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IN DEPTH ANALYSIS OF THE IMPACT ON LEARNING PATTERNS AND KNOWLEDGE ACQUISITION OF A CURRICULUM INNOVATION IN MEDICAL EDUCATION

Jos Van der Veken UGent (2008)
abstract
Aim The focus of the current dissertation was on an impact evaluation of the implementation of an innovative medical curriculum on students’ learning patterns and their knowledge acquisition. In view of the central research objective we formulated three key research questions related to the impact on students’ learning patterns, and one research question concerning the impact of knowledge acquisition: (RQ1) Does the innovation of a medical curriculum result in changes in student‘s learning patterns? (RQ2) Are the changes in students’ learning patterns consistent with expectations that build on the characteristics of the innovative medical curriculum? (RQ3) Does the implementation of an innovative medical curriculum result in longitudinal changes in students’ learning patterns? (RQ4) What is the differential impact of the implementation on different medical curricula on knowledge acquisition? Methods In the context of this dissertation, we applied an adapted version of Vermunt’s Inventory of Learning Styles (ILS) to examine the learning patterns of medical students in different curricula. The choice for this measurement instrument was justified by its theoretical background and conceptual base that respects the complex nature of learning patterns as they are related to various levels of learning. Regarding the second focus of this dissertation - comparing the acquisition of knowledge in two different curricula - we drew upon the Dutch Inter-University Progress Test (PT) to measure the differential impact on knowledge acquisition. Results (RQ1) Does the innovation of a medical curriculum result in changes in student‘s learning patterns? This research question was explored in chapter 3 by comparing third year medical students enrolled in three different curricula: CMC (conventional medical curriculum), ICMC (integrated contextual medical curriculum) and PBL (problem based learning). The ILS revealed differences in learning patterns between students from the three curricula. With the exception of two strategies/orientations, the overall differential impact at the control and conceptual level of learning was very clear. No significant impact was detected on strategies at the executive level of learning (processing strategies). (RQ2) Are the changes in students’ learning patterns consistent with expectations that build on the characteristics of the innovative medical curriculum? Scrutinizing the potential effect of being involved in the innovatice medical curriculum on processing strategies, we found significant differences between the three curricula in relation to five out of the six ILS scales. In relation to the four regulation strategies, we observed significantly higher scores for self regulation in PBL students. ICMC students showed significantly less lack of regulation. But in relation to leadership and external regulation no significant differences were observed. In relation to the four learning orientations, our expectations were met for the vocational orientation and ambivalence in PBL students. No significant differences between students studying the different curricula were observed as to being decisive in making choices and growing interest in learning. (RQ3) Does the implementation of an innovative medical curriculum result in longitudinal changes in students’ learning patterns? We focused first of all on changes in the patterns related to the executive level (processing strategies) in the ILS. ICMC students structure to a higher extent elements of the subject matter into a whole (structuring). In contrast to our prediction, ICMC students did not relate significantly more parts of the subject matter to each other and/or to their prior knowledge (relating). The expected differential impact of introductory tutorials and individual scientific projects on the tendency of students to express personal views about study topics (critical processing) and the capability to translate study content into personal opinions or expressions (expressing) was not confirmed. In contrast, the ICMC students reflected a significant increase in use of sources of knowledge in the fourth ICMC curricular year. Concerning our expectations to changes in strategies at the control level (regulation strategies), we observed a slightly higher score in the fourth ICMC curricular year in relation to self regulation of learning content. The ICMC students performed also significantly better on lack of regulation, and this from the third year on. In relation to the conceptual level of the ILS-model (learning orientations) we observed, as predicted, in the ICMC students a decrease in their certificate-orientation (learning orientation) in the fourth curricular year. There was no such change in CMC students. The vocation-orientation increased independently of the type of curriculum. The hypothesis that introducing community oriented medicine and vertical integration would increase vocation-orientation was not confirmed. (RQ4) What is the differential impact of the implementation on different medical curricula on knowledge acquisition? The differential impact on knowledge acquisition in conventional and innovated curricula was studied via a longitudinal and cross-sectional design. This study confirmed the assumptions about the potential of the integrated contextual medical curriculum. The stronger integration of biomedical and clinical sciences in ICMC leads to a more gradual and steady mastery of clinical knowledge. Consistently, ICMC students reflect a significantly larger mastery. At the same time, a stronger emphasis on clinical relevant biomedical sciences in the early years of the ICMC led to a steeper learning curve of basic biomedical knowledge. This type of knowledge continued to increase in the later years of this curriculum. We observed that ICMC students already attain in year three a high level of basic medical sciences knowledge which is only reached one year later by CMC students. Furthermore ICMC students attained in year five a high mastery level of clinical medical sciences knowledge, which was not reached by CMC students in year six. ICMC students also showed a yearly superior increase in the acquisition of knowledge, and this in the domain of basic biomedical sciences as well as in the domain of clinical sciences. We could conclude that ICMC students scored – at the end of their medical studies - significantly higher on both basic and clinical sciences. We perceived that the basic and clinical medical knowledge increases from year to year and up to a higher level in ICMC students, as compared to CMC students. In contrast, we observed in CMC students a fast growth of basic medical knowledge from year three to four and no growth at all from year four to year five. The increase in clinical knowledge was equal in CMC and ICMC students, but stagnated in CMC students after year five. The cross-sectional comparison revealed a significant increase for ICMC students of the basic medical sciences scores from year five to year six which was not observed in the scores of CMC students. The increase in the mastery of the basic sciences was slower in CMC students, till the fifth year. Conclusions The Inventory of Learning Styles of Vermunt was adopted and proved helpful to identify in a reliable way learning patterns of students. Our study showed that students in conventional and innovative curricula adopt different ILS learning patterns. The ILS revealed significant curricular effects relating to processing strategies, regulation strategies and learning orientations. The majority of the effects appear to confirm general expectations in respect of the impact of studying in a conventional or an integrated problem-based curricula by showing that students from an innovative curriculum manifest more deep learning, better structuring of subject matter, more self-regulation and a stronger orientation towards their future profession. We believe that these results offer empirical support for the introduction of innovative curricula and help to underpin assumptions relating to traditional and innovative curricula that thus far were hardly confirmed with empirical evidence. Therefore our results are important to curriculum (re)designers and those interested in the evaluation of curriculum reforms. The differential impact on knowledge acquisition in conventional and innovated curricula has seldom been studied in a longitudinal and cross-sectional design. Our study confirmed the assumptions about the potential of the integrated contextualized curriculum. The stronger integration of biomedical and clinical sciences in the ICMC apparently leads to a more gradual and steady mastery of clinical knowledge. Consistently, ICMC students reflect a significantly larger mastery of the knowledge base. At the same time, it could be shown that the stronger emphasis on clinical relevant biomedical sciences in the early years of the ICMC led to a steeper learning curve of the basic biomedical knowledge domain of the PT. The latter type of knowledge continued to increase in the later years of the curriculum.
Please use this url to cite or link to this publication:
author
promoter
UGent and UGent
organization
alternative title
Impact on learning patterns and knowledge acquisition of a medical curriculum innovation
year
type
dissertation (monograph)
subject
pages
107 pages
publisher
Faculty of Medicine and Health Sciences
place of publication
Ghent
defense location
Grote Aula - Volderstraat
defense date
2008-10-22 17:00
language
English
UGent publication?
yes
classification
D1
id
520662
handle
http://hdl.handle.net/1854/LU-520662
date created
2009-03-17 16:16:12
date last changed
2009-06-02 10:45:55
@phdthesis{520662,
  abstract     = {Aim
The focus of the current dissertation was on an impact evaluation of the implementation of an innovative medical curriculum on students{\textquoteright} learning patterns and their knowledge acquisition. In view of the central research objective we formulated three key research questions related to the impact on students{\textquoteright} learning patterns, and one research question concerning the impact of knowledge acquisition:
(RQ1) \unmatched{0009}Does the innovation of a medical curriculum result in changes in student{\textquoteleft}s learning patterns?
(RQ2) \unmatched{0009}Are the changes in students{\textquoteright} learning patterns consistent with expectations that build on the characteristics of the innovative medical curriculum?
(RQ3) \unmatched{0009}Does the implementation of an innovative medical curriculum result in longitudinal changes in students{\textquoteright} learning patterns?
(RQ4) \unmatched{0009}What is the differential impact of the implementation on different medical curricula on knowledge acquisition?
Methods
In the context of this dissertation, we applied an adapted version of Vermunt{\textquoteright}s Inventory of Learning Styles (ILS) to examine the learning patterns of medical students in different curricula. The choice for this measurement instrument was justified by its theoretical background and conceptual base that respects the complex nature of learning patterns as they are related to various levels of learning. Regarding the second focus of this dissertation - comparing the acquisition of knowledge in two different curricula - we drew upon the Dutch Inter-University Progress Test (PT) to measure the differential impact on knowledge acquisition.
Results

(RQ1) Does the innovation of a medical curriculum result in changes in student{\textquoteleft}s learning patterns?
This research question was explored in chapter 3 by comparing third year medical students enrolled in three different curricula: CMC (conventional medical curriculum), ICMC (integrated contextual medical curriculum) and PBL (problem based learning). The ILS revealed differences in learning patterns between students from the three curricula. With the exception of two strategies/orientations, the overall differential impact at the control and conceptual level of learning was very clear. No significant impact was detected on strategies at the executive level of learning (processing strategies).
(RQ2) Are the changes in students{\textquoteright} learning patterns consistent with expectations that build on the characteristics of the innovative medical curriculum?
Scrutinizing the potential effect of being involved in the innovatice medical curriculum on processing strategies, we found significant differences between the three curricula in relation to five out of the six ILS scales. In relation to the four regulation strategies, we observed significantly higher scores for self regulation in PBL students. ICMC students showed significantly less lack of regulation. But in relation to leadership and external regulation no significant differences were observed. In relation to the four learning orientations, our expectations were met for the vocational orientation and ambivalence in PBL students. No significant differences between students studying the different curricula were observed as to being decisive in making choices and growing interest in learning. 
(RQ3) Does the implementation of an innovative medical curriculum result in longitudinal changes in students{\textquoteright} learning patterns?
We focused first of all on changes in the patterns related to the executive level (processing strategies) in the ILS. ICMC students structure to a higher extent elements of the subject matter into a whole (structuring). In contrast to our prediction, ICMC students did not relate significantly more parts of the subject matter to each other and/or to their prior knowledge (relating). The expected differential impact of introductory tutorials and individual scientific projects on the tendency of students to express personal views about study topics (critical processing) and the capability to translate study content into personal opinions or expressions (expressing) was not confirmed. In contrast, the ICMC students reflected a significant increase in use of sources of knowledge in the fourth ICMC curricular year. Concerning our expectations to changes in strategies at the control level (regulation strategies), we observed a slightly higher score in the fourth ICMC curricular year in relation to self regulation of learning content. The ICMC students performed also significantly better on lack of regulation, and this from the third year on. In relation to the conceptual level of the ILS-model (learning orientations) we observed, as predicted, in the ICMC students a decrease in their certificate-orientation (learning orientation) in the fourth curricular year. There was no such change in CMC students. The vocation-orientation increased independently of the type of curriculum. The hypothesis that introducing community oriented medicine and vertical integration would increase vocation-orientation was not confirmed.
(RQ4) What is the differential impact of the implementation on different medical curricula on knowledge acquisition?
The differential impact on knowledge acquisition in conventional and innovated curricula was studied via a longitudinal and cross-sectional design. This study confirmed the assumptions about the potential of the integrated contextual medical curriculum. The stronger integration of biomedical and clinical sciences in ICMC leads to a more gradual and steady mastery of clinical knowledge. Consistently, ICMC students reflect a significantly larger mastery. At the same time, a stronger emphasis on clinical relevant biomedical sciences in the early years of the ICMC led to a steeper learning curve of basic biomedical knowledge. This type of knowledge continued to increase in the later years of this curriculum.
We observed that ICMC students already attain in year three a high level of basic medical sciences knowledge which is only reached one year later by CMC students. Furthermore ICMC students attained in year five a high mastery level of clinical medical sciences knowledge, which was not reached by CMC students in year six. ICMC students also showed a yearly superior increase in the acquisition of knowledge, and this in the domain of basic biomedical sciences as well as in the domain of clinical sciences. We could conclude that ICMC students scored -- at the end of their medical studies - significantly higher on both basic and clinical sciences. We perceived that the basic and clinical medical knowledge increases from year to year and up to a higher level in ICMC students, as compared to CMC students. In contrast, we observed in CMC students a fast growth of basic medical knowledge from year three to four and no growth at all from year four to year five. The increase in clinical knowledge was equal in CMC and ICMC students, but stagnated in CMC students after year five. The cross-sectional comparison revealed a significant increase for ICMC students of the basic medical sciences scores from year five to year six which was not observed in the scores of CMC students. The increase in the mastery of the basic sciences was slower in CMC students, till the fifth year.
Conclusions
The Inventory of Learning Styles of Vermunt was adopted and proved helpful to identify in a reliable way learning patterns of students. Our study showed that students in conventional and innovative curricula adopt different ILS learning patterns. The ILS revealed significant curricular effects relating to processing strategies, regulation strategies and learning orientations. The majority of the effects appear to confirm general expectations in respect of the impact of studying in a conventional or an integrated problem-based curricula by showing that students from an innovative curriculum manifest more deep learning, better structuring of subject matter, more self-regulation and a stronger orientation towards their future profession. We believe that these results offer empirical support for the introduction of innovative curricula and help to underpin assumptions relating to traditional and innovative curricula that thus far were hardly confirmed with empirical evidence. Therefore our results are important to curriculum (re)designers and those interested in the evaluation of curriculum reforms. The differential impact on knowledge acquisition in conventional and innovated curricula has seldom been studied in a longitudinal and cross-sectional design. Our study confirmed the assumptions about the potential of the integrated contextualized curriculum. The stronger integration of biomedical and clinical sciences in the ICMC apparently leads to a more gradual and steady mastery of clinical knowledge. Consistently, ICMC students reflect a significantly larger mastery of the knowledge base. At the same time, it could be shown that the stronger emphasis on clinical relevant biomedical sciences in the early years of the ICMC led to a steeper learning curve of the basic biomedical knowledge domain of the PT. The latter type of knowledge continued to increase in the later years of the curriculum.},
  author       = {Van der Veken, Jos},
  language     = {eng},
  pages        = {107},
  publisher    = {Faculty of Medicine and Health Sciences},
  school       = {Ghent University},
  title        = {IN DEPTH ANALYSIS OF THE IMPACT ON LEARNING PATTERNS AND KNOWLEDGE ACQUISITION OF A CURRICULUM INNOVATION IN MEDICAL EDUCATION},
  year         = {2008},
}

Chicago
Van der Veken, Jos. 2008. “In Depth Analysis of the Impact on Learning Patterns and Knowledge Acquisition of A Curriculum Innovation in Medical Education”. Ghent: Faculty of Medicine and Health Sciences.
APA
Van der Veken, J. (2008). IN DEPTH ANALYSIS OF THE IMPACT ON LEARNING PATTERNS AND KNOWLEDGE ACQUISITION OF A CURRICULUM INNOVATION IN MEDICAL EDUCATION. Faculty of Medicine and Health Sciences, Ghent.
Vancouver
1.
Van der Veken J. IN DEPTH ANALYSIS OF THE IMPACT ON LEARNING PATTERNS AND KNOWLEDGE ACQUISITION OF A CURRICULUM INNOVATION IN MEDICAL EDUCATION. [Ghent]: Faculty of Medicine and Health Sciences; 2008.
MLA
Van der Veken, Jos. “In Depth Analysis of the Impact on Learning Patterns and Knowledge Acquisition of A Curriculum Innovation in Medical Education.” 2008 : n. pag. Print.