Association of Pedagogical Training with the Social Skills of Medical Tutors in Problem-Based Learning Curriculum

Abstract

Background

Satisfactory interaction between tutor and student is fundamental to the success of problem-based learning, and social skills (SS) are essential in this context. The factors associated with a better repertoire of teachers’ SS are still unclear. Therefore, we aimed to assess tutors’ SS and investigate which factors might be related to a better repertoire of SS.

Methods

This cross-sectional study was conducted in Brazil and included tutors from the first to the eighth semester of the Unichristus Medical School. SS repertoire was assessed using the ISS-2-Del Prette and Del Prette questionnaire applied by psychologists. Generalized linear regression models with robust errors were used to verify the association between the study variables.

Results

A total of 74 tutors participated, 50% of whom were female, with an average age of 39.6 years. There was a deficit in assertive conversation in 41.1% of the tutors, in expressing positive feelings in 47.9%, and in self-control and coping in 54.8%. Pedagogical training was associated with better SS (95vs86, p = 0.036). Length of medical activity and teaching experience were not associated with better SS.

Conclusions

The authors conclude that SS deficiency among tutors is highly prevalent and the lack of pedagogical training was significantly associated with a lower repertoire of skills.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02123-8.

Introduction

Problem-based learning (PBL) is a teaching and learning method centered on the student learning that aims to develop students’ knowledge, skills, attitudes, and values [1]. The role of the tutor as a facilitator or mediator in the teaching environment is fundamental for an effective teaching–learning process.

The teacher (tutor) must have the ability to communicate informally, empathize with students, and create a learning environment that encourages the free exchange of ideas and the free negotiation of concepts [2–4]. The quality of the relationship between the tutor and the student depends on the repertoire of Social skills (SS) presented by the tutor [5].

The main classes of SS include communication skills, civility skills, assertive coping skills or the defense of rights and citizenship, empathic skills, professional or work-related social skills, and self-monitoring skills [6]. In the academic context, SS is related to professional performance, adjustment to the institution, and university students’ physical and psychological well-being. In addition, SS have behavioral, personal, situational, and cultural dimensions that influence their learning [7, 8]. Furthermore, SS can be classified as intrapersonal (problem-solving skills, anger management, dealing with frustration) and interpersonal skills (ability to speak and listen to opinions, feelings, assertiveness, and good non-verbal communication, among others) [9].

The teacher is an agent of the educational process and, therefore, needs to be socially competent since it is fundamental to the learning process [10]. The quality of the relationship between the tutor and the student depends on the repertoire of SS the tutor presents. It is important that the teachers know and develop important skills such as resolving conflicts within a group of students; coordinating group tasks; maintaining satisfactory relationships in the workplace; being optimistic and persevering; being self-motivated for teaching; knowing how to deal with their emotions, with students’ emotions, with stressful situations, and with criticism; being creative; having self-control; trusting in their abilities; and knowing how to give and receive praise, among others [11].

In the systematic review by Vieira-Santos, Del Prette, and Del Prette, it is emphasized that the teacher-student relationship can have many consequences on the student’s academic life, including impact on university dropouts, satisfaction with the university experience and academic adaptation, and interest and participation in the classroom; students quality of life; quality of the teaching–learning process; incorporation of essential values into ethical professional practice, greater learning of academic content; and development of ethical values for professional practice. [12]

In the literature, there is a greater number of studies evaluating the SS of university students from different areas, and there are practically no studies evaluating SS of university teachers and even fewer of PBL tutors. Educational institutions need to consider the development of SS as an essential part of teacher’s training and not just cognitive capacity. [6, 13]

In this study, we aimed to investigate the SS profile of PBL tutors on a private medicine course at a university center and which factors would be related to a better repertoire of these skills, using the the Del-Prette Social Skills Inventory-2 (SSI-Del-Prette) [4]. This inventory has been adapted and validated for different populations, such as adolescents, college students, and older people, indicating its versatility and relevance across age groups [14, 15].

Methods

Study Design

We conducted a cross-sectional, descriptive study, with quantitative analysis, based on data collection from teachers, carried out in the Medicine Course of a private teaching institution in the city of Fortaleza/Ceará, which adopts a hybrid teaching methodology (active learning methodologies and traditional teaching with theoretical classes). This medical school in particular is relevant because it was one of the first in the country to implement the active methodology, with the first teachers having been trained in Canada to bring the method to Brazil, and it is still relevant today for the development of the active methodology nationally. The study was carried out from November 2020 to February 2022 and was approved by the Research Ethics Committee (CEP) of the Christus University Center, a body that oversees human research accordingly to Brazilian law, under opinion number 4260452 and CAAE number 33462820.0.0000.5049.

Population and Sample

Tutors from the first to the eighth semester of the course agreed to participate in the study by signing the informed consent form (ICF). Tutors over 59 were excluded since the ISS2-Del Prette can only be applied to individuals aged 18–59 [16]. All of them were PBL teachers, and the participation was voluntary.

Data Collection and Variables

The questionnaire was administered in person, on a date previously scheduled with the tutors, in a private room, in the presence of a psychologist from the institution and two researchers. The tutors initially answered a questionnaire with sociodemographic data. They also answered about their professional and teaching experience.

The SS repertoire was assessed using the ISS2-Del Prette, which analyzes data relating to five SS items: coping with risk; self-affirmation in the expression of positive affection; conversation and social resourcefulness; self-exposure to strangers or new situations; and self-control of aggression in adverse situations [16].

The ISS2-Del Prette is a self-report instrument with 38 items describing situations of social interaction in different contexts (work, family, and leisure, among others), in which the person estimates the frequency of the most likely behaviors in interaction with different interlocutors (family, friends, authority, and strangers, among others). The scale contains five points, ranging from 0 (never or rarely), 1 (infrequently), 2 (regularly), 3 (very often), and 4 (always or almost always). Depending on the values assigned by the respondent, the interpretation of the answers allows the social repertoire to be assessed through a total score which can be characterized as (a) highly elaborated SS repertoire (above average), (b) elaborated SS repertoire (above average), (c) good SS repertoire (includes the average), (d) lower average SS repertoire (below average), and (e) lower SS repertoire (below average). This instrument results in a separate score for each of the five SS domains, and a total score is also assigned. The interpretation of the participant’s total score and factor scores is based on their position, in terms of percentiles (P), in relation to their subgroup of the same sex and age group, used as a reference.

The SS metrics comprise four classes: establishing potentially educational interactive contexts, transmitting or exposing content on social skills, establishing limits and discipline, and monitoring positively, which have 32 subclasses [17]. The ISS2-Del-Prette assesses five factors (F1, assertive conversion; F2, affective/sexual approach; F3, expression of positive feelings; F4, self-control/coping; F5, social development), in two age groups: 18–38 years and 39–59 years [18]. This instrument is a valuable means of examining social performance in different contexts and populations and helping professionals ascertain the existence or absence of deficits in this area, making it possible to diagnose and plan intervention measures that can be used [7, 19].

This particular questionnaire was chosen because studies have shown that the SSI-Del-Prette has strong internal consistency and reliability, making it a robust instrument for evaluating social skills. Additionally, the SSI-Del-Prette has been shown to have convergent validity with other measures of social skills and assertiveness, further supporting its utility in capturing different facets of social competence [20].

A psychologist from the institution evaluated the results of the questionnaires since only this professional category is allowed to carry out the analysis.

The participation of tutors in pedagogical training for active methodologies was also investigated. Our institution holds periodic, non-compulsory pedagogical training courses ranging from 40 to 80 h. In addition, all novice tutors take part in a 4-h theoretical course on the methodology and then take part in practical training for 12 h, audited by experienced tutors to improve their performance. In addition to the technical aspects of the methodology, the best way to conduct small group dynamics and the importance of social skills are discussed. The training sessions distribute and discuss the manuals containing these last two topics [21, 22].

Statistical Analysis

The quantitative categorical results were presented in the form of percentages and counts and the numerical results in the form of measures of central tendency. A correlation matrix was constructed between the social skills scores and the categorical variables. Kolmogorov–Smirnov normality tests were carried out for the numerical variables. Generalized linear regression models with robust errors were used to check the significance level of the association between the study variables and social skills. A p-value of less than 0.05 was considered significant. The data collected was tabulated and analyzed using IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. IBM Corp. Released 2015.

Results

Seventy-four tutors from the first to the eighth semester took part in the study out of 82 tutors at the institution, 50% of whom were female. The average age of the participants was 39.6 ± 8.3 years, and 81.1% were married. Thirty-one percent (n = 23) of the tutors worked only in PBL activities. Twenty percent of the tutors had received pedagogical training before beginning their tutoring activities. All the participants’ data can be seen in Table 1.

Table 1.

Demographic characteristics and professional training of problem-based learning tutors at a university center

	N (%) or mean (SD)
Sex, N (%)
Female	37 (50.0)
Male	37 (50.0)
Age (years)	39.6 (8.3)
Marital status, N (%)
Single	12 (16.2%)
Married	60 (81.1%)
Divorced	02 (2.7%)
Religion, N (%)
Catholic	53 (71.6%)
Evangelical	03 (4.1%)
Christian	02 (2.7%)
Spiritist	06 (8.1%)
Atheist	01 (1.4%)
Adventist	01 (1.4%)
No religion	06 (8.1%)
No information	02 (2.7%)
Time since graduation (years)
Mean (SD)	16.9 (8.53)
Median (IQR)	14.0 (10.0; 21.0)
Teaching time (years)
Mean (SD)	8.2 (7.26)
Median (IQR)	5.5 (3.0; 11.0)
Tutoring time (years)
Mean (SD)	3.9 (3.25)
Median (IQR)	3.0 (2.0. 5.0)
Previous pedagogical training, N (%)	20 (27.0%)

The results of the tutors’ social skills assessment are shown in Supplementary Table 1. The tutors’ total score was 88.42 on average, with a standard deviation of 12.88, ranging from a minimum of 61 to a maximum of 116. The results for all the factors can be seen in Supplementary Table 1.

When we then analyzed the categorization of tutors according to the scale applied, there is a deficit (i.e., lower and lower average results) in assertive conversation in 41.1% of tutors, affective-sexual approach in 44.4%, expression of positive feelings in 47.9%, self-control and coping in 54.8%, and social resourcefulness in 37.0%. The complete categorization can be seen in Table 2.

Table 2.

Classification of the social skills repertoire of problem-based learning tutors at a university center

N = 74	Highly elaborate	Elaborated	Good	Lower middle	Bottom
	(%)	(%)	(%)	(%)	(%)
Total score	23.3	15.1	4.1	26.0	31.5
Factor 1 (Assertive conversation)	24.6	23.3	11.0	13.7	27.4
Factor 2 (Affective-sexual approach)	29.2	22.2	4.2	23.6	20.8
Factor 3 (Expression of positive feeling)	23.3	17.8	11.0	21.9	26.0
Factor 4 (Self-control-coping)	24.7	16.4	4.1	26.0	28.8
Factor 5 (Social resourcefulness)	37.0	17.8	8.2	21.9	15.1

The characteristics associated with the social skills factors are analyzed below. Teachers’ pedagogical training was associated with the affective-sexual approach factor (median of 7.5 in those who had been trained versus 6 in those who had not, p-value 0.007), social resourcefulness (median 19 in those who had been trained and 16 in those who had not, p-value 0.008), and total social skills score, with a median of 95 in those who had been trained and 86 in those who had not, p-value 0.036. In addition to pedagogical training, the following variables were also associated with the positive feeling expression factor: marital status (median of 28 in married people versus 24.5 in single people, p < 0.001) and religion (median of 28 in Catholics versus 25 of other religions, p = 0.025). The age variable was tested but showed no statistically significant association with any variable (data not shown). Table 3 shows all the results of the tests of association between the variables studied and the total score and the score for factors 1 to 5 of social skills.

Table 3.

Results of the association study between the study variables and the social skills scores. Values expressed as medians and lower and upper quartiles

	Factor 1		Factor 2		Factor 3		Factor 4		Factor 5		Total score	p
Pedagogical training		0.183		0.007		0.212		0.073		0.008		0.036
Yes	38		7.5		27.5		13.5		19		95
	(35–41.5)		(5.5–9)		(25.5–30.0)		(10.5–15.5)		(15.5–20)		(86.5–102)
No	36.5		6		27		11		16		86
	(31–41)		(3–7)		(25–30)		(10–13)		(14–18)		(79–96)
Sex		0.605		0.053		0.065		0.768		0.567		0.849
Male	37		6		28		12		17		87
	(32–41)		(3–7)		(26–30)		(10–14)		(14–19)		(75–99)
Female	37		6		27		11		17		90
	(32–41)		(5–8)		(24–29)		(10–14)		(15–19)		(76–96)
Marital status		0.189		0.368		0.000		0.231		0.354		0.045
Single	33.5		6		24.50		13.00		16.00		77.00
	(27.5–39)		(3–7.5)		(21.5–26.5)		(11–15)		(13–18.5)		(71–93.5)
Married	38		6		28.00		11.00		17.00		90.00
	(33–41.5)		(4–8)		(26–30)		(10–14)		(15–19)		(83–99)
Religion		0.888		0.853		0.025		0.580		0.467		0.593
Catholic	37		6		28		13.5		19.00		87
	(33–40)		(4–8)		(26–30)		(10.5–15.5)		(15.5–20)		(79–96)
Other	37		6		25		11		16.00		84
	(27–45)		(4–8)		(22–29)		(10–13)		(14–18)		72–103)
Semester		0.132		0.149		0.131		0.923		0.533		0.375
1 a 4	37		5		27.5		11		17		88
	(34–41)		(3–7)		(26–30)		(9–15)		(15–19)		(82–97)
5 more	37.5		6		27		12		16		88.5
	(27.5–41)		(5–8)		(24–30)		(10–14)		(14–19)		(75.5–98.5)
Specialization		0.748		0.531		0.713		0.978		0.550		0.826
Yes	37		6		27		12		17		90
	(32–41)		(4–8)		(25–30)		(10–14)		(14–19)		(79–98)
No	37		6		28		11		16		86
	(32–42)		(4–6)		(20–30)		(7–18)		(9–20)		(73–102)
Master’s degree		0.670		0.618		0.736		0.466		0.673		0.823
Yes	37		6		27		11		16		86
	(32–42)		(4–7)		(25–30)		(8–14)		(13–20)		(79–99)
No	37		6		27.5		12		17		86.5
	(31–41)		(4–8)		(25–30)		(10–14)		(15–19)		(79–98)
Doctorate		0.784		0.494		0.891		0.735		0.392		0.796
Yes	37		6		28		11		18		90
	(32–42)		(3–8)		(25–30)		(9–15)		(14–20)		(75–102)
No	37		6		27		12		16		87
	(31–41)		(4–8)		(25–30)		(10–14)		(15–18)		(79–97)
Guidance of extracurricular activities		0.403		0.235		0.293		0.799		0.249		0.589
Yes	38		6		27		11		17.5		88.5
	(33–42)		(5–8)		(24–29)		(10–14)		(14–20)		(79–102)
No	37		5		28		12		16		86.5
	(31–41)		(3–8)		(25–35)		(9–14)		(15–18)		(79–96)
Guidance of student teaching		0.182		0.295		0.540		0.768		0.320		0.320
Yes	38		6		27		11		16		90
	(33–44)		(4–8)		(26–30)		(10–15)		(15–19)		(82–102)
No	37		6		27		12		17		86
	(31–41)		(4–7)		(25–30)		(10–14)		(14–19)		(79–98)

Factor 1, assertive conversation; Factor 2, affective-sexual approach; Factor 3, expression of positive feelings; Factor 4, self-control and coping; Factor 5, social resourcefulness

It was also found that the characteristics of the tutors’ length of service, represented by the variables “length of time since graduation,” “length of time as a teacher,” or “length of time as a PBL tutor” were not statistically associated with factors 1 to 5 or with the total social skills score. As mentioned above, Figure 1 shows a linear correlation matrix demonstrating the association between the scores and the variables.

Fig. 1.

Correlation matrix between time since graduation, starting teaching, and starting PBL experiences with the 5 SS factors and the total SS score

Discussion

In this study, it was found that around half of the teaching staff presented low or very low social skills repertoire, especially in items that are critical to personal and professional adjustment, such as the expression of positive feelings and self-control and coping. In addition, the total SS score was significantly higher in tutors who had received pedagogical training before starting their teaching activities. This result highlights the importance of pedagogical training in SS for tutors.

The demographic profile of the population studied reflects that of medical teachers in Brazil, suggesting that our results may be representative of the country [23, 24]. The time spent working as a tutor in the PBL methodology ranged from 6 months to 11 years, with a median of 3 years (interquartile range: 1 to 11 years) in the study by Sousa, Falbo Neto, and Falbo, close to the findings of the present study [25].

This study found that nearly a half of the tutors have inappropriate social skills. The gap is worrying since SS are essential for the composition of an effective and credible tutor. It is known that for quality tutoring, four characteristics are needed: social work skills (competence in stimulating group discussion), communication skills (dexterity in expressing oneself in a way that the student understands), empathic skills (willingness to engage with the student in an authentic way), and knowledge of the content. Furthermore, for some authors, teacher credibility depends on five criteria: sociability, character, competence, composure, and extroversion [26, 27]. Deficits in assertive and coping skills were the ones that stood out the most in our results. These findings align with the literature, which describes these skills as one of the most challenging in different interpersonal situations related to the university context. Therefore, attention should be paid to developing this SS in tutors since knowing how to deal with difficult interpersonal situations is a differentiator for conducting a tutorial session [28, 29].

Another critical point to discuss is the importance of teacher training in social skills and its challenges. We found that only 8.1% of our tutors had taken part in pedagogical training at our institution. This low number can be explained by the fact that most of our tutors (91.9%) are practicing physicians and that it is not compulsory to participate in the training offered. Most doctors start as teachers with little or no teaching experience. The thoughts of these professionals are mostly that teaching is secondary to the medical profession, which leads us to a more significant challenge of motivating them to spontaneously participate in the professionalization of teaching [30]. Furthermore, regardless of the teacher’s profession, it is known that the process of change, i.e., training in an instructional technique, requires much continuous work. Furthermore, applying active methodologies, compared to traditional classes, usually requires a long period of preparation [31].

Despite the small number of tutors participating in the pedagogical training, we found that there was a positive association with SS. It is worth noting that although the literature reports that teaching itself can lead tutors to acquire SS, our study did not show these findings. On the contrary, we found that the characteristics of the tutors’ time in the profession were not statistically associated social skills score. This finding suggests that just participating in the methodology was insufficient to develop SS. Therefore, a diagnostic assessment carried out through a SS inventory (an uncommon action in educational institutions) followed by pedagogical training would be an essential strategy to be used in educational institutions. The importance of this training is reinforced by the assumption that although education is a social phenomenon, that is, mediated by relationships between its subjects, this does not mean that these relationships occur without conflict, naturally and automatically, as tending towards well-being or as effective promoters of the growing development of these subjects—teacher, student, technical-pedagogical team [32].

In addition to the association with training, marital status (married) and religion were associated with the positive expression factor. Concerning marital status, marriage in developing social skills is a complex and multifaceted issue with significant implications in various contexts. According to the literature, married people of both sexes report more happiness than those who have never married or are divorced, separated, or widowed. In addition, people who cohabitate with a partner are significantly happier in some cultures than those who live alone, influencing their positive expression in their social relationships [33]. As for religion, research has shown that religious experience contributes to a subjective change with consequent behavior modification, causing personal growth through greater tolerance in interpersonal relationships, inclusion in social groups, self-knowledge, and the development of empathy. It also determines their leadership style and specifies the nature of their relationships with their peers, which can positively impact the work environment. Thus, it is assumed that religion is one of the factors involved in the good performance of teachers (the group’s main leader) in the educational environment and in the performance of those they lead [34, 35]. Also, Hilgenberg, in his work entitled Manifest and Self-Recognized Social Skills: a study of teachers’ subjectivity, observed that the main influences received in the process of building interpersonal relational knowledge were religion, parents, and the school’s working environment [32].

This study had some noteworthy limitations. First, as this is a cross-sectional study, the associated factors we found cannot be defined as causal. In addition, although we used a validated social skills scale, it is not exhaustive of the social skills of each individual, even though it has shown good accuracy in the studies that tested it. Moreover, as the study was carried out in a single center, the results found here may not be generalizable to all medical schools .

Conclusion

We conclude that about one-half of PBL teachers have insufficient social skills and that pedagogical training is associated with higher scores of these skills. Therefore, the results of this study draw attention to the importance of SS for tutors and the planning of the evaluation of SS and training programs for teaching staff at medical schools. In addition to the importance of SS for the population studied, the PBL teachers, it is likely that the effect is generalizable to all educators who work with small groups.

Our results also suggest that developing teacher training that prioritizes strengthening social interactions and interpersonal skills could lead to better performance in the teaching–learning process in PBL. We emphasize the need for constant investment in teacher development, intending to reinforce the qualities of the tutor and their good relationship with the students.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

SS

Social skills

PBL

Problem-based learning

SD

Standard deviation

IQR

Interquartile range

Author Contribution

Author’s contributions were as follows: DCOS, MK, YBF, HALR, and CMCO have made substantial contributions to conception and design. HALR and MK revised the manuscript critically for relevant intellectual content. All authors approved the submission.

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics Approval and Consent to Participate

Written informed consent was obtained from participants. The survey was approved by the Research Ethics Committee Comitê de ética em Pesquisa da Unichristus in Brazil. All methods were carried out in accordance with relevant guidelines and regulations.

Consent for Publication

Not applicable.

Competing Interests

The authors declare no competing interests.