Teaching and Learning Forum 2000 [ Proceedings Contents ]

Fostering of self directed learning in the unit Medical Science 283

Julie Kendrick and Rosemary Johnston
Department of Health Information Management
Curtin University of Technology
    In depth knowledge of medical science is necessary for accurate clinical classification of diseases and associated procedures (Nosology). As the Nosology field is a main source of employment for the Bachelor of Science (Health Information Management) graduates in the field of clinical coding, a unit meeting specific professional needs had to be designed. The existing generic unit was too broadly based, consequently a relevant, medically current, and course linked unit was written for Semester 2, 1999.

    The new format to encourage independent learning was based on self directed principles and consisted of workbook completion, multimedia presentations and review seminars. Learning goals were set with a range of choice for student participation (group or individual), assessment and due dates. Self regulation was maintained by informal contracts; students were monitored and encouraged to seek help from staff throughout the semester.

    Structured evaluation of the students' understanding of information sources, research ability and presentation skills via various modes was carried out throughout the semester. The students' attitude to problem solving, group cohesion, workbook completion and response to self directed learning has been analysed, the results of which indicate a substantial increase in enjoyment of the unit, understanding of the material and relevance of this knowledge to the degree. It was rewarding for both staff and students to see a noticeable overall increase in the pass mark. Analysis also enabled reflection and further course revision.

    The formula of learning with guidance from a variety of self chosen, self regulated options will enable graduates to become self seeking and motivated in knowledge acquirement as they set and meet their personal and professional goals.

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Student and staff dissatisfaction prompted a major review of the unit Principles of Disease Processes 283, a core second year unit in the Bachelor of Science (Health Information Management) program. The structure and content of the existing unit was not sufficiently relevant to the Health Information Management program, so early in 1999 it was taken over by the Department of Health Information Management (HIM) for restructuring to fulfill course objectives and professional competencies.

The unit content, integral to other corequisite units, was divided into a series of teaching strategies, all suitable for self directed learning and catered for internal, distance and extension students. Based on the premise that medical knowledge, technology and terminology are dynamic, students need to learn and foster self regulation in information seeking so as graduates, the responsibility for learning is shifted from the institution to the individual.

End of semester unit evaluation questionnaires over a period of years had documented student desire for change of content and delivery. Through internal staff development, HIM lecturers were exposed to new teaching methods and approaches, including the University's move toward self directed learning (SDL). It was felt that the new unit would be ideally suited to this mode of teaching, enabling students to learn the required academic information, enhance generic skills and in particular, recognise the value of self regulated learning.

Staff then went on a steep learning curve to examine the ways and means of establishing a totally SDL unit. The goal was to provide students with the professional competencies and range of skills necessary to enable them to become self regulated learners and work effectively in groups.

Need for fostering of self directed learning

A paper presented at the Ninth National Casemix Conference discussed the very issue of the accuracy of coding being linked to the coder's depth of medical knowledge (Stevens, Unwin and Codde, 1997). The paper went on to discuss that a coder who achieved the highest accuracy rate participated in, or sought, ongoing coder education.

Current literature supports the view that graduates need to learn to effectively use a variety of information sources (Bruce, 1998) and develop self regulated learning strategies (Lindner and Harris, 1993; Grow, 1991; Hiemstra, 1994) if they are to be successful both within, and external to, the academic environment. Zimmerman (1998) supports this view when writing of the need for the development of a self regulated approach to learning where self monitoring can be an invaluable tool in the continued success in the university environment. Such skills will enhance learning in the dynamic field of medical science. This view is further supported by Zimmerman, Greenberg and Weinstein (1994) where time management skills in terms of self regulating academic study time is discussed. The authors write of students who have control of their time as having less tensions. In the field of medicine and clinical classification where deadlines must be met in order for hospitals to produce correct budgets, the skill of time management, ability to work as a team member and the skill to self assess and monitor is invaluable, particularly if tensions are reduced. To ensure that graduates do seek continuing education it is imperative they be given the skills to become self regulated learners and there is no return to the expectation of 'spoon feeding'.

The unit

The new unit written to include self directed learning is Medical Science 283 (formerly Principles of Disease Processes 283). It was revised to include two study modules: pharmacology and clinical medicine. Similar teaching strategies were used for both modules which were coordinated by the same facilitator.

The unit objectives and content are as follows:

Students will be able to:

Changes that took place

The previous format of the unit consisted of formal lectures with set readings taught within fixed time constraints. This comprised a 2 hour lecture and a 2 hour laboratory session held each teaching week. Assessment included the writing up of a wet laboratory manual, doing three tests and a final examination. Ninety percent (90%) attendance at lectures and laboratories was compulsory. Students did not like this rigid format and information delivered in a didactic manner.

The new format of the unit provides information given in a workbook, similar to that used in first year medical terminology, with exercises and content used for exams. There is also a comprehensive choice of other assessment. Students have the opportunity to learn and develop skills in goal setting, group work and self regulation.

Having chosen research topics from a wide range, presentation mode choices are as follows:

Assessment was a mix of set and peer assessment for presentations; workbook completion and seminar participation. The final examination, which had to be passed, was based on workbook material only.

Staff and students negotiated the dates for workbook completion and review seminars. Presentation dates were set, but students chose the day on which they wished to present.

Teaching strategies included attendance at an introductory lecture to explain the format and expectations of the unit. The video 'Collaborative Learning' (Macbeth and MacCallum, 1996) was also viewed and discussed. Students divided into groups and entered into informal individual contracts with staff. The contract included personal goal setting, establishing dates for completion of the workbook and assessment options. It was continually impressed upon the students that academic help was always available.

Students were given the opportunity to self evaluate the effectiveness of working within groups in accordance with a materials package on this topic (Clarke, Wideman and Eadie, 1990). Students also had a further opportunity to self evaluate when they completed an eight self directed characteristics checklist (Radloff and de la Harpe, 1999) at the start of the unit, (Week 1), half way through (Week 6) and at the unit's completion (Week 14). This enabled the students to personally assess how they were going and whether the changes were working.


Expected outcomes Measures Actual outcomes

1.Self regulated students, self seeking students; passive students become active students 1a.Determine the number of different types of information sources used 1a.Prescribed textbooks, reference books, journal articles, web sites.
1b.Choice of assessment options 1b.Students made traditional choices of standard research reports, as well as other options eg: poster, web page, educational package and role play.
1c.SDL checklist characteristic shifts 1c.Students completed the self directed characteristics checklist during Week 1, 6 and 14 of the unit. Analysis of the checklists saw a definite shift. Across most characteristics there was an increase in the student's perception of their importance. The characteristic of accessing and applying knowledge decreased in its level importance by Week 14, at the same time as the current level in the learner increased. The current level in students for all other characteristics showed an increase.
1d.Student satisfaction questionnaires 1d.The majority of students were well satisfied with the unit. Comments and constructive criticisms form the basis for the latter sections of this paper.

2.Workbook completion 2.Monitor contract compliance 2.Given the informal nature of contracts, those students who were motivated complied with the contracts, those who were less so tended to have more difficulty adhering to their own goal setting. There was compliance early in the semester but this dropped off, hence workbook completion prior to exams ranged from 5% to 100%.

3.Ability to goal set, manage time and work effectively as a team member 3a.Adherence to assessment contracts 3a.All presentations and research reports were completed on time.
3b.Determine the number of assessment options completed by due dates 3b.All
3c.Completion of self evaluation regarding effectiveness by working in a group. 3c.All

4.Course material delivered successfully and content understood 4.Academic and peer assessment 4.Student: research material of own topic very well understood: room for improvement to increase all knowledge gained from presentations. Academic: well pleased with effort in researching topics, room for improvement in workbook completion.

5.Industry standards met 5.60% final pass mark for unit 5.All students passed.

6.Use of varied information sources 6.Identify the different types of information sources used. 6.Prescribed textbooks, reference books, journal articles, web sites, personal communications.

7.Abolish dissatisfaction with the unit and establish a higher pass rate and a higher average pass mark 7.Compare withdrawal and pass rates for the new unit compared with the superseded unit. 7.No student withdrew whereas, previously some students withdrew fearing failure. Pass rate was 100% compared with a high past failure rate. The average pass mark was also higher.

8.Improved quality of work 8.Quality of work measured by teacher observation and experience. 8.Much improved. Far more relevant to the degree.

Highlights of project

What we have learned about self directed learning through implementing the project

What we would do differently

What strategies worked to encourage the students to be self directed in their learning

What is to be done next with the unit


In conclusion, some advice we would offer to others wanting to encourage self directed learning in their students would be:


Bruce, C.S. (1998). Portrait of an information literate person. HERDSA News, 16(3), 9-11.

Clarke, J., Wideman, R and Eadie, S. (1990). Together we learn - cooperative small group learning. Prentice Hall Canada Inc, Toronto.

Grow, G.O. (1991). Teaching learners to be self-directed. Adult Education Quarterly, 41(3), 125-149.

Hiemstra, R. (1994). Helping learners take responsibility for self-directed activities. New Directions for Adult and Continuing Education, 64, 81-87.

Lindner, R.W. and Harris, B. (1993). Teaching self-regulated learning strategies: Proceedings of selected research and development presentations at the Convention of the Association for Educational Communications and Technology, held in January 1993.

Macbeth, J. and MacCallum, J. (1996). Collaborative learning: Working together in small groups. Murdoch University, Perth. (Videocasette). http://cleo.murdoch.edu.au/tlc/videos/learning/video_collab_learn.html

Radloff, A. and de la Harpe, B. (1999). Self directed characteristics checklist. Centre for Educational Advancement, Curtin University, Perth.

Stevens, S., Unwin, E. and Codde, J. (1997). A review of hospital medical record audits: Implications for funding and training. Proceedings of the Ninth Casemix Conference in Australia, held in Brisbane, September 1997. Canberra.

Zimmerman, B.J. (1998). Academic studying and the development of personal skill: a self regulatory perspective. Educational Psychologist, 33(2/3), 73-86.

Zimmerman, B.J., Greenberg, D. and Weinstein, C.E. (1994). Self-regulating academic study time: a strategic approach. In Schunk, D.H. and Zimmerman, B.J. (Eds.), Self-regulation of learning and performance: Issues and educational applications. Lawrence Erlbaum Associates, Hillsdale, New Jersey, pp. 181-199.

Please cite as: Kendrick, J. and Johnston, R. (2000). Fostering of self directed learning in the unit Medical Science 283. In A. Herrmann and M.M. Kulski (Eds), Flexible Futures in Tertiary Teaching. Proceedings of the 9th Annual Teaching Learning Forum, 2-4 February 2000. Perth: Curtin University of Technology. http://lsn.curtin.edu.au/tlf/tlf2000/kendrick.html

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