RESEARCH

Student use of self-directed learning time in an undergraduate

medical curriculum
James Gould MD1†, Iain Arseneau MD1†, Stephen Dalziel MD1†, Harrison Petropolis MD1†,
Karen Mann BN MSc PhD2
1
Class of 2015, Faculty of Medicine, Dalhousie University
2
Division of Medical Education, Faculty of Medicine, Dalhousie University
†
Authors were equal contributors

Abstract
Introduction: In 2010, Dalhousie University implemented a new MD curriculum, placing an emphasis on self-directed
learning (SDL) time. This study sought to understand how students use this time and whether they would benefit
from more structure during SDL. We hypothesized that students spend significant amounts of SDL time on non-
academic activities and would prefer to have more specific guidance and tasks.
Methods: Pre-clerkship medical students at Dalhousie (n=223) were sent an online survey consisting of 18 questions
using a combination of Likert scales, and text boxes for qualitative responses. Chi-square analysis was performed for
each survey question.
Results: Eighty-five percent (n=93) of medical students responded that time scheduled for SDL was sufficient
(p<0.001) and 67% (n=73) responded that they would benefit from more specific guidance and tasks during SDL
time (p<0.001). Forty-five percent responded that they “rarely” spent SDL time on non-academic activities (n=49),
however only 14% (n=15) responded “most of the time” (p<0.001).
Conclusion: The majority of respondents used SDL time for academic activities but felt they would benefit from
more specific guidance and tasks. This is inconsistent with our hypothesis that students are spending significant
amounts of SDL time on non-academic activities, but supports our hypothesis that students would prefer more
structure.

I n September 2010, Dalhousie University unveiled a

new curriculum for its MD program. One of the major
changes in this curriculum was the implementation of
education. SDL has been proposed as a way to better
prepare student physicians to become life-long
learners and is increasingly prevalent in medical
self-directed learning (SDL) time. This is time during education.4-6 However, the existing literature suggests
which the school may not schedule other activities, and only a comparable, or at best moderate improvement
students are encouraged to use this time to address their in knowledge when students use SDL as compared
own specific learning needs. Gibbons describes “SDL is to more traditional approaches.7 In general, SDL was
any increase in knowledge, skill, accomplishment, or facilitated by providing study guides or online-modules
personal development that an individual selects and that allow students to work at their own pace and on
brings about by his or her own efforts using any method their own time while still providing structure.8,9
in any circumstances at any time”.1 There have been few studies reported on how
Spencer and Jordan outlined key principles of SDL, students use SDL time. One survey conducted at a
which include diagnosing learning needs, formulating medical institution in Saudi Arabia found that greater
goals, identifying resources, implementing appropriate than half of their students responded that they used SDL
activities, and evaluating outcomes.2 These principles time for non-academic activities.10 Recent evidence has
are in keeping with the adult learner who wants also suggested that learning may improve when some
focused, relevant content that can be directly applied to direction is given to “self-regulated” study time.11 In this
practice. model, students are able to control the speed or rate of
Canadian medical schools strive to produce their learning but are provided direction with regards
physicians who will display the core competencies to content or their learning. Building on this framework
outlined by CanMEDS.3 One of those competencies the objectives of this study were to [1] understand
is that of “life-long learner”. Learning can be difficult how first and second year students in the Dalhousie
once the student has left the confines of a structured undergraduate medicine program use their protected
academic environment; however, medical knowledge is SDL time and [2] whether students would benefit from
expanding rapidly highlighting the need for continued more guidance on how to best utilize this time. We

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 Student use of self-directed learning

predicted that a) students spend significant amounts three used the options strongly disagree, disagree,
of SDL time on non-academic activities (considered in neutral, agree, or strongly agree. For the purposes of
our study to be any activity that is not directly related the statistical analysis, strongly disagree and disagree
to the medical curriculum or objectives) and b) would were grouped as negative responses, neutral remained
prefer to have more guided tasks during SDL time. neutral, and agree and strongly agree were grouped
as positive responses. Significant differences between
Methods these three groups were explored. For questions four
through eleven, the possible options were never, rarely,
Study Design half of the time, most of the time, and all of the time. No
Dalhousie University is located in Halifax, Nova Scotia, grouping was performed for these prompts. Questions
Canada and offers a 4-year Doctor of Medicine (MD) twelve through eighteen consisted of qualitative data,
program. The study included first and second year collected in the form of text boxes. As such, no data
medical students who are in their pre-clerkship years analysis was performed, but these comments were used
of training. Third and fourth year clerkship students to guide our discussion, and develop hypotheses for
were excluded as these years consist mostly of clinical potential follow-up studies. Question 6 was erroneously
rotations, and at the time of this study were largely included in duplicate in our survey. For the sake of
unchanged from previous curriculum iterations. The transparency, the results for each of the two inclusions
pre-clerkship curriculum is a mix of case-based learning were analyzed as if they were separate questions.
(CBL), didactic lecture, and SDL. During the study
period the first and second year classes at Dalhousie Results
University Medical School comprised 223 students.
A convenience sample was collected from the total Of the 223 students invited to participate, 123 people
population (n=109). This study received approval from opened the survey, and 109 completed it, giving a
the Dalhousie University Health Sciences Research response rate of 48.9%. The results for statements 1-3,
Ethics Board. which relate to the students satisfaction with SDL, are
The study was conducted as a cross-sectional summarized in Table 1. The results for statements 4-11,
survey design using Dalhousie’s endorsed online which explore how students use their SDL time, are
survey tool, Opinio. Each eligible participant was summarized in Table 2.
sent a secure explanatory email containing a link to In Table 1, we see that students felt that time
access the survey using an online survey tool. The first allocated for SDL was sufficient (p<0.001), but that
webpage provided the rationale for the survey and they would benefit from more guidance during SDL
required participants to click a check box to continue, time (p<0.001) Furthermore when responses to the
indicating informed consent. Participation in the question “I would benefit from the provision of more
survey remained anonymous and students were able to specific guidelines and tasks to be used during SDL”
withdraw from the study up until submission. Students were grouped into negative (strongly disagree and
were only able to complete the survey once. The survey disagree), neutral, and positive (strongly agree and
consisted of 18 questions (Supplemental File 1, online) agree), 67% (n=73) responded positively, 9% (n=10)
using a combination of 5-point Likert scaling, and text had a neutral stance, while 24% (n=26) responded
boxes for qualitative responses. Survey questions were negatively (p<0.005).
developed by the authors. We sought to ensure that When responses for “If time allocated for SDL
all major components of the pre-clerkship curriculum were increased then I would spend this extra time
(electives, tutorials, labs, lectures) were represented. on academic activities” were grouped into negative
The draft survey was reviewed by a medical educator (strongly disagree and disagree), neutral, and positive
for completeness and clarity, and revisions were made (strongly agree and agree), the differences were no
based on the feedback received. Participants completed longer significant (p=0.4346).
the survey in May-June of 2013. Two electronic Table 2 indicates that students spend significant
reminders were sent at 1 week intervals between the amounts of SDL time on various academic activities,
start and end dates of the study. and that students are not spending the majority of their
SDL time on non-academic activities (p<0.001).
Data Analysis Qualitative responses further explained the
Data analysis was performed using GraphPad Prism quantitative survey results. Comments indicating that
6 software. A Chi-square analysis was performed students used SDL time on non-academic activity
for each survey question with P values less than 0.05 included: “Honestly, I usually come home, make sure
required for significance. Questions one, two, and my cases are done, and take a nap” and “If I haven't

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Student use of self-directed learning

Question Responses - n (%)

Strongly Disagree Neutral Agree Strongly Total Sample P-value
Disagree Agree SD
Time allocated for SDL is 0 (0) 6 (5.5) 10 (9.2) 71 (65.1) 22 (20.2) 109 28.66 <0.001
sufficient
If the allocated time for SDL 8 (7.3) 34 (31.2) 36 (33.0) 23 (21.1) 8 (7.3) 109 13.54 <0.001
is increased then I will spend
more time on academic
activities
I would benefit from the 5 (4.6) 21 (19.3) 10 (9.2) 37 (33.9) 36 (33.0) 109 14.62 <0.001
provision of more specific
guidance and tasks to be used
during SDL time
Table 1. Dalhousie medical students response to appropriateness of self-directed learning (SDL) in pre-clerkship training.

finished the case, then I'll work on it. Otherwise I CBL preparation (46.8% responded with ‘most of the
treat it as any other time off ”. Responses collected that time, 38.53% responded’ half of the time’). CBL tutorials
indicate students complete SDL during unprotected are two-hour group learning sessions that occur three
time include: “[I] Prioritize many commitments of our times weekly in the first and second year curriculum.
schedule...[I] participate in non-academic activities that These sessions require that students review preparation
would otherwise be challenging to be involved in (after material and answer guiding questions pertaining to a
4:30 or on the weekends); then I would do my SDL after patient/clinical scenario prior to the session. It seems
4:30 or on the weekends”. Some responses related to justified that students would allocate significant SDL
variability in usage of SDL time included: “[Allocation time to CBL preparation as it is generally considered
of SDL time] depends on what day of the week it is, “mandatory” by students to do some level of preparation
and the task at hand”. “Early in the week I use it for for these sessions in order to facilitate group discussion.
case preparation. Later in the week I review lectures”
and “Early in the unit, I spend more SDL time on SDL during unprotected time
non-academic activities (about ½) and the rest I use in Despite the reported use of SDL time for CBL
preparation for case tutorials. As an exam approaches preparation, many comments collected in the survey
I use SDL time for review and tend to use all allocated suggest that students are using protected SDL time for
time for school work.” Finally, responses that indicate non-academic activity with the intent of doing SDL
students desire more guidance in their SDL include: during an “un-protected time” such as the evenings or weekend.
“Lack of guidance leads to lots of wasted SDL time”, “It These qualitative results indicate that many
is really nice to have time to spend to properly learn students feel that SDL can be completed at any time
material at my own pace. I would agree however, that they choose. However protected SDL time has been
some guidance as to how to use the time would likely implemented in place of traditional didactic lecture
benefit many students.” time. In the traditional model there would still be an
expectation that students do some form of “SDL” or
Discussion “study” outside of lecture. Therefore, while the intent
may be that students will study more if given this
The objectives of this study were to understand additional protected SDL time, this was not previously
how first and second year students in the Dalhousie shown to be the case.10 Rather, the provision of this
undergraduate medicine program use their protected extra SDL time may simply provide more flexibility
SDL time and whether students would benefit from in scheduling study time as well as non-academic
more guidance on how to best utilize this time. activities, possibly at the expense of didactic teaching
or other structured curriculum activities.
Use of SDL time
We hypothesized that students use a significant amount Variability in SDL use
of their protected time for non-academic activities. Based on qualitative responses it appears that student
However, the results suggest that most students do allocation of SDL time may be variable, depending on
use SDL time for academic activity. A significant the day of the week, as well as the proximity to unit
proportion of students reported using SDL time for exams. One possible solution would be that SDL time

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 Student use of self-directed learning

Responses - n (%)
Question Never Rarely Half the Most of All of the Total Sample SD P-value
time the time time
I spend SDL allocated time for case- 2 (1.8) 11 (10.1) 42 (38.5) 51 (46.8) 3 (2.8) 109 23.04 <0.001
based learning preparation
I spend SDL allocated time for lecture 6 (5.6) 52 (48.1) 33 (30.6) 17 (15.7) 0 (0.0) 108 21.13 <0.001
objectives
I spend SDL allocated time for self- 2 (1.8) 37 (33.9) 35 (32.1) 33 (30.3) 2 (1.8) 109 18.13 <0.001
study individually
I spend SDL allocated time preparing 5 (4.6) 67 (61.5) 26 (23.9) 11 (10.1) 0 (0.0) 109 27.09 <0.001
for lab
I spend SDL allocated time preparing 17 (15.6) 56 (51.4) 29 (26.6) 6 (5.5) 1 (0.9) 109 21.95 <0.001
for Professional Competencies
I spend SDL allocated time preparing 11 (10.1) 36 (33.0) 43 (39.5) 17 (15.6) 2 (1.8) 109 17.20 <0.001
for or attending electives
I spend SDL allocated time for non- 3 (2.8) 49 (45.0) 42 (38.5) 15 (13.8) 0 (0.0) 109 22.49 <0.001
academic activities
I spend SDL time for self-study 2 (1.9) 26 (24.1) 39 (36.1) 39 (36.1) 2 (1.9) 108 18.66 <0.001
individually*
I spend SDL time for group discussions 48 (44.4) 50 (46.3) 9 (8.3) 1 (0.9) 0 (0.0) 108 25.26 <0.001

Table 2. Dalhousie medical students use of their self-directed learning (SDL) time in pre-clerkship training. *This question was duplicated in the
survey and both responses were analyzed and presented for transparency.

could be slowly increased in quantity throughout the responsible for curriculum decisions to take this into
unit, with didactic teaching front loaded in the unit consideration when making curriculum changes.
and SDL time for studying closer to end of the unit Medical students are responsible for learning a
during exams. However, further study of variability in vast amount of material at a rapid pace. There have
students’ SDL use over the semester and in proximity been attempts to identify students who are most likely
to unit exam would be needed before any curriculum to succeed in an SDL environment by measuring SDL
change would be recommended. readiness using the scale developed by Guglielmino;
however there have been questions about its
Guiding SDL time applicability for medical students.6,12-13 In addition, it
The second objective of this study was to determine if has been demonstrated that SDL readiness can actually
students perceived they would benefit from guidance regress during medical education.14 Therefore, it may
on how to utilize SDL time. The results of this study, not be a matter of determining whether or not SDL is
both qualitative and quantitative clearly demonstrate effective, or which students are more prepared for SDL,
that students would prefer some form of guidance in but instead of providing adequate support and guidance
order to direct the use of their SDL time. Curriculum for students during SDL time, while still cultivating
structured in a way that included guidance or objectives life-long learning skills. Indeed, there is literature to
for students to utilize during their SDL would be support that students may need more support in terms
better defined as “directed, self regulated learning”. It of managing their SDL time.15
appears that medical students at Dalhousie University Previous studies at Dalhousie have indicated that
would prefer this additional direction. Currently in the a hybrid problem-based learning (PBL) curriculum
curriculum there are a set of objectives linked to each contributed to students’ SDL skills.16 One potential
lecture, CBL case and lab as well as overall objectives solution for students’ desire for increased guidance
for the unit. If these objectives could be improved is to introduce more PBL- and CBL-style resources
upon and be more specific, then students may feel that students could utilize or work through without
like they have more direction in their SDL time. necessarily involving additional group discussion or
However, further research into these suggestions and tutor commitments. Dalhousie’s curriculum contains a
this type of curriculum would be needed to determine few excellent examples of attempts to introduce such
its effectiveness. It would be important for those guidance. During the pediatrics rotation, students are
given access to 32 CLIPP cases (Computer-assisted

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Student use of self-directed learning

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Dermatology uses online cases at the pre-clerkship outcomes with medical students. Fam Med 2002;34(3):197-200.
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level during the obstetrics rotation. If more of these Taghavinia M, et al. Study guides: effective tools to improve self-directed
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12. Guglielmino LM. Development of the Self-Directed Learning Readiness
improved student uptake and retention of important Scale. (Doctoral dissertation, University of Georgia, 1977). Dissertation
material, and improvement in their own perceived SDL abilities. Abstracts International 1978;38:6467A.
13. Hoban JD, Lawson SR, Mazmanian PE, Best AM, Seibel HR. The Self-
Directed Learning Readiness Scale: a factor analysis study. Medical
Limitations Education 2005;39(4):370-379.
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medical training promote or deter self-directed learning? a longitudinal
cross analyses, for example: do the students who report mixed-methods study. Acad Med 2013;88(11):1754-1764.
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Exploring first-year undergraduate medical students’ self-directed learning
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time” meant that they spent most of their actual time
on a given activity, or if they merely allocated some
amount of time to the activity during “most” of their
SDL sessions. Future studies could consider assigning
percentages of SDL time used for each different type of
activity, with a sum total of 100%.
Finally, the response rate of 48.9%, combined with
the anonymity of the study also makes it difficult to
determine if our respondents are truly representative
of the student body as a whole.

Conclusion

First and second year Dalhousie medical students

reported that they used their SDL allocated time for
academic activities, and perceived they would benefit
from the provision of more specific guidance and tasks
to be used during SDL time.

References
1. Gibbons Maurice. The Self-Directed Learning Handbook: Challenging
Adolescent Students to Excel San Francisco; Jossey-Bass, 2002. Print.
2. Spencer JA, Jordan RK. Learner centered approach in medical education.
BMJ 1999;318(7193):1280-1283.
3. Frank, JR. (Ed). 2005. The CanMEDS 2005 physician competency
framework. Better standards. Better physicians. Better care. Ottawa: The
Royal College of Physicians and Surgeons of Canada.

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