Opinion on agile methodology in education among the nursing students

Abstract

BACKGROUND:

Agile methodology (AM) is an innovative, active, project-based learning method. The scrum is a popular agile framework widely used in project management and education. This study evaluates the opinions on agile adaptation in nursing curricula among nursing students to identify how AM can be applied in higher education to facilitate learning.

MATERIALS AND METHODS:

The study employed a cross-sectional design and was conducted at two colleges affiliated with health science university, Bengaluru, India in 2021-22. A 23-item agile scrum perception tool (ASPT) was used to evaluate the opinions on AM among the nursing students after the agile training. The data were analyzed by using IBM SPSS version 28. Descriptive statistics was used to evaluate the opinion.

RESULTS:

A total of 133 students responded to the questionnaire. Nearly, 99 (74%) of the students strongly agreed the team leader’s (TL) responsibility for managing the time was good. Around 109 (82%) of the students felt that the product owner (PO)/outcome evaluator (OE) explained the course objectives well. About 107 (76%) of students strongly agreed that the learning was facilitated by AM.

CONCLUSION:

The agile scrum framework (SF) can be taught and fostered to improve collaborative learning, teamwork, leadership abilities, and educational outcomes. The policymakers should set the criteria for implementing agile in the curriculum, and nurse managers should allocate the budget for organizing the training program in the form of workshops and conferences for the nursing educators and nurses which could help to improve the self-directed learning and safe collaborative quality of patient care.

Introduction

Learning is an activity or process by studying, practicing, or experiencing something after gaining knowledge or skill. The learning process in the healthcare environment is unique because the students perform the activities with actual patients. Due to advancements in the healthcare system, it is a challenge for faculty to choose an appropriate learning method to meet the needs of society and improve the quality of care.[1] The twenty-first-century concept of teaching is active, student-centered, team-based, project-based, and problem-based learning that integrates theory, practice, knowledge, skills, application of knowledge in solving problems, and effective decision-making.[2]

One of the active learning methods is agile methodology (AM). AM is a software management framework in which the team completes the task within the set duration in different phases called sprints. Seventeen software practitioners coined Agile to set up the Agile Manifesto, which includes 12 principles and four core values. One of the popular methods of agile is scrum.[3] It has been widely used in education. It is called eduScrum and was described by Jeff Sutherland and Ken Schwaber.

The scrum framework (SF) has three roles (product owner (PO)/outcome evaluator (OE)/faculty),(scrum master (SM)/team leader (TL), and (Development team (DT)/student team), five events/activities (sprint, sprint planning, daily meeting, review meeting and retrospective meetings), and three protocols (product backlog, sprint backlog, and increment).[4,5]

Agile scrum improves the student’s engagement, collaboration and interaction, reflection by metacognitive thinking, practical skills, leadership abilities, and emotional intelligence through trust, motivation, and communication. These skills determine the students learning.[3,6,7,8,9,10,11,12] Literature stated the detailed application of agile scrum methodology in nursing education.[3]

The various empirical evaluations of the survey stated that the scrum provides experiential learning through creativity, coaching, and continuous feedback. The studies noted that the students’ opinions on agile scrum were positive and well appreciated, and it improves the efficiency of educational processes in foreign countries. Most of the literature review explained the qualitative data on the opinions of software engineers and computer engineering students’ perspectives.[7,9] Opinions on AM in quantitative aspects among the allied health students were scarce.[3] The agile scrum implementation and students’ perception of agile scum-related studies were limited in India.

Further, literature related to active learning strategies needs to be more extensive due to the constraints of incorporating such programs into the curriculum. Based on the reasons mentioned previously, the researchers aimed to evaluate the opinions on AM among nursing students after the successful implementation of AM. Exploring the student’s views on the agile scrum method helps the faculty to understand and ascertain the appropriateness, adaptability, strengths, weaknesses, and sustainability while incorporating agile into their curriculum. Further, it helps to know how an agile course enhances the educational outcome. Most of the literature review explained the qualitative data on the opinions of software engineers and computer engineering students’ perspectives. Opinions on AM in quantitative aspects among the allied health students were scarce. There are very few studies focusing on the students’ views in India. So, the researchers aimed to evaluate the opinions on AM among nursing students to elicit agreement and appreciation of agile in the nursing curriculum and outline future recommendations.

Material and Methods

Study design and setting

A cross-sectional study was conducted between August 2021 and May 2022 among fourth-year B.Sc. nursing students at two nursing colleges affiliated with health university, Bengaluru, India. The students who had agile training and returned the completed questionnaire were included in this study.

Study participants and sampling technique

The study population included fourth-year B.Sc. nursing students. The total strength of the students in both the colleges was 137 students. Four students who did not attend the agile training were excluded. All the students attending the AM in the newborn course who consented to participate were included in the study using purposive sampling techniques. The sample size was calculated as mentioned in the previous study.[3] The total sample size was 133.

Data collection tool and technique

An expert-validated pilot-tested 23-item ASPT (Agile scrum perception tool) questionnaire was administered to the fourth-year nursing students. According to Cronbach’s alpha, the reliability coefficient was 0.87, showing that the internal consistency of the questionnaire was good. This researcher developed a questionnaire consisting of two sections:

Part A: Consisted of three items to obtain baseline information regarding the demographic profile of the nursing students including age, sex, and scholastic performance in the previous year.

Part B: Consisted of a 23-item questionnaire with six-factor structures to assess students’ opinions on AM. The factors or domains of the questionnaire focus on the team leader’s responsibilities, scrum team, student team, opinion on agile training, scrum activities, and benefits of the SF. Responses were rated using a five-point Likert scale (strongly agree—5, agree—4, neutral—3, disagree—2, and strongly disagree—1). The purpose of the study, objectives, and duration of the course was explained. The students had agile training for 21 days in the newborn course. In this SF, the students followed all the principles, events, and protocols. After the agile training, the students were administered the ASPT and took 20–30 min to fill out the questionnaire. The students’ response was based on a self-assessment of their learning experience and their opinion on the level of exposure and team performance they had in their course using AM.

Institutional ethics committee approval

Ethical approval for the study was obtained from the Institutional Ethics Committee. Before proceeding with the questionnaire, permissions were obtained from the head of the institutes; fourth-year students were informed about the purpose of the study, and written consent was obtained from the willing candidates.

Statistical analysis

Data were coded and entered into the Microsoft Excel 2010-manufactured by Microsoft spreadsheet. The analysis was carried out using IBM SPSS version 28- Manufactured by IBM for Windows. The descriptive statistics were carried out to find the agreement of each item. The mean score of the individual and for the factors were carried out.

Result

Demographic characteristics

The study evaluated the opinions of AM among fourth-year nursing students. The demographic data showed the participant’s mean age, sex, and scholastic performance in the previous year. The mean age of the experimental students was 20.95 ± 0.54 years and most of the participants were females. The mean score of the scholastic performance of students was 65.5 ± 7.4.

Students addressed the questionnaire through a Likert scale ranging from strongly agree to strongly disagree. Graph 1 mentions the team leader’s responsibilities. The majority of the students, 99 (74%), strongly agreed with the team leader’s responsibilities including time management by TL, TL was good at maintaining the team, the team effort was good in achieving the outcome, and overall, time management was good.

Graph 1.

Team Leader Responsibilities

The Scrum team’s responsibilities are represented in Graph 2. The majority of the students, 109 (82%), strongly agreed with the PO/OE roles; such course objectives were well explained, offered continuous feedback, the team leader facilitated the learning activities, members allotted to the team were adequate, team members helped the underperformed team, and they carried out well the prioritized topics.

Graph 2.

Scrum Team

Graph 3 represents the student team’s responsibilities. Most of the students, around 99 (74%), agreed that their communication was improved; they can make a burndown chart, and retrospective meetings help further enhance their learning.

Graph 3.

Student Team

Opinion on agile training is represented in Graph 4. About 101 (76%) students strongly agreed that agile was useful, easy to follow, and it facilitated learning.

Graph 4.

Opinion on Agile Training

Graph 5 represents the scrum activities. The majority of the students, 102 (77%), strongly agreed that the accountability of the student team was improved, sprint (setting the time to complete the objectives) was adequate to achieve the objectives in three weeks, and sprint planning was effective.

Graph 5.

Scrum activities

Scrum benefits are represented in Graph 6. About 102 (77%) students strongly agreed that the scrum promoted hands-on training, helped in adopting the changes, and collaboration between the PO/TL was good.

Graph 6.

Scrum benefits

Table 1 presents the mean scores and standard deviation of nursing students’ opinions regarding the AM. It was found that the mean scores of students’ views on AM were higher (108.4 ± 4.63) regarding team leader responsibilities (18.68 ± 1.22), scrum team responsibilities (32.93 ± 1.53), student team (14.09 ± 1.01), opinion on agile training (14.2 ± 0.98), scrum activities (14.25 ± 0.98), and scrum benefits (14.25 ± 0.97), respectively.

Table 1.

Students’ opinions on Agile Methodology

Items		Max score		Mean±SD
Factor 1
Team leader responsibilitiesTime management was good.				4.66±0.51
TL was skilled in maintaining the team				4.65±0.48
Time management by TL was good				4.72±0.50
Team effort was good in achieving the outcome				4.65±0.51
Total		20		18.68±1.22
Factor 2
Scrum teamThe course objective was well explained by Outcome evaluator (OE)				4.81±0.41
PO/OE (Outcome evaluator and stakeholder) (HOD) offered continuous formative feedback to the individual and the team.				4.79±0.43
All the learning activities were facilitated by the TL/SM.				4.60±0.51
Members allotted to the team were adequate				4.58±0.50
Team members were able to help the underperformed students				4.76±0.45
Product backlog (List of topics for learning) was clear and adequate				4.75±0.48
Sprint backlog (Prioritized topics selected from the list of topics) was well carried out				4.65±0.50
Total		35		32.93±1.53
Factor 3
Student teamActive Communication and interaction within and between DT/ST were improved				4.714±0.52
Burndown chart (Graphical representation of work left to do versus time) making was made easy.				4.714±0.49
Retrospective meeting (student team discussion about what went well during just completed work/sprint) helped for further improvement in learning				4.661±0.49
Total		15		14.09±1.01
Factor 4
Opinion on agile trainingAgile was useful				4.71±0.50
Learning was facilitated by agile methodology				4.76±0.43
Agile framework was easy to follow				4.73±0.48
Total		15		14.2±0.98
Factor 5
Scrum activitiesAccountability of ST was improved in each sprint				4.75±0.451
Sprint (event within a fixed duration of time to complete the task/objectives/work) duration was adequate to achieve a goal (within 3 weeks)				4.74±0.44
Sprint planning (work of planning for learning) was effective				4.77±0.42
Total		15		14.25±0.92
Factor 6
Scrum benefitsPromoted hands-on experience				4.75±0.47
It helped to adopt the changes				4.75±0.433
Collaboration between PO/OE and TL was good				4.74±0.49
Total		15		14.25±0.97
Overall, Total				108.4±4.63

The study revealed that students were delighted and perceived positively about AM due to higher agreement of the mean score in all domains.

Discussion

The present study aimed to evaluate the opinions of nursing students on AM. The result showed that the students strongly agreed with all aspects of the application of the agile SF in their curriculum. This result was consistent with the studies where the students enjoyed and were engaged, and further, they want to continue in future sessions.[9,10,11,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31] The domain and opinions were discussed with similar studies.

Team leader responsibilities

Most of the students (74%) strongly agreed with the team leader’s responsibility to manage the team skillfully to complete the course objectives with time management. This study’s findings are supported by a previous study done by Noll et al.[13] which stated that the scrum master acts as a manager and helps the team to achieve the objectives. The scrum master/team leader played a significant role as process anchor, stand-up facilitator, impediment remover, sprint planner, scrum facilitator, and integration anchor. Krehbiel stated that the scrum master led the group work as a facilitator in learning.[14]

Another study by Green et al.[15] reported that most students were satisfied with the scrum master responsibilities. The team leader/scrum master, who was well-known about the theory rules of Scrum, helped the team to be more productive in achieving the task, tracking the progress to meet the commitment, resolving the impediments, and leading the team skillfully for improvement through retrospective and daily meetings. Kastl and Romeike[16] revealed that the students highly agreed that their self-organization and ability to work as teams were strengthened in achieving the objectives. Another study by Fernandes[17] stated that the students agreed that the scrum master played a crucial role in managing the team skillfully by applying the method properly, keeping the group calm and taking the lead, teaching the method, and allowing them to do things quickly. Students strongly agreed the team effort in achieving the outcome and time management by TL was good. Several studies in the literature have reported similar results.^[18-14]

Scrum team

The study result revealed that students strongly agreed that the course objectives were well explained by the PO/OE. This result was supported by Green[15] where the majority of the students rated that the PO outlined course objectives well while discussing the product backlog and communicating properly in sprint planning. Pocsova[19] stated that 63.6% of students appreciated the organization of agile coursework, and they were able to influence the course of the lesson. Mahnic[21] revealed that students agreed that the course was well prepared and conducted, and it shows the importance of good coaching when agile methods are introduced to novices and participants learn a great deal of agile methodologies.[7,22]

The students strongly agreed that the PO and stakeholders offered continuous feedback to individuals and teams. A similar result was supported by Linden[11] where the students appreciated the formative feedback, which improves their quality of learning and helps them stay on track. Further, it helped them learn from their mistakes, and they were able to demonstrate their learning through resubmission. The students rated the PO role more positively; hence, the course objective was well explained, and the responses to questions outside and inside the class environment were good.[23] The finding from Fernandes[17] stated that students rated task assignment, performance monitoring, visual management, and regular feedback as the main advantages of using scrum and their impact on positive team performance.

Most of the students strongly agreed that the members allotted to the team were adequate. This result was supported by Mark C. Paulk et al.[24] study, where 36% of students perceived that 7–9 members of the team were adequate. Jia 2012[25] stated that 5–9 members were adequate for the scrum practice and helped the team to be more focused.[17,20]

The students highly agreed that the team members could help the underperforming students. The study results are supported by one group member who is having difficulty learning helped by the rest of the group to help him achieve the goal.[25]

Krehbiel et al.[14] stated that the students rated high levels of understanding and appreciation for using sprint planning meetings as a means of collaboration with others. Scrum master led the group work as a facilitator; agile facilitated learning, enhancing teamwork, and improving creativity.

Green[15] also stated that most students agreed that the PO outlines course objectives while discussing the product backlog and communicating properly in sprint planning. The scrum master maintained the sprint backlog, and the team members worked together to solve the problems and complete their objectives.

Student team

The students were highly rated, and cooperation between the team members was good.[17] Social interaction was high through active involvement.[26] 65% of students preferred to work in teams, and 82% wanted to work in pairs. Their communication and interaction between and within the teams were excellent.

Students rated that the burndown chart was valuable in assessing the progress in learning. Similar results found in the study revealed that the students were well-known about the burndown chart.[15]

The retrospective meeting was excellent and helped to improve the self-organization. Students rated their essential abilities, such as teamwork, communication, time management, student management, flexibility in adopting the changes, and active participation, as improved after the successful scrum training.[19]

Studies by Rodriguez[27] and Kroop[22] proved that 93.33% of the students agreed or somewhat agreed that Scrum provides students with metrics to present the team performance through retrospective meetings and helps further improve learning. On the contrary, the students strongly disagree with the communication among the team members, motivation, organization, and overall efficiency of working with Scrum.[28]

Opinion on agile training

Students strongly agreed the agile training was useful. The previous studies stated that students accepted an eduscrum as an active learning method, which must be used continuously in teaching by Tudevdanga.[29] The students also stated that the Scrum never bored, attended the class till the end, learned contents very happily, and improved their self-efficacy through emotional intelligence.[20,29,30,31] There is a positive relationship found between self-efficacy and emotional intelligence.[32]

Machnic V[18] stated that 86.67% of students noted that the course was valuable and exciting, improved their self-motivation for learning, satisfied with the work on the project, and enjoyed the scrum learning method.[22]

Rodriguez G et al.[27] stated that the students highly agreed that agile methods are helpful (73.2%) for increasing the efficiency of the educational process, engaging, effective, and easy to follow (51.3%), and 34% of the students rated that agile was more comfortable.[8] 31.8% of the students agreed to continue agile learning in the future.[16] 55% of students stated that agile learning provided a lot of independence in their learning and helped in using creative thinking to strengthen the learning pattern and improve their reflection abilities.[23] The students agreed that the learning was facilitated by AM. It promotes self-directed learning and group learning.[3,9] Students rated that they were highly satisfied with the scrum method[14] and scrum more positively as a didactic method.[20]

Scrum activities

Students rated the scrum activities positively. The study supported by a previous study done by Green P[15] revealed that all the team members participated, and sprint reviews and retrospective meetings helped to incorporate the changes that were implemented.

Students strongly agreed that the sprint duration was adequate. This result was supported by Mark C Paulk et al.[24] where the Sprint length of 2–4 weeks was sufficient to complete the task/objectives. Sprint planning was effective, and it was highly rated by the students.

Scrum benefits

Students strongly agreed that Scrum promoted hands-on experience. It was supported by the Kroop[22] study, where students enjoyed the scrum learning due to its more of practical session with the most interesting process through integration, control, and continuous feedback for their improvement.

The students strongly agreed that Scrum improved soft skills such as communication, teamwork, and practical skills and adopted the changes. The study stated that the students agreed that the eduscrum improves teamwork, collaboration with the PO, TL, and ST, and trust with peers, which helps them to teach each other through knowledge sharing and problem-solving.[20,21,27]

In contrast, Roque Hernández[28] reported that the students strongly agreed that the scrum team does not adopt the changes.

Strength of the study

The study was conducted among the nursing students in the Indian context. It is an eye-opener that helps to improve the learning pattern. Agile is a flexible learning method that can be modified according to the student’s opinion, including the course duration, team division, team leaders’ responsibilities, and evaluation methods.

Limitation and Recommendations

The study can be conducted with a larger sample to assess the generalizability. The students’ opinions were obtained only once after the agile training and can be ascertained in each sprint to improve the working pattern and change the learning schedule. The opinion was evaluated by a self-assessment questionnaire. The team responses/peer group opinions may be valued in future research. Qualitative data can be collected to explore the in-depth opinion on agile adaptation in higher education. The teachers’ views about the challenges of incorporating agile into the curriculum can be evaluated.

Conclusion

The study evaluated the students’ opinions of the healthcare profession. Further, the study recommended that policymakers set the criteria for implementing the agile method into the nursing curriculum with prescribed hours of theory and practical sessions. Nurse managers should allocate the budget, plan, organize, and implement the training program through workshops and conferences for nursing educators and nurses, which could help improve self-directed learning and safe, collaborative quality of patient care. The study concluded that the skilled faculty must incorporate the agile scrum methodology.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.