Correlation Between Learning Approach and Students Objective-Structured Clinical Examination Passing Rate.
Sulistiyana, Catur S., M.D., M.Med.Ed., Cahyani, Diana D., S.Ked., Maryam, Ruri E., M.D., M.Biomed., Khasanah, Uswatun, S.Pd., M.Pd. *
Department of Medical Education, Faculty of Medicine, Swadaya Gunung Jati University, Cirebon, Indonesia.
Student of Faculty of Medicine, Swadaya Gunung Jati University, Cirebon, Indonesia.
Department of Microbiology, Faculty of Medicine, Swadaya Gunung Jati University, Cirebon, Indonesia.
Department of Epidemiology and Biostatistics, Faculty of Medicine, Swadaya Gunung Jati University, Cirebon, Indonesia.
Context: In medical school, learning approach used by students while preparing for assessment can vary from one individual to another. Students may conduct deep or either surface learning approach when studying for an examination. Objective-structured clinical examination (OSCE) is one of assessments for medical students’ learning outcome which may require different learning approach from other written examinations. Different types of learning approach thus may affect the students’ OSCE outcome. Aims: To analyze correlation between learning approach used by medical students and OSCE passing rate. Settings and Design: A cross-sectional study conducted in February 2018 at the Faculty of Medicine, Swadaya Gunung Jati University. Methods and Material: Learning approach of 146 medical students was assessed using Revised Study Process Questionnaire 2 Factors (R-SPQ-2F). Data of OSCE passing rate was obtained from the academic section of Faculty of Medicine, Swadaya Gunung Jati University. Rank Spearman test was used to analyze the correlation between learning approach and OSCE passing rate. Results: Eighty-three students out of 146 (56,8%) ran into deep approach, while 63 students (43.2%) applied surface approach. Rank Spearman analysis showed that learning approach is significantly correlated with students’ OSCE passing rate (p = 0.001; CI 95%). Conclusion: Deep learning approach resulted in higher OSCE passing rate.
*Corresponding author: +6281320001650; Department of Epidemiology and Biostatistics, Faculty of Medicine, Swadaya Gunung Jati University, Cirebon, Indonesia; firstname.lastname@example.org
Received : 26 December, 2019
Accepted: 2 January 2020
Published : 9 February 2020
Keywords : Learning approach, objective structured clinical examination (OSCE).
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
The application of a competency-based curriculum in Indonesia necessitates medical doctor graduates to hold minimum required competencies . A medical school graduate must capable to demonstrate his clinical skills in the work field. Therefore, to evaluate the clinical competencies of medical students, an objective assessment is needed to measure that competency. One of the recommended assessment methods for measuring clinical competency is objective-structured clinical examination (OSCE) [1,2].
OSCE is a standardized-evaluation aimed to assess the components of clinical competencies including history taking, physical examination, workup, diagnosis, pharmacology and non-pharmacology patient management, communication skills, laboratory results interpretation, and professional behavior, by using a scaled rubric [1-3]. The OSCE was first introduced by Harden from Dundee University . The aim of the OSCE is to assess student competencies and clinical skills in an objective and structured manner [2,3].
The Medical Faculty of Swadaya Gunung Jati University uses OSCE to measure the achievement of students’ clinical competencies. OSCE is conducted at the end of every semester from the 1st to the 7th with similar arrangement with national OSCE. In this exam format, students will go through several stations, where at each station they will be tested for 15 minutes on different clinical skills according to competence areas . According to data from academic section, OSCE outcome in 2016 did not meet the expected goal. A lot of students required to take OSCE Remedial. This phenomenon could be caused by many factors. Previous studies have shown that factors such as learning approach, anxiety, and stress level influence nursing and midwifery students’ OSCE outcome [3-5]. Therefore, this study was conducted to determine what factors might influence the results of OSCE passing rate in the Medical Faculty of Swadaya Gunung Jati University.
Subjects and Methods
This cross-sectional study was approved by Ethical Committee of Faculty of Medicine of Swadaya Gunung Jati University No. 102/EC/FK/XI/2017. This study used a cross sectional design, which was conducted at the Faculty of Medicine, Swadaya Gunung Djati University in February 2018. The population in this study were all students of the Faculty of Medicine, Swadaya Gunung Jati University in 2018. Total sample of this study was 146 respondents consisting of 1st and 2nd year students in academic year 2017/2018 who underwent OSCE. Learning approach was assessed using the Revised Study Process Questionnaire 2 Factors (R-SPQ-2F) questionnaire [6,7] and divided into two categories: deep and surface learning. OSCE passing rate was secondary data from academic section of Faulty of Medicine of Swadaya Gunung Jati University and categorized into pass and not pass. Correlation analysis was performed using Spearman Rank test.
The Revised Study Process Questionnaire 2 Factors (R-SPQ-2F) questionnaire data were categorized into two types of learning approach: deep and surface learning. Table 1 describes the frequency of the learning approach that was conducted by students when preparing OSCE. Majority of the students have performed deep learning approach when they study for OSCE preparation.
OSCE passing rate of the 1st and 2nd year students in academic year 2017/2018 that was obtained from academic section was categorized into two: pass and not pass. The frequency of the data was figured in the table 2.
Spearman Rank test was analyzed to determine the correlation between learning approach and the OSCE passing rate. Table 3 describes the statistical analysis result.
Results showed that the learning approach used by students in dealing with OSCE was majorly deep learning approach. According to Biggs and Edwin, people who conduct deep learning have urge from themselves to satisfy their curiosity about the study material. Meanwhile, people doing surface learning have external force where they expect to pass without necessity to study hard [8-10].
Correlation analysis revealed that the student learning approach significantly affected the outcome of the OSCE exam (p = 0.000). The students who applied deep learning approach for OSCE preparation could pass more than those who used surface learning. This result is in accordance with previous studies [11,12]. OSCE has a dynamic and temporary impact on learning, while the catalytic effect is more persistent. For the success of OSCE outcome, students are required to study in depth, thoroughly and comprehensively. It is important to note, that in order to be successful in the exam, an appropriate learning approach is needed. In OSCE, not only memory is tested, but also procedural and patient management skills in an integrative manner. This need could be met by conducting deep learning approach, where the learning approach would emphasize more and result in a long-time outcome [11,13]. It is because when students conduct deep learning, they also involve concept understanding and integrative knowledge, strong willing to learn, high intrinsic motivation, interactions and relationships. Meanwhile, in surface learning, they will focus on memorization of unrelated facts that leads to a retention in the superficial layer .
It was found that students experienced difficulties when OSCE was caused by several things such as time management, subjectivity assessment, turn order when called, lack of study preparation, anxiety while in the examination room and too fixated on assessment . But in addition to these conditions, the students also stated that the difficulties in facing OSCE were balanced with the struggle to graduate, including by preparing themselves as best as possible by learning and practicing. Another factor that influences OSCE graduation is the purpose and interest of students to study.
Majority of students in the Faculty of Medicine of Swadaya Gunung Jati University applied deep learning approach when studying for OSCE. Thus, in turn, the deep learning approach resulted in higher OSCE passing rate.
The authors would like to thank Faculty of Medicine of Swadaya Gunung Jati University for the research grant and all support provided.
The article has not been previously presented or published, and is not part of a PhD or thesis project.
CONFLICT OF INTEREST
There are no financial, personal, or professional conflicts of interest to declare.
Indonesian Medical Council. Standar Kompetensi Dokter Indonesia, (2012).
Khan R, Payne MWC, Chahine S. Peer assessment in the objective structured clinical examination: A scoping review. Medical Teacher. 2017;39 (7):745-56. doi: 10.1080/0142159X.2017.1309375
Kristina SA, Gustriawanto N, Rokhman MR, Aditama H, Sari IP. Students’ first experience with Objective Structured Clinical Examination in a pharmacy school in Indonesia. Journal of Applied Pharmaceutical Science 2018;8(9):102-6. doi: 10.7324/JAPS.2018.8915
Faramarzi M, Pasha H, Bakhtiari A, Salmalian H, Delavar MA, Amiri FN, et al. Test anxiety in objective structured clinical examinations (OSCEs) compared with traditional assessment methods in undergraduate midwifery students. Health. 2013;5(12):2204-9. doi: 10.4236/health.2013.512299
Katowa-Mukwato P, Mwape L, Kabinga-Makukula M, Mweemba P, Maimbolwa MC. Implementation of objective structured clinical examination for assessing nursing students’ clinical competencies: Lessons and implications. Creative Education 2013;4(10A):48-53. doi: 10.4236/ce.2013.410A008
Justicia F, Pichardo MC, Cano F, Berbén ABG, Fuente JDl. The Revised Two-Factor Study Process Questionnaire (R-SPQ-2F): Exploratory and confirmatory factor analyses at item level. European Journal of Psychology of Education. 2008;XXIII(3):355-72.
Biggs, J.B., Kember, D., & Leung, D.Y.P. (2001) The Revised Two Factor Study Process Questionnaire: R-SPQ-2F. British Journal of Educational Psychology. 71, 133-149.
Bälter O, Cleveland-Innes M, Pettersson K, Scheja M, Svedin M. Student approaches to learning in relation to online course completion. Canadian Journal of Higher Education. 2013;43(3):1-18.
Howie P, Bagnall R. A critique of the deep and surface approaches to learning model. Teaching in Higher Education. 2013;18(4):389-400. doi: 10.1080/13562517.2012.733689
Delgado ÁHdA, Almeida JPR, Mendes LSB, Oliveira INd, Ezequie OdS, Lucchetti ALG, et al. Are surface and deep learning approaches associated with study patterns and choices among medical students? A cross-sectional study. Sao Paulo Medical Journal. 2018;136(5):414-20. doi: 10.1590/1516-3180.2018.0200060818
Triyani, R GR, Suryadi E. Dampak OSCE terhadap pembelajaran dan efek katalitik OSCE pada mahasiswa tahun ke I,II,II Fakultas Kedokteran Universitas Gadjah Mada. Jurnal Pendidikan Kedokteran Indonesia. 2014;3(1):38-45.
May W, Chung E-K, Elliott D, Fisher D. The relationship between medical students’ learning approaches and performance on a summative high-stakes clinical performance examination. Medical Teacher. 2012;34(4):e236-e41. doi: 10.3109/0142159X.2012.652995
Jhala M, Mathur J. The association between deep learning approach and case based learning. BMC Medical Education. 2019;19(106):1-4. doi: 10.1186/s12909-019-1516-z
Meeks MD, Williams F, Knotts TL, James KD. Deep vs. surface learning: An empirical test of generational differences. International Journal of Education and Research. 2013;1(8):1-16