In the questionnaire, the 284 students evaluated tutors’ promotion of the five learning approaches. Table 2.1 presents the students’ levels of agreeability with those learning approaches. Nearly half agreed with the (a) ‘searching for links between the issues discussed in the tutorial group’ (45.4%, n = 129), (b) ‘generating clear learning issues on one’s own’ (40.5%, n = 115), (c) ‘searching for various resources on one’s own’ (43.7%, n = 124) and (d) ‘applying knowledge to the discussed problem’ (45.5%, n = 129) items. Furthermore, Table 2.2 shows that the self-directed learning category had the highest mean score of the learning approaches (mean ± SD = 3.50 ± 1.0, scale = 1–5), while the intra-personal behaviour category had the lowest mean score (mean ± SD = 2.98 ± 1.0, scale = 1–5). At the item level, the ‘searching for various resources by themselves’ item had the highest mean score (mean ± SD = 3.58 ± 1.1, scale = 1–5), while the ‘providing a clear picture of their strengths and weaknesses as a tutor’ item had lowest mean score (mean ± SD = 2.78 ± 1.2, scale = 1–5). Figure 1 presents the mean scores of the learning approaches awarded by the students.
Table 2.1
Students’ levels of agreeability with the learning approaches of tutors (N = 284).
Variable | Strongly disagree | Disagree | Neutral | Agree | Strongly agree |
Constructive/active learning |
Summarizing what has been learnt in one’s own words | 24(8.5) | 33(11.6) | 77(27.1) | 107(37.7) | 43(15.1) |
Searching for links between the issues discussed in the tutorial group | 26(9.2) | 28(9.9) | 60(21.1) | 129(45.4) | 41(14.4) |
Understanding underlying mechanisms/theories | 25(8.8) | 38(13.4) | 84(29.6) | 99(34.9) | 38(13.4) |
Self-directed learning | | | | | |
Generating clear learning issues on one’s own | 23(8.1) | 36(12.7) | 66(23.2) | 115(40.5) | 44(15.5) |
Searching for various resources on one’s own | 21(7.4) | 27(9.5) | 57(20.1) | 124(43.7) | 55(19.4) |
Contextual learning | | | | | |
Applying knowledge to the discussed problem | 18(6.3) | 26(9.2) | 72(25.4) | 129(45.4) | 39(13.7) |
Applying knowledge to other situations/problems | 23(8.1) | 49(17.3) | 88(31.0) | 100(35.2) | 24(8.5) |
Collaborative learning | | | | | |
Giving constructive feedback on group work | 34(12.0) | 46(16.2) | 88(31.0) | 89(31.3) | 27(9.5) |
Evaluating group cooperation regularly | 37(13.0) | 48(16.9) | 81(28.5) | 85(29.9) | 33(11.6) |
Intra-personal behaviour | | | | | |
Providing a clear picture of their strengths and weaknesses as a tutor | 54(19.0) | 52(18.3) | 104(36.6) | 50(17.6) | 24(8.5) |
Showing a clear motivation to fulfil the role of a tutor | 31(10.9) | 39(13.7) | 95(33.5) | 85(29.9) | 34(12.0) |
Table 2.2
Mean scores of the learning approaches (N = 284).
Variable | Mean ± SD (1–5) |
Constructive/active learning | 3.39 ± 1.0 |
Summarizing what has been learnt in one’s own words | 3.39 ± 1.1 |
Searching for links between the issues discussed in the tutorial group | 3.46 ± 1.1 |
Understanding underlying mechanisms/theories | 3.31 ± 1.1 |
Self-directed learning | 3.50 ± 1.0 |
Generating clear learning issues on one’s own | 3.43 ± 1.1 |
Searching for various resources on one’s own | 3.58 ± 1.1 |
Contextual learning | 3.35 ± 0.9 |
Applying knowledge to the discussed problem | 3.51 ± 1.0 |
Applying knowledge to other situations/problems | 3.19 ± 1.1 |
Collaborative learning | 3.10 ± 1.1 |
Giving constructive feedback on group work | 3.10 ± 1.2 |
Evaluating group cooperation regularly | 3.10 ± 1.2 |
Intra-personal behaviour | 2.98 ± 1.0 |
Providing a clear picture of their strengths and weaknesses as a tutor | 2.78 ± 1.2 |
Showing a clear motivation to fulfil the role of a tutor | 3.18 ± 1.2 |
Table 3 shows the mean performance ranking for tutors awarded by the students and tutors’ promotion of the learning approaches by percentage. The results reveal that the mean performance ranking for tutors was above halfway (mean ± SD = 6.32 ± 2.0, N = 284, min = 1, max = 10). The performance ranking was well distributed among rankings 5 (13.0%, n = 37), 6 (22.9%, n = 65), 7 (18.7%, n = 53) and 8 (16.5%, n = 47). Overall, most tutors performed sufficiently, namely they received rankings from 1 to 6 out of 10 (52.8%, n = 150). Figure 2 presents the distribution of tutors’ mean performance rankings.
Table 3
Mean performance ranking for tutors awarded by the students and tutors’ promotion of the learning approaches by percentage (N = 284).
| N | Min | Max | Mean | SD |
Performance ranking | 284 | 1 | 10 | 6.32 | 2.0 |
| Count | % |
Total | 284 | 100.0 |
Performance ranking | 1 | 7 | 2.5 |
2 | 6 | 2.1 |
3 | 13 | 4.6 |
4 | 22 | 7.7 |
5 | 37 | 13.0 |
6 | 65 | 22.9 |
7 | 53 | 18.7 |
8 | 47 | 16.5 |
9 | 14 | 4.9 |
10 | 20 | 7.0 |
Performance ranking | Sufficient (1–6) | 150 | 52.8 |
Excellent (7–10) | 134 | 47.2 |
As presented in Table 4, the reliability statistics showed adequate Cronbach’s alpha values of 0.789 (N = 3, 95% CI = 0.74–0.83) for the constructive/active learning category, 0.608 (N = 2, 95% CI = 0.50–0.69) for the self-directed learning category, 0.710 (N = 2, 95% CI = 0.63–0.77) for the contextual learning category, 0.796 (N = 2, 95% CI = 0.74–0.84) for the collaborative learning category and 0.738 (N = 2, 95% CI = 0.67–0.79) for the intra-personal behaviour category.
Table 4
Reliability of the learning approach categories.
Category | No. of items | Cronbach’s alpha | 95% confidence interval |
Constructive/active learning | 3 | 0.789 | 0.74–0.83 |
Self-directed learning | 2 | 0.608 | 0.50–0.69 |
Contextual learning | 2 | 0.710 | 0.63–0.77 |
Collaborative learning | 2 | 0.796 | 0.74–0.84 |
Intra-personal behaviour | 2 | 0.738 | 0.67–0.79 |
Table 5 presents the correlations among the learning approaches. The results reveal that the constructive/active learning category was significantly positively correlated (N = 284, p < 0.001) with all the other learning categories: self-directed learning (r = 0.503), contextual learning (r = 0.575), collaborative learning (r = 0.517) and intra-personal behaviour (r = 0.604). This implies that when the constructive/active learning approach is adopted, the other learning approaches are established more dominantly. Similarly, the self-directed learning category was significantly positively correlated (p < 0.001) with the contextual learning (r = 0.509), collaborative learning (r = 0.338) and intra-personal behaviour (r = 0.459) categories. The contextual learning category also had a significant positive correlation (p < 0.001) with collaborative learning (r = 0.555) and intra-personal behaviour (r = 0.584). Finally, the collaborative learning and intra-personal behaviour categories were significantly positively correlated (p < 0.001, r = 0.564).
Table 5
Correlations among the learning approaches.
Category | Self-directed learning | Contextual learning | Collaborative learning | Intra-personal behaviour |
Constructive/active learning | r | 0.503** | 0.575** | 0.517** | 0.604** |
p-value | < 0.001 | < 0.001 | < 0.001 | < 0.001 |
N | 284 | 284 | 284 | 284 |
Self-directed learning | r | | 0.509** | 0.338** | 0.459** |
p-value | | < 0.001 | < 0.001 | < 0.001 |
N | | 284 | 284 | 284 |
Contextual learning | r | | | 0.555** | 0.584** |
p-value | | | < 0.001 | < 0.001 |
N | | | 284 | 284 |
Collaborative learning | r | | | | 0.564** |
p-value | | | | < 0.001 |
N | | | | 284 |
**. Correlation is significant at the 0.01 level (two-tailed). |
Table 6 shows the associations for the male and female students’ assessments of tutors’ learning approaches. The results reveal significant associations among the scores for the constructive/active learning (female: 3.56 ± 0.9 vs male: 3.28 ± 1.0, p = 0.019), self-directed learning (3.79 ± 0.9 vs 3.33 ± 1.0, p < 0.001), contextual learning (3.55 ± 0.9 vs 3.23 ± 0.9, p = 0.005) and collaborative learning (3.28 ± 1.1 vs 2.99 ± 1.1, p = 0.031) approaches. Specifically, significantly higher scores were recorded among the female students, suggesting that tutors’ learning approaches tended to be viewed more favourably by this group. Moreover, the female students awarded tutors the highest score for the self-directed learning approach (3.79 ± 0.9), while the male students awarded the lowest score for the intra-personal behaviour approach (2.97 ± 1.1).
Table 6
Associations between the male and female students’ assessment of tutors’ learning approaches.
Category | Male | Female | p-value |
Total | 176 | 108 | - |
Constructive/active learning | 3.28 ± 1.0 | 3.56 ± 0.9 | 0.019a |
Self-directed learning | 3.33 ± 1.0 | 3.79 ± 0.9 | < 0.001a |
Contextual learning | 3.23 ± 0.9 | 3.55 ± 0.9 | 0.005a |
Collaborative learning | 2.99 ± 1.1 | 3.28 ± 1.1 | 0.031a |
Intra-personal behaviour | 2.97 ± 1.1 | 3.00 ± 0.9 | 0.824 |
a-significant using the independent t-test at < 0.05. |
Table 7 presents the associations between the sufficient and excellent scores for tutors’ learning approaches awarded by the students. The independent t-test and Welch’s t-test results reveal significant associations (p < 0.001) among all the learning approaches. Specifically, significantly higher excellent scores than sufficient scores were reported for the constructive/active learning (excellent: 3.87 ± 0.7 vs sufficient: 2.95 ± 0.9), self-directed learning (3.93 ± 0.7 vs 3.12 ± 1.0), contextual learning (3.80 ± 0.7 vs 2.95 ± 0.9), collaborative learning (3.59 ± 0.9 vs 2.66 ± 1.0) and intra-personal behaviour (3.56 ± 0.8 vs 2.47 ± 1.0) approaches.
Table 7
Associations between the sufficient and excellent scores for tutors’ learning approaches awarded by the students.
Category | Sufficient | Excellent | p-value |
Total | 150 | 134 | - |
Constructive/active learning | 2.95 ± 0.9 | 3.87 ± 0.7 | < 0.001b |
Self-directed learning | 3.12 ± 1.0 | 3.93 ± 0.7 | < 0.001b |
Contextual learning | 2.95 ± 0.9 | 3.80 ± 0.7 | < 0.001b |
Collaborative learning | 2.66 ± 1.0 | 3.59 ± 0.9 | < 0.001a |
Intra-personal behaviour | 2.47 ± 1.0 | 3.56 ± 0.8 | < 0.001b |
a-significant using the independent t-test at < 0.05. b-significant using Welch’s t-test at < 0.05. |
Table 8 shows the correlations between the students’ performance rankings for their tutors and the learning approaches. The results reveal a significantly positive correlation between tutors’ performance rankings and all the learning approaches: constructive/active learning (p < 0.001, r = 0.640), self-directed learning (p < 0.001, r = 0.537), contextual learning (p < 0.001, r = 0.568), collaborative learning (p < 0.001, r = 0.638) and intra-personal behaviour (p < 0.001, r = 0.638). This suggests that students award tutors’ higher performance rankings when there is greater engagement with learning approaches.
Table 8
Correlations between the performance ranking for tutors awarded by the students and learning approaches.
Category | Performance ranking (1–10) |
Constructive/active learning | r | 0.640** |
p-value | < 0.001 |
N | 284 |
Self-directed learning | r | 0.537** |
p-value | < 0.001 |
N | 284 |
Contextual learning | r | 0.568** |
p-value | < 0.001 |
N | 284 |
Collaborative learning | r | 0.472** |
p-value | < 0.001 |
N | 284 |
Intra-personal behaviour | r | 0.638** |
p-value | < 0.001 |
N | 284 |
**. Correlation is significant at the 0.01 level (two-tailed). |
Finally, Table 9 presents the associations between the students’ gender and tutors’ mean performance ranking. The results show a significant association (p = 0.001) between the students’ gender (both male and female) and their provision of sufficient and excellent performance rankings for their tutors. Specifically, significantly higher sufficient and excellent rankings were observed among the male students [sufficient: 71.3% (N = 107) vs 28.7% (N = 43)] than among the female students [excellent: 51.5% (N = 69) vs 48.5% (N = 65)]. However, the female students (6.87 ± 1.9) awarded a significantly higher mean performance ranking (1–10) than the male students (5.98 ± 2.1) (p < 0.001), according to the independent t-test at < 0.05.
Table 9
Associations between the students’ gender and mean performance ranking for tutors awarded by the students (N = 284).
| Total | Gender | p-value |
Male | Female |
Total | 284 | 176 (62.0%) | 108 (38.0%) | - |
Performance ranking | Sufficient | 150 | 107 (71.3%) | 43 (28.7%) | 0.001a |
Excellent | 134 | 69 (51.5%) | 65 (48.5%) |
Mean ± SD (1–10) | 5.98 ± 2.1 | 6.87 ± 1.9 | < 0.001b |
a-significant using the Chi-square test at < 0.05. b-significant using the independent t-test at < 0.05. |
At the end of the questionnaire, the students were asked an open-ended question on their recommendations for improving PBL. The following five themes emerged from their responses.
Tutor’s role
Some students opined that during the sessions, the tutor should be more of a facilitator than an observer. Moreover, the tutor should put effort into preparing for the sessions. Some preferred having a tutor who specialized in the same area as the discussed case to gain more knowledge about the topic. However, others believed that tutors should provide them with information and resources.
PBL session planning
Some students suggested conducting online PBL sessions. Many of them complained about the timing of PBL within the module and suggested separating PBL sessions from exams. Other concerns were the inclusion of materials that required explanation through lectures and topic redundancy, as students felt that the same information was repeated in lectures and PBL sessions. Thus, they suggested that the topics and materials taught in lectures be integrated and supported by PBL. Additionally, students emphasized that cases should be clear, relevant and meaningful, for a comprehensive understanding of the purpose of the case. Moreover, they thought that certain objectives were difficult, vast, unclear and scattered across the various PBL groups. They suggested re-evaluating the objectives of PBL cases.
PBL implementation
Some students preferred to use audio-visual material for enhancing learning. Others reported that PBL sessions were misused as homework or for completing presentations and assignments. They also felt the need for clear points for evaluation.
Safe learning environment
Students shared that in certain sessions, they did not feel safe to express their thoughts and ideas, without the fear of harsh criticism.
Improving group dynamics
The students opined that participation should be encouraged to make the sessions more motivational and interactive.
The data from the faculty focus groups were also analysed according to the five major themes: tutors’ insights into their strengths and weaknesses, challenges in conducting PBL, tutors’ ways of preparing for PBL, feedback and suggestions for improving PBL workshops.
Theme 1: Tutors’ insights into their strengths and weaknesses
Most of the senior faculty members said that at the beginning of their tutoring journey, they would reflect upon their practice, strengths and weaknesses after each session, until they mastered them and it became routine. Overall, the participants cited both direct and indirect ways of gaining greater insight into one’s practices. The group agreed that receiving direct feedback from students helped identify their strengths and weaknesses. An additional indirect method was observing group dynamics, such as students’ motivation, interaction and engagement. They added that reflection and improvement are dynamic processes. They explained that, for example, if students performed well, it made a tutor believe that they too were doing well. The group also mentioned that by reading and expanding knowledge and mindfulness, they could assess their strengths and weaknesses better.
Theme 2: Challenges in conducting PBL
Tutor-related challenges
Time management was a major challenge, followed by the acceptance of diversity among students and management of dominant students. The age gap between the tutor and students was cited as another challenge in PBL. The other challenges mentioned were meeting objectives and obtaining answers from students. Additionally, some of the tutors perceived case content as challenging, especially when they found the case stimulating. If a tutor does not prefer the case’s specialty or context, then facilitating and making students view the case as a real-world scenario become challenging. Lastly, an emerging challenge was the non-recognition of the value of PBL by some of the tutors, who were only looking to cover their teaching hours.
Student-related challenges
Most of the faculty members faced challenges in convincing students of the value of PBL. Another challenge was involving students, as they seemed unmotivated, exhausted and uncommitted to achieving the objectives. The tutors added that students tended to distribute the objectives among themselves, causing difficulties in summarizing and limiting the diversity of research resources.
Theme 3: Tutors’ ways of preparing for PBL
Pre-session preparation
Before the session, most of the faculty members reviewed the curriculum, lectures and objectives. However, some only read the objectives; their intention was to remain authentic by considering themselves as students and ignite interest in investigating the case. They believed that this would make students feel more responsible for their learning processes.
Case-related preparation
The group agreed that creating cases on the basis of real-world scenarios helped prepare the sessions. Most of the faculty members thought that the best ways to prepare were reading the case in advance, reviewing the objectives and devising ways to direct, stimulate and engage students. Another approach was watching videos of PBL sessions, reading the latest reviews of the case and searching for advanced resources. In case discussion sessions, some of the tutors addressed clarifications by case writers to understand how to link the case objectives.
Site-related preparation
One group mentioned that they usually did not check the assigned session locations beforehand, while another group would check the location for suitability.
Theme 4: Feedback
The tutors approached feedback differently. Some of the faculty members provided group feedback at the end of each session by collectively asking students about what went well and what needed improvement in terms of the sessions, cases and tutor. Others provided feedback only on the PBL content and process. Only one of the 21 tutors participating in the focus groups provided individual feedback to each student; the others did not do this because of time constraints. Some of the tutors allowed students to provide peer feedback. However, they agreed that students were not trained to do this. Overall, there was consensus on feedback being an integral part of the PBL process.
Theme 5: Suggestions for improving PBL workshops
When questioned about the prospect of being observed by a trained PBL faculty member from the MED during sessions and receiving reports on their strengths and possible areas of improvement, the senior tutors were supportive but only as an optional opportunity outside the purview of administration. By contrast, the junior tutors felt that observations might be stressful and instead suggested internal peer review within departments.