Collaboration Rather Than Isolation: Preparing Doctors of Tomorrow for Improved Medical Diagnosis

Introduction Globally, medical schools are responding to the need for more doctors by admitting a greater number of medical students and increasing class sizes. Unfortunately, this increased intake may have detrimental effects on students' learning given the finite resources available for clinical as well as skills training. As a result, educators have called for more cost-effective methods of training and instructional methods that rely less on faculty resources than the traditional one-on-one apprenticeship model. Currently, frontline research proposes an increased focus on the role of collaborative learning in undergraduate medical education.

Recent studies have shown that collaborative learning in the form of dyad training (that is, training in pairs) compared to individual training in a simulated setting leads to improved skills transfer into the clinical workspace as well as improved skills retention. In addition, dyad training is thought to be more cost-effective than individual training because it only requires half the instructional resources, while producing similar or better educational outcomes. Concerns have been raised though, if the potentially reduced hands-on time associated with collaborative learning may affect students' learning in a negative direction over time. Therefore, examining the impact of different constellations of collaborative learning and the conditions under which the training is most effective is key to identifying when and how collaborative learning may improve students' learning outcomes.

In this study, the investigators wish to explore the optimal student ratio in the simulated setting for subsequent skills transfer. The study aims to explore if there are differences in the effect of collaborative learning as a function of the number of collaborators with respect to future individual learning and transfer. Additionally, the investigators will aim to get a better understanding of the interactive processes that take place during collaborative learning. Many different theories have been used to understand collaborative learning, but few observational data have been reported in the medical literature. To gain a deeper understanding of what happens and why, the investigators plan to video record participants during their initial training and code the videos using the ICAP framework. The ICAP framework was developed by Chi in 2009 and is based on students' behaviours to reflect different modes of engagement in learning. The four behavioural modes are described as passive (P), active (A), constructive (C) and interactive (I) and each mode is associated with different examples of learning activities that can be coded. The ICAP theory proposes a hierarchical distribution of learning activities, where interactive activities are superior to constructive activities, which are superior to active activities, which are superior to passive activities (I>C>A>P). The investigators aim to investigate if this framework can serve as a conceptual framework to describe the activities that takes place during training and if these activities can be related to learning outcomes.

Hypothesis/Research question

• Collaborative learning during initial practice leads to different levels of overt learning activities in the students. The higher level of engagement in the ICAP-hierarchy, the higher outcome on the transfer test.
• The amount of hands on time during initial practice may have effect on the immediate skills transfer