Context of study
To analyze students' perspectives about the purposes of notetaking and to examine their written notes in depth, three volunteer students were interviewed in an environment that provided anonymity. These students are referred to as Student 1, 2 and 3. The three students that were interviewed were registered in the module “Orofacial Pain and Jaw Function 2” which is part of the course “Clinical Odontology 2” (https://utbildning.ki.se/course-syllabus/2TL016/24160) in the third year, e.g. 6th semester, of the Study Programme in Dentistry (SPD) at the Department of Dental Medicine at Karolinska Institutet. Since the context of the study has previously been described in detail (Lindberg et al. 2020, submitted), only a summary will follow. At the time of data collection, the total number of full-time students at the SPD was 423, divided into approximately 85 students per academic year. The SPD comprises ten semesters, and five years, providing 300 European Credit Transfer and Accumulation System (ECTS). The first three years are on a basic level and the last two years are on an advanced level. During the course of the SPD, the students are expected to develop in their role as health-care providers, but also to learn about rules and regulations, quality assessments, scientific evaluations, and reflect upon present evidence (https://ki.se/selma/programme-syllabus/2TL13). After graduation, the students apply for licensure from The National Board of Health and Welfare (https://legitimation.socialstyrelsen.se/sv/utbildad-i-sverige/tandlakare) to be allowed to work as dentists in Sweden.
At least three weeks prior to each lecture, teacher-constructed PowerPoints were posted on the online learning platform. During lectures, the students could choose to either write their notes by hand or on digital tools such as a laptops or tablets, on blank sheets or on the PowerPoint-handouts. Altogether, 24 students volunteered to hand over copies of their notes (in total 237 pages). These were analyzed regarding method used for notetaking, that is, digital and/or paper-and-pencil, and types of notes, which were of three kinds: notes that consist of 1) copied teacher-written texts; 2) complemented teacher-written text; or 3) a mixture of 1 and 2. After reviewing the notes of these 24 dental students, we asked this cohort for volunteers to participate in in-depth interviews. Three students volunteered to participate.
Material-based interviews
The semi-structured material-based interviews took place on a neutral place for the students, but with academic familiarity. For such interviews, there is an agenda – in this particular case, the focus was on each student’s notes. Questions prepared for semi-structured interviews are open-ended and allow for individual follow-up questions related to the interviewee’s answer (16), starting with questions like “Are these notes representative for the way you take notes in general?” and “Do you have a specific strategy for your notetaking?”. The following questions were related to the content, form and structure of each student’s notes, but also of their purposes with their notes, how they structured them, and how they used them in relation to lectures, other teaching material and examinations (17). The interviews were conducted in October 2018 at Stockholm University by two of the researchers (VL, NCh). Thus, the interviews were not conducted at the Department of Dental Medicine at Karolinska Institutet, which is the place for the dentist programme. The interviews lasted 43.34 min for Student 1, 59.00 min for Student 2, and 114.12 min for Student 3. To secure confidentiality of the interview-setting, that was video recorded, the participants were instructed not to reveal any personal information during the interview. Further, the camera focused only on a table where the students’ notes were displayed, and only the hands of the participants were visible. This because it was important for the researchers to be able to check what aspects of their notes each student emphasized, by pointing at specific parts of their notes (17). After completion of the interview, the volunteering students left an anonymized copy of their handwritten or digitally written notes from the lectures. These notes consisted of 11 pages from Student 1, 14 pages from Student 2, and 25 pages from Student 3. Further, they also left their digital summaries of the module content consisting of 34 pages from Student 1, 41 pages from Student 2, and 29 pages from Student 3.
This study was based firstly on students’ notes, and secondly on material-based interviews with three of these students. Material-based interviews are basically a theoretical recontextualization of think-aloud interviews, originating from cognitivistic traditions, into a New Literacy Studies (NLS) tradition. In her study of teachers’ assessment of nursing students’ written tests, Orrell (18) interviewed teachers while they were reading and assessing students’ responses. The interviews were mainly based on teachers commenting students’ responses aloud. The purpose of Orrell’s study was to highlight experienced teachers’ cognitions during the action of assessment. However, the main idea in think-aloud interviews – to capture the thoughts of the individual interviewees – is problematic for studies that foreground the social practice. The idea that it is possible to claim that you can capture people’s thoughts through interviews has been criticized, firstly based on e.g. Vygotsky’s (19) work. According to him, thinking and speech are related to each other, but they are not the same. Secondly, an interview is a specific kind of conversation: the conditions differ from other kinds of conversations, and interviews also have limitations (20-22). An interview is a joint construction between interviewer and interviewee: each party have their interpretations of the meaning of the questions posed. Also, the issue of interpretation concerns aspects like what questions are not posed, which answers the interviewer will or will not pose follow-up questions, and what answers the interviewer supports or does not support by various kinds of facial expressions, gestures, humming etc. Most of these aspects are unconscious but can be identified when analyzing interview situations. Based on this critique, interview studies have been methodologically developed to contextualize the interview situation (17,22). Since dental students’ notetaking is considered a social practice, we prefer material-based as the concept that describes both the kind of interview we used, but also the theoretical basis for what we claim based on these interviews: the data that are co-constructed.
In the present study the interviewers and interviewees, i.e. students, sat around a table on which the students’ notes were placed, in a small conference room at Stockholm university, which is a familiar academic setting both for the interviewers and the interviewees. Before the actual interview, the students were instructed to speak freely, but to avoid details that could reveal their identity. They were informed that only their answers would be analyzed as well as the notes pointed out by their hands, hence, no facial or body expressions, gestures, confirmatory sounds etc. were to be analyzed. This, to make the interviewees as relaxed as possible. During the interview the students were asked to answer questions regarding their notetaking based on what, how, and why, that is for what purpose. Also, when appropriate, they were asked to highlight their answers with examples from their notes placed on the table. During the course of the interview the interviewers now and then added questions for further clarifications regarding any of the above-mentioned aspects of notetaking.
Thematic analysis
Thematic analysis may be described as a method for identifying, analyzing, and reporting patterns in a data. Patton (23) and others (24,25) describe a thematic analytic process as progressing from a description in which data has been organized to reveal patterns of meaning, a summary, an interpretation that attempts to theorize the importance of the patterns, their general meanings and inferences. Thematic analysis is here combined with New Literacy Studies for the purpose of capturing patterned response or meaning within interview data that relates to students’ notetaking. Prevalence is ensured by the refinement of analysis, in themes and potential sub-themes. A theme is determined by what it captures in relation to the research questions. The themes created relate to the data, i.e. the interview transcripts of three students’ notetaking, and were generated by a thorough, inclusive, and comprehensive coding process. Themes include data made sense of, i.e. interpreted, and not data paraphrased or described. Each theme has been described in detail and given a nuanced account.
The analytical procedure involved noticing patterns of meaning and issues of potential interest in the data. Also, analysis involved a relational reading, that is, a constant moving back and forth between the data set, the transcripts analyzed, and the analysis of data produced. The analytical steps performed (by SLJ and MCh) in this study were as follows:
- The first step concerned familiarization with data which was achieved in the process of transcription of the interviews, that also involved a reading and re-reading of data, and the noting of ideas.
- In a second step, data for each student was coded in relation to interesting features, which here comprised of the following analytical questions: a) what do they write; b) how do they write; and c) for what purpose do they write?
- A third step comprised collating codes into preliminary themes, by gathering of relevant data.
- In a fourth step, these themes were controlled in relation to the previously identified features and in relation to the entire data set. This additionally ensures that themes are internally coherent, consistent and distinctive. The controlling generated a thematic map of the analysis.
- A fifth step involved the definition of each theme and their naming. The themes (T1-T8; Table 1) were: professional vocabulary, core content, clinical examples, multimodal accentuation, synthesis, mnemonic strategies, academic purposes, and professional purposes. Examples of multimodal accentuation are for instance when students use color for highlighting words or sentences as well as details in pictures, draw arrows between notes in different parts or on teacher-provided handouts.
- The sixth and final step involved the selection of extract examples that vividly illustrated the themes. These selected extracts were then related back to the research question of the study.