Medical students’ learning approaches and examination outcomes: longitudinal and cross-sectional studies in a problem-based system

Abstract

Entwistle learning approaches are an evidence-based lens for analysing and improving student learning. Quantifying potential effects on attainment and in specific medical curriculum types merits further attention. This study aimed to explore medical students’ learning approaches in an integrated, problem-based curriculum, namely their validity, reliability, distribution, and how they change with student progression; their association with satisfaction; their association with cumulative attainment (examinations). Within the pragmatism paradigm, two series of mixed-methods questionnaires were analysed multi-cross-sectionally and longitudinally. Of seven surveys of Liverpool medical students (n ~ 115 to 201 responders, postal) and one of prospective medical students (n ~ 968 responders, on-campus), six included Entwistle 18-item Short RASI—Revised Approaches to Studying Inventory and six included ‘satisfaction’ items. Comparing four entry-cohorts, three academic years (9-year period), four levels (year-groups), and follow-ups allowed: cross-tabulation or correlation of learning approaches with demography, satisfaction, and attainment; principal components analysis of learning approaches; and multiple regression on attainment. Relatively high deep and strategic approach and relatively low surface approach prevailed, with strategic approach predominating overall, and deep and strategic approach waning and surface approach increasing from pre-admission to mid-Year 5. In multivariable analysis, deep approach remained associated with sustained (cumulative) high attainment and surface approach was inversely associated with passing Year 1 examinations first time (adjusted odds ratio = 0.89, p = 0.008), while higher ‘satisfaction’ was associated with higher strategic and lower surface approach but not with attainment. This study illuminates difficulties in maintaining cohesive active learning systems while promoting deep approach, attainment, and satisfaction and dissuading surface approach.