European Journal of Cardiovascular Medicine

The introduction of Competency-Based Medical Education (CBME)  by the National Medical Commission (NMC) has significantly transformed the landscape of medical education in India. There is now a greater focus on teaching–learning strategies that centre around the student. While various definitions exist, the core idea of Self-Directed Learning (SDL) lies in its components: self—indicating the learner takes initiative; directed—implying structured guidance and monitoring; and learning—highlighting its relevance to lifelong education.

To foster the development of SDL and reflective abilities, several methods are currently in use, such as problem-based learning, small group discussions, self and peer assessments, use of self-learning materials, independent library work, project-based learning, and computer-assisted instruction. This shift marks a transition from traditional pedagogy to adult learning principles (andragogy), emphasizing learner autonomy within the evolving SDL model in medical education. ,

SDL introduces diversity in teaching methodologies and allows curriculum planners to align specific learning outcomes with this approach. However, the way SDL is implemented varies across institutions. ,

This particular study aimed to conduct SDL sessions for first-year undergraduate medical students in biochemistry and evaluate their effectiveness based on feedback from both students and faculty. One engaging technique used was role-playing, where students assume various roles or act out specific scenarios—either individually, in pairs, or groups. This approach helps in increasing student involvement, enriching instructional methods, and simulating real-life situations. Role-playing also aids in developing essential skills such as negotiation, collaboration, debate, persuasion, and teamwork, which are crucial in real-world professional settings.

Aims and Objectives:

Aim:

To study the effectiveness of implementation of SDL through role play on Oral Glucose Tolerance Test

Objectives:

• To study the effectiveness of SDL implementation in the Biochemistry department
• To obtain student perception on use of Self-directed learning
• To obtain faculty perception about self-directed learning as a part of CBME curriculum

The study was conducted after obtaining approval from the institutional ethics committee. The study was carried out among medical undergraduates of Phase 1 MBBS, 2023 batch and faculty of the Biochemistry Department at Government medical college, Anantapuramu, Andhra Pradesh.  150 undergraduate medical students were admitted per each academic year by the college. The session was conducted between 2 to 4 pm in a lecture gallery. Out of 150, 138 students attended the session.

Teaching learning methodology; One hour lecture on the topic by the faculty and Role play by students. One hour lecture on OGTT was given one week prior to the actual session. Learning objectives were framed at the end of the lecture. Enacting role play by students created enthusiasm,, preparing charts, Observing the rehearsal probed many other students to study. Students were voluntarily asked to give their names to act as Doctor, Patient, Patient attendant, Lab technician. Role play was planned in a two-hour setting one week after the theory class.  The Role play was executed by the students in three settings. A) Doctor - Patient conversation, b) Patient, Patient attendant, Lab technician’s conversation, c) Presentation of OGTT charts in the Biochemistry department for the samples received on that day.

SDL was implemented in the following way  

1. Learning Objectives: At the end of the session Phase 1 MBBS students should be able to i)explain indications, contraindications in performing OGTT ii) Know the normal values &explain the ADA criteria of DM. iii)Discuss the importance of Glycated Hemoglobin. Explain how to prepare the patient for OGTT test. iv) Draw both normal & abnormal OGTT curves on graph paper
2. Learning Resources: Vasudevan textbook of Biochemistry 10 e, My loft app for library access, Information available in net, OGTT charts available in net.
3. Learning Strategies: Self-study to perform pre & post test
4. Adopting & Executing Learning Activities: Role play, charts
5. Monitor & Evaluate performance: Pretest, Post test, Feedback forms

Assessment: Structured VSAQ’s on different subheadings of OGTT were framed. Both Pre and Post test was conducted on the same day before and after the session. At the end of the session feedback was taken from both students and faculty using google forms.

Statistical analysis:

Mean± SD was calculated for the marks obtained in both pre- and Post- test in Microsoft Excel software and student t- test was applied for statistical significance. (p value < 0.001 was considered significant).

Activity at home after the session was given to write in their logbook about the content of OGTT and the process students underwent to do this SDL session along with Reflection (What happened? So what? What next?).

The responses for the feedback form for all the questionnaire on the Likert scale were tabulated and the satisfaction index (SI) for each item was calculated using the following formula

                                         [(n1, ×,1) +(n2, ×,1) +(n4, ×,1) +(n5, ×,1)] ×20

                                                        (n1+n2+n4+n5)

where n is the total number of students obtaining the score depicted in the subscript for that item To understand students' perceptions of the activity, a satisfaction index was used to explore their level of satisfaction with each individual item.".^[i]

Qualitative analysis: To record the perceptions of the students and faculty, open-ended questions on self-directed learning were asked using Google Forms. The students were asked about the usefulness of self-directed learning (insights), ways to improve it and factors facilitating and hindering the sessions and the faculty were asked about advantages and disadvantages of self-directed learning

Out of 150 students, 138 enrolled and actively participated in the self-directed learning activity, and feedback was successfully collected from all 138 participants. The Mean ± SD of Pretest was 11.6 ± 2.3 and mean ± SD of Post test was 16.3 ± 1.85. The p value is <0.001 which is significant (as shown in table no 1).

Table No1: Mean and SD values of pre and post-test marks obtained by students

Table no 2: Student feedback student responses to feedback questionnaire and satisfaction index.

Scores were determined as follows: 1-Strongly disagree, 2-Disagree, 3-Neutral, 4-Agree, and 5-Strongly agree

Table no 3: Faculty responses to the feedback questionnaire: scores and satisfaction index

      Scores were determined as follows: 1-strongly disagree, 2-disagree, 3-neutral, 4-agree, and 5-strongly agree

First-year MBBS students often require guidance and support to develop into self-directed learners. At the onset of their medical education, they typically rely heavily on instructors, as they are not yet prepared to manage their own learning independently. This reliance tends to decrease as they progress through the various stages of the MBBS program. The aim of our study was to evaluate how acceptable the self-directed learning (SDL) approach is to Phase 1 students and to explore their perceptions regarding this learning method.

Our research objective was to test the acceptability of the SDL approach in phase 1 students and assess their perceptions of the approach. in our study mean S.D values of marks (Table no 1) obtained in pre and posttest were statistically significant.  In the present study the feedback from the students (Table no.2, Figure no 1) and faculty (Table no 3, Figure no 2) confirmed that the implementation of SDL activity among phase 1 students was achievable. (Table. No 2 and Figure No 1).

The data from the SDL feedback survey shows a predominantly positive response from students regarding the impact of SDL activities on various aspects of their learning.

1. Skill Improvement and Engagement: The results from Q1 and Q2 indicate a strong positive impact of the sessions on students' skill development and engagement. Specifically, in response to Q1, "The sessions have helped in improving my SDL skills," the Skill Improvement (SI) score reached 81, with an overwhelming 99% of students (137 out of 138) agreeing or strongly agreeing. Similarly, Q2, "I was engaged in the learning process," showed a high SI score of 80, with a comparable level of agreement. These findings highlight the effectiveness of the sessions in fostering self-directed learning (SDL) and maintaining high levels of student engagement. The consistently high ratings across both questions suggest that the implementation of student-centered strategies was successful, supporting learners in taking active ownership of their educational experience.

 2. Collaboration and Depth of Learning:  The responses to Q3 and Q4 further underscore the positive impact of the sessions on collaboration and depth of learning. Q3, "SDL has improved collaborative learning," received an SI score of 81, while Q4, "The activity enabled in-depth coverage of the topic," slightly surpassed it with an SI of 82. These results indicate that students recognized the role of self-directed learning in enhancing peer-to-peer interaction and promoting meaningful academic discussions. The high scores reflect that SDL not only supported individual autonomy but also facilitated a richer, more collaborative learning environment. This suggests that the activities were effective in encouraging students to engage more deeply with the subject matter while benefiting from shared perspectives and group learning dynamics.

3. Autonomy and Self-Pacing: The feedback on autonomy and self-pacing highlights students' strong appreciation for the flexibility provided by self-directed learning. Q5, "It was good to study at our own pace," received a notably high SI score of 85, indicating that learners valued the ability to manage their own learning schedules. Similarly, Q7, "SDL has improved my ownership of learning," achieved an SI of 83, reinforcing the perception that SDL effectively empowered students to take greater responsibility for their academic progress. Together, these responses suggest that the SDL approach was successful in fostering a sense of autonomy and personal investment in learning, key components of a student-centered educational experience.

4. Analytical and Reflective Thinking: The results from Q6 and Q10 highlight the positive influence of the SDL sessions on students’ analytical and reflective thinking skills. Q6, which assessed students' analytical abilities, received an SI score of 82, while Q10, focused on self-evaluation, scored slightly higher at 83. These high scores indicate that students felt the sessions enhanced their capacity for critical thinking and self-reflection. The findings suggest that SDL not only encouraged deeper engagement with content but also supported the development of essential cognitive skills, enabling students to analyze information more effectively and evaluate their own learning processes with greater insight.

5. Personal Awareness and Growth: The response to Q8, "I am more aware of my strengths in learning now," received the highest SI score of 86, highlighting the significant personal impact of the SDL sessions on students’ self-awareness and metacognitive abilities. This strong outcome suggests that beyond improving academic skills, SDL played a crucial role in fostering personal growth by helping students better understand their individual learning strengths. The emphasis on self-reflection and independent learning appears to have empowered students to develop more effective and personalized learning strategies, contributing to their overall development as autonomous and self-aware learners.

6. Negative Impact Assessment: Q9, "SDL session has no impact on my learning skills," was intentionally framed as a negatively worded statement to assess any potential dissent. The majority of students—113 out of 138—disagreed with this statement (scoring it 1 or 2), resulting in a solid SI score of 81. This strong rejection of the negative phrasing further reinforces the overall positive perception of SDL among students. The findings indicate that most students clearly recognized the beneficial impact of the sessions on their learning skills, affirming the effectiveness of SDL in enhancing their educational experience.

Overall, the high satisfaction indices across all questions—especially on items related to engagement, autonomy, and personal learning growth—indicate that Self-Directed Learning was well-received by the students and effectively enhanced various cognitive and metacognitive skills.

The only minor variance came in areas like personal awareness (Q8) and study at own pace (Q5), which scored slightly higher, showing perhaps a stronger appreciation for autonomy and introspection. A study conducted by Frambach et al.    involving students from three different medical schools indicated that learners from various cultural backgrounds gradually adapt to self-directed learning (SDL) as they advance through their academic years. The early stages of medical education, particularly certain modules, significantly contribute to fostering SDL habits. Similarly, research by Kidane et al. . highlighted the positive impact of problem-based learning, tutorial sessions, and tutor involvement on the development of SDL.

On the other hand, traditional teaching methods such as lectures and formal assessments were found to hinder the cultivation of SDL skills. In alignment with the guidelines set by the National Medical Commission (NMC), small-group SDL activities were implemented for medical students. To nurture SDL capabilities, diverse instructional strategies have been used, including the incorporation of SDL principles into case-based, team-based, and problem-based learning formats. , ,

The feedback from faculty in our study confirmed the need for implementation of SDL as a part of CBME curriculum. (Table No3, Figure No 3) Numerous studies have compared the acquisition of knowledge by students using the SDL approach with traditional methods of teaching. These studies have demonstrated that self-directed learning (SDL) enhances knowledge acquisition more effectively than traditional teaching approaches. , ,

Limitations:

The study's findings are based on data collected from a single institution, which may limit the generalizability of the results. Furthermore, the questionnaire-based feedback may be influenced by response bias, particularly acquiescence bias. Adjustment of teaching hours for SDL in the schedule

This study has shown that SDL is well accepted by most students and faculty, and they were satisfied with the approach. The findings indicated an enhancement in students' comprehension of the subject matter, with many reporting increased confidence in their ability to engage in independent learning. The study further highlights that structured self-directed learning (SDL) sessions can be effectively integrated into Biochemistry education, potentially fostering lifelong learning abilities that are crucial for advancing patient care.

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