The best laid plans: medical students' responses tonew curricula

This thesis explores whether a carefully designed educational program canimpact unfavourably on a proportion of students, what the magnitude of thisproportion may be, whether previously identified deep enhancing featurescould stimulate surface approaches in some students, and the possible reasonsfor such paradoxical impact. These questions are set within a context ofcontinuing efforts to find the ideal medical curriculum, and where evaluationstudies of these curricular methods have failed to demonstrate the expecteddegree of positive impact. This leads to the final question of the thesis, which iswhether the phenomenon of different responses by different students, couldhelp explain the less-than-expected positive impact of curricular innovationsreported in the literature.The questions were explored through a series of three studies. The First studyconsisted of individual student interviews and surveys (using the R-SPQ-2F,Biggs et al 2001) during a traditional program in medicine and upon conclusionof an educational program designed along currently accepted principlesassociated with higher quality learning outcomes. The two follow up studiesincluded surveying students in two other settings in medical education. Thesestudies were useful to overcome some of the limitations of the First study, andto explore the possible wider prevalence of the findings of the First study.The findings of the First study indicated that one-third of the student group didrespond unfavourable to a carefully designed educational program. Theinterview findings highlighted this phenomenon, and illustrated how thesestudents responded to deep enhancing curricular features by changing to moresurface approaches. The survey findings supported these findings, and helpedcluster and categorise students into subgroups who responded to the Pilotprogram in distinct ways. The two follow up studies indicated similar patterns ofresponse in the other settings of medical education, and suggested that thisphenomenon may be more widely prevalent.The findings suggest an area of research that requires further exploration. Ifconfirmed and extended by further work, the findings could have significanttheoretical and practical implications for medical education. From a theoreticalperspective, the findings enrich the current theory of student approaches tolearning by beginning to unravel the complex interaction between student andcontext factors that lead to approaches. The thesis further contributes to theliterature by its finding that some previously identified deep enhancing contextfactors could stimulate change to more surface approaches in some students,and by the finding that different students approaches could change in differentdirections, when measured before and after the same deep enhancing����educational context. From a practical perspective, the findings could be relevantto designers and evaluators of medical curricula, and to facilitators of smallgroup learning. An understanding of the different patterns of response that maybe expected, and an understanding of different strategies that may bettersupport these different subgroups, may help optimise the benefits of curriculardesign