Self-directed learning for medical graduates: A boon or bane in disguise? A cross-sectional study in Chennai

Abstract

BACKGROUND:

Self-directed learning (SDL) is an essential aspect of adult education or andragogy, gaining significance in medical education with the introduction of competency-based medical education. The primary objective of this study is to assess the self-directed learning abilities of second-year medical undergraduates in Chennai, South India, and to identify potential challenges and gaps in their learning process.

MATERIALS AND METHODS:

A cross-sectional study was conducted among 82 second-year medical students attending self-directed learning sessions at a medical college in Chennai. Data were collected using the self-directed learning instrument (SDLI), a standardized questionnaire, administered through Google Forms. Participants’ identities were maintained confidential. Data were analyzed using SPSS version 22.0. Descriptive data were presented as proportions and percentages. Normally distributed quantitative data were expressed as mean and standard deviation. Non-normal continuous data were expressed as median and interquartile range (IQR).

RESULTS:

The majority of the students (61%) demonstrated a high level of SDL ability, with a median score of 76. Students exhibited strong learning motivation (mean score 4.11) but struggled with planning and implementation (mean score 3.07). The maximum mean score was 4.11 for item 3 (constant improvement and excelling in learning), and the minimum mean score was 3.07 for item 11 (arranging and controlling learning time). The students showed high self-monitoring (mean score 3.76) and interpersonal communication skills (mean score 4.00).

CONCLUSIONS:

SDL emerges as a boon for medical undergraduates in this study. By providing adequate training to faculty members on SDL implementation and guidance to students on planning and time management, SDL can play a pivotal role in enhancing medical education quality and fostering life-long learning among future medical professionals.

Introduction

The Competency-Based Medical Education (CBME) for the Indian Medical Graduate (IMG), developed by the National Medical Commission (NMC), represents a transformative step toward preparing future doctors with the necessary skills, knowledge, and abilities to make evidence-based decisions, provide empathetic and compassionate patient care, and employ a holistic approach to patient care.[1] To achieve these objectives, the revised undergraduate medical education curriculum incorporates various innovative teaching and learning strategies, with self-directed learning (SDL) being a crucial component.[2]

According to the Medical Council of India, the Indian Medical Graduate is expected to fulfill multiple roles, including clinician, leader, communicator, life-long learner, and professional. In line with these expectations, self-directed learning is recognized as a core competency and a vital element in the development of well-rounded medical graduates.[2] Knowles defines SDL as “a process in which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating goals, identifying human and material resources for learning, choosing, and implementing appropriate learning strategies, and evaluating learning outcomes.”[3] This definition underscores the potential for SDL to occur both independently and with instructor guidance. In the latter scenario, instructors act as facilitators, enabling students to collaborate, engage in group discussions, and work together to solve problems.

The concept of SDL extends beyond andragogy, as it encompasses the broader notion of self-determined learning, or heutagogy.[4] SDL involves four stages, emphasizing the need for internal motivation to acquire new knowledge and expertise in areas of personal interest. This motivation drives learners to become more self-reliant, proactive, and ultimately, more effective in their professional roles.[5]

Various assessment tools have been developed worldwide to evaluate SDL capabilities among students across different fields of study, such as nursing, medicine, and dentistry.[6] In this study, we employ the self-directed learning instrument (SDLI), a validated measure designed specifically for medical students in India. By evaluating the SDL abilities of medical undergraduates, we can identify gaps in their learning process, understand the challenges they face, and, ultimately, develop targeted strategies to enhance their educational experience.

The growing recognition of SDL’s importance in medical education highlights the need for an in-depth understanding of how it impacts student performance and professional development. By assessing SDL abilities among medical undergraduates, this study aims to contribute valuable insights into the factors that promote or hinder self-directed learning and to guide the implementation of tailored educational interventions that foster the development of competent and well-rounded medical graduates. Competency-Based Medical Education considers SDL as one of its core components, which needs a deeper understanding in terms of students’ perspective.

In the Indian context, minimal studies have been done using SDLI tool. It provides the first-hand information on the understanding of SDL among medical undergraduates and aids in the identification of potential gaps and challenges in the implementation of the same in the competency-based curriculum.

Material and Methods

Study design and setting

This study employed a cross-sectional design to assess the self-directed learning abilities of second-year medical undergraduates at a medical college in urban Chennai.

Study participants and sampling

The study population consisted of all second-year medical students enrolled in the college. Universal sampling was used to select participants who were present on the day of the self-directed learning (SDL) session. A total of 110 students were enrolled in the class, out of which 82 attended the SDL session and agreed to participate in the study after providing informed consent. The remaining 28 students were absent during the session and were not included in the study. To maintain participant confidentiality and anonymity, no identifying information was collected.

Data collection tool and technique

The self-directed learning instrument (SDLI), developed by Shen et al.,[7] was used to assess the students’ SDL abilities. This structured and validated tool has been specifically designed to evaluate the SDL abilities of nursing and medical students. The SDLI consists of 20 items across four domains:

1. Learning Motivation (Q. 1-6)

2. Planning and Implementation (Q. 7-12)

3. Self-Monitoring (Q. 13-16)

4. Interpersonal Communication (Q. 17-20).

Each item is rated on a five-point Likert scale, where 1 = Strongly disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, and 5 = Strongly Agree, allowing the participants to indicate the extent to which they agree or disagree with the statements. Validation of the study questionnaire was done by conducting a pilot study among ten students. Cronbach’s alpha for each item in the questionnaire was found to be >0.70. This questionnaire can be used for undergraduate medical students also.

Data collection procedure

One day before the SDL session, the faculty provided the students with the study materials via a group communication platform, ensuring that all students had access to the resources. The SDL session was then conducted, allowing students to engage with the materials and participate in self-directed learning activities. Upon completion of the SDL session, participants were asked to complete a questionnaire assessing their SDL abilities. The questionnaire was administered through Google Forms to facilitate the efficient collection and management of responses.

Data analysis

Data collected from the questionnaires were entered into an Excel spreadsheet and analyzed using the Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics were employed to express the data as frequency and percentage. The SDLI scores were calculated by summing the item scores within each domain, as well as the total scores for all domains combined. Higher scores indicated higher levels of SDL ability.

Ethical considerations

As mentioned previously, ethical clearance (1705/IEC/2022) was obtained from the Institutional Ethical Committee before conducting the study. Informed consent was obtained from all participants, and their confidentiality and anonymity were maintained throughout the study. No personal identification information was recorded, and participation in the study was voluntary.

Results

Participant demographics

A total of 82 second-year medical students participated in this study. The mean age of the participants was 19 ± 2.16 years. The majority of the participants were female (61%), with males comprising 39% of the respondents.

Self-directed learning instrument (SDLI) responses

Table 1 presents the percentage of responses for each item in the SDLI questionnaire, as well as the mean scores for each item. The maximum mean score was 4.11 for item 3, “I strongly hope to constantly improve and excel in my learning,” whereas the minimum mean score was 3.07 for item 11, “I am good at arranging and controlling my learning time.” The students exhibited a high level of learning motivation (4.11) but had a lower score in the planning and implementation domain (3.07). They demonstrated the ability to self-monitor their learning by understanding their strengths and weaknesses (3.76). Furthermore, their interpersonal communication skills were also rated highly (4.00). A majority of the students agreed (67.1%) that interacting with others helps them plan for further learning, while only 32.9% agreed that they can effectively arrange and control their learning time.

Table 1.

Distribution of responses and mean scores for SDLI items among second-year medical students (n=82)

Items	Strongly disagree (%)	Disagree (%)	Neutral (%)	Agree (%)	Strongly Agree (%)	Mean Score (SD)
Learning Motivation domain
I know what I need to learn	8.5	6.1	26.8	45.1	13.4	3.49 (1.08)
Regardless of the results or effectiveness of my learning, I still like learning	2.4	6.1	20.7	58.5	12.2	3.72 (0.85)
I strongly hope to constantly improve and excel in my learning	1.2	0	17.1	50	31.7	4.11 (0.77)
My successes and failures inspire me to continue learning	1.2	4.9	15.9	53.7	24.4	3.95 (0.84)
I enjoy finding answers to questions	1.2	3.7	15.9	58.5	20.7	3.94 (0.79)
I will not give up learning because I face some difficulties	1.2	6.1	11.0	61.0	20.7	3.94 (0.82)
Planning and Implementation
I can proactively establish my learning goals	0	3.7	31.7	51.2	13.4	3.74 (0.73)
I know what learning strategies are appropriate for me in reaching my learning goals	4.9	12.2	22.0	41.5	19.5	3.59 (1.09)
I set the priorities of my learning	2.4	7.3	22.0	56.1	12.2	3.68 (0.87)
Whether in the clinical practicum, classroom or on my own, I am able to follow my own plan of learning	4.9	9.8	36.6	35.4	13.4	3.43 (1.01)
I am good at arranging and controlling my learning time	7.3	25.6	26.8	32.9	7.3	3.07 (1.09)
I know how to find resources for my learning	3.7	11.0	18.3	57.3	9.8	3.59 (0.94)
Self-Monitoring
I can connect new knowledge with my own personal experiences	2.4	7.3	24.4	57.3	8.5	3.62 (0.84)
I understand the strengths and weakness of my learning	3.7	3.7	19.5	59.8	13.4	3.76 (0.87)
I can monitor my learning progress	2.4	9.8	24.4	51.2	12.2	3.61 (0.91)
I can evaluate on my own my learning outcomes	2.4	3.7	28.0	56.1	9.8	3.67 (0.80)
Interpersonal Communication
My interaction with others helps me plan for further learning	2.4	1.2	17.1	67.1	12.2	3.85 (0.74)
I would like to learn the language and culture of those whom I frequently interact with.	1.2	1.2	19.5	52.4	25.6	4.00 (0.79)
I am able to express messages effectively in oral presentations	8.5	9.8	25.6	48.8	7.3	3.37 (1.05)
I am able to communicate messages effectively in writing	2.4	6.1	22.0	47.6	22.0	3.80 (0.94)

SDLI scores distribution

The SDLI scores were plotted using a box plot [Figure 1], which revealed a minimum score of 40, a maximum score of 100, and a median score of 76. Based on these scores, the level of self-directed learning was assessed among the students as high-level SDL (scores above 73.9) and low-level SDL (scores below 73.9).

Figure 1.

Box plot showing the median, interquartile range of self-directed learning ability scores among second-year medical students (n = 82)

Out of the 82 participants, 50 (61%) demonstrated a high level of SDL ability, while 32 (39%) exhibited a low level of SDL ability. The distribution of SDL ability among the participants is presented below:

High-level SDL: 50 (61%).

Low-level SDL: 32 (39%).

SDLI domain analysis

An analysis of the SDLI domains revealed that the participants showed strong learning motivation, with a mean score of 4.11. However, their planning and implementation skills were lower, with a mean score of 3.07. The participants demonstrated the ability to self-monitor their learning, with a mean score of 3.76. Additionally, their interpersonal communication skills were rated highly, with a mean score of 4.00.

Discussion

The current CBME curriculum aims to enable medical students to become life-long learners as a key component of the Indian Medical Graduate goals. The shift from conventional teacher-centered teaching methods to student-centered approaches has facilitated medical undergraduates in applying their acquired knowledge and using their skills creatively. This study is the first of its kind conducted in urban Chennai, utilizing the validated SDLI to assess the self-directed learning abilities among medical undergraduates.

In this study, the mean age of the students was 19 ± 2.16 years. This age group is consistent with findings from other studies.[8] The majority of the participants were females (61%), which aligns with the results of similar studies.[9] The male-to-female ratio in medical education has evolved over time, with an increase in the gross enrolment ratio (GER) for females, leading to a greater number of females attending medical schools at undergraduate and postgraduate levels.[10]

We employed the self-directed learning instrument (SDLI) tool, a standardized and validated instrument used to assess SDL among medical and nursing students. This instrument has been widely used for both medical[11] and nursing[12] students. The maximum mean score in our study was 4.11 for item 3, which was lower compared to a study conducted among medical students in Dehradun[11] but higher than a study conducted among nursing students in Taiwan.[12] Item 3, “I strongly hope to constantly improve and excel in my learning,” indicates a strong motivation among medical students to continually work towards enhancing their learning. In Taiwan, the SDLI was assessed among nursing students who need to develop a specific set of skills and may not have as much intrinsic motivation.

For item 11, “I am good at arranging and controlling my learning time,” the score was low in our study, a finding that has also been noted in various other studies.[8,9] This item primarily focuses on planning and implementation, which highlights the need for more guidance from faculty members on time management, planning, and resource management.

In our study, the majority of students (61%) demonstrated a high level of self-directed learning ability (SDLA). This finding is similar to a study conducted among high school students in Japan.[13] This can be attributed to the availability of resources provided a day before the session, 24/7 access to the library and the internet, and a supportive learning environment. Increasing faculty support has been a key suggestion in previous studies[14] to ensure equitable assistance for all students.

Our study findings add to the growing body of literature that supports the benefits of self-directed learning in medical education. Students who demonstrate high levels of SDLA are likely to be more adaptive and responsive to the ever-changing demands of the medical profession.[15] Furthermore, they are better equipped to develop essential professional skills such as critical thinking, problem-solving, and clinical decision-making.

However, it is essential to acknowledge the challenges faced by students in the planning and implementation domain, as evidenced by the lower scores in item 11. Medical educators should consider incorporating strategies to address these challenges in their teaching methods. For instance, offering workshops or seminars on time management, resource allocation, and goal-setting can empower students to take charge of their learning and further enhance their SDL abilities.[16]

Moreover, a supportive learning environment that encourages collaboration, feedback, and open communication between faculty and students can foster the development of SDL skills. Medical educators should play a proactive role in facilitating group discussions, encouraging peer-to-peer learning, and providing timely feedback on students’ learning progress.[17]

Limitation and recommendation

The present study has the following set of limitations. This study was conducted in urban Chennai, and the results may not be generalizable to other settings or populations. Further research should be conducted in diverse contexts and among different student populations to better understand the factors that contribute to the development of SDL abilities in medical education. This study relies on students’ self-reporting of their SDL abilities using the SDLI instrument, which may introduce a certain degree of bias. Students might overestimate or underestimate their skills based on their perceptions, leading to inaccuracies in the results. Future studies could incorporate additional assessment methods, such as peer evaluations or objective measures of students’ SDL skills, to validate and complement the self-reported data. The cross-sectional design of the study only provides a snapshot of the participants’ SDL abilities at a single point in time. It does not allow for the examination of the development or changes in SDL skills over time or in response to specific interventions. Longitudinal studies with repeated assessments at various time points throughout the medical curriculum would provide a more comprehensive understanding of the factors influencing the growth and development of SDL abilities among medical students.

In addition, the use of technology in medical education has seen a significant rise in recent years. The integration of online resources, e-learning platforms, and mobile applications can support self-directed learning by providing students with easy access to a vast array of learning materials and tools. Future studies can explore the impact of incorporating technology-enhanced learning methods on the SDL abilities of medical students.

Lastly, the role of faculty development in promoting self-directed learning should not be overlooked. Educators should be equipped with the necessary knowledge, skills, and attitudes to foster SDL in their students. Faculty development programs can offer training on various teaching methodologies, assessment techniques, and student-centered approaches that encourage the development of SDL skills in medical students.

Conclusion

In conclusion, our study provides valuable insights into the self-directed learning abilities of medical undergraduates in urban Chennai. The findings highlight the importance of fostering SDL skills in medical education to better prepare students for the challenges of the medical profession. Medical educators should focus on addressing the challenges faced by students in the planning and implementation domain, leveraging technology-enhanced learning methods, and investing in faculty development to effectively promote self-directed learning in medical education. By doing so, we can ensure the development of medical professionals who are not only competent but also adaptive and responsive to the dynamic nature of the healthcare landscape.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.