Research question 1
What challenges do student groups in medical undergraduate education face in evaluating and improving upon creative ideas according to teachers?
Novelty–usefulness tension
The majority of the example descriptions (29 of 38) could be characterised by student groups trying to find a way to manage the twin goals of novelty and usefulness. We discuss three example descriptions representative for each of the three categories: NovLo_UseLo, NovHi_UseLo and NovLo_UseHi (Table 1). The teachers reported 10 cases where student groups evaluated novel but ineffective or infeasible ideas to implement in practice (NovHi_UseLo). The socio-cultural theory of creativity argues that the evaluation of ideas takes place in the collaboration between students, the material and social environment, and is intertwined with culture. In line with this theory, we found that teachers reported several reasons for the impracticality of ideas (idea is not feasible or effective):
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The student group has insufficient knowledge and expertise to further develop an idea (i.e., collaboration between students);
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The task or project has insufficient budget (i.e., material environment) to further develop an idea;
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There is a lack of collaboration from the social environment, such as pharmaceutical companies or research groups (i.e., social environment);
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The existing legal law inhibits the further development of an idea (i.e., culture).
An example is a student group who worked on reducing the reactions to misophonia (a disorder in which emotional or physiological reactions occur to a sound with a specific pattern) but found their solution of noise-cancelling headphones for these specific sounds unworkable without financial resources. Secondly, the teachers reported 12 cases where student groups evaluated feasible or effective ideas that lacked novelty (NovLo_UseHi). In these cases, the groups often sought consensus around a digital solution for their healthcare problem, with over half focusing on apps or websites. Finally, the teachers also reported seven cases in which the student groups evaluated ideas that were low in both novelty and usefulness (NovLo_UseLo). An example is a student group who worked on preventing dehydration in the elderly but found their solution of an "E-teach" smart bottle unworkable due to its high cost and prior existence.
Table 1
Overview of each of three main novelty–usefulness tensions reported by teachers, and the frequencies of each.
| Low usefulness | High usefulness |
Low novelty | (iii) NovLo_UseLo: 7 | (ii) NovLo_UseHi: 12 |
‘Elderly people who drink too little water are easily dehydrated and this is bad for their health. […] The students’ lifestyle approach was that we need to make elderly people more aware that they are at risk of dehydration. […] The students came up with the idea of a smart drinking cup. They wanted to integrate the cup with e-technology and e-health, so that the smart drinking cup would tell elderly to drink more. […] However, the students abandoned the idea, because it has already been thought of several times and it does not work; it is expensive and it is typical tech-optimism that does not fit well with the elderly population. So then the students abandoned that path’ [T14 dehydration in elderly people]. | ‘I think those were all girls. […] One of those girls had asthma herself and they wanted to develop something with an app for asthmatics. Well, within the hospital, we have two very big examples of that, Air Bridge and Asthma Buddy, so those ideas have already been developed. […. ] Within their ideas, there was just nothing innovative’ [T5 asthma]. |
High novelty | (i) NovHi_UseLo: 10 | NovHi_UseHi* |
‘There was a group who were working on the problem of misophonia [a condition where normal sounds cause a psychological reaction]. The students generated a very interesting idea for that problem. […] A headphone-like device that would filter specific sounds out, so [the wearer] could still follow the conversation. The students had all kinds of contacts with technical companies; however, the students got stuck because their idea was not feasible without any funding’ [T1 misophonia]. | |
Note: See Supplementary Material (Appendix 2 for all quotes). *Example descriptions of student groups who evaluated highly novel and useful ideas are beyond the scope of this article. |
Groups dynamics |
Furthermore, teachers reported challenges with group dynamics during the idea evaluation (six of 38), often with some (dominant) students suggesting ideas and other group members tending to accept them without question (four of 6). In the other two examples with group challenges, a student proposed an idea but was abruptly ignored or ridiculed by the others. For example, a student group worked on the problem of tinnitus (a hearing disorder), but one student who suggested some ideas withdrew from the group after being ignored by the others.
‘Once, I had a student group that worked on preventing noise-induced hearing loss during festivals, and these students were stuck at one point, but they had come up with a nice questionnaire to measure noice-induced hearing loss. […] This was a student group with one man and four women. The man was completely overshadowed by the women. He did not get a single chance to advocate ideas with these women, although I noticed that he had very good ideas. He also became very frustrated in the process because his ideas were not heard’ [T13 tinnitus].
Research question 2
What kind of teaching activities do teachers report using when student groups experience the above challenges?
We found that the teacher responses were contingent on the student groups’ reactions triggered by the novelty–usefulness tension. Some student groups reacted positively and were still motivated to continue with their idea, while other groups reacted with negative emotions, such as anxiety, frustration and fear. These groups often have trouble letting go of their idea and embracing alternative ideas. Finally, teachers also reported several teaching activities to address problematic group dynamics.
Teaching activities related to positive student emotions
Teachers responded both with cognitive and metacognitive teaching activities for student groups that were motivated to continue with their idea (see Table 2). They asked detailed questions about the problem or the students’ proposed idea (cognitive level) and helped groups take the next step, such as seeking feedback from stakeholders. They also encouraged students to explore alternative ideas with stakeholders (metacognitive level). In this way, teachers tried to let student groups revisit or improve their proposed idea without directly instructing them to do so. Once teachers noticed that student groups were highly motivated to continue with their proposed idea, they reported that they supported the student groups with their chosen idea.
Teaching activities related to negative student emotions
Teachers responded to negative reactions by using affective teaching activities to create a positive motivational climate, acknowledging and normalising failure (see Table 2). This was done by asking student groups about their motivation after rejection from stakeholders in the field, acknowledging declining motivation, and reducing fear and anxiety among students through reassurance. The teachers then also used metacognitive teaching activities to guide the students in finding alternative ideas or modifying their existing ideas with stakeholders.
Teaching activities related to group dynamics
Finally, teachers reported using several activities to address problematic group dynamics, such as informing students of the importance of diversity in perspectives and encouraging students to contribute ideas. They focused on improving communication skills, including informing students of group dynamics, encouraging idea sharing and building, complimenting students, and encouraging individuals to speak up (see Table 2).
Table 2
Representative quotes illustrating teaching activities contingent on student groups’ reactions
Teaching activities | Contingent on: | Quotes from participants |
Cognitive | Positive emotions | ‘The father of one of the students had ended up in the hospital and had experienced delirium. A delirium is a dysregulation of your thinking and the brain caused by a serious illness. […] The student had dived into the problem and learned that delirium occurs with serious illness and procedures. […] Then the student thought, could we come up with something to prevent that? For example, could we measure certain values, put them in an app, and have the app calculate the likelihood of delirium. […] The students spent quite some time on that idea; they wanted to make that idea into a prototype. However, something that impaired their process was that the students immediately worked on the five or ten most important parameters, and not so much on what a delirium is. […] I asked the students whether they felt that they knew enough about the whole clinical picture of delirium […] And how it would be to talk to a geriatric nurse, for example, or people who work in the recovery room. […] I tried to give the students some knowledge’ [T6 delirium]. |
Metacognitive |
Affective | Negative emotions | ‘The students wanted to come up with something so that children who are in the hospital for long periods of time could still have contact with their pets. The students came up with all kinds of ideas, and the bottom line was that none of their ideas were possible. […] The students were very disappointed. [...] That did something to them, especially because these students felt that they had found the egg of Columbus several times in six weeks. [...] At one point, I noticed that the students were a bit worn out. [...] I asked them how they were feeling. The students said, “yes, I hate to say it, but [this failure] does affect my motivation”. I replied by telling the students that it was good of them to say this, because that is why I asked about it, and it is very normal that this happens. So that is a bit of normalising that I do. I also work with the students to see how they can take the next step’ [T6 long-term hospital visit]. |
Socio-communicative | Group dynamics | ‘At one point, I did say something about it to the students: “You know, every time he comes up with something that might be weird or crazy, you guys should actually try to build on that instead of cutting him off or saying that his idea cannot be done”. He actually had really funny ideas. [...] I mentioned that I did not think it was fair that every time he came up with a crazy idea, the other students laughed about it or ignored it. Indeed, sometimes the ideas he brought up were not entirely useful, but he did think beyond what was already there. He did dare; he did have guts. [...] In the end, I wrote this in my evaluation, and I also said to him that he should have more confidence in himself and that what he did was good. I said this because I noticed that [the rejection of his ideas] made him insecure and that at a certain point he gave up, which is a shame’ [T5 genetic disorders]. |
Note: See Supplementary Material (Appendix 2 for all quotes). |