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Year : 2019  |  Volume : 8  |  Issue : 2  |  Page : 69-74

Students' perceptions of problem-based learning tutors, topics, and examinations and their hindrance or promotion of deep and surface learning: A mixed-methods study

1 Department of Health Professions Education, College of Medicine, Sulaiman Al Rajhi Colleges, Al Bukayriyah, Saudi Arabia
2 Faculty of Health Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, Netherlands
3 Department of Medical Education, College of Medicine, Qassim University, Buraydah, Saudi Arabia

Date of Web Publication13-Sep-2019

Correspondence Address:
Dr. Ahmad Saleh Alamro
Department of Medical Education, College of Medicine, Qassim University, P.O. Box 6655, Buraydah 51452
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjhs.sjhs_106_19

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Background: In problem-based learning (PBL) curricula implemented around the world, it is assumed that students adopt a deep learning approach to studying and aim to gain a profound understanding of the subjects being studied. However, it is not clear which PBL components initiate or deter deep learning and to what extent this happens and why. Aim: This study explored to which extent students used a deep or surface learning approach in PBL and whether this differs across years. We also investigated which PBL components students perceived to be hindrances to deep or surface learning. Methods: The study took place at Sulaiman Al Rajhi Medical College, Qassim, Kingdom of Saudi Arabia. A mixed-methods approach was applied. A validated questionnaire and semi-structured focus group interviews were conducted sequentially. Results: First-, second-, and third-year students reported, in scale 1–5, for deep learning scores, respectively, with mean (M) = 3.55, M = 3.41, and M = 3.55. First-, second-, and third-year students reported, in scale 1–5, for surface learning scores, respectively, with M = 2.88, M = 2.78, and M = 2.89. The differences for both deep and surface learning across the years were statistically nonsignificant. According to students, they study deeply on main learning objectives and superficially on minor objectives as indicated by tutors, they are stimulated toward deep learning through interesting topics during self-study, and examinations drive them toward deep or surface learning depending on the question format and necessity to pass. Conclusions: The results of this study confirm that students' perceptions of PBL components affect their approaches to deep and surface learning. These effects are not entirely negative or positive. Students seem to frequently employ a deep learning approach in PBL throughout the 3 years. These conclusions will allow program administrators/educationalists to constructively design curricula around the perceptions of learners of PBL tutors, topics, and examinations.

Keywords: Assessment, deep learning, problem-based learning, surface learning, tutor

How to cite this article:
Bsiso MM, Dolmans DH, Alamro AS. Students' perceptions of problem-based learning tutors, topics, and examinations and their hindrance or promotion of deep and surface learning: A mixed-methods study. Saudi J Health Sci 2019;8:69-74

How to cite this URL:
Bsiso MM, Dolmans DH, Alamro AS. Students' perceptions of problem-based learning tutors, topics, and examinations and their hindrance or promotion of deep and surface learning: A mixed-methods study. Saudi J Health Sci [serial online] 2019 [cited 2023 Jun 9];8:69-74. Available from: https://www.saudijhealthsci.org/text.asp?2019/8/2/69/264679

  Introduction Top

In problem-based learning (PBL) curricula implemented around the world, it is assumed that students adopt a deep learning approach to studying and aim to gain a profound understanding of the subjects being studied.

Medical educationalists in recent decades divided learning approaches into two distinct categories: one being a deep approach and the other being a surface approach.[1] A deep approach is a path that relates ideas, uses evidence, and seeks meaning to understand a topic. A surface approach is limited to memorization and syllabus-driven learning usually motivated by the fear of failure. These approaches may be a product of the educational environment rather than exclusively due to individual student characteristics.[2] Students memorizing terms and concepts in order to pass an examination rather than studying materials to deeply understand the underlying principles of a topic and how it relates to their prior knowledge is a reflection of that. The preparation of the students for the examination in this case entails a surface learning approach.

In PBL, curriculum components are constructively aligned in order to facilitate students to adopt a deep learning approach.[3] This happens through constructive alignment (CA) of teaching and learning activities. Students construct meaning by doing learning activities in a learning environment appropriate to achieving the desired learning outcomes.[4] It begins by stimulating student learning through problems while tutors facilitate the discussion by promoting group work and student interactions. Students are facilitated by a tutor to develop learning outcomes related to a problem during a group discussion instead of receiving an informative lecture. This motivates students to study the topics in more depth while reading the literature and presenting the knowledge they acquired. To be achieved successfully, key curriculum components such as teaching methods, assessment tasks, learning activities, and outcomes must be closely related.[5] Aligning educational activities and assessment tasks around intended learning outcomes helps fill potential learning gaps faced by students during self-study.[6]

The past two decades of research has also suggested that certain components in CA within PBL curricula along with students' perceptions of them may influence deep or surface learning. Research also indicates that learning approaches seem to shift away from deep learning and more toward surface learning over progression of the period of study.[7],[8] Interestingly, however, student-generated learning issues stemming from a problem are not the only factors influencing students' learning approach; rather, examinations, course objectives, lectures, tutor guidance, and reference literature may also be influential factors on students' self-study.[9],[10] It is also known that learners' perceptions of components such as study load, tutors or mentors, and assessment schemes may direct them toward a deep or surface learning approach.[11],[12] In a review by Dolmans et al.,[13] summarizing 21 studies revolving around PBL and students' approaches to learning, it was concluded that PBL does not seem to have a major impact on surface learning while it enhances deep learning, with contextual differences seemingly playing an influential role.

On the other hand, it is not fully known which components drive or hinder each of the learning approaches and to what extent this happens and why. More information is also needed as to whether deep learning fades over time within a PBL system because there is still not enough conclusive data in this regard. This study aims to shed more light on these issues. It was necessary to identify which PBL curriculum elements promote or hinder deep or surface learning approach from the students' perspective. Dinsmore and Alexander[1] also highlighted the importance of including (a) a clear definition of deep learning with a conceptual framework and the use of validated scales and (b) exploration of deep learning within a specified learning context that takes into account the impact of the environment on deep learning. To fulfill this, it was crucial to build upon the work of Biggs et al.[14] by using a revised version of the Revised Two-Factor Study Process Questionnaire (R-SPQ-2FQ) which is an instrument used to evaluate the learning approaches of students.

Understanding these realities will allow for the identification and remediation of inhibitors to deep learning in PBL curricula and may help program directors better align educational methods and designs toward deep learning as perceived by learners. This will in turn allow for enhanced application of knowledge by learners in clinical and related settings.

This study aimed to explore the following: (1) to what extent do students use deep and surface learning approaches for studying in PBL? And how does this differ across years 1, 2, and 3? (2) and what PBL curriculum elements promote or hinder deep or surface learning approach from the students' perceptions?

  Methods Top

This study took place in the Medical College of Sulaiman Al Rajhi Colleges (Saudi Arabia) (SRC). SRC has adopted the PBL curriculum from Maastricht University (The Netherlands). The Bachelor program (MBBS) is divided into the basic sciences (years 1–3) which is the focus of this study and the clinical sciences (years 4 and 5). The curriculum is designed for self-directed learning and shaped around problems/cases that are discussed during tutorials within a framework of blocks and clusters. Students need to develop learning outcomes and then conduct self-study and report back to the tutorial group. Each year includes longitudinal courses that are integrated and run parallel to the overall program. All students were male because the female program was newly opened and is separate from male students.

Thirty-six first-year, 55 second-year, and 41 third-year medical students were requested to complete the PBL-R-SPQ (159 total). The total number of students responding to the questionnaire was 54 from the first year, with a response rate of 86%; 42 from the second year, with a response rate of 76%; and 24 from the third year, with a response rate of 59%. The total number of students participating was 120, with an overall response rate of 75%. The average age of the students was 19 years, and all were male with no female participants.

Twelve students were randomly chosen and were requested to take part in focus group interviews. Two focus group interviews were conducted with six students in each group. Per focus group, two first-year students, two second-year students, and two third-year students participated in the interviews. This was done in order to obtain the most balanced and beneficial range of participants and to allow us to analyze the trends and variations in deep learning approaches between the different years.

This mixed-methods study aims to provide quantitative (1st research question) and qualitative (2nd research question) data for the research questions poised above. The R-SPQ-2FQ and the semi-structured focus group interviews were conducted sequentially. The questionnaire was sent out to all first-, second-, and third-year students. Responses were optional, with respondents receiving community service hours for participation.

We made use of a slightly altered earlier validated tool of previous studies within the local context of the medical college, which in our case was the R-SPQ-2FQ[14] [Table 1]. This questionnaire contained 17 scale items and two open-comment items. The Deep Learning Scale contains 8 items, and the Surface Learning Scale contains 9 items. The participants rated each item on a scale from 1 to 5, ranging from 1 = never, 2 = sometimes, 3 = half of the time, 4 = frequently, and 5 = always. Cronbach's alpha reliability coefficient for all deep scale items across the 3 years is 0.66 and for the surface scale across the 3 years is 0.82, as shown in [Table 1]. This meets the levels for acceptability commonly used in the social sciences, for example, 0.70.[15]
Table 1: Summary of mean and standard deviation for deep and learning approach items for all students (n=120)

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For the interviews, we developed a semi-structured interview guide sheet based on the six PBL curriculum components in order to help along the interview process and probe for desired information. The interview questions dealt with the influence of group discussions in the tutorial sessions, assessment, course objectives, lectures, the tutor's role, and reference literature on deep and surface learning.[10] All participants were required to fill and sign the consent form before partaking in the interview.

The analysis of the questionnaire data was carried out with IBM SPSS Statistics for Windows, Version 24.0. (Armonk, NY, USA, IBM Corp.). The mean scores for deep and surface learning were calculated per year; analysis of variance (ANOVA) was used to compare the average scores for each factor within the various curriculum years [Table 1] and [Table 2]. A one-way ANOVA was conducted to compare the differences of deep learning across the years. The same was done to compare the differences of surface learning across the years.
Table 2: Summary of mean, standard deviation, and Cronbach's alpha for surface and deep learning across all years

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The interviews were audio-recorded and transcribed innately. The author listened to the audio recordings and for each interview, specific codes were assigned. These codes were then clustered into overarching themes. These themes were repeatedly verified and revised using a cyclic analytical process, shifting back and forth between the two focus group interviews, resembling the open coding and axial coding stages of grounded theory.[16] We chose this approach because it gives efficient inductive guidelines for collecting and analyzing the data. In order to increase the credibility and transferability of our data, we conducted member checking where the students who participated in the interviews were asked to give feedback about the accuracy of the thematic report.

Ethical approval was obtained from the Research Committee at SRC and was approved by the Vice Dean for Academic Affairs prior to the data collection process as required by SRC policy.

  Results Top

To observe students' extent of deep and surface learning across years, we compared the deep and surface learning scores of the students of all the 3 years, as shown in [Table 1]. For deep approach scores, first-year students reported mean (M) = 3.55 and standard deviation (SD) =0.54. Second-year students reported M = 3.41 and SD = 0.55. Finally, third-year students reported M = 3.55 and SD = 0.37. The differences for deep learning across the years were statistically nonsignificant (F (2, 117) =1.01, P = 0.37). For surface approach scores, first-year students reported M = 2.88 and SD = 0.71. Second-year students reported M = 2.78 and SD = 0.76. Finally, third-year students reported M = 2.89 and SD = 0.57. The differences for surface learning across the years were statistically nonsignificant (F [2, 117) = 0.28, P = 0.75).

Below are students' perceptions of the PBL components that promote or hinder deep or surface learning approaches, with tutors, topics, and examinations identified as the main themes.

Students study deeply on main objectives as indicated by tutors

Analysis of the qualitative data suggested that the majority of students perceived tutors as playing an important role in influencing students' study approach to topics. Most students studied topics deeply when the tutor indicated the importance of doing so by referring to the learning objectives they should focus on: “If tutors say study this topic deeply, I do it,” and “Sometimes the tutor says something very important that forces you to dive more deeply into that topic.” Some students studied topics in a surface way when the tutor mentioned a specific objective as being minor: “Tutor is the main driving force for how I learn.”

Students are stimulated toward deep learning through interesting topics during self-study

The majority of students reported that they usually dive deeper into topics they are interested in during self-study. This is sparked by their interest about the specific topic and their desire to understand why things happen: “I cannot move on until I fully understand the topic,” and “The topic itself makes you ask, why does this happen.”

Examinations drive students toward deep and surface learning

The majority of students indicated that examinations drive their learning approach and prioritize those topics that will be tested: “When we have lots of tests, we focus on that rather than study other topics deeply.” Most first- and second-year students study basic science topics deeply that will come in the examination and clinical topics that will not come in the examination in a surface way: “I study the topic deeply when I know it is coming in the exam.”

On the other hand, most third-year students prepare for physical examinations by studying the related topics deeply: “Before hospital visits and physical examinations, I must study the cases deeply to prepare.” The experiences of students usually shape their learning approaches where they tend to study deeply for certain types of examinations such as long-form questions (multiple essay questions [MEQs]) and usually superficially for multiple-choice questions (MCQs): “Surface learning is always associated with MCQs, with MEQs we have to go deeper.” Surface learning is mostly utilized for examinations such as international progress tests where MCQs make up the format of the examination and memorization and educated guessing may be sufficient to pass due to time constraints: “In order to progress in the progress tests, you must study the topics superficially because I don't have time.”

  Discussion Top

The first aim of this study was to explore to which extent students used a deep or surface learning approach in PBL and whether this differs across years. We applied the recommendations of Dinsmore and Alexander[1] which highlighted the importance of future research on deep learning to be based on a clear conceptual framework using validated scales and to be conducted within a specified learning context that takes into account the cultural/environmental circumstances impacting deep learning. To do this, a valid and reliable instrument (the R-SPQ-2F) was used to collect data within SRC's unique learning context.[6],[17]

On the one hand, students seemed to employ a deep learning approach to their study about half of the time/frequently (3.5) although not almost always. On the other hand, they employed a surface approach to their study about half of the time (2.9). This is in accordance with the study of Dolmans et al.[17] which showed that students in a PBL curriculum tend to take a deep learning approach to study rather than a superficial one. In addition, these results demonstrated that there were no significant differences in the study approach between consecutive years, which is not in line with research by Groves[12] who indicated that deep learning fades over time. Overall, the data from all the 3 years demonstrate the continuity of students taking a frequent deep approach to learning.

The second aim of our study was to investigate which PBL components students perceived to be hindrances to deep or surface learning and why. Data from the questionnaire showed that tutor and student interest about topics were the main drivers of deep learning, whereas examinations and tutors were the main drivers of surface learning. This indicated that students used both approaches of learning in their self-study and examination preparation depending on circumstances within the curriculum, which is in line with the findings of Dinsmore and Alexander.[1] The data from our focus group interviews shed light on those circumstances by giving valuable qualitative insight about how perceptions of PBL components promote and hinder deep and surface learning, which was a recommendation for future research on this subject by Dolmans et al.[13] Students felt that certain PBL curriculum elements such as tutor's emphasis on learning objectives and interesting topics motivated them to take a deep approach during self-study, whereas other elements such as MCQ examinations and tutor's nonemphasis on minor learning objectives drove them toward a surface approach, which is in line with earlier studies.[3],[13],[18],[19]

Students' perceptions on the crucial role of tutors may be explained by the role that faculty members play in developing examinations or from tutors' experience of previous examinations. Students at SRC seem to be very highly grade oriented because examinations have a direct impact on their grade point averages (GPAs). Many students at SRC have scholarships that must be maintained with a minimum GPA, thus forcing students to allocate substantial attention to passing examinations, even if it means taking superficial paths to learning. Tutors are seen as the gatekeepers of that process, hence explaining their substantial influence on students' learning approach. At the same time, students at SRC seem to possess an inherent yearning for gaining valuable knowledge that may be interesting and useful for future career endeavors. They tend to value the idea that this knowledge will someday be applied in their clinical practice later on in future. Topics that are designed to stimulate and facilitate these perceptions may explain why deep learning takes place in this part of the curriculum.

This research has a few limitations. The first one is that participants in the study only gave self-report data and actual behaviors were neither observed nor compared with student achievement within the curriculum. Therefore, students' perceptions of their own behaviors and thoughts may vary in both theory and practice, especially because students at SRC come from diverse cultural and academic backgrounds. Second, all participants were male students because SRC is a male medical college which only recently started a female section of the program. This may have influenced the results of the study because research shows that male and female students learn differently.[20] Third, the lower response rate of third-year students to the questionnaire (59%) may also have impacted the reliability of results negatively although overall the response rate was above 75%.

For future research, there is a need for more long-term studies on deep and surface learning approaches of students and how these change from the basic sciences phase to the clinical sciences phase of the PBL curriculum. This will give us a longitudinal overview of the perceptions of students as the curriculum circumstances change. Furthermore, more qualitative studies applying semi-structured interviews are needed in other international PBL contexts to confirm our findings and to give us more understanding as to why and how PBL does or does not enhance deep and surface learning. It will also help in standardizing qualitative tools for future research.

  Conclusions Top

This study has several practical implications. These data are important because few qualitative studies have been conducted in this field. The insights given on the perceptions of learners on the obstacles and motivators for deep and surface learning in PBL will allow program directors, trainers, faculty members, and others to design and constructively align PBL components such as examinations and learning/teaching activities based on how students perceive them, as recommended by Baeten et al.[3] This will allow for deep learning to be enhanced when it is appropriate and for surface learning to be enhanced when it is appropriate, which will, in turn, better prepare students in applying their obtained knowledge in future professional settings.

We recommend that program directors upgrade tutor training programs to take into account the impacts of tutor guidance on students' perceptions and learning approaches. Tutors should be trained to be cautious when emphasizing or de-emphasizing the importance of learning objectives. Guidance should be done with the purpose of motivating deep learning of the program's desired learning objectives rather than for the purpose of preparing students for examinations. In addition, examinations should be upgraded to include MEQs in order to drive deep learning. Constructively aligning them with the intended learning outcomes of the program will also help drive deep learning as recommended by Biggs.[4] Finally, topics should be designed to stimulate the interest of students and should be practically relevant to the future professions which learners will enter.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2]

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