|Year : 2014 | Volume
| Issue : 3 | Page : 289-292
Self-directed learning readiness among fifth semester MBBS students in a teaching institution of South India
Sitanshu Sekhar Kar1, KC Premarajan2, Archana Ramalingam3, S Iswarya3, A Sujiv3, L Subitha4
1 Associate Professor of Preventive and Social Medicine, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Professor of Preventive and Social Medicine, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
3 Junior Resident, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
4 Assistant Professor, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
|Date of Web Publication||26-Feb-2015|
Sitanshu Sekhar Kar
Associate Professor of PSM, JIPMER, Puducherry
Source of Support: None, Conflict of Interest: None
Background: Lifelong learning is a skill that must be acquired by medical graduates and proposes that students take the responsibility for learning process. The present study was carried out to measure readiness for self-directed learning among fifth semester MBBS studentsin a tertiary care teaching hospital. Methods: Readiness assessment was carried out among 87 fifth semester MBBS students using Fishers' 40-item self-directed learning readiness score (SDLRS) instrument after taking informed written consent. A total of 40 items were classified into three domains: Self-management (9 items), desire for learning (16 items) and self-control (15 items). Institute scientific society and ethical committee clearance was obtained. The data were entered and analyzed using IBM-SPSS version 21. Chi-square test was used to elicit relationship between readiness assessment and gender, presence of a physician in family and area of residence. Results: Out of 87 students, 64 (73.5%) students consented to be assessed for readiness toward self-directed learning. The mean SDLRS score was 140.4 ± 24.4, with 19 students (30%) scoring more than 150 indicating high readiness.The mean scores in the three domains of self-management, desire for learning and self-control were 38.8 ± 9.8, 47.3 ± 6.9 and 54.3 ± 10.4, respectively. Males had a higher readiness for self-directed learning than females (P = 0.045). Discussion: Self-directed learning scores were lower among our MBBS students than reported elsewhere in the literature.
Keywords: Medical students, readiness assessment, self-directed learning, SDLRS
|How to cite this article:|
Kar SS, Premarajan K C, Ramalingam A, Iswarya S, Sujiv A, Subitha L. Self-directed learning readiness among fifth semester MBBS students in a teaching institution of South India. Educ Health 2014;27:289-92
|How to cite this URL:|
Kar SS, Premarajan K C, Ramalingam A, Iswarya S, Sujiv A, Subitha L. Self-directed learning readiness among fifth semester MBBS students in a teaching institution of South India. Educ Health [serial online] 2014 [cited 2020 Jul 6];27:289-92. Available from: http://www.educationforhealth.net/text.asp?2014/27/3/289/152193
| Background|| |
Medical students are expected to possess self-directed learning (SDL) skills to pursue lifelong learning. SDL is widely used in the education of medical and other healthcare professional students. The undergraduate medical education programme in India is designed to create a graduate who possess the requisite knowledge, skills, attitudes, values and responsiveness to patients, so that he or she provides appropriate and effective first contact care for a community. The Medical Council of India, which sets uniform standards for higher qualifications in medicine, stipulates that Indian medical graduates should be lifelong learners committed to continuously improving their skills and knowledge. 
SDL is defined as the process of an individual deciding what they need to learn and to what depth and breadth.  Readiness for SDL is the degree to which an individual possesses attitudes and abilities necessary for SDL.  It also refers to a broader process that includes the ability for autonomy and self-actualization. In summmary, in SDL the learner controls the process of learning.  Understanding students' SDL stage allows teachers to take appropriate action to help students and the school achieve the educational objectives. 
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) is among the top three medical colleges in India. In the past few years, its admission of MBBS students has been increased in a phased manner from 75 to 150 for the 2012-13 academic year. In line with the vision of JIPMER to foster innovations in education to create lifelong learners and encourage creative young minds to reach their fullest potential, an educational innovation programme on student centered learning was piloted in 2012 for fifth semester students in the Department of Community Medicine.
SDL readiness among medical students has not been studied in the southern part of India.  Studies have been carried out among students in developed nations, but they differ in many respects from our student population. Our students are generally younger (18-19 years) than Western students, less independent, more dependent on family and teachers, less trained for SDL during their school years and more accustomed to a rote learning style. Hence, the present study reports the findings of readiness for SDL among fifth semester medical students and also notes the differences in readiness for SDL according to students' demographic and background characteristics.
| Methods|| |
The MBBS course at the JIPMER spans four and a half years and is divided into pre-clinical (anatomy, biochemistry, physiology), para-clinical (pathology, microbiology, pharmacology, forensic medicine) and clinical phases (medicine, surgery, obsttetricts, etc.) followed by a one year compulsory rotating internship. Community medicine is taught in the second through seventh semesters.
An education innovation project evaluation was carried out among all 87 MBBS students in the fifth semester in the 2012-13 academic year during the non-communicable disease epidemiology portion of the community medicine subject.We report here baseline findings of a readiness assessment of students using Fishers' 40-item self-directed learning readiness score (SDLRS) instrument.  The SDLRS has 40 items grouped under three domains: Self-management (9 items), desire for learning (16 items) and self-control (15 items). In each item, students indicate on a 5-point Likert scale how often the item describes their characteristics ("1" = Almost never true of me; I hardly ever feel this way, 2 = Not often true of me; I feel this way less than half the time, 3 = Sometimes true of me; I feel this way about half the time, 4 = Usually true of me; I feel this way more than half the time and "5" = Almost always true of me; there are very few times when I don't feel this way).
The SDL readiness scale was developed and piloted among nursing students in University of Sydney in 2001 to help nurse educators diagnose students' learning needsfor modifying teaching strategies best suited to the students.  This tool has been used in exploring first-year undergraduate medical students' SDL readiness to physiology in Manipal India. 
For the present study, students were assembled in a lecture hall and the researchers distributed the SDLRS instrument along with a questionnaire addressing socio-demographic variables. Variables included gender, presence of a physician in family, area of residence of parents (town or village), board of pre-university schooling and language of instruction at school and current place of stay.
The readiness for SDL was categorized as high (>150 scores) and low (≤150). Domain wise scores (self-management, desire for learning and self-control) were also analysed. Association between readiness assessment and gender, presence of a physician in family and area of residence were assesed. Institute ethics committee approved the study.
| Results|| |
Out of the 87 students approached to participate, 64 (74%) returned completed forms. Nearly all (97%) were from urban backgrounds and most (72%) were currently living in hostels. About half (48%) had attained state board during their pre-university schooling, and most (92%) had English as the medium of instruction in shool. The demographic details of the students are given in [Table 1].
The mean total SDLRS score was 140.4 ± 24.4. Males had a higher mean total score (148.7 ± 22.3) than females (135.10 ± 24.4; P = 0.029). The mean scores of hostelites 140.5 ± 26.5) and day scholars (140.2 ± 18.7) were similar (P = 0.95). The mean SDLRS scores was similar in students with or without a physician in the family [Table 2].
|Table 2: Self-directed learning readiness scores of the study participants|
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About 30% of the students scored high readiness for SDL (>150 score). More males had higher readiness scores than females (44% vs. 21%, P = 0.04). Demonstrating high readiness for SDL was not associated with having a physician in the family, type of preuniversity school attended, medium of instruction in school and current place of residence.
The mean scores in the three domains of self-management, desire for learning and self-control were 38.8 ± 9.8, 47.3 ± 6.9 and 54.3 ± 10.4, respectively. Males scored higher in all three domains than females [Table 3]. The hostellers scored higher in self-management, while the dayscholars scored higher in the domain of desire for self-learning. There was no significant difference in the domain-specific scores by presence of a doctor in the family, type of school and medium instruction in the school.
|Table 3: Domain specificscores of the students in the self-directed learning readiness scoreassessment|
Click here to view
| Discussion|| |
The SDLRS scale helps medical educators assess students' learning needs to be able to implement teaching strategies best suited to the students. Use of the readiness assessment may be able to provide valuable data for curriculum development. 
The mean SDLRS score was found to be 140.4 and high readiness for SDL was found among 30% students. Mean SDLRS scores among 118 first year MBBS students in Melaka Manipal Medical College (MMMC), Manipal, India were found to be 151.4, and 60.2% of the students were in the high readiness category.  High mean score and readiness were attributed to the curriculum of MMMC, Manipal as it encompasses problem-based learning and similar SDL activities from basic sciences. Another study conducted in Lalitpur, Nepal  also reported higher mean readiness and individual domain scores among first MBBS students than found for the fifth semester students of our school (152.7 ± 14.6). A likely reason for high scores in this Nepalese school is its implementation of problem based and enquiry driven curriculum in the medical stream.
In our study high readiness was reported more often among boys than girls. Presence of a doctor in family, board of education and medium of school instruction and current place of residence did not affect high readiness. We did not find any prior studies with findings of low readiness to learn scores similar to our own. In India and South Asia, rote learning and reproduction of factual information predominates within schools. The entrance examination for the MBBS course similarlyconcentrates on factual information. Our assessment indicates that before replacing the traditional teacher centric educational approach with student-centered learning, students will require proper orientation and sensitization.
We did not find any association with other demographic variables like presence of doctor in family, current habitation of the students (hostelite vs day scholar) and area of residence (urban vs rural) with readiness of our students for SDL. This differs from previous studies that have shown that readiness for SDL increases with age, maturity and as student's progress across a course. ,,,
Based on different stages of SDL, a teacher can assume different roles. Dependent learners (state 1) need an authority-figure to give them explicit directions on what to do, how to do it and when. For these students, learning is teacher-centered. Students capable of moderate self-direction (state 2) are "available". They are interested or interestable. They respond to motivational techniques. Students at the intermediate self-direction (state 3) have skills and knowledge, and they see themselves as participants in their own education. Students capable of high self-direction (state 4) set their own goals and standards with or without help from experts. 
Since 2008, JIPMER was declared as an autonomous institute by an act of Indian Parliament. This provides an opportunity to modify our curriculum and create medical education innovation programmes, such as problem-based learning. Information about the readiness of our students for SDL will be crucial at our institute.
Limitations of the study
The small sample size could have obscured some important groups differences. Also, the appropriateness and understandability of each item of the Fisher's SDLRS instrument has not been validated among Indian MBBS students.
| Conclusion|| |
SDL scores were lower among our MBBS students than reported elsewhere in the literature. This study points out the need to address our students' SDL skills, and need for ways to build SDL skills in our students.
| Acknowledgement|| |
The authors would like to acknowledge the students of fifth semester for participating in the study. We would like to acknowledge the help of faculty and fellows of PSG-FAIMER Regional Institute (PSG-FRI) particularly Dr Thomas Chaco, Dr Ravi Shankar, Dr Amol Dongre, Dr Sheetal Bhandary, Dr YS Shivan for their valuable comments and suggestions in reviewing the manuscript.
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Fisher M, King J, Tague G. Development of a self-directed learning readiness scale for nursing education. Nurse Educ Today 2001;21:516-25.
Shankar R, Bajracharya O, Jha N, Gurung SB, Ansari SR, Thapa HS. Change in medical students′ readiness for self-directed learning after a partially problem-based learning first year curriculum at the KIST Medical College In Lalitpur, Nepal. Educ Health (Abingdon) 2011;24:552.
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[Table 1], [Table 2], [Table 3]
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