Years Of Undergraduate Education Research Articles

The association between quality of clinical education and assertiveness in operating room and anesthesia nursing students: A cross-sectional study

BackgroundAssertiveness provides a nurse with the foundation for establishing successful relationships with patients, family members, and healthcare team members. Clinical education creates a unique opportunity to prepare students for professional identity because knowledge alone is not enough to provide safe care, and without clinical education, training efficient and competent people will be very difficult and impossible. This study aimed to determine the association between the quality of clinical education and assertiveness of operating room and anesthesia students. MethodIn this analytical cross-sectional study, 230 students who were in the second year of undergraduate education participated. The research was conducted in the 2022 academic year at the Department of Nursing School, Shiraz University of Medical Sciences. Clinical Education Quality Assessment Questionnaire and Gambler and Ritchie Assertiveness Questionnaire were data collection instruments. Statistical methods used included descriptive statistics such as mean, standard deviation, independent t-test, Chi-square test, and regression analysis. ResultsOut of 230 students participating in this study, 103 were operating room nursing students, and 127 were anesthesia nursing students. One hundred forty-one students were female, and 89 were male, 79 % of whom were aged 18–32 years. A significant relationship was found between the quality of clinical education and interest in the field, the number of children, and employment during education (P = 0.01). Also, a significant relationship was observed between decisiveness and the main variables (P = 0.01). The correlation analysis results showed students who scored higher on assertiveness had reported the quality of their clinical training higher (r = 0.23, p < 0.001). ConclusionAssertiveness as a communication style can play an important role in improving performance and quality of care in tense, stressful care settings. Improving assertiveness can be considered as a useful factor in the clinical training of the operating room and anesthesia nursing students. Therefore, it is suggested that the instructors should include instruction on assertiveness in nursing education courses.

Disparities in patient-resident physician communication and counseling: A multi-perspective exploratory qualitative study.

Effective communication between physicians and patients plays an integral role in clinical care. Gaps in a physician's ability to ensure effective communication, especially with patients from diverse backgrounds, are known causes of medical errors. This study explores the potential biases and disparities in patient-resident communication, which may influence a patient's quality of care. This exploratory qualitative study was conducted at the largest academic medical center in Pakistan. Purposive sampling was used to approach participants from surgery, medicine, obstetrics and gynecology, pediatrics and family medicine. Faculty, fellows and residents working in these departments and medical students in their fourth and fifth years of undergraduate education with prior experience of at least one month in these specialties during their clinical rotations were included. Focus group discussions (FGDs) lasting 45-60 minutes were conducted with each cohort of healthcare professionals separately, using a semi-structured interview guide. Sixty participants (19 males and 41 females, mean age: 32.9, SD: 10.9) took part in the study. Thematic analysis revealed five major themes. Four themes focused on residents' biases and patient disparities hindering patient-resident communication: (1) patient-resident gender discordance (2) ethnicity and language barriers, (3) differing social class of the patient, and (4) challenging patient-resident interactions (patients resistant to treatment, exceedingly inquisitive and those with multiple attendants, etc.). The fifth theme identified the need for a communication skills curriculum in postgraduate medical education. Opposite gender and discordant socioeconomic/cultural backgrounds of patients pose a challenge to effective patient-physician communication. Self-identification and awareness of residents' biases when interacting with patients can ensure their active elimination and improve their communication skills. Integrating these components in a standardized curriculum within postgraduate programs can enable resident-physicians to provide the same level of care and communicate more efficiently with patients of all backgrounds.

The challenging reality of the clinical learning environment at Damascus University Faculty of Dental Medicine in Syria: a qualitative study

Introduction: In Syria, specialist dentists undergo five years of undergraduate education and four years of postgraduate education. In the latter, students engage in treating complex cases as part of their professional training. This study aimed to obtain in-depth qualitative understanding of the clinical learning environment at Damascus University Faculty of Dental Medicine, Syria. Methods: Semi-structured interviews were held with eight postgraduate dental students at Damascus University Faculty of Dental Medicine. The faculty has eight clinical departments; therefore, a single participant was purposively sampled from each department. The male-female ratio of the eight interviewed participants was 1:1. All interviews were conducted between 26th April 2020 and 8th January 2021. Data was analyzed inductively using reflective thematic analysis. Pragmatic saturation was discussed during the analysis and the authors made an interpretative judgement to stop data collection at the eighth interview. Results: Major themes which emerged covered different aspects of the clinical learning environment such as clinical training, social interaction and assessment procedures. Faculty’s negligence of their teaching duties was one of the most recurrent themes. In clinical training and due to faculty inaccessibility, students had to rely on themselves or their senior peers in training. The social climate was perceived negatively and assessment was described as unfair and biased. Discussion: The findings of this study showcased the continuing deterioration of the clinical learning environment at Damascus University. It is hoped that these findings will encourage decision makers to introduce a comprehensive reform that addresses the curriculum, teaching practices and assessment procedures in clinical professional training.

Becoming the Mentors We Needed: Formative First-Year Practices and Motivating Factors of Peer Mentorship in College

The purpose of this qualitative study was to examine formative first-year practices and motivating factors that encouraged first-year college students to pursue peer mentorship roles. The examination of peer mentorship within undergraduate populations owes much to Jacobi’s (1991) study on mentoring and academic success, which more recently has been continued by Nora and Crisp (2007), Crisp and Cruz (2009), and Crisp et al. (2017). Peer mentorship bolsters both individual student development and undergraduate enrollment (Crisp et al., 2017; Yomtov et al., 2017), and assuming a peer mentor role contributes in meaningful ways to a college learning environment (Kuh et al., 2011). Although a significant amount of research has been conducted on peer mentorship, there has been less focus on motivating factors during the first year of college that prompt peer mentors to seek such roles in their second year of undergraduate education. The results of this study indicated students were motivated to pursue peer mentorship roles for four reasons: the desire for community, their sense of self-efficacy, a vocational connection, and the opportunity to impact incoming students’ experiences. Implications of these results are discussed in terms of implementing formative best practices into first-year experiences as a means of encouraging and recruiting second-year peer mentors.

The challenging reality of the clinical learning environment at Damascus University Faculty of Dental Medicine in Syria: a qualitative study

Introduction: In Syria, specialist dentists undergo five years of undergraduate education and four years of postgraduate education. In the latter, students engage in treating complex cases as part of their professional training. This study aimed to obtain in-depth qualitative understanding of the clinical learning environment at Damascus University Faculty of Dental Medicine, Syria. Methods: Semi-structured interviews were held with eight postgraduate dental students at Damascus University Faculty of Dental Medicine. The faculty has eight clinical departments; therefore, a single participant was purposively sampled from each department. The male-female ratio of the eight interviewed participants was 1:1. Data was analyzed inductively using reflective thematic analysis. Pragmatic saturation was discussed during the analysis and the authors made an interpretative judgement to stop data collection at the eighth interview. Results: Major themes which emerged covered different aspects of the clinical learning environment such as clinical training, social interaction and assessment procedures. Faculty’s negligence of their teaching duties was one of the most recurrent themes. In clinical training and due to faculty inaccessibility, students had to rely on themselves or their senior peers in training. The social climate was perceived negatively and assessment was described as unfair and biased. Discussion: The findings of this study showcased the continuing deterioration of the clinical learning environment at Damascus University. It is hoped that these findings will encourage decision makers to introduce a comprehensive reform that addresses the curriculum, teaching practices and assessment procedures in clinical professional training.

Reconceptualizing Response to Writing from a Longitudinal Perspective: Writing Development and Dialogic Interaction

Resumen Given the amount of time writing instructors spend in providing feedback on writing, researchers have sought to understand many dimensions of feedback, especially the practices that best support student writing development. A number of researchers have sought to understand student perspectives on response to writing, and this study builds on that work by examining student perceptions of responses to writing from a longitudinal perspective. This interview-based study draws on data from college students who were interviewed once each year for five years (four years of undergraduate education and a fifth year in graduate school or the workplace). Conducted at a major private university in the United States, this article draws its data from a five-year longitudinal study of 189 college students (a random sample of 12% of the incoming freshman class) that collected student’s writing in and out of class, and included semi-structured interviews with a subgroup of 39 students once each year during the five-year period. The interviews focused on the students’ writing lives and investigated many aspects of their writing experience both in and out of school. This article presents an analysis of their perceptions of factors that contributed to their development as writers, especially feedback, as the initial coding of the interview data showed that feedback was by far the most influential contributor to student’s writing development. Further analysis of the interviews focused on understanding the who, what, when, where, why, and how of feedback, that is, the analysis sought at a fine-grained level to understand the ways and degree to which feedback contributed to student’s growth as writers. Elements of theories of dialogism and dialectic were particularly useful in highlighting the features of effective responses to writing; specifically, the idea that the most impactful forms of feedback took place when there were frequent and ongoing dialogues between a writer and a responder with a particular set of characteristics. These types of conversations were particularly impactful when conducted with peers outside of classroom settings. Results suggest that future researchers on feedback should look beyond individual instances of feedback to ongoing chains of communication, and to seek to understand the ways in which writers integrate feedback into their writing practices. Results also showed that feedback from peers outside of classroom settings were highly influential on students’ sense of their own writing development. Implications for research and teaching are discussed. Specifically, it is suggested that teachers and those responsible for writing pedagogy are encouraged to consider ways in which they can facilitate multiple, ongoing streams of high-quality feedback for their students, and to prioritize these conversations in their instructional practice and writing pedagogies. Keywords language instruction, writing, learning processes, feedback, literacy methods

Pre-Service Pre-School Teachers’ Music Education Self-Efficacy Levels: A Case Study

Purpose: This study aims to examine pre-service preschool teachers’ music education self-efficacy levels in terms of their gender and grades. Design: The research has been designed as descriptive research based on the survey model. The data collection tool includes the 'Music Education Self-Efficacy Scale for Preschool Teacher Candidates' developed by Yıldız (2017). The study group includes 221 pre-service preschool teachers. Findings: Research indicates that pre-service preschool teachers' music education self-efficacy is at a 'good level.' Considering grades, it is found that as the grade level increases, there is an increase in the self-efficacy beliefs of pre-service preschool teachers related to music education. The lowest music education self-efficacy levels belong to freshman pre-service preschool teachers, and the highest music education self-efficacy levels belong to senior pre-service preschool teachers. However, it is found that the music education self-efficacy levels do not significantly differ according to gender. Highlights: It draws attention to a significant increase in the music education self-efficacy belief levels of the 3rd and 4th grade pre-service preschool teachers who took 'Early Childhood Music Education' as a compulsory course in the 2nd year of undergraduate education.

Pre-Service Pre-School Teachers’ Music Education Self-Efficacy Levels: A Case Study

Purpose: This study aims to examine pre-service preschool teachers’ music education self-efficacy levels in terms of their gender and grades.&#x0D; Design: The research has been designed as descriptive research based on the survey model. The data collection tool includes the 'Music Education Self-Efficacy Scale for Preschool Teacher Candidates' developed by Yıldız (2017). The study group includes 221 pre-service preschool teachers.&#x0D; Findings: Research indicates that pre-service preschool teachers' music education self-efficacy is at a 'good level.' Considering grades, it is found that as the grade level increases, there is an increase in the self-efficacy beliefs of pre-service preschool teachers related to music education. The lowest music education self-efficacy levels belong to freshman pre-service preschool teachers, and the highest music education self-efficacy levels belong to senior pre-service preschool teachers. However, it is found that the music education self-efficacy levels do not significantly differ according to gender.&#x0D; Highlights: It draws attention to a significant increase in the music education self-efficacy belief levels of the 3rd and 4th grade pre-service preschool teachers who took 'Early Childhood Music Education' as a compulsory course in the 2nd year of undergraduate education.

Connecting knowledge: First-year health care students’ learning in early interprofessional tutorials

ABSTRACT Collaboration across professional boundaries is an essential aspect of health care, and interprofessional education (IPE) is a common way to help increase students’ collaborative abilities. Research on how and when IPE should be arranged in a curriculum remains, however, inconclusive. How students actually develop interprofessional competencies have been difficult to demonstrate and is still an under-researched area. Studying IPE in context is therefore important to understand its full complexity. This paper examines how students work with scenarios from professional health care contexts when learning together in interprofessional problem-based learning tutorials during the first year of undergraduate education. The data are video-recorded tutorials of students from medicine, nursing, occupational therapy, speech and language pathology, and physiotherapy programmes. The analysis focuses on students’ discussing their readings of the literature. Drawing on “Communities of Practice,” findings show that students discuss and connect professional knowledge, with “brokers” (the tutors) and “boundary objects” (scenarios) supporting the emergence of students’ professional knowledge. The scenarios, as boundary objects, also enabled the students to turn into brokers themselves. The paper contributes to research on interprofessional learning and offers support for implementing IPE in the early stages of undergraduate education.

Narrative sensitivity in medical students: A mixed-method exploration

Objective. The paper introduced the concept of narrative sensitivity. The study aimed to identify the facets of narrative sensitivity (NS) in medical students and assess the changes in NS during undergraduate medical education.Methods. A mixed-method study was designed to explore NS. Data was collected from a group of students in their second year (N=50) and then in their fifth year (N=42) of their undergraduate education. The data was analysed using thematic analysis in accordance with consensual qualitative research. A coding system was developed to identify and refine the facets of NS. The theme frequencies were counted for each year separately and Fisher’s exact test was conducted to assess the statistical significance of NS change between both years.Results. Nine themes related to NS were identified in the data. The frequency of themes indicated a trend towards a decline in NS between the second and fifth years of undergraduate education. However, the exploratory nature of this study and the small sample size did not allow any definitive conclusions regarding changes over time.Conclusions. The findings raised doubts about the outcome of undergraduate education based on a narrow biomedical perspective. The study supported the arguments for giving emphasis on the training of communication skills including narrative sensitivity during medical education.

Emerging Proof Productions of Freshmen in Euclidean Geometry Proof Tasks between Conjecturing and Proving

ABSTRACT This study was conducted to examine the effectiveness of proof tasks in the transition from conjecture to proof in Euclidean geometry on freshmen’s proof schemes. In line with this aim, the proof schemes of the freshmen who performed conjecture-proof and theorem-proof tasks were compared. The freshmen were composed of 109 pre-service middle school mathematics teachers who are enrolled in their first year of undergraduate education. The study was modeled as a multiple-case study. Fifty-three freshmen performed conjecture-proof tasks in Case-1, and fifty-six freshmen performed theorem-proof tasks in Case-2. The video recordings, including the written proof reports, reflection papers, and proof explanations of the freshmen, were used as data collection tools in the tasks. The proof schemes were used as construct maps to evaluate the proofs of freshmen and analyzed using Winsteps Rasch software. The proof schemes in freshmen’s proof tasks were evaluated by the Wright Map and supported with direct quotations from the proofs. In the study, it was observed that the proof schemes of freshmen who made proofs based on their own conjectures were mostly empirical and analytical proof schemes, while the proof schemes of freshmen who made proof of the presented theorem were generally external and empirical proof schemes.

The Effect of Collaborative Learning on Academic Motivation

This paper explores the effect of collaborative learning on academic motivation among students from 17 institutions throughout the United States. Even in the presence of a wide array of potential confounders, collaborative learning exerted a statistically significant and positive influence on students’ academic motivation levels across four years of undergraduate education. Tests for the presence of interaction effects suggest that the relationship between collaborative learning and academic motivation is similar for all students, regardless of racial or ethnic background.

Writing Skills Development for Graduate Studies and Career Readiness in Science and Aging Fields: A Case Study Approach.

Increasing the number of racially and ethnically underrepresented students who pursue scientific graduate studies in programs focusing on science and aging offers an opportunity to increase the number of aging specialists while simultaneously promoting diversity in the research labor market and supporting new ideas. This case study aims to better understand how students participating in an academic preparatory program experience a writing class contextualized within (1) students' writing background and (2) students' future ambitions related to science and aging. The individually-tailored writing class was taught as a critical component of a comprehensive educational program that targets underrepresented racial and ethnic minority undergraduate students who are interested in pursuing scientific graduate studies in fields related to aging. The researchers conducted semi-structured qualitative interviews with students (n = 4) enrolled in the 24-month fellowship training program, which included participation in the writing course during the summer prior to their senior year of undergraduate education. All participants were young adult college students who identified as Black or African American and female. Using thematic coding, statements about professional writing skills were divided into four primary themes: (1) prior experiences, (2) class experiences, (3) future goals and ambitions, and (4) structural considerations. These themes suggest potential implications for effective interventions aimed to advance the writing skills and academic and career readiness of racially and ethnically diverse students entering fields of science and aging.

Nursing Students' Perception Levels of Spirituality and Spiritual Care in Turkey.

The present study was conducted to determine nursing students' perception levels of spirituality and spiritual care and the factors affecting these levels. The study was carried out in the nursing faculty of a university located in eastern Turkey between April and June 2019. The study population was made up of students studying within adepartment of nursing (n = 1250), and involved asample size of420 students, determined by power analysis. Data were obtained from an 'Introductory Information Form' that included students' sociodemographic characteristics and questions related to spiritual care and the Spirituality and Spiritual Care Rating Scale (SSCRS). Students scored, on average, 59.8 ± 9.7 on the SSCRS. Gender, year of undergraduate education, father's education level, knowledge of spiritual care, beliefs on the relationship between spiritual care and nursing care, and the ability to meet patients' spiritual needs were variables with an impact on the total SSCRS scores (p < 0.05). The findings show that spiritual care perception levels of nursing students were high.

Current trends in removable partial prosthodontics education in dental colleges of Pakistan.

The objective of this study was to investigate the current trends in undergraduate teaching of removable partial prosthodontics in various dental colleges of Pakistan. A cross-sectional study was conducted in which a questionnaire was sent by email to head of Prosthodontics department of thirty-one dental institutes of Pakistan. The survey included multiple questions regarding current trends in removable partial prosthodontics education in undergraduate dental colleges. Out of thirty-one questionnaires, twenty-six were completely filled and returned. In 19 (73%) dental colleges, removable partial denture is taught over a period of at least two years of undergraduate education. Students of only six dental colleges fabricate 10-12 removable partial dentures during their Prosthodontic rotation. Lectures and live clinical demonstration for construction of removable acrylic dentures are reported to be carried out in all the dental schools. Simple hinge articulator is the articulator of choice in 22 (84.6%) colleges. Even though twenty-four out of twenty-six colleges (92.3%) teach fabrication of cast partial dentures in lectures, none of the student fabricate these dentures during their Prosthodontic rotation. This survey is the first to comprehensively report the teaching practices of removable denture Prosthodontics in undergraduate dental colleges of Pakistan. Faculty of all twenty-six colleges give clinical demonstrations of acrylic partial denture construction before students start working in the dental OPD. Most of the dental colleges report use of similar impression materials and techniques in removable partial denture fabrication. More than 90% of dental colleges teach cast partial dentures theoretically, but their construction is grossly neglected in all the dental colleges. It is important that this skill is taught and practised by students in order to have the necessary skill set, so they can provide comprehensive treatment to partially dentate patients once they graduate.

Sexual myths and attitudes regarding sexuality of nursing students: A mixed method study.

To determine the nursing students' sexual myths and attitudes regarding sexuality, and to explore their views towards sexual care in practice. A mixed-method sequential explanatory design was used. Data were collected using Questionnaire Form, Sexual Myths Scale (SMS), Sexual Attitude and Beliefs Scale (SABS), and Focus-Group Interview Form. The average scores on the SMS and the SABS were 58.66 ± 18.74 and 37.50 ± 6.97, respectively, indicating students' sexual myths and their attitudes regarding sexuality were moderate. A positive, significant correlation was found between SMS and SABS scores (p < 0.001). In the interviews, the views on the barriers and facilitators in sexual care and the negative effect of sexual myths on sexual care were revealed. Courses regarding sexuality should include into nursing curriculum from the first years of undergraduate education.

Synthetic Anatomy: arts based learning to explore the possibilities of form and function

We have developed an interdisciplinary module for students in their second year of undergraduate education which imports, into anatomy, the techniques and perspectives of success &amp; assessment practices of art school. The module brings together biomedical engineers and anatomy students to speculate on and design imagined bodies that probe the boundaries of clinical, evolutionary and developmental anatomy. The students produce a technical and critical reflective portfolio and participate in a small, collaborative group project to 3D print imagined anatomy. Teaching and assessment emphasise the freedom to take risks and learn from failed avenues of investigation. A key emphasis is on structural exploration and experimentation coupled with reflection rather than literature review or writing per se. Technical teaching on 3D prints is accompanied by class workshops that explore the dimensions of documentation, the language of visual presentation and value of reflection. Workshops are led by visiting artists and we have applied the technique of the “crit”, which is a widely used form of group reflection in art and architecture schools, as a means of delivering a high degree of rigour into the science classroom. Projects are completed by mixed teams of engineering and anatomy students. There is no exam but a final “show” of projects is assessed on outcomes that are in part designed by the class at the start of the module. For learning outcomes and assessment, in addition to applying a technical and cognitive taxonomy we have introduced elements of Bloom’s less well‐known, affective taxonomy to authentically assess student commitment, pride, value and engagement. We have found that students are highly satisfied with their learning experience regardless of assessed outcome and show an extraordinary commitment to the course. Our emerging conclusion is that by paying attention to the material craft of science and exploring and reflecting on its community of practice, we can design and deliver modules that are a more valid preparation for higher level research both in terms of skills and passion for this subject.Support or Funding InformationKings College London Cultural InstituteStudent project work from the Synthetic Anatomy moduleFigure 1

A Survey on the Study Habits of the Taiwanese University Students: Comparison of the Four Years of Undergraduate Education

This study was conducted in order to examine the probable differences among the study habits of students on different academic levels: freshmen, sophomores, juniors, and seniors in Taiwanese universities. Thus, 14 departments were randomly chosen in three universities in central Taiwan. In total, 964 respondents were considered in this study. The research instrument was a 24-item questionnaire adopted from the Study Skill Assessment Questionnaire, originally developed by University of Houston Clear Lake, Texas. The questionnaire items used in this study clustered three study habits/skills constructs (eight items each) which were: time management and procrastination, study aids and note-taking, and organizing and processing information. Applying a Pearson Chi-square test (a ≤.05) for each of the 24 items of the questionnaire, it was revealed that there is no significant difference among students of different years with respect to item 4 (preparing a “to do” list), item 18 (breaking assignments into manageable parts), and item 22 (using questions to better organize and understand studying material). As for the other 21 items of the questionnaire, the subjects’ responses varied with a low significance, showing a little difference in study habits among the students of four levels of undergraduate education. Furthermore, and using the rubrics suggested by the original questionnaire developer, it was measured that the lowest score for all of the surveyed constructs was 18.74 (low range) for sophomores on “study aids and note-taking”, while the highest score was 26.26 (medium-high range) for seniors on “organizing and processing information”.

A cohort study of sustainability education in nursing

PurposeThe purpose of this paper is to assess the contribution of scenario-based learning aimed at raising awareness of sustainability in health-care practitioners. The Lancet Countdown on Climate Change calls for urgent action on health and climate change; this requires appropriate knowledge, skills and competencies that can be gained through undergraduate education. The International Council of Nurses calls for leadership in nursing for sustainability; however, climate change and health are given little attention in nursing and health-care curricula.Design/methodology/approachA cohort of nursing and midwifery students was introduced to sustainability and climate change in the context of health care through scenario-based learning sessions in each of their three years of undergraduate education. Questionnaires were used to collect data on participant’s attitudes toward sustainability and climate change, how useful the educational sessions were and the extent to which their clinical practice had changed.FindingsSignificant differences were found between scores in Years 1 and 2 suggesting greater awareness of the importance of sustainability in nursing education and practice. Comparison of Years 2 and 3 scores found participants more likely to apply sustainability principles in clinical practice and challenge unsustainable practices in the work environment.Research limitations/implicationsFurther research is required to explore sustainability practice in postgraduate nurses/midwives. However, this study supports the need for sustainability education to be embedded within health-care professional degrees through applied and participatory pedagogical approaches.Originality/valueTo the best of the authors’ knowledge, this is the first study to evaluate sustainability education and its impact on nursing attitudes towards practice.

Implementation of problem-oriented learning sessions in para-clinical years of medical college

Background: In order to develop competent health care professionals and to help medical students to acquire clinical reasoning, critical thinking and problem-solving skills, it was decided to initiate problem-oriented learning (POL) sessions as a part of implementation of integrated learning in the second year of undergraduate education of medical students in a medical college. Methods: A group of 150 students in the second year of their undergraduate education was divided into 10 sets of 15 members each. For each weekly POL session, one lead department was identified and from that department, one faculty member was assigned for each of the 10 groups for clarity and guidance. Four to five departments in all were involved in these POL sessions based on the topic and were instructed to frame their objectives and share these with the lead department at least one week prior to each session to develop appropriate problems for discussion. Results: Initial results failed to meet the desired objectives. The entire exercise was restructured and attention was given to the areas where weaknesses were identified. Faculty members were provided with additional information about POL and the number of sessions was reduced to two per month. Faculty members were instructed to be discussion facilitators rather than to become involved in didactic teaching. Subsequently, a significant improvement was observed both in terms of outcomes and student participation. Conclusion: It is relatively easy to start a new mode of teaching-learning; however, outcomes improve when efforts are planned systematically and implementation is revisited after challenges and gaps are identified.