Promoting Self-Directed Learning Among Allied Health Science Students: Implementation and Perceptions

Introduction

Allied health science (AHS) education is a life-long process embracing undergraduate education, training to be a health professional in the hospital setting, and continuing health education in the form of conferences, training, and workshops. The students of AHS generally have difficulty understanding medical terminologies, and concepts of pre-clinical subjects such as biochemistry and clinical correlation. It is essential to introduce innovative teaching-learning methods that are learner-centric, to motivate the students to learn biochemistry and build confidence among them that they are important stakeholders in the healthcare field for which they need to gear up for future careers.

Self-directed learning (SDL) is the adult model of learning where students take the initiative to decide their learning needs, set learning goals, identify resources for learning the required topic, choose and implement learning strategies to acquire knowledge and finally evaluate learning outcomes with or without the help of peers and teachers.^1-3 Healthcare professionals must possess critical thinking and problem-solving skills, as well as the ability to engage in self-directed learning. These competencies are crucial not only during their undergraduate studies but also for success in their careers post-graduation.⁴ Flipped classroom is one of the strategies to promote SDL and it helps in creating problem-based learning inside the class and replacing direct instruction with videos or guides in order to provide instructional content to be accessed as required by students.^5,6

There is a paucity of research on the effectiveness of learner-centric strategies to promote SDL among AHS students, especially in the Indian context. In the present study, we intended to implement various learner-centric methods such as flipped classrooms, knowledge maps, problem-based learning, quizzes, debates, and seminars to promote SDL among the AHS students.

Materials and Methods

This research protocol was implemented after obtaining approval from the Institutional Ethics Committee (FMIEC/CCM/750/2022, dated 12.11.2022). Permission was obtained from the head of the institution to include first-year AHS students of Father Muller College of Allied Health Sciences, Mangalore as study participants. Voluntary informed consent was obtained from all the participants to take part in the research.

This was a quasi-experimental study design carried out for a period of eleven months from December 2022 to October 2023. A convenient sampling method was used to include consenting 117 students as participants. Participants with incomplete data and non-participation in the activities were excluded.

Data Collection: As a part of regular teaching-learning, the Department of Biochemistry planned learner-centric methods throughout the academic year. Strategies to promote SDL were knowledge maps, presentation of reports of lab rounds, seminars by students, and problembased learning.

All these activities were group-based. Students were divided into 13 groups of 10 students each. Each activity was preceded and followed by a formative assessment. The activities and assessments were aligned with the curriculum of theory and practical for AHS (Table 1). The questionnaires used in the program were prepared by the authors and validated by five experts among medical educators and allied health science teachers.

Assessment of perceptions of learners: The perceptions of learners were assessed on the SDL strategies with a feedback questionnaire prepared by the researchers. The participants had to give feedback on a 5-point Likert scale for the statements and also open-ended questions about what went well, what could have been done well, and any suggestions for improvement.

Statistical Analysis: Results of open-ended questions in the feedback were subjected to thematic analysis and responses on the Likert scale were expressed as percentages of students giving feedback under strongly agree/agree/neutral/disagree/strongly disagree categories.

Results

Thematic analysis for the responses to open-ended questions is presented in Table 2. Learning process, teamwork, communication skills, and difficulty level of the topics were the themes identified. Developing confidence in learning, learning new things, learning resource searching, enjoying learning biochemistry, team co-operation, teamwork, sharing responsibilities, inspiration from peers, the happiness of group activity, boosting confidence, improving communication skills, and overcoming stage fear were liked by students. 

The difficulty level of the topics given for problembased learning (PBL), condensing the wide range of information available, the difficulty of presenting in front of others, the lack of team support, and a few members in the group not participating were the issues not liked by the students. Students suggested more such activities in the future, frequent interactions with the facilitator during PBL, more lab rounds and practicals, and requested a “biochemistry exhibition” (Table 2).

Perceptions were assessed by a 5-point Likert scale (Table 3). The percentage of students who either agreed/ strongly agreed with various statements was considered, 90.6% agreed/strongly agreed that pre-briefing helped them to work on the SDL, 96.6% opined that they were able to gain new knowledge of biochemistry and its applications in health sciences, 96.6% opined that the longitudinal SDL program helped them to develop as a life-long learner. Regarding learning of searching for resources and spending adequate time on learning, the percentage of students who agreed /strongly agreed was 98.1% and 98.3% respectively. About 88% of the students agreed/strongly agreed that all members of the team contributed significantly to group activities, and 94.9% agreed/strongly agreed that they improved communication skills because of the activities given. All 100% of students wanted to participate in learner-centric SDL programs in the future (Table 3). It was observed that more than 10% of the students showed a negative perception (disagree and strongly disagree responses) towards teamwork, higher-order thinking, and engaging in learning. They did not agree with the statements that “all members of the team contributed significantly”, “learner-centric strategies promoted higher order thinking” and “I learnt how to work in a team” (Table 3).

When the opinion of students was sought on “which activity/strategy did they like the most?” 29.9% were in favour of knowledge map presentations, 27.3% were for lab rounds, 23.9% for PBL, and 18.8% liked seminar presentations the most (Figure 1).

Discussion

In the present study, learner-centric strategies were implemented to promote SDL among allied health science students and to assess the perceptions of students. Overall, it was noted that students had positive perceptions of SDL and they suggested more such activities in the future to enable better learning of biochemistry.

Students appreciated the learner-centric nature of the teaching-learning methods such as presenting knowledge maps, lab rounds, presenting seminars, and problem-based learning. The learners preferred the knowledge map presentations the most, followed by lab rounds, problem-based learning, and presentation of seminars. They agreed that these strategies enabled them to learn new things, search for resources, make the subject interesting, improve their confidence level, help them to overcome stage fear, develop communication skills, and promoted team spirit. Students also perceived SDL to help in the correlation of basic science knowledge with health science. Firstyear medical undergraduates had positive perceptions about PBL and preferred it as a method to promote selfdirected learning, use of additional resources, active involvement, enjoyable learning, basic science-clinical correlation, improvement in communication skills, critical thinking, and teamwork.⁷ Various other studies with medical students observed the effectiveness of SDL and positive perceptions of students on learner-centric strategies.^2,3,5 However, in a study comparing Lab Rounds (27.3%) PBL (23.9%) Seminars (18.9%) Knowledge maps (29.9%) learning outcomes of traditional lectures and PBL, Choi et al., did not find any significant difference between the two methods in terms of learning outcomes.⁴ These authors observed that students in the PBL group scored better in critical thinking and problem-solving when compared to students in the traditional lecture method. They also observed a significant positive correlation between critical thinking with problem-solving and SDL.⁴

In the present study, a majority of the students opined that SDL promotes higher-order thinking skills (88%) and time management skills (98.3%). Grooming creativity was one of the aspects liked by the students (98.3%) about the learner-centric strategies implemented. However, a small percentage of students (12%) did not agree that SDL improves time management skills. One more noteworthy finding in this study was the positive perceptions of students (94%) that the SDL program helped them to develop professionalism, and develop as an ethical health professional of integrity, a right attitude, and good interpersonal relationships. In a previous study, Mehboob reported students’ perception that SDL constantly improved learning, and successes and failures inspired learning but, 49.2% of students had difficulty with time management.⁸ Lee et al., evaluated the relationship between SDL and professional nursing values and observed that SDL had significant positive effects on professional nursing value.⁹

The uniqueness of our SDL program was that we used multiple strategies to promote SDL among the students and it is one of the pioneering studies implementing SDL for allied health sciences, especially in India. Students had expressed the need for frequent interactions between the learners and the facilitator. Teamwork, communication skills, and searching for resources were the challenges faced by students. Self-directed learning could be more effectively implemented by addressing these challenges.

Conclusions

Various learner-centric strategies were effective in promoting SDL among AHS and developing them as life-long learners. The learning of a subject was made interesting and enjoyable. Based on the feedback from learners, the SDL program could be more effectively implemented in the future. Implementing SDL for AHS students would go a long way in the implementation of learner-centric strategies across the disciplines and institutions.

Conflict of Interest

None

Acknowledgement

The authors are grateful to the authorities of Father Muller College of Allied Health Sciences who extended their support, and all the AHS students who participated in the research.