feedback is aimed at identifying students’ strengths as well as learning gaps on a number of outcomes. These may include: knowledge, team work, communication skills, interpersonal skills, life-long and leadership skills among others. This study highlights the experiences and perceptions of health sciences students regarding tutor feedback in a PBL setting. Learning in a PBL tutorial group setting is not only a cognitive process, but also influenced by socio-contextual factors. Therefore, this study has utilized both psychological as well as socio-cultural theory to understand and explain the students’ experiences and perceptions of tutor feedback. It is envisaged that findings from the study will perhaps contribute to not only knowledge on the subject of feedback, but also to general teaching practice in health sciences education within Africa and beyond. Therefore, the over-arching objective of the study was to explore students’ experiences and responses to tutor feedback as well as factors that influence those responses in a PBL tutorial setting in an African context. It was an exploratory qualitative study using a case study approach. The study involved third year undergraduate health sciences students from Makerere University, College of Health Sciences that had attended PBL tutorials. The health sciences students who participated in the study were drawn from five disciplines namely: Medicine, Radiography, Nursing, Pharmacy and Dentistry. The tutorial groups thus consisted of students from these disciplines. Some of the tutors were also involved in the study to provide more understanding of the student experiences. Purposive-convenience sampling was used to select participants into the study. Multiple data collection methods used, included: in-depth individual interviews with students and tutors, focus group discussions with students, document reviews and observations of the tutorial process and the feedback process. Participant responses from the interviews and focus groups were audio recorded and transcribed. The observations were guided by a checklist. For analysis of the transcriptions, thematic analysis was used in which raw data was coded. The developed codes were further related resulting into categories and subsequently into themes and clusters. The analysis was iterative in nature in which data was constantly compared. The findings from the student interviews and focus group discussions were grouped into five clusters, each cluster having a number of themes. The first cluster related to the focus and nature of tutor feedback received by students during PBL tutorials. The themes from this cluster reflected that tutor feedback seemed to be limited in scope to address all the intended PBL outcomes. This observation was also reflected in the interview responses with the tutors. The second cluster was about factors influencing students’ responses to tutor feedback. It was found out that both cognitive and socio-contextual factors influenced students’ responses to tutor feedback. The themes in yet another cluster related to the ways in which students utilized tutor feedback in their learning. It was found out that students used feedback to activate their prior knowledge, reflect upon their own performance and also to engage in self-regulated learning processes. The last cluster and related themes spoke to the students’ experiences of the feedback delivery process. The responses from the student interviews and focus group discussions were supported by key findings from the tutorial observations, document reviews and information from the tutors. An interpretation of these findings was guided by a framework developed from the Activity Theory. Overall, the key outcome of this study was the development of a structured feedback tool for PBL tutors.

AFRIKAANSE OPSOMMING : Probleemgebaseerde Leer en Onderrig (PBL) word algemeen deur gesondheidswetenskap-opvoeders aanvaar sedert die onstaan daarvan by die McMaster Mediese Skool in Kanada. Dit is ʼn student-gesentreerde benadering waarin studente saam probleme oplos en op hulle leerervaringe reflekteer. PBL behels die ontwerp van take deur die skep van scenario’s wat dien as snellers vir leer. Studente werk in klein groepe, ook bekend as tutoriaal groepe, met ‘student-gesentreerde’ eerder as ‘opvoeder-gesentreerde’ ondersteuning van tutors. Hierdie benadering stel studente in staat om verantwoordelikheid te neem vir hulle eie leer, navorsing te doen, teorie en praktyk te integreer, sowel as kennis en vaardighede toe te pas terwyl hulle oplossings ontwikkel vir die leertaak wat aangebied word. Met hierdie benadering konstrueer studente hulle eie kennis en reguleer hulle hul eie leeraktiwiteite ten einde die beoogde leeruitkomste te bereik. Tutor-terugvoer is ʼn belangrike aspek van die PBL tutoriaal proses. Hierdie terugvoer is daarop gemik om die sterkpunte sowel as leemtes van studente in verskeie areas van leeruitkomste, insluitende onder meer kennis, spanwerk, kommunikasievaardighede, interpersoonlike-vaardighede, lewens- en leierskapsvaardighede, te identifiseer. Hierdie studie beklemtoon die ervarings en persepsies van studente in die gesondheidswetenskappe met betrekking tot tutor-terugvoer in die gebruik van die PBL benadering. Leer in PBL tutoriaalgroepe is nie slegs ʼn kognitiewe proses nie, maar word ook beïnvloed deur sosio-kontekstuele faktore; daarom maak hierdie studie gebruik van sielkundige sowel as sosio-kulturele teorieë om student- ervarings en persepsies van tutor-terugvoer te verklaar en te verduidelik. Dit word in die vooruitsig gestel dat die bevindings van hierdie studie dalk nie net sal bydra tot kennis op die gebied van terugvoer nie, maar ook op algemene onderrigpraktyk van gesondheidswetenskappe in Afrika en ook verder. Die oorkoepelende doelwit van hierdie studie is daarom die verkenning van studente ervarings en response op tutor-terugvoer, sowel as die faktore wat hierdie response in ʼn PBL tutoriaal-situasie in die Afrika konteks beïnvloed. Dit was ʼn verkennende kwalitatiewe studie wat gebruik gemaak het van ʼn gevallestudie benadering. Die studie het voorgraadse derdejaar studente in gesondheidswetenskappe van die Makerere University, College of Health Sciences, wat die PBL tutoriale bygewoon het, betrek. Die studente wat aan die studie deelgeneem het, is uit vyf dissiplines geselekteer, naamlik: Medies, Radiografie, Verpleging, Farmakologie en Tandheelkunde; daarom het die tutoriaal groepe ook uit studente van hierdie dissiplines bestaan. Daar is sommige van die tutors by die studie betrek om ʼn beter begrip aan die studente se ervaring te gee. Doelgerigte en gerieflikheidsgedrewe steekproewe was gebruik om die deelnemers aan die studie te selekteer. Veelvuldige data-versamelingsmetodes, insluitende individuele in-diepte onderhoude met studente en tutors, fokusgroep-onderhoude met studente, dokument-resensies en waarnemings van die terugvoerproses tydens tutorial, is gebruik. Die ouditiewe response van die deelnemers is band-opgeneem en getranskribeer. Die waarnemings was gerig deur ʼn kontrolelys. Tematiese analises waarin die rou data gekodeer was, is vir die analise van die transkripsies gebruik. Die kodes wat ontwikkel was het verdere verwantskappe getoon wat gelei het tot die identifisering van kategorieë en uiteindelik tot temas en klusters. Die ontleding waarin die data voortdurend vergelyk was, was herhalend van aard. Die bevindings van die individuele in-diepte student-onderhoude en die fokusgroep-onderhoude was gegroepeer in vyf klusters – elk met ʼn aantal temas. Die eerste kluster is verwant aan die fokus en aard van die tutor-terugvoer aan studente gedurende PBL tutoriale. Die temas van hierdie kluster het gereflekteer dat tutor-terugvoer waarskynlik van beperkende omvang was om al die beoogde PBL uitkomste aan te spreek. Hierdie waarneming was ook gereflekteer met die response van die tutors. Die tweede kluster het gehandel oor die faktore wat studente respons op tutor-terugvoer beïnvloed. Daar is bevind dat beide kognitiewe en sosio-kontekstuele faktore die studente se respons op tutor-terugvoer beïnvloed. Die temas in ʼn volgende kluster het die verwantskap getoon met die wyse waarop studente tutor-terugvoer gebruik in hulle leerproses. Daar was bevind dat studente terugvoer gebruik om hulle voorkennis te aktiveer, op hulle eie prestasie te reflekteer asook om in ʼn selfregulerende leerproses betrokke te raak. Die laaste kluster en gepaardgaande temas het die studente ervarings van die terugvoerproses aangespreek. Die respons van die individuele student-onderhoude en ook fokusgroeponderhoude is ondersteun deur sleutelbevindinge van die tutoriaal waarnemings, dokument-resensies sowel as inligting bekom van die tutors. Die interpretasie van bevindinge in hierdie studie was gerig deur ʼn raamwerk ontwikkel vanuit die Aktiwiteitsteorie. Die sleutel uitkomste van hierdie studie was die ontwikkeling van ʼn gestruktureerde hulpmiddel vir PBL tutors om te gebruik tydens die terugvoerproses.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103754
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