How do they cope?: the transition to an undergraduate, case-based learning medical program at the University of Adelaide.

Abstract

The transition to university has been described as a “battle” for students as their ways of learning are challenged and threatened. Most students transitioning into Medicine at the University of Adelaide encounter the Case-based Learning (CBL) approach, used across the whole curriculum, for the first time. The transition experiences of students across various university programs have been investigated but not for students entering medical programs. A Transition Pedagogy model which integrates co-curricular and curricular components provides a framework for investigating the complexities of the environment experienced by transitioning students. The framework designates key strategies in four dedicated areas that extend across six curriculum principles. The purpose of this study was to investigate strategies used in these four areas by transitioning students, academics and administrative staff in the specific context of a CBL medical program. A mixed-methods research design was used. Students, academics and administrative staff completed questionnaires and participated in Focus Groups. Students completed the “First Year Experience Questionnaire” (FYEQ) for comparison with a general cohort of first year university students studying at nine Australian universities. Students’ distress levels were measured two weeks before examinations in Semesters One and Two. Students and tutors completed questionnaires to investigate the alignment of their perceptions about the Case-based Learning approach. Tutors completed the “Approaches to Teaching Inventory” to investigate the relationship between a student’s perceptions of the CBL approach and their tutor’s approach to teaching. Focus Groups explored questionnaire findings to generate a deeper understanding of the strategies employed by students, academics and administrative staff involved in the transition process. Although medical students scored significantly higher than the general cohort of first year university students in four domains of the FYEQ, namely sense of purpose, student identity, course satisfaction and being prepared and present, they scored significantly lower on the domain comprehending and coping. However, these results did not apply to international medical students. This provided an unanticipated avenue of investigation which established that international students were receiving more effective orientation and scaffolding for transition than domestic students in the four areas of the Transition Pedagogy model. Evidence highlighted the need for professional development for CBL tutors to include mentoring for new tutors, peer review of teaching and the principles and practice of appropriate orientation and scaffolding for transitioning students. The Transition Pedagogy model provided an effective framework for investigating the first year experience for medical students, and the comparison between the learning experiences of international and domestic students demonstrates how a first year curriculum could be implemented in a way that improves the transition experience. To achieve a third generation approach that embraces co-curricular and curricular components, a transition pedagogy for medical students should be organised in a systematic manner that begins with policy changes at the level of governance and involves changes in practices of preparing students for the process of Case-based Learning, through extended orientation and the provision of scaffolding to develop the skills essential for self-directed learning.