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 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 36  |  Issue : 2  |  Page : 39-42

Promoting active learning and student engagement in undergraduate medical education


1 Deputy Director – Academics, Sri Balaji Vidyapeeth – Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission09-Dec-2021
Date of Decision05-Mar-2022
Date of Acceptance04-Aug-2022
Date of Web Publication16-Nov-2022

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_140_21

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  Abstract 


Medical student is expected to acquire a significant amount of knowledge during their training period and this becomes major stress for them. The purpose of the current review was to understand the need for active learning and student engagement and identify the various tools or strategies to promote student engagement. An extensive search of all materials related to the topic was carried out on the PubMed search engine, and a total of 21 articles were selected based on their suitability with the current review objectives. Keywords used in the search include student engagement and medical education in the title alone only. Student engagement is a crucial aspect to ensure active learning as it aids in stimulating and enhancing the ability of students to comprehend the concepts and apply them. As we envisage interactive teaching should be the new norm in medical education delivery, it becomes a crucial factor that medical teachers should use appropriate tools/vignettes to ensure student engagement. To conclude, considering the complexities in medical education, ensuring student engagement during the teaching–learning session is of paramount importance. It becomes the responsibility of the teachers to employ various strategies and tools to engage students in the class, as it will help them to acquire knowledge and skills better and will eventually prepare them for their future competent medical practitioner.

Keywords: Active learning, medical education, student engagement


How to cite this article:
Shrivastava SR, Shrivastava PS. Promoting active learning and student engagement in undergraduate medical education. J Med Soc 2022;36:39-42

How to cite this URL:
Shrivastava SR, Shrivastava PS. Promoting active learning and student engagement in undergraduate medical education. J Med Soc [serial online] 2022 [cited 2022 Nov 26];36:39-42. Available from: https://www.jmedsoc.org/text.asp?2022/36/2/39/361280




  Introduction Top


Considering the complexities in the field of medicine and the pace with which the knowledge continues to expand, there is no doubt that the delivery of medical education should be planned systematically.[1] Medical student is expected to acquire a significant amount of knowledge during their training period and this becomes major stress for them. This calls for the need to employ a wide range of interactive teaching–learning methods to make the process of learning benefits for the students.[1],[2] We must acknowledge that regardless of the fact that interactive teaching–learning methods are far superior in terms of knowledge acquisition or deep learning, still, lectures remain the most common mode of teaching–learning method employed in the majority of medical institutions in undergraduate teaching.[2],[3] The purpose of the current review was to understand the need for active learning and student engagement and identify the various tools or strategies to promote student engagement.


  Methods Top


An extensive search of all materials related to the topic was carried out on the PubMed search engine. Relevant research articles focusing on student engagement in medical education published in the period 2005–2021 were included in the review. A total of 23 studies similar to the current study objectives were identified initially, of which two were excluded due to the unavailability of the complete version of the articles. Overall, 21 articles were selected based upon their suitability with the current review objectives and analyzed. Keywords used in the search include student engagement and medical education in the title alone only (namely, student engagement [ti], student engagement [ti] AND medical education [ti], learner engagement [ti] AND medical education [ti], active learning [ti], and learner engagement [ti]). The articles published in only the English language were included in the review [Figure 1]. The collected information is presented under the following subheadings, namely active learning: the need, student engagement, tools to promote student engagement, and practical recommendations, to facilitate student engagement.
Figure 1: Flowchart for selection of research articles

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  Active Learning: The Need Top


Most educational theories advocate that learning should be an active process, wherein the learners construct their own understanding and acquire new knowledge by adding new information to existing knowledge.[2],[3],[4] Furthermore, it has even been proposed that learning can be better by facilitating social interactions in the learning environment.[1],[3] For better attainment of the learning outcomes, the information passed on to the medical students should be done in the form of an active process, wherein students are engaged in their learning.[3],[4] In this process of active learning, the student interacts with peers and their teachers through discussions, questioning, etc., and this aids them to not only acquire the desired knowledge, skills, or attitude but even develop critical thinking, clinical reasoning, and problem-solving skills.[3],[4],[5]


  Student Engagement Top


Student engagement is a crucial aspect to ensure active learning as it aids in stimulating and enhancing the ability of students to comprehend the concepts and apply them.[3],[5],[6] In general, student engagement refers to the time and energy which a student spends to be attentive, involved, and motivated to acquire knowledge or skills.[5],[6] The findings of different studies have shown that students who are more engaged in the learning process tend to become high achievers.[6],[7] Further, it has been revealed that students who are better engaged have better contentment from the course and attainment of the intended learning objectives.[5],[6],[7] A number of parameters such as age, amount of time spent with family and friends, involvement in physical exercise or mind relaxation techniques (such as meditation), ability/encouragement for the student to reflect upon the learning experiences, involvement in extracurricular activities, and ability to pursue hobbies while pursuing the undergraduate training, etc., determine the extent of student engagement.[6],[7],[8],[9]


  Tools to Promote Student Engagement Top


As we envisage interactive teaching should be the new norm in medical education delivery, it becomes a crucial factor that medical teachers should use appropriate tools/vignettes to ensure student engagement.[10],[11],[12],[13],[14],[15],[16],[17],[18],[19] A novel approach has been the employment of bite-sized learning, wherein small learning units are organized around predefined objectives and the learning process is facilitated by educational technologies (such as online modules or mobile apps).[10] This novel approach has been used in different streams of medicine with encouraging results and teachers can look forward to using it to make it useful for the students.[10],[11] Flipped classroom is another approach to promote student engagement, wherein the students come well prepared with the content of the session as the teacher has already instructed, the class mainly focuses on the discussion aspect, and all students actively learn together.[12]

One of the obvious ways to detect student engagement is through question asking or question answering or other ways, in which a student takes participation in the class. Teachers should always encourage these acts in the class, but it becomes a little difficult from the student's perspective to come forward, especially in large-group teaching sessions.[13] This challenge can be better dealt with using different social media applications in the teaching–learning process, and microblogs have been adopted as an educational tool to deal with it.[13],[14] In another medical college, podcasts have been employed to engage students in the teaching–learning process.[15] Simulation has also been used in medical teaching to promote student engagement as the learning simulates real-life situations, and students learn not only based on the experience which they had, but also by reflection.[16],[17] The participation of students in simulation-based activities aids them to acquire decision-making and leadership skills.[16],[17]

The role of feedback in envisaging student engagement also needs to be explored, as it significantly aids the student to understand their strengths, their weaknesses, and the areas, in which they have to focus more to ensure attainment of the learning competencies.[18],[19] Apart from these strategies, teachers can also employ other interactive teaching–learning methodologies, such as think-pair-share, 1-min write, the question of the day, demonstrations, role plays, and partial note handouts.[5] Further, teachers can also use memes, cartoons, visual props, or clips from movies, etc., to relate them to real-life events and indirectly enhance the opportunities for student engagement. Finally, it is also recommended to measure the extent of student engagement and a number of approaches have been tried to assess the same and thereby gain insights about active learning during the sessions.[20],[21]


  Practical Recommendations to Facilitate Student Engagement Top


Acknowledging the fact that the attention span for students is quite brief and that the students of today are having many other priorities, it is quite essential to plan for the appropriate teaching–learning methods.[1],[2] On a similar note, we have to respect that all medical students are adult learners, and they learn at their pace and at their time of convenience, if we really want to engage them in the sessions, the traditional approach of a teacher coming in class and reading from the presentation will not pay rich dividends.[1],[2] A teacher has to be quite involved in the class and should identify the point while students are not paying attention. At such a moment, the session can be stopped and students can be inquired about the aspects of the topic which they want to learn, and that as a teacher you will change your approach for their benefit.[2],[5]

As the students of today's generation are quite attracted to technology and employ them in different aspects of life, it becomes an indispensable need to incorporate technology (such as the use of gamification apps and the pear deck app) in the sessions to ensure the attention of more number of students.[5],[7] It is always good to give some options from which students can decide which one they wish to learn, as such a decision will automatically make them inclined to get involved in the session. The remaining aspects of the topic can be given to the students as assignments, as a part of self-directed learning, which in turn is also quite crucial to make them lifelong learners.[5],[8] Another strategy that can significantly aid in the process of student engagement is either presenting a learning task as a challenge to them or as a game, wherein they work either in pairs or small groups to resolve the challenge. Further, the students can be given some kind of responsibility (such as group leader or in charge of the activity) to keep them involved. These kinds of assignments also help in improving the group dynamics and instill teamwork/leadership skills among them.[5],[7]

The engagement of students can also be enhanced by means of including an interesting activity at the start of the session, which will eventually act as a triggering event for the students to focus on the topic. It is also recommended to limit the overall duration of lectures or at least introduce some kind of interruptions by the employment of interactive teaching methods (namely, brainstorming, think-pair-share, and questioning).[5],[7],[8] Further, the idea of presenting the knowledge in the form of diagrams, images, or videos can also prove to be quite effective, as such an approach will engage all types of learners in the class.[7],[8] Teachers can reiterate at the beginning of the class that they want all of them to participate actively in the session. During the session, it is a good strategy to call out students by their names, give adequate time for the students to respond to the raised questions, and applaud them for their responses.[2],[8] At the end of the session, it is always a good practice to summarize the work and again remind the students that you are looking forward to more active participation from their side in future teaching–learning sessions.


  Lessons From the Field Top


At Shri Sathya Sai Medical College and Research Institute, a constituent unit of the Sri Balaji Vidyapeeth, Deemed to be University, Puducherry, a number of curricular innovations have been planned and implemented to benefit the medical students. From the first professional year, students have been exposed to early community exposure, wherein they are trained about the basics of research, including quantitative research and participatory rural appraisal methods by the Department of Community Medicine. Across all their professional years, students have been trained using various interactive teaching–learning methods, such as problem-based learning, case-based learning, flipped classrooms, and standardized patients. Similarly, to appeal to all types of students, smooth integration of information technology, such as a learning management system or Google Classrooms for undergraduate students or an e-portfolio for postgraduate residents, has been implemented. All these activities are being carried out by the faculty members from different departments, who are trained by the Medical Education Unit of the Institution.


  Conclusion Top


Considering the complexities in medical education, ensuring student engagement during the teaching–learning session is of paramount importance. It becomes the responsibility of the teachers to employ various strategies and tools to engage students in the class, as it will help them to acquire knowledge and skills better and will eventually prepare them for their future competent medical practitioner.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
O'Malley PG, Khandekar JD, Phillips RA. Residency training in the modern era: The pipe dream of less time to learn more, care better, and be more professional. Arch Intern Med 2005;165:2561-2.  Back to cited text no. 1
    
2.
Lujan HL, DiCarlo SE. Too much teaching, not enough learning: What is the solution? Adv Physiol Educ 2006;30:17-22.  Back to cited text no. 2
    
3.
Stephenson CR, Bonnes SL, Sawatsky AP, Richards LW, Schleck CD, Mandrekar JN, et al. The relationship between learner engagement and teaching effectiveness: A novel assessment of student engagement in continuing medical education. BMC Med Educ 2020;20:403.  Back to cited text no. 3
    
4.
Michael J. Where's the evidence that active learning works? Adv Physiol Educ 2006;30:159-67.  Back to cited text no. 4
    
5.
Girling A, Pierce E. Pick 'n' mix teaching: A solution to learner engagement? Br J Nurs 2019;28:126-7.  Back to cited text no. 5
    
6.
Bernard JS. Student engagement: A principle-based concept analysis. Int J Nurs Educ Scholarsh 2015;12:111-21.  Back to cited text no. 6
    
7.
Boulton CA, Hughes E, Kent C, Smith JR, Williams HT. Student engagement and wellbeing over time at a higher education institution. PLoS One 2019;14:e0225770.  Back to cited text no. 7
    
8.
Peters H, Zdravkovic M, João Costa M, Celenza A, Ghias K, Klamen D, et al. Twelve tips for enhancing student engagement. Med Teach 2019;41:632-7.  Back to cited text no. 8
    
9.
Baños JH, Noah JP, Harada CN. Predictors of student engagement in learning communities. J Med Educ Curric Dev 2019;6:2382120519840330.  Back to cited text no. 9
    
10.
Manning KD, Spicer JO, Golub L, Akbashev M, Klein R. The micro revolution: Effect of Bite-Sized Teaching (BST) on learner engagement and learning in postgraduate medical education. BMC Med Educ 2021;21:69.  Back to cited text no. 10
    
11.
Schwartz AC, Cotes RO, Kim J, Ward MC, Manning KD. Bite-sized teaching: Engaging the modern learner in psychiatry. Acad Psychiatry 2019;43:315-8.  Back to cited text no. 11
    
12.
Puppe JM, Nelson DM. How to flip the classroom to improve learner engagement. J Nurses Prof Dev 2019;35:196-203.  Back to cited text no. 12
    
13.
Pickering JD, Swinnerton BJ. Exploring the dimensions of medical student engagement with technology-enhanced learning resources and assessing the impact on assessment outcomes. Anat Sci Educ 2019;12:117-28.  Back to cited text no. 13
    
14.
Saperstein AK, Ledford CJ, Servey J, Cafferty LA, McClintick SH, Bernstein E. Microblog use and student engagement in the large-classroom setting. Fam Med 2015;47:204-9.  Back to cited text no. 14
    
15.
Gipson M, Richards J. Student engagement through podcasting. Nurse Educ 2011;36:161-4.  Back to cited text no. 15
    
16.
Rubio R, del Moral I, Maestre JM. Enhancing learner engagement in simulation through scenario design. Acad Med 2014;89:1316-7.  Back to cited text no. 16
    
17.
Abdool PS, Nirula L, Bonato S, Rajji TK, Silver IL. Simulation in undergraduate psychiatry: Exploring the depth of learner engagement. Acad Psychiatry 2017;41:251-61.  Back to cited text no. 17
    
18.
Lewis KD, Patel A, Lopreiato JO. A focus on feedback: Improving learner engagement and faculty delivery of feedback in hospital medicine. Pediatr Clin North Am 2019;66:867-80.  Back to cited text no. 18
    
19.
McGinness HT, Caldwell PH, Gunasekera H, Scott KM. An educational intervention to increase student engagement in feedback. Med Teach 2020;42:1289-97.  Back to cited text no. 19
    
20.
Lee S, Valtis YK, Jun T, Wang D, Zhang B, Chung EH, et al. Measuring and improving student engagement in clinical training. Educ Prim Care 2018;29:22-6.  Back to cited text no. 20
    
21.
Alimoglu MK, Sarac DB, Alparslan D, Karakas AA, Altintas L. An observation tool for instructor and student behaviors to measure in-class learner engagement: A validation study. Med Educ Online 2014;19:24037.  Back to cited text no. 21
    


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