Learning contexts at two UK medical schools: a comparative study using mixed methods.

Introduction: The context in which learning takes place exerts a powerful effect on the approach learners take to their work. In some instances learners will be forced by the nature of a task to adopt a less-favoured approach.In this study, we used a combination of qualitative and quantitative methods to compare the effect of context on learning at different UK medical schools. We compared schools with conventional, and problem-based curricula.

Method: We had collected data from 30 interviews with third year medical students in one UK medical school with a conventional, lecture-based curriculum in relation to a previous study. The interview guide had explored effects of context and approach to learning. We used the same guide to interview 6 students in another UK medical school with a problem-based curriculum.We then put together a pack of validated questionnaires, which measured the phenomena that had emerged in the interviews. In particular we selected questionnaires which measured the criteria on which students from the different schools appeared to demonstrate greatest variance.

Results: There were two areas where students from schools with differing curricula differed - basic learning activity and assessment. Students at the lecture-based school attended lectures where they received information while students at the Problem-based school attended tutorials where they stimulated prior knowledge and identified new learning objectives. Progress -testing at the problem-based school helped students gain a sense of accumulating a body of knowledge needed for their life in medicine while students' at the lecture-based school directed their learning towards passing the next set of exams.The findings from quantitative, questionnaire data correlated with the interview findings. They showed that students at a school with a PBL curriculum scored significantly higher for reflection in learning, self-efficacy in self-directed learning and for deep approach to learning.

Conclusion: We set out to determine whether students at different medical schools approach their learning differently. We have succeeded in demonstrating that this is the case.The differences that we detected in learning context and approaches to learning in medical students at the two schools predict that learning at the non PBL school is likely to be via a surface approach and not integrated. These differences have major implications for the outcomes of medical student learning at the two schools in terms of accessibility and sustainability of learning.