Self-directed learning readiness among medical, dental and nursing students: a cross-sectional study at a tertiary care medical university

Self-directed learning readiness among medical, dental and nursing students: a cross-sectional study at a tertiary care medical university | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Self-directed learning readiness among medical, dental and nursing students: a cross-sectional study at a tertiary care medical university Apjit Kaur, Shally Awasthi, Amita Pandey This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3993294/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose – The present study analysed self-directed learning readiness among undergraduate medical, dental and nursing students across the academic years. Methods - The cohort consisted of the undergraduate medical, dental and nursing students of King George's Medical University, Lucknow, India. After institutional ethical clearance, the study started in October 2022 and data collection was completed in March 2023. Following voluntary consent, 746 /775 students (335 medical, 220 dental, and 220 nursing students) recorded their socio-demographic details on a semi-structured questionnaire. They filled the Modified Kumar self-directed learning readiness scale to assess the three domains of self-management, desire for learning and self-control. Data was analysed using SPSS version 26.0 (IBM Corp.). Results − 59.6% of the participants were females, 74% were students aged between 20–24 years, 90% were hostellers, 74% belonged to the middle socioeconomic status and 54% of students had a rural background. Statistical analysis revealed that self-management, desire for learning and self-control were not statistically different at the time of entry into the three courses. However, medical students demonstrated a statistically significant decrease in all parameters as they progressed in years of education. Nursing students maintained their parameters. Scores of female students were higher, but the effect of other demographic parameters was insignificant. Conclusion - The maximum decrease in scores of medical students may be attributed to academic and infrastructure issues. This sets a need for further large-scale longitudinal studies using mixed methods that address various facets of curriculum and institutional infrastructure. Self-directed learning Self-directed learning readiness Self-directed learning readiness scale medical dental and nursing undergraduate students Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Malcolm Knowles ( 1975 ) defined self-directed learning (SDL) as a process in which “individuals take initiative, with or without the help of others in diagnosing their learning needs formulating goals, identifying human and material resources for learning, choosing and implementing appropriate learning strategies and evaluating learning outcomes”. (Knowles 1975 ) Sargeant et al added ‘willingness of the learner’ to this definition. (Sargeant et al 2013 ) SDL necessitates motivation, discipline and a methodological approach. The focus is on the learner rather than the teacher or the instructor. SDL can take place in formal education, online courses or on-the-job training. This approach is becoming increasingly popular, as technology and access to information have made it easy for people to learn on their terms. Individuals with internal motivation have the desire and ability to impact and steer the events that influence their lives. (El-Hosany et al 2017) To make a learner self-directed, the mentor/guide must directly transition the responsibility towards the learner. The concept of SDL does not undermine the relevance of a teacher. Rather it highlights the teacher as a facilitator who ensures that the learner reaches the intended target. Thus, SDL is integral to andragogy. (Duke et al 2002, Fisher et al 2014, Grow et al1991, Ginzburg et al 2020 ) SDL is an important skill that can help individuals establish learning goals, develop new skills and take control of their personal and professional development. Regulatory bodies including the National Medical Commission, the Dental Council of India and the Indian Nursing Councils mandate andragogy for undergraduate medical education. The role of SDL in medical education and medical education emphasizes for students to be lifelong learners. (Loeng 2020 , Rillera and Marzo 2018, Kaufman and Mann 2010 ) Didactic lectures have in modern times, taken a backseat, as a method of teaching. Interactive teaching-learning sessions have come centre stage. The Liaison Committee on Medical Education (LCME), USA and Canada, mandate medical institutions to provide facilities for SDL. (Fong et 2016) In 2019, the curriculum for IMG transitioned to being competency-based. SDL was incorporated by NMC such that 309 hours were dedicated during the MBBS course. Of these, 1st year was allotted 98 hours, and subsequently 85, 66 and 60 hours in the 2nd, 3rd and Final year respectively. (Medical Council of India 2018, Regulations on Graduate Medical Education, 2019) The American Dental Association and Commission on Change and Innovation in Dental Education, both recognized the need for analytical thinking and SDL. The faculty of general dental practice of the Royal College of Surgeons of England too recognized SDL as a learning method of great significance. Academic achievements were dependent upon the individual’s attitude towards SDL. (Royal College of Surgeons of England 2011) Akin to medicine, nursing education is not static. This forms the basis for nursing graduates to become lifelong learners. They must have all the abilities needed to decide the course and style of their learning. The nursing educators too, must have the ability to strategize in favour of learning objectives. (Carol 2013) Learners need to be equipped with SDL skills that propel them towards their academic goals. The authors used a Self-directed learning readiness scale to study the SDL readiness among medical, dental and nursing students of a residential medical university. The outcomes of the study would be considered to modify the teaching-learning to enhance self-directed learning readiness. This is in alignment to prepare the undergraduates as lifelong learners. Materials and Methods A cross-sectional study was conducted on the undergraduate students of medical, dental and nursing courses at the King George's Medical University, Lucknow, India. Students from all academic years of all three courses were approached. 1250 medical, 400 dental, and 400 Nursing students were in the sampling frame. With a 95% confidence level and precision of ± 0.05 P total of 775 students constituted the study sample (335 medical UG + 220 dental UG + 220 nursing UG students) After institutional ethical clearance, the study started in October 2022 and data collection was completed in March 2023. Data analysis was completed by June 2023. Study Tools: Socio-demographic details: A semi-structured questionnaire was applied to obtain socio-demographic details of the participants. Self-Directed Learning Readiness Scale (SDLRS-36 items) Kumar et al 2018 validated the version on Indian students of SDLR including 36 items on 3 subscales i.e., self-management (SM − 10 items), desire for learning (DL- 11 items), and self-control (SC -15 items). This scale is a validated version of SDLR developed by Fisher et al 2001 , which comprised 40 items including 3 factors 13 items of SM, 12 DL items and 15 self-controls (SC items). Procedural details: randomly selected students (computer-generated numbers) were introduced to the researcher and the purpose of the study. A form was given to them physically, that had the purpose of the study and the 3-domain questionnaire. In this form after giving their consent and information about themselves, they had to tick the statements of SDLR. Forms were collected after three hours. One week after the first dissemination of the form, a reminder to fill out the form was sent to selected participants who have not responded. Further, a second and third reminder was given till we got our sample size. Statistical Analysis: Data was analyzed by applying SPSS version 26.0 (IBM Corp.). Descriptive statistics was used to characterize the sample on demographic, academic, personality, and SDLRS variables. Analysis of variance (ANOVA) was used to compare SDLRS scores between academic programs, students' socio-demographic details, and educational backgrounds. Post-hoc analyses was done to explore significant differences between specific academic programs students' socio-demographic details, and educational backgrounds. Observations And Results 746 / 775 students responded to the questionnaire. The cohort had a higher number of female students, 444/746. (59.6%). The majority of the students, 90% students were hostellers. 74% hailed from families of the middle socio-economic status (SES). 52% of students had a rural background. Self-Directed Learning Readiness Scale (SDLRS-36 items) was used for the study. Three domains evaluated were Self-management, Desire for learning and self-control. The scores were calculated for each domain/student/year/course. A comparative graph of year-wise self-management (Fig. 1) revealed that the self-management score was higher in MBBS 1st year students than the students in the medical 5th year (statistically significant, p < 0.05). No significant change was seen in dental and Nursing student’s scores Post hoc Analysis for Desire of Learning, depicted in Fig. 2 revealed that the score was significantly higher in medical (MBBS) 1st year students compared to the students in 5th year. Also, dental (BDS) 1st-year students had higher scores than final year (p < 0.05). There was no significant change in scores of Nursing students over the years of academic progression. The analysis of Self-control using the Turkey post hoc test showed statistically higher scores in both MBBS 1st year students compared to the students in MBBS 5th year (p < 0.05) and BDS students compared to their final year. No change in scores was noted in the scores of nursing undergraduates (Fig. 3). Self-management scores of first-year undergraduates of all three courses were similar. Scores of self-management among MBBS, BDS and nursing final-year students also did not have a significant difference. (Fig. 4) Figure 5, the box plot graph of Desire for learning showed that it was statistically significantly higher in MBBS 1st year students than the students in MBBS 5th year (p < 0.05) & BDS 1st year students in comparison to BDS 4th year students (p < 0.05). However, no statistically significant difference in the desire to learn of the nursing 1st-year students as compared to nursing 4th year was identified. Also, the desire for learning of the MBBS 1st year students as compared to Nursing and BDS 1st year students were similar. A statistically significant difference was not observed in the desire to learn among the final-year students of MBBS, BDS and Nursing. Comparative box plot of Self Control (Fig. 6) reveals that both MBBS and BDS 1st year students had significantly higher self-control as compared to final years (p < 0.05). The nursing students did not show this pattern. The self-control scores of the first-year students of all three courses did not show a significant difference. Likewise, the scores for final-year students of these courses did not vary significantly. The overall SDLR scores of MBBS and BDS students were higher in 1st year and decreased significantly in the final year. The overall SDLR of Nursing students was similar to MBBS and BDS in 1st year but did not change in the final year Discussion The current study has the uniqueness of providing medical, dental and nursing courses on the same campus. The National Medical Council of India mandates that education for the Indian Medical Graduate (IMG) should follow an andragogy pattern, thus shifting the responsibility of learning to the individual student. In India, till standard twelve of school education, learning is pedagogical, where students follow pre-set methods, syllabi and resources. (Medical Council of India 2021) Ginzburg et al ( 2020 ) in their commentary highlighted the nuances of self-directed learning. Self-directed learning has found its place not only in medicine but in dental and nursing education too. (Fisher et al 2001 , Taylor 2023) The decision to join the medical, dental or nursing field, is most often, a conscious decision by the individual. Thus, it could be presumed that students would be aware of the intense efforts and commitment inherent in the courses. The challenge is compounded by the fact that the learning is life-long. The question arises - Are our undergraduate students prepared for Self- Directed Learning? This study aimed to assess the self-directed learning readiness among contemporary students of medical, dental and nursing courses at the undergraduate level. The cohort had a higher number of female students, 59.6%, as compared to males 40.4%. This is by the national trends reported in the Ministry of Education release of the All-India Survey of Higher Education (AISHE)for 2020–2021. In the report of 2014-15, 45% of females were enrolled out of the total enrolment. This percentage rose to 49% as per the 2020-21 report. In the present study majority of participants (74%) were in the age range of 19 years to 27 years in the present study. The age at which most students appear for medical and paramedical entrance exams is 18 years. However, only a small percentage cleared the exam on the first attempt. This leads them into the age bracket reflected in the study cohort. Self-directed learning readiness was assessed under three domains- self-management, desire for learning and self-control. From data analysis, it emerged that all three domains had similar mean percentages in the first year of education. This could be an outcome of the fact that medical and dental students have a common entrance exam. Those who are unsuccessful in the attempt, often opt for nursing, as it is a closely allied field. Thus, it is logical to expect the students to have similar characteristics and attitudes towards the education they desire. In the current educational scenario, MBBS is a stepping stone to the higher destinations of post-graduation and super-speciality. The constant need for consistency and perseverance with regular schedules becomes too demanding. Work overload and tight schedules lead to procrastination of tasks. This, in a way, adversely impacts self-management. The course duration of dentistry and nursing is shorter. Nursing has a further advantage in that the graduate nurse finds adequate opportunities for employability. This keeps the tempo of work alive and in sync with the time schedules. It can be argued that a decrease in the desire for learning scores is unexpected for courses (both medical and dental) that naturally lead to progression towards higher education. But here it must be remembered that the DL was analysed in the context of the current courses. It is common knowledge that a vast part of the syllabus that is covered during undergraduate years does not follow the pattern of the competitive examinations that ensue. This becomes a deterrent to the desire to learn in the context of the courses. The nursing course has a relatively narrower syllabus with early clinical exposure. Probably this combines to maintain the constancy in mean percentages of all three domains of SDLR. Kalyani Premkumar et al analysed the self-directed learning readiness scores of medical students of Christian Medical College, Vellore, India. Their study aimed to evaluate the opinions of faculty and students regarding the factors that impact self-directed learning, both by enhancing or deterring it. They also studied the role of curriculum and culture in this regard. For this, they collected data from students of all the undergraduate years. Faculty was interviewed. Thus, their study had a mixed-method design. They too reported a statistically significant decrease in SDLRS scores for students over the years of course progression. Their qualitative analysis showed a notable role of curriculum and culture in causing the drop in scores. Their observations support our explanations. and lend strength to the thought that together, extensive and exhaustive curricula lead to a decrease in self-management. Faten et al (2022) studied SDL in Medical students using Fisher’s scale comprising similar three domains. Their cohort had 300 students of which only 96 responded. They clubbed the students into pre-clinical and clinical groups. Their observations revealed that the domains of desire for learning and self-control had a positive correlation if self-management was controlled. Similarly, if the desire for learning was controlled then both self-management and self-control had a positive correlation. They suggested that the relatively lower scores of SDLR in their study meant that self-directed learning alone could not be relied upon for desired learning. Strategies to assist students in enhancing their readiness for independent learning need implementation. Punita Sharma et al ( 2022 ) studied Readiness for Self-directed Learning among undergraduate Medical Students of Northern India and the impact of the measures that were implemented. Their cohort was medical students of the 2018 and 2019 batch. The 2019 batch was introduced to the tools of SDL. They observed that the students of the 2019 batch of MBBS who were sensitised to SDL and used the methods for the same had higher scores as compared to the students from the 2018 batch. The results were statistically significant. They attributed the enhanced scores to the use of various teaching modalities to impart SDL. Their study further emphasized that by promoting the characteristics of self-directed learning, medical graduates could become lifelong learners. Kar SS et al ( 2014 ) and Madhavi et al (2017) in their research on medical students in south India documented that the self-directed learning scores were lower for medical students than the standard mean. Only 30% and 36% of their study population respectively had high scores (more than 150). Al Radini et al 21 made similar observations. Shanker et al (2011) from Nepal reported an increase in Self-management scores in their study cohort after exposing the students to a partially problem-based learning method. The desire for learning and self-control scores did not show an impact. S Malta et al ( 2010 ) observed that self-directed learning readiness progresses with academic progression. However, their cohort was not medical students. Nevertheless, it does give food for thought that self-directed learning readiness is modifiable. This concept is supported by the analysis carried out by Kocaman G et al ( 2009 ) on nursing students who depicted an increase in scores with academic growth. They related SDL to be a maturation process. The study carried out by Balamurugan S and Kumar H ( 2015 ) highlighted that self-directed learning is a process, rather than an exam-centred event. This too resonates with the idea that SDLR is an ongoing, inducible capacity that can be impacted by variables. This brings validation to our suggestion that the curricula should be modified to bring about the enhancement of SDLR scores. The current study is unique as it compared three domains of SDLR across three courses at a residential medical university. A literature search does not reveal a similar study. However, this being a cross-sectional study, it does not trace the changes in the domains over the course of the study for the same batch. Also, it being a single-method questionnaire-based study, it does not address the qualitative aspects associated with SDLR. Further studies can be planned to assess the impact of the introduction of SDL methods on the SDLR. Emotional Intelligence can also be evaluated for its impact on SDLR as students’ progress in their academic years. Based on the outcomes of the study the authors suggest that the undergraduate students should be introduced to the concept of SDL during the foundation course in all three courses. The SDL methods should be integrated with the teaching-learning process. There should be simultaneous longitudinal studies that aim to assess all factors from multifaceted spheres that bear an impact on the SDLR of candidates. Early identification of lacunae and their redressal could, perhaps lay the foundation for better-prepared lifelong learners. Declarations Nil financial disclosure. No conflict of interests Author Contribution AK, SA and AP actively participated in the formulation of the manuscript. AK wrote the manuscript and prepared the figures. All authors reviewed the manuscript. References Knowles, M. S. (1975). Self-Directed Learning: A Guide for Learners and Teachers . Cambridge Adult Education, Prentice Hall Regents. Sargeant, J., Bruce, D., & Campbell, C. M. (2013). 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3","display":"","copyAsset":false,"role":"figure","size":46999,"visible":true,"origin":"","legend":"\u003cp\u003eComparative graph of the year-wise self-control for medical (MBBS), dental (BDS) and nursing students\u003c/p\u003e","description":"","filename":"FIGURE3.png","url":"https://assets-eu.researchsquare.com/files/rs-3993294/v1/1169159f943f728d42ed5621.png"},{"id":51970902,"identity":"a7849917-4e50-40fa-93dc-9f9b8d2878a9","added_by":"auto","created_at":"2024-03-04 18:49:05","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":73793,"visible":true,"origin":"","legend":"\u003cp\u003eBox-plot of percentage score for self-management by pursuing the course for medical (MBBS), dental (BDS) and nursing students\u003c/p\u003e","description":"","filename":"FIGURE4.png","url":"https://assets-eu.researchsquare.com/files/rs-3993294/v1/14b4807d02b25aeae06af713.png"},{"id":51970903,"identity":"d9f9106f-7d93-4e2f-895f-8ce9c3338921","added_by":"auto","created_at":"2024-03-04 18:49:05","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":71690,"visible":true,"origin":"","legend":"\u003cp\u003eBox-plot of percentage score for total desire for learning by pursuing the course for medical (MBBS), dental (BDS) and nursing students\u003c/p\u003e","description":"","filename":"FIGURE5.png","url":"https://assets-eu.researchsquare.com/files/rs-3993294/v1/54289a3d2079d93cb92a4423.png"},{"id":51970904,"identity":"ea8567e3-1f7e-40d0-a192-c558f5dd999b","added_by":"auto","created_at":"2024-03-04 18:49:05","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":65031,"visible":true,"origin":"","legend":"\u003cp\u003eBox-plot of percentage score for self-control by pursuing the course for medical (MBBS), dental (BDS) and nursing students\u003c/p\u003e","description":"","filename":"FIGURE6.png","url":"https://assets-eu.researchsquare.com/files/rs-3993294/v1/7e3283bb9d707014b767d780.png"},{"id":51974024,"identity":"ef1007b7-4170-4a03-b84c-86c218cc2cb4","added_by":"auto","created_at":"2024-03-04 19:05:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":535623,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3993294/v1/a8cab89b-d10b-4d7f-bb52-a6095ad6a3b5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Self-directed learning readiness among medical, dental and nursing students: a cross-sectional study at a tertiary care medical university","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalcolm Knowles (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1975\u003c/span\u003e) defined self-directed learning (SDL) as a process in which \u0026ldquo;individuals take initiative, with or without the help of others in diagnosing their learning needs formulating goals, identifying human and material resources for learning, choosing and implementing appropriate learning strategies and evaluating learning outcomes\u0026rdquo;. (Knowles \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1975\u003c/span\u003e) Sargeant et al added \u0026lsquo;willingness of the learner\u0026rsquo; to this definition. (Sargeant et al \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) SDL necessitates motivation, discipline and a methodological approach. The focus is on the learner rather than the teacher or the instructor. SDL can take place in formal education, online courses or on-the-job training. This approach is becoming increasingly popular, as technology and access to information have made it easy for people to learn on their terms.\u003c/p\u003e \u003cp\u003eIndividuals with internal motivation have the desire and ability to impact and steer the events that influence their lives. (El-Hosany et al 2017) To make a learner self-directed, the mentor/guide must directly transition the responsibility towards the learner. The concept of SDL does not undermine the relevance of a teacher. Rather it highlights the teacher as a facilitator who ensures that the learner reaches the intended target. Thus, SDL is integral to andragogy. (Duke et al 2002, Fisher et al 2014, Grow et al1991, Ginzburg et al \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) SDL is an important skill that can help individuals establish learning goals, develop new skills and take control of their personal and professional development.\u003c/p\u003e \u003cp\u003eRegulatory bodies including the National Medical Commission, the Dental Council of India and the Indian Nursing Councils mandate andragogy for undergraduate medical education. The role of SDL in medical education and medical education emphasizes for students to be lifelong learners. (Loeng \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Rillera and Marzo 2018, Kaufman and Mann \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) Didactic lectures have in modern times, taken a backseat, as a method of teaching. Interactive teaching-learning sessions have come centre stage. The Liaison Committee on Medical Education (LCME), USA and Canada, mandate medical institutions to provide facilities for SDL. (Fong et 2016) In 2019, the curriculum for IMG transitioned to being competency-based. SDL was incorporated by NMC such that 309 hours were dedicated during the MBBS course. Of these, 1st year was allotted 98 hours, and subsequently 85, 66 and 60 hours in the 2nd, 3rd and Final year respectively. (Medical Council of India 2018, Regulations on Graduate Medical Education, 2019) The American Dental Association and Commission on Change and Innovation in Dental Education, both recognized the need for analytical thinking and SDL. The faculty of general dental practice of the Royal College of Surgeons of England too recognized SDL as a learning method of great significance. Academic achievements were dependent upon the individual\u0026rsquo;s attitude towards SDL. (Royal College of Surgeons of England 2011) Akin to medicine, nursing education is not static. This forms the basis for nursing graduates to become lifelong learners. They must have all the abilities needed to decide the course and style of their learning. The nursing educators too, must have the ability to strategize in favour of learning objectives. (Carol 2013)\u003c/p\u003e \u003cp\u003eLearners need to be equipped with SDL skills that propel them towards their academic goals. The authors used a Self-directed learning readiness scale to study the SDL readiness among medical, dental and nursing students of a residential medical university. The outcomes of the study would be considered to modify the teaching-learning to enhance self-directed learning readiness. This is in alignment to prepare the undergraduates as lifelong learners.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eA cross-sectional study was conducted on the undergraduate students of medical, dental and nursing courses at the King George's Medical University, Lucknow, India. Students from all academic years of all three courses were approached. 1250 medical, 400 dental, and 400 Nursing students were in the sampling frame. With a 95% confidence level and precision of \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;0.05 P total of 775 students constituted the study sample (335 medical UG\u0026thinsp;+\u0026thinsp;220 dental UG\u0026thinsp;+\u0026thinsp;220 nursing UG students)\u003c/p\u003e \u003cp\u003eAfter institutional ethical clearance, the study started in October 2022 and data collection was completed in March 2023. Data analysis was completed by June 2023.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Tools:\u003c/h2\u003e \u003cp\u003eSocio-demographic details: A semi-structured questionnaire was applied to obtain socio-demographic details of the participants. Self-Directed Learning Readiness Scale (SDLRS-36 items) Kumar et al 2018 validated the version on Indian students of SDLR including 36 items on 3 subscales i.e., self-management (SM \u0026minus;\u0026thinsp;10 items), desire for learning (DL- 11 items), and self-control (SC -15 items). This scale is a validated version of SDLR developed by Fisher et al \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2001\u003c/span\u003e, which comprised 40 items including 3 factors 13 items of SM, 12 DL items and 15 self-controls (SC items).\u003c/p\u003e \u003cp\u003eProcedural details: randomly selected students (computer-generated numbers) were introduced to the researcher and the purpose of the study. A form was given to them physically, that had the purpose of the study and the 3-domain questionnaire. In this form after giving their consent and information about themselves, they had to tick the statements of SDLR. Forms were collected after three hours. One week after the first dissemination of the form, a reminder to fill out the form was sent to selected participants who have not responded. Further, a second and third reminder was given till we got our sample size.\u003c/p\u003e \u003cp\u003eStatistical Analysis: Data was analyzed by applying SPSS version 26.0 (IBM Corp.). Descriptive statistics was used to characterize the sample on demographic, academic, personality, and SDLRS variables. Analysis of variance (ANOVA) was used to compare SDLRS scores between academic programs, students' socio-demographic details, and educational backgrounds. Post-hoc analyses was done to explore significant differences between specific academic programs students' socio-demographic details, and educational backgrounds.\u003c/p\u003e \u003c/div\u003e"},{"header":"Observations And Results","content":"\u003cp\u003e746 / 775 students responded to the questionnaire. The cohort had a higher number of female students, 444/746. (59.6%). The majority of the students, 90% students were hostellers. 74% hailed from families of the middle socio-economic status (SES). 52% of students had a rural background.\u003c/p\u003e\n\u003cp\u003eSelf-Directed Learning Readiness Scale (SDLRS-36 items) was used for the study. Three domains evaluated were Self-management, Desire for learning and self-control. The scores were calculated for each domain/student/year/course. A comparative graph of year-wise self-management (Fig.\u0026nbsp;1) revealed that the self-management score was higher in MBBS 1st year students than the students in the medical 5th year (statistically significant, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant change was seen in dental and Nursing student\u0026rsquo;s scores\u003c/p\u003e\n\u003cp\u003ePost hoc Analysis for Desire of Learning, depicted in Fig.\u0026nbsp;2 revealed that the score was significantly higher in medical (MBBS) 1st year students compared to the students in 5th year. Also, dental (BDS) 1st-year students had higher scores than final year (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no significant change in scores of Nursing students over the years of academic progression.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe analysis of Self-control using the Turkey post hoc test showed statistically higher scores in both MBBS 1st year students compared to the students in MBBS 5th year (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and BDS students compared to their final year. No change in scores was noted in the scores of nursing undergraduates (Fig.\u0026nbsp;3).\u003c/p\u003e\n\u003cp\u003eSelf-management scores of first-year undergraduates of all three courses were similar. Scores of self-management among MBBS, BDS and nursing final-year students also did not have a significant difference. (Fig.\u0026nbsp;4)\u003c/p\u003e\n\u003cp\u003eFigure 5, the box plot graph of Desire for learning showed that it was statistically significantly higher in MBBS 1st year students than the students in MBBS 5th year (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) \u0026amp; BDS 1st year students in comparison to BDS 4th year students (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, no statistically significant difference in the desire to learn of the nursing 1st-year students as compared to nursing 4th year was identified. Also, the desire for learning of the MBBS 1st year students as compared to Nursing and BDS 1st year students were similar.\u003c/p\u003e\n\u003cp\u003eA statistically significant difference was not observed in the desire to learn among the final-year students of MBBS, BDS and Nursing.\u003c/p\u003e\n\u003cp\u003eComparative box plot of Self Control (Fig.\u0026nbsp;6) reveals that both MBBS and BDS 1st year students had significantly higher self-control as compared to final years (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The nursing students did not show this pattern. The self-control scores of the first-year students of all three courses did not show a significant difference. Likewise, the scores for final-year students of these courses did not vary significantly.\u003c/p\u003e\n\u003cp\u003eThe overall SDLR scores of MBBS and BDS students were higher in 1st year and decreased significantly in the final year. The overall SDLR of Nursing students was similar to MBBS and BDS in 1st year but did not change in the final year\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study has the uniqueness of providing medical, dental and nursing courses on the same campus. The National Medical Council of India mandates that education for the Indian Medical Graduate (IMG) should follow an andragogy pattern, thus shifting the responsibility of learning to the individual student. In India, till standard twelve of school education, learning is pedagogical, where students follow pre-set methods, syllabi and resources. (Medical Council of India 2021) Ginzburg et al (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) in their commentary highlighted the nuances of self-directed learning. Self-directed learning has found its place not only in medicine but in dental and nursing education too. (Fisher et al \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2001\u003c/span\u003e, Taylor 2023) The decision to join the medical, dental or nursing field, is most often, a conscious decision by the individual. Thus, it could be presumed that students would be aware of the intense efforts and commitment inherent in the courses. The challenge is compounded by the fact that the learning is life-long. The question arises - Are our undergraduate students prepared for Self- Directed Learning? This study aimed to assess the self-directed learning readiness among contemporary students of medical, dental and nursing courses at the undergraduate level.\u003c/p\u003e \u003cp\u003eThe cohort had a higher number of female students, 59.6%, as compared to males 40.4%. This is by the national trends reported in the Ministry of Education release of the All-India Survey of Higher Education (AISHE)for 2020\u0026ndash;2021. In the report of 2014-15, 45% of females were enrolled out of the total enrolment. This percentage rose to 49% as per the 2020-21 report.\u003c/p\u003e \u003cp\u003eIn the present study majority of participants (74%) were in the age range of 19 years to 27 years in the present study. The age at which most students appear for medical and paramedical entrance exams is 18 years. However, only a small percentage cleared the exam on the first attempt. This leads them into the age bracket reflected in the study cohort.\u003c/p\u003e \u003cp\u003eSelf-directed learning readiness was assessed under three domains- self-management, desire for learning and self-control. From data analysis, it emerged that all three domains had similar mean percentages in the first year of education. This could be an outcome of the fact that medical and dental students have a common entrance exam. Those who are unsuccessful in the attempt, often opt for nursing, as it is a closely allied field. Thus, it is logical to expect the students to have similar characteristics and attitudes towards the education they desire.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn the current educational scenario, MBBS is a stepping stone to the higher destinations of post-graduation and super-speciality. The constant need for consistency and perseverance with regular schedules becomes too demanding. Work overload and tight schedules lead to procrastination of tasks. This, in a way, adversely impacts self-management. The course duration of dentistry and nursing is shorter. Nursing has a further advantage in that the graduate nurse finds adequate opportunities for employability. This keeps the tempo of work alive and in sync with the time schedules. It can be argued that a decrease in the desire for learning scores is unexpected for courses (both medical and dental) that naturally lead to progression towards higher education. But here it must be remembered that the DL was analysed in the context of the current courses. It is common knowledge that a vast part of the syllabus that is covered during undergraduate years does not follow the pattern of the competitive examinations that ensue. This becomes a deterrent to the desire to learn in the context of the courses. The nursing course has a relatively narrower syllabus with early clinical exposure. Probably this combines to maintain the constancy in mean percentages of all three domains of SDLR.\u003c/p\u003e \u003cp\u003eKalyani Premkumar et al analysed the self-directed learning readiness scores of medical students of Christian Medical College, Vellore, India. Their study aimed to evaluate the opinions of faculty and students regarding the factors that impact self-directed learning, both by enhancing or deterring it. They also studied the role of curriculum and culture in this regard. For this, they collected data from students of all the undergraduate years. Faculty was interviewed. Thus, their study had a mixed-method design. They too reported a statistically significant decrease in SDLRS scores for students over the years of course progression. Their qualitative analysis showed a notable role of curriculum and culture in causing the drop in scores. Their observations support our explanations. and lend strength to the thought that together, extensive and exhaustive curricula lead to a decrease in self-management.\u003c/p\u003e \u003cp\u003eFaten et al (2022) studied SDL in Medical students using Fisher\u0026rsquo;s scale comprising similar three domains. Their cohort had 300 students of which only 96 responded. They clubbed the students into pre-clinical and clinical groups. Their observations revealed that the domains of desire for learning and self-control had a positive correlation if self-management was controlled. Similarly, if the desire for learning was controlled then both self-management and self-control had a positive correlation. They suggested that the relatively lower scores of SDLR in their study meant that self-directed learning alone could not be relied upon for desired learning. Strategies to assist students in enhancing their readiness for independent learning need implementation.\u003c/p\u003e \u003cp\u003ePunita Sharma et al (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) studied Readiness for Self-directed Learning among undergraduate Medical Students of Northern India and the impact of the measures that were implemented. Their cohort was medical students of the 2018 and 2019 batch. The 2019 batch was introduced to the tools of SDL. They observed that the students of the 2019 batch of MBBS who were sensitised to SDL and used the methods for the same had higher scores as compared to the students from the 2018 batch. The results were statistically significant. They attributed the enhanced scores to the use of various teaching modalities to impart SDL. Their study further emphasized that by promoting the characteristics of self-directed learning, medical graduates could become lifelong learners.\u003c/p\u003e \u003cp\u003eKar SS et al (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) and Madhavi et al (2017) in their research on medical students in south India documented that the self-directed learning scores were lower for medical students than the standard mean. Only 30% and 36% of their study population respectively had high scores (more than 150). Al Radini et al\u003csup\u003e21\u003c/sup\u003e made similar observations.\u003c/p\u003e \u003cp\u003eShanker et al (2011) from Nepal reported an increase in Self-management scores in their study cohort after exposing the students to a partially problem-based learning method. The desire for learning and self-control scores did not show an impact.\u003c/p\u003e \u003cp\u003eS Malta et al (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) observed that self-directed learning readiness progresses with academic progression. However, their cohort was not medical students. Nevertheless, it does give food for thought that self-directed learning readiness is modifiable. This concept is supported by the analysis carried out by Kocaman G et al (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) on nursing students who depicted an increase in scores with academic growth. They related SDL to be a maturation process. The study carried out by Balamurugan S and Kumar H (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) highlighted that self-directed learning is a process, rather than an exam-centred event. This too resonates with the idea that SDLR is an ongoing, inducible capacity that can be impacted by variables. This brings validation to our suggestion that the curricula should be modified to bring about the enhancement of SDLR scores.\u003c/p\u003e \u003cp\u003eThe current study is unique as it compared three domains of SDLR across three courses at a residential medical university. A literature search does not reveal a similar study. However, this being a cross-sectional study, it does not trace the changes in the domains over the course of the study for the same batch. Also, it being a single-method questionnaire-based study, it does not address the qualitative aspects associated with SDLR. Further studies can be planned to assess the impact of the introduction of SDL methods on the SDLR. Emotional Intelligence can also be evaluated for its impact on SDLR as students\u0026rsquo; progress in their academic years.\u003c/p\u003e \u003cp\u003eBased on the outcomes of the study the authors suggest that the undergraduate students should be introduced to the concept of SDL during the foundation course in all three courses. The SDL methods should be integrated with the teaching-learning process. There should be simultaneous longitudinal studies that aim to assess all factors from multifaceted spheres that bear an impact on the SDLR of candidates. Early identification of lacunae and their redressal could, perhaps lay the foundation for better-prepared lifelong learners.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eNil financial disclosure.\u003c/p\u003e \u003cp\u003eNo conflict of interests\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAK, SA and AP actively participated in the formulation of the manuscript. AK wrote the manuscript and prepared the figures. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKnowles, M. S. (1975). \u003cem\u003eSelf-Directed Learning: A Guide for Learners and Teachers\u003c/em\u003e. Cambridge Adult Education, Prentice Hall Regents.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSargeant, J., Bruce, D., \u0026amp; Campbell, C. M. (2013). Practicing physicians\u0026rsquo; needs for assessment and feedback as part of professional development. \u003cem\u003eThe Journal Of Continuing Education In The Health Professions\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e, S54\u0026ndash;S62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Hosany, W. A. E., \u0026amp; Sleem, W. F. (2017). 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Self-directed learning readiness (SDLR) among medical students: A questionnaire-based study from an Indian medical school. \u003cem\u003eSouth-East Asian J Med Educ\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(2), 59\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4038/seajme.v9i2.86\u003c/span\u003e\u003cspan address=\"10.4038/seajme.v9i2.86\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Self-directed learning, Self-directed learning readiness, Self-directed learning readiness scale, medical, dental and nursing undergraduate students","lastPublishedDoi":"10.21203/rs.3.rs-3993294/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3993294/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003e\u0026ndash; The present study analysed self-directed learning readiness among undergraduate medical, dental and nursing students across the academic years.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e- The cohort consisted of the undergraduate medical, dental and nursing students of King George's Medical University, Lucknow, India. After institutional ethical clearance, the study started in October 2022 and data collection was completed in March 2023. Following voluntary consent, 746 /775 students (335 medical, 220 dental, and 220 nursing students) recorded their socio-demographic details on a semi-structured questionnaire. They filled the Modified Kumar self-directed learning readiness scale to assess the three domains of self-management, desire for learning and self-control. Data was analysed using SPSS version 26.0 (IBM Corp.).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e\u0026minus;\u0026thinsp;59.6% of the participants were females, 74% were students aged between 20\u0026ndash;24 years, 90% were hostellers, 74% belonged to the middle socioeconomic status and 54% of students had a rural background. Statistical analysis revealed that self-management, desire for learning and self-control were not statistically different at the time of entry into the three courses. However, medical students demonstrated a statistically significant decrease in all parameters as they progressed in years of education. Nursing students maintained their parameters. Scores of female students were higher, but the effect of other demographic parameters was insignificant.\u003c/p\u003e\u003ch2\u003eConclusion -\u003c/h2\u003e \u003cp\u003eThe maximum decrease in scores of medical students may be attributed to academic and infrastructure issues. This sets a need for further large-scale longitudinal studies using mixed methods that address various facets of curriculum and institutional infrastructure.\u003c/p\u003e","manuscriptTitle":"Self-directed learning readiness among medical, dental and nursing students: a cross-sectional study at a tertiary care medical university","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-04 18:49:01","doi":"10.21203/rs.3.rs-3993294/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"16a131b0-d745-40cd-9a67-bd2c8052f80e","owner":[],"postedDate":"March 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-04T18:49:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-04 18:49:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3993294","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3993294","identity":"rs-3993294","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}