Medical Education, 1977,11,394-398
\
\,
*
*
programme
dicine and Dentistry, University of Rochester, New York
summary
1974). The programme has now completed its third
(1s) !in the ciences has been develop&'' &' 'the University of Rochester fS&661' 'of. !rkeclirifi6' and Dentistry which ilftrohres' tudetlts as a learni&Tuf'&achers as a ing team workidg kiith. teaching team. The teachers &xvd' 8s guides to learning r a t h e r d h asis&ces aPexpeW information and f@tEtIda ils g&W&sts Wthe?itxIdUi%tional roles. The programme, which f h ~-#&embd by some s W ~ shastprovided ; ~ ~~~~faWm&te. ko the lecturelaboratory-conference format of the traditional curriculum. Some of the advantages of such an ISP are discussed and its effectiveness assessed.
y W &{@eration and has been adopted as a formal
part of the educational programme of the medical school. The general goals as stated by the ISP teachers are as follows. (1) To develop an individualized learneroriented,, .grogramme using a multidisciplinary approach with a problem-solving format for the sfu& ,sf..tfie basic sciences of medicine. (2) To encourage medical teachers to function as a teaching taqm ser$w, as guides in learning rather than primarily as sources of expert information, and thus to encourage the teachers to cover areas of study in which they cannot serve as sources of expert knowledge, i.e. to function as generalists rather than as specialists in their educational roles. (3) To encourage students to communicate effectively with Key words : *EDUCATION, MEDICAL, UNDERGRADUeach other as they study and to work together to ATE ; *PROBLEM SOLVING ; *CURRICULUM; TEACHING/ solve problems as a learning team; to provide more methods ; EDUCATIONAL MEASUREMENT; EVALUATION free time to explore special interests; and to involve STUDIES; NEWYORK the students in developing the academic content of ISP. (4) To provide improved knowledge and assessment of student abilities through long-term associaAn independent studies programme (ISP) in the tion of individual students and teachers, and to use basic medical sciences for the second year of medical this information for effective and regular feedback t c study has been developed with a group of ten the student regarding his educational progress; to teachers and a student body of sixteen students identify the student's paths of potential development selected from the ninety-six students in the first year and to assess his aptitudes for the practice of mediclass at the University of Rochester School of cine. ( 5 ) To place the main responsibility for learning Medicine and Dentistry. In planning the ISP, inon the student through independent study which formation from other educational programmes was requires that he obtain his information through the utilized of which the programme at McMaster use of the library, a variety of audio-visual and other University provided most data (Neufeld & Barrows, self-instructional aids and computer based educational programmes, and as a result of this selfCorrespondence: Dr H. R. Morgan, Director of the Ineducation to anticipate that these students will be dependent Studies Program, Box 697, School of Medicine and better prepared as doctors to keep up to date in Dentistry, University of Rochester, Rochester, New York their medical knowledge. 14642, U.S.A. 394
A problem-oriented independthtMudiesprogramme
Implementation
3%
guidance of a teacher witW&hiadB kral&k@:&&
396
H . R. Morgan
Evaluation of the student At the end of each eight week basic science section and case protocol assignment, individual instructors write an evaluation of the performance of each student and rate him on an honours, good pass, or fail basis. Three times during the year a comprehensive interdisciplinary examination is given to assess the progress of the students. It consists of objective questions to test information, and essays related to case protocols selected to illustrate the application of basic sciences to the solution of a patient’s clinical problems. These examinations, being planned to reinforce the students’ education, are multidisciplinary and, given only three times, avoid the disrupting influence of frequent examinations on the educational experience.
Evaluation of the ISP After three years of operation it has become clear that this programme, with its heavy responsibility on the individual student for his own education, is probably suitable only for students with strong selfdiscipline, motivation and a sense of direction. In the three years of operation, one student withdrew from the ISP in preference for the more structured regular curriculum. Each year an evaluation of the programme is conducted by giving the students an evaluation form for each component of the programme, i.e. immunology, pathology, microbiology, behavioural sciences, pharmacology, case problems, etc. This involves a checklist of a number of evaluation elements, and in addition the student writes a paragraph discussing the strengths and weaknesses of the individual educational sections. These questionnaires and recommendations to the ISP teachers are summarized by each teacher for review of the programme and as a basis for revision of ISP, with extensive changes in the study outlines, case protocols, and the ISP reference collection resulting at the end of each academic year. In addition, the references and A-V aids are evaluated by each student each time they are used. At the end of the year these evaluations of each reference and A-V teaching aid are reviewed and serve as a basis for the retention or otherwise of each element. Another aspect of evaluation of the programme has been derived from the progressive rise in num-
bers of students applying each year, since students are selected by a lottery mechanism from all applicants from the first year class. The number of applicants from the ninety-six students in the first year class has risen from 1972-76 as follows: 26 of 96,27,37,63. As the programme has developed and become better known, increasing numbers of students have been attracted to this type of study. Some objective data regarding the efficiency of this educational programme is provided by the results of the National Board Examinations taken by ISP students and students in the regular curriculum (Table 1). The results of the three years show that in first year subjects (i.e. anatomy, physiology and biochemistry) the ISP students’ scores were usually lower than students in the regular curriculum whereas second year subject scores (pathology, microbiology, pharmacology and behavioural sciences) were somewhat higher with one exception. Thus the ISP is providing an information base in second year subjects which is at least equivalent to that provided by the traditional curriculum. An examination of the change in rating of the students on the National Board Examinations for first year subject scores as compared to second year subject scores (Fig. 1) however suggests that the ISP provides an educational experience which provides a greater impetus for learning because the relative changes in the average scores for first year and second year subjects show that ISP students show greater percentage improvement as compared to students in the traditional programme. An important evaluation of ISP is provided by a letter which was writtten by the students in the 1974-75 class to the teachers: ‘As the ISP class of 1974-75 we would like to acknowledge our appreciation for being able to participate in the learning experience we had this year. We have found the opportunity to work in an independent study format valuable, productive, and enjoyable. We would like to thank the staff for the time and energy they have contributed. Although we have submitted suggestions for changes and improvements in the programme, our overall experience has been positive and we wish to state our feelings of gratitude and satisfaction. ‘We think it would be useful for the record to comment from our experience in the Independent Study Programme what we have found to be the major benefits of independent study. First, it permitted us to learn in the ways we individually find
397
A problem-oriented independent studies programme TABLE 1. National Board average scores Subjects First year courses Year
Composite averages Second year courses
No. of students
Anat.
Phys.
Biochem.
Path.
Micro.
Pharm.
Beh. Sc.
1st year courses
2nd year courses
15 82
459 500
550 520
518 533
553 531
608 549
546 543
564 523
509 518
568 531
15 76
498 503
516 544
547
550
596 535
593 567
596 566
556 529
540 532
585 549
16 81
432 456
512 504
454 493
533 496
565 548
512 520
521 51 1
466 484
533 518
1973 ISP
Non ISP 1974 ISP
Non ISP 1975
ISP Non ISP
Av. Score
I973
1974
I975 +8.3%
580-
+ 11.6%
570560-
r
t 3.2%
550540-
530520 -
+3.6% ?- 2
I
I
0-1
+14.3%
0- I
t7. I % 0-2
51 0500-
4900-1
480-
advantage of involvement in educational opportunities and activities that otherwise would not have been feasible. Fourth, is the valuable experience, which will be of increasing importance when we become practising doctors, of taking responsibility for our self-education. Finally, we would like to mention the benefit of getting an earlier introduction to and involvement with clinical medicine, in parallel with our study of the basic medical sciences. We see all of these benefits as unique to the ISP in contrast to what would have been our experiences in the regular curriculum.’ As an additional means for evaluating the programme, the ISP teachers requested that an independent evaluation committee be constituted to examine the programme as it was developed and put into operation ; this special review committee has prepared a separate report on its study of the ISP (Geersma et al., 1977) which, however, covers only the start-up years.
470-
Discussion FIG. 1 . Change in average scores between first year and second year National Board examinations. 0,Non-ISP students; x, ISP students; 1. average of grades of first year courses; 2, average of grades of second year courses.
most productive, rather than being tied to a classroom and lecture format which many of us have found limiting. Second, the nature of the seminars facilitated active involvement with the course material, teachers, and with fellow students, drawing on the diverse inputs students could collectively bring. Third, we had the time to pursue questions or areas of particular, individual interest. In part this was manifest by permitting some students to take
After three years of operation the independent studies programme has achieved many of its major goals and has presented to students in the second year of medical studies an alternative pathway for the study of basic medical sciences which many of them prefer. The programme has proved highly demanding because of the case problem-solving format and the fact that students develop special interests which grow out of their study of the case problem protocols requiring significant additional effort and library research. This type of learning appears to give to many students a greater degree of satisfaction than the classical lecture-laboratory-conference
398
H . R. Morgan
type of programme which is the format for the regular curriculum. The students also have a significant input into the ISP by their detailed critiques and production of an ISP study aid and thus are actively engaged in the continuing evolution of the programme. Another aspect of ISP is the satisfaction the teachers developed by engaging in an educational enterprise in which they and students become members of a learning team. The teachers have learned to admit ignorance when students ask questions covering areas not within their special expertise. This leads both the teacher and the student to work together to provide the answers before the next discussion session is held.
Acknowledgment The ISP is based on the combined efforts of Drs William Au, Howard N. Harrison, Martin R. Klemperer, Herbert R. Morgan, John J. Sandt, Daniel B. Schuster, R. Knight Steel, I. Donald Stuard, Philip L. Townes, and Donald A. Young.
References GEERTSMA, R.H., MEYEROWITZ, S., SALZMAN, L.F. & DONOVAN, J.C. (1977) A n independent study program within a medical curriculum. Journal of Medical Education, 53, 123. NEUFELD,V.R. & BARROWS,H.D. (1974) The ‘McMaster Philosophy’: a n approach to medical education. Journal of Medical Education, 49, 1040.
\
\,
*
*
programme
dicine and Dentistry, University of Rochester, New York
summary
1974). The programme has now completed its third
(1s) !in the ciences has been develop&'' &' 'the University of Rochester fS&661' 'of. !rkeclirifi6' and Dentistry which ilftrohres' tudetlts as a learni&Tuf'&achers as a ing team workidg kiith. teaching team. The teachers &xvd' 8s guides to learning r a t h e r d h asis&ces aPexpeW information and f@tEtIda ils g&W&sts Wthe?itxIdUi%tional roles. The programme, which f h ~-#&embd by some s W ~ shastprovided ; ~ ~~~~faWm&te. ko the lecturelaboratory-conference format of the traditional curriculum. Some of the advantages of such an ISP are discussed and its effectiveness assessed.
y W &{@eration and has been adopted as a formal
part of the educational programme of the medical school. The general goals as stated by the ISP teachers are as follows. (1) To develop an individualized learneroriented,, .grogramme using a multidisciplinary approach with a problem-solving format for the sfu& ,sf..tfie basic sciences of medicine. (2) To encourage medical teachers to function as a teaching taqm ser$w, as guides in learning rather than primarily as sources of expert information, and thus to encourage the teachers to cover areas of study in which they cannot serve as sources of expert knowledge, i.e. to function as generalists rather than as specialists in their educational roles. (3) To encourage students to communicate effectively with Key words : *EDUCATION, MEDICAL, UNDERGRADUeach other as they study and to work together to ATE ; *PROBLEM SOLVING ; *CURRICULUM; TEACHING/ solve problems as a learning team; to provide more methods ; EDUCATIONAL MEASUREMENT; EVALUATION free time to explore special interests; and to involve STUDIES; NEWYORK the students in developing the academic content of ISP. (4) To provide improved knowledge and assessment of student abilities through long-term associaAn independent studies programme (ISP) in the tion of individual students and teachers, and to use basic medical sciences for the second year of medical this information for effective and regular feedback t c study has been developed with a group of ten the student regarding his educational progress; to teachers and a student body of sixteen students identify the student's paths of potential development selected from the ninety-six students in the first year and to assess his aptitudes for the practice of mediclass at the University of Rochester School of cine. ( 5 ) To place the main responsibility for learning Medicine and Dentistry. In planning the ISP, inon the student through independent study which formation from other educational programmes was requires that he obtain his information through the utilized of which the programme at McMaster use of the library, a variety of audio-visual and other University provided most data (Neufeld & Barrows, self-instructional aids and computer based educational programmes, and as a result of this selfCorrespondence: Dr H. R. Morgan, Director of the Ineducation to anticipate that these students will be dependent Studies Program, Box 697, School of Medicine and better prepared as doctors to keep up to date in Dentistry, University of Rochester, Rochester, New York their medical knowledge. 14642, U.S.A. 394
A problem-oriented independthtMudiesprogramme
Implementation
3%
guidance of a teacher witW&hiadB kral&k@:&&
396
H . R. Morgan
Evaluation of the student At the end of each eight week basic science section and case protocol assignment, individual instructors write an evaluation of the performance of each student and rate him on an honours, good pass, or fail basis. Three times during the year a comprehensive interdisciplinary examination is given to assess the progress of the students. It consists of objective questions to test information, and essays related to case protocols selected to illustrate the application of basic sciences to the solution of a patient’s clinical problems. These examinations, being planned to reinforce the students’ education, are multidisciplinary and, given only three times, avoid the disrupting influence of frequent examinations on the educational experience.
Evaluation of the ISP After three years of operation it has become clear that this programme, with its heavy responsibility on the individual student for his own education, is probably suitable only for students with strong selfdiscipline, motivation and a sense of direction. In the three years of operation, one student withdrew from the ISP in preference for the more structured regular curriculum. Each year an evaluation of the programme is conducted by giving the students an evaluation form for each component of the programme, i.e. immunology, pathology, microbiology, behavioural sciences, pharmacology, case problems, etc. This involves a checklist of a number of evaluation elements, and in addition the student writes a paragraph discussing the strengths and weaknesses of the individual educational sections. These questionnaires and recommendations to the ISP teachers are summarized by each teacher for review of the programme and as a basis for revision of ISP, with extensive changes in the study outlines, case protocols, and the ISP reference collection resulting at the end of each academic year. In addition, the references and A-V aids are evaluated by each student each time they are used. At the end of the year these evaluations of each reference and A-V teaching aid are reviewed and serve as a basis for the retention or otherwise of each element. Another aspect of evaluation of the programme has been derived from the progressive rise in num-
bers of students applying each year, since students are selected by a lottery mechanism from all applicants from the first year class. The number of applicants from the ninety-six students in the first year class has risen from 1972-76 as follows: 26 of 96,27,37,63. As the programme has developed and become better known, increasing numbers of students have been attracted to this type of study. Some objective data regarding the efficiency of this educational programme is provided by the results of the National Board Examinations taken by ISP students and students in the regular curriculum (Table 1). The results of the three years show that in first year subjects (i.e. anatomy, physiology and biochemistry) the ISP students’ scores were usually lower than students in the regular curriculum whereas second year subject scores (pathology, microbiology, pharmacology and behavioural sciences) were somewhat higher with one exception. Thus the ISP is providing an information base in second year subjects which is at least equivalent to that provided by the traditional curriculum. An examination of the change in rating of the students on the National Board Examinations for first year subject scores as compared to second year subject scores (Fig. 1) however suggests that the ISP provides an educational experience which provides a greater impetus for learning because the relative changes in the average scores for first year and second year subjects show that ISP students show greater percentage improvement as compared to students in the traditional programme. An important evaluation of ISP is provided by a letter which was writtten by the students in the 1974-75 class to the teachers: ‘As the ISP class of 1974-75 we would like to acknowledge our appreciation for being able to participate in the learning experience we had this year. We have found the opportunity to work in an independent study format valuable, productive, and enjoyable. We would like to thank the staff for the time and energy they have contributed. Although we have submitted suggestions for changes and improvements in the programme, our overall experience has been positive and we wish to state our feelings of gratitude and satisfaction. ‘We think it would be useful for the record to comment from our experience in the Independent Study Programme what we have found to be the major benefits of independent study. First, it permitted us to learn in the ways we individually find
397
A problem-oriented independent studies programme TABLE 1. National Board average scores Subjects First year courses Year
Composite averages Second year courses
No. of students
Anat.
Phys.
Biochem.
Path.
Micro.
Pharm.
Beh. Sc.
1st year courses
2nd year courses
15 82
459 500
550 520
518 533
553 531
608 549
546 543
564 523
509 518
568 531
15 76
498 503
516 544
547
550
596 535
593 567
596 566
556 529
540 532
585 549
16 81
432 456
512 504
454 493
533 496
565 548
512 520
521 51 1
466 484
533 518
1973 ISP
Non ISP 1974 ISP
Non ISP 1975
ISP Non ISP
Av. Score
I973
1974
I975 +8.3%
580-
+ 11.6%
570560-
r
t 3.2%
550540-
530520 -
+3.6% ?- 2
I
I
0-1
+14.3%
0- I
t7. I % 0-2
51 0500-
4900-1
480-
advantage of involvement in educational opportunities and activities that otherwise would not have been feasible. Fourth, is the valuable experience, which will be of increasing importance when we become practising doctors, of taking responsibility for our self-education. Finally, we would like to mention the benefit of getting an earlier introduction to and involvement with clinical medicine, in parallel with our study of the basic medical sciences. We see all of these benefits as unique to the ISP in contrast to what would have been our experiences in the regular curriculum.’ As an additional means for evaluating the programme, the ISP teachers requested that an independent evaluation committee be constituted to examine the programme as it was developed and put into operation ; this special review committee has prepared a separate report on its study of the ISP (Geersma et al., 1977) which, however, covers only the start-up years.
470-
Discussion FIG. 1 . Change in average scores between first year and second year National Board examinations. 0,Non-ISP students; x, ISP students; 1. average of grades of first year courses; 2, average of grades of second year courses.
most productive, rather than being tied to a classroom and lecture format which many of us have found limiting. Second, the nature of the seminars facilitated active involvement with the course material, teachers, and with fellow students, drawing on the diverse inputs students could collectively bring. Third, we had the time to pursue questions or areas of particular, individual interest. In part this was manifest by permitting some students to take
After three years of operation the independent studies programme has achieved many of its major goals and has presented to students in the second year of medical studies an alternative pathway for the study of basic medical sciences which many of them prefer. The programme has proved highly demanding because of the case problem-solving format and the fact that students develop special interests which grow out of their study of the case problem protocols requiring significant additional effort and library research. This type of learning appears to give to many students a greater degree of satisfaction than the classical lecture-laboratory-conference
398
H . R. Morgan
type of programme which is the format for the regular curriculum. The students also have a significant input into the ISP by their detailed critiques and production of an ISP study aid and thus are actively engaged in the continuing evolution of the programme. Another aspect of ISP is the satisfaction the teachers developed by engaging in an educational enterprise in which they and students become members of a learning team. The teachers have learned to admit ignorance when students ask questions covering areas not within their special expertise. This leads both the teacher and the student to work together to provide the answers before the next discussion session is held.
Acknowledgment The ISP is based on the combined efforts of Drs William Au, Howard N. Harrison, Martin R. Klemperer, Herbert R. Morgan, John J. Sandt, Daniel B. Schuster, R. Knight Steel, I. Donald Stuard, Philip L. Townes, and Donald A. Young.
References GEERTSMA, R.H., MEYEROWITZ, S., SALZMAN, L.F. & DONOVAN, J.C. (1977) A n independent study program within a medical curriculum. Journal of Medical Education, 53, 123. NEUFELD,V.R. & BARROWS,H.D. (1974) The ‘McMaster Philosophy’: a n approach to medical education. Journal of Medical Education, 49, 1040.
