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Does the Study Guide Represent a Helpful Learning Tool for Medical

Students? Students Perspectives

Bassem Aldeek 1,2

, Nasra Ayoub 1,2

, Reda A. Jamjoom 1,3

, Saad Almahayawi

4, and

Asim T. Al Sharif 1, Awatef AlSebyani

5 , Mohamed Mashat

5,

1Medical Education Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi

Arabia.2 Faculty of Medicine, Mansoura University, Mansoura, Egypt.

3 Surgery Department,

4 Otorhinolaryngology Department, Faculty of Medicine, King Abdulaziz

University, Jeddah, Saudi Arabia.

5 Six year medical students, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

*Corresponding author:

Prof. Nasra Ayuob

Department of Medical education,

Faculty of Medicine,

King Abdulaziz University, Jeddah, Saudi Arabia,

Tel.: 00966530112205

Fax:009666400855 nasraayuob@gmail.com

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Abstract

This study has assessed medical students’ level of satisfaction with and utilization of study

guides and whether they were helpful to the learning process. Subjects and Methods: This

cross-sectional study used a self-administered questionnaire that was validated by faculty

members and students and was piloted before distribution. It was distributed to all basic

(second- and third-year) medical students at the Faculty of Medicine, King Abdulaziz

University, Jeddah, SA, during the 2012–2013 academic year. Results: About 78% of the

participating students indicated that they preferred to have a study guide for each course.

They were satisfied with the structure of the study guides apart from the absence of

teachers’ personal comments. They were not satisfied with the use of the study guides as

logbooks and their inclusion of self-assessment exercises. They were also not satisfied with

the study guides as notebooks and felt that they did not contain adequate educational

resources. Conclusion: Although the participating students were not fully satisfied with the

study guides, they reported that some courses study guide were useful for their learning

while others were not. More efforts are needed to improve the study guides so that they are

helpful logbooks and notebooks that include self-assessment exercises and updated

educational resources.

Key words: Study guide-Utilization-effect- medical-students-learning

Introduction

High-quality medical education is increasingly becoming an important subject worldwide.

Nowadays, studies, textbooks, conferences, and associations, such as the Association of

Medical Education in Europe (AMEE), are all demonstrating a great interest in the

improvement of medical education. What students learn, how they learn, where they learn,

and how the learning is best organized and assessed are questions being addressed not only

by medical education enthusiasts, but also more generally by healthcare professionals (Bin

Abdulrahman et al., 2012). Furthermore, there has been a move in medical education

away from the traditional teacher-centred model to a student-centred model (Harden et al,

1984).

In Saudi Arabia, there has also been a growing interest in and rapid development of the

quality of medical education. In fact, there has been a dramatic change from the traditional

spoon-feeding method of learning to a more innovative student-centred model, where

students adopt an instructional approach and influence the content, activities, materials, and

pace of learning. The student-centred model contains several complementary aids such as

problem-based learning, directed self-learning, tutorials, seminars, etc. In 2002, curriculum

planners decided to implement a new undergraduate medical curriculum that is organized in

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blocks of integrated system-based modules (Al-Hazimi, 2012). However, students are

unfamiliar with this new dynamic approach to learning and therefore need guidance and

assistance, thus emphasizing the role and importance of study guides. A study guide

represents a method of interaction between the student and the course, as it provides

supportive information that can make a major contribution to learning.

A study guide has been defined as a manual that structures study efforts and attempts to

enhance the learning derived from textbooks by encouraging students to process the

textbook in certain ways. It can be in a printed or electronic format that is designed to assist

students with their learning (Philippe, 2006). Harden and Crosby (2000a) had described

study guide functions to include the following: providing students with information,

managing the students’ learning, and prescribing students’ activities.

A study guide has been stated to play an important role in the contexts of information

overload, curriculum reform, and the encouragement of active learning (Hodgkinson,

1994), and all these contexts were present in the medical curriculum at King Abdulaziz

University (KAU). In fact, AMEE has pointed out that resource material creator and study

guide producer are one of the twelve roles of the good teacher (Harden, 2000b), and the

role of the study guide in promoting teaching and learning is an increasing subject of

interest worldwide.

A previous study had described the study guide components and how it was implemented

in the Faculty of Medicine (FOM) at KAU as a part of the developed medical curriculum

(Al-Hazimi, 2012). This study take a step further by assessing medical students’

satisfaction with and utilization of the study guides and whether they were helpful during

their learning.

Subjects and Methods

This cross-sectional study was conducted at FOM KAU among the basic (second- and

third-year) medical students during the 2012–2013 academic year. Ethical approval was

obtained from the biomedical research ethics committee at FOM. A well-designed, self-

administered questionnaire was prepared to assess students’ satisfaction with and utilization

of the study guide and its impact on their learning from the students’ point of view. The

questionnaire was divided into three main sections. In the first section, demographic data of

the participating students, as well a percentage of their attendance at lectures, tutorials, and

practical sessions, were gathered. In the second section, students’ perception of the various

aspects of the study guides (e.g., course information, content, objectives, resources, self-

assessment exercises and activities) was assessed using a five-point Likert scale (1=

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strongly disagree, 5 = strongly agree). Non-satisfaction was considered to be a mean score

less than 3. In the third section, students were asked to rate the usefulness of the study

guides from their point of view.

The questionnaire was submitted to 5 faculty members to validate its questions. It was then

distributed to 20 students to ensure face and content validity. The questionnaire was

slightly modified in response to their feedback. The results of the pilot study were not

included in the final study results. The final version of questionnaire was distributed to all

second- and third-year medical students.

Statistical analysis

The data were coded and entered in the Statistical Package of Social Sciences (SPSS, Inc.,

version 16.0; Chicago, IL, USA). Statistical analysis was done using a descriptive

qualitative and analytical analysis (student t-test), and results were presented in the form of

the mean and standard deviation (SD). A p-value less than 0.05 was considered to be

statistically significant.

Results:

Three hundred and thirty out of 610 medical students (54.1%) responded to the

questionnaire. The response was higher from third-year students and male students (Figures

1 and 2). About 78% of the participating students indicated that they preferred to have a

study guide for each course and module (Figure 3). The overall attendance of the

participating students was higher for tutorials, followed by practical sessions and then

lectures. There was no significant difference between second- and third-year students

regarding whether they attended more than 50% of the tutorials, while the percentage of

second-year students who attended more than 50% of the lectures and practical sessions

was significantly higher than those of the third-year students (p < 0.001) (Figure 4).

Figure (1):Level of students participating in the study. Figure (2):Gender of students participating in the study.

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The overall participants were satisfied with the structure of the study guides apart from the

absence of teachers’ personal comments on the topics (these data are not shown). The third-

year students were more satisfied than the second-year students with the structure of the

study guides regarding the overview of the course topic (4.05 + 0.95 versus 3.7 + 1.02) and

the inclusion of the course learning objectives (4.04 + 0.97 versus 3.6 + 0.95); this

difference was statistically significant (p = 0.005 and p < 0.001, respectively). Satisfaction

of the second-year students with teachers’ personal comments on the topics within the

study guides was significantly higher than that of the third-year students (p < 0.001) (Figure

5).

Satisfaction of the participating students with the activities included within the study guides

was assessed. There was low satisfaction among the all participants with the study guides

Lectures Practical

sesions Tutorials

Figure (4): Attendance of participating students in different educational sessions.

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as logbooks and their inclusion of self-assessment exercises, and they were also not

satisfied with them as notebooks (these data are not shown). There was a significant

difference between the second- and third-year students regarding their satisfaction with the

study guides as logbooks and notebooks (p < 0.001 and p = 0.033, respectively) (Figure 6).

Most of the participants in this study were not satisfied with the educational resources

included in the study guides apart from the references to up-to-date textbooks and links to

helpful electronic resources (3.04 + 1.15 and 3.14 + 1.55) (Table 1). The third-year students

were significantly less satisfied with the educational resources available in the study guides

than the second-year students. Among all participants, a higher number preferred to have

soft copies of the study guides. A significant number (p < 0.001) of second-year students

preferred to have hard copies of the study guides, while a significant number (p = 0.006) of

third-year students preferred to have soft copies (Figure 7).

*

*

* * *

* * * *

*

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Table (1) Students satisfaction with the study guide regards the educational resources.

Study guide include Second year Third year P value Total

Mean SD Mean SD Mean SD

Reference to up to date texts 3.06 + 1.2 3.10 + 1.01 0.74 3.04 + 1.15

Reference to related articles in journals 3.02 + 1.14 2.6 + 1.04 0.003 2.82 + 1.08

Quotations from texts 3.04 + 1.08 2.5 + .83 <0 .001 2.77 + 1.03

Quotations from articles published in journal 3.13 + 1.06 2.82 + 1.06 <0 .001 2.73 + 1.05

Complete texts or articles 2.82 + 1.06 2.11 + .83 <0 .001 2.56 + 1.04

Links to helpful electronic resources 3.32 + 1.11 2.97 + 1.008 0.009 3.14 + 1.55

Resources of virtual learning 2.98 + 1.03 2.51 + .83 < 0.001 2.79 + 1.02

Short notes on the importance of the topic 2.97 + 1.04 2.55 + 1.02 0.002 2.73 + 0.96

Definitions or terminology 2.94 + 1.01 2.47 +0 .99 <0 .001 2.70 + 1.03

Prefence of soft copy study guide 3.4 + 1.06 3.79 + 1.16 0.006 3.57 + 1.12

Prefence of hard copy study guide 3.58 + 1.15 2.56 + 1.09 <0 .001 3.04 + 1.21

Regarding the usefulness of the study guide for individual courses or modules of the

medical curriculum, it was found that the study guides for the cardiovascular,

musculoskeletal and immune, and blood and lymphatic system modules were ranked as the

most useful (65.2%, 63.6%, and 59.1%, respectively) by the participants (Figure 8).

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Discussion

Students are considered to be the cornerstone of the educational process; they possess

different skills, needs, and motivations that are influenced by a number of factors (Dodds et

al., 1984). Designing an ideal study guide is crucial to enhancing the quality of the learning

experience. Having a study guide to assist and manage the student’s learning experience is

very helpful (Harden and Crosby, 2000a). A study guide keeps in contact the students,

institutions, and the material provider (McKillop et al., 1998).

In this study, only about 78% of the participating students indicated that they preferred to

have a study guide for each course and module, which reflects a lack of understanding of

the importance of study guides in the learning process. Most studies have found that it is

essential to have a study guide for each course, as it significantly improves students’

performance (Horton and Lovitt, 1989; Holsgrove et al., 1998).

The pattern of the participating students’ attendance at different educational sessions was

assessed as an indicator for their interest in the study and their preference of certain

teaching and learning methods. It was noticed that the overall attendance of the

participating students was the most for tutorials, followed by practical sessions and then

lectures. This finding shows that students prefer active sessions with a smaller number of

attendees.

The most important question addressed in this study was, “Are the medical students

satisfied with their study guides?” The study assessed this question from three

perspectives—the study guide’s structure, inclusion of activities, and educational resources.

In a study conducted at the United Arab Emirates University, Holsgrove et al. (1998)

reported, that a well-planned study guide should contain course aims, learning objectives,

cross-referencing for the module, information about resources, the course timetable, student

lists and study groups, and other management information. Almost all of these components

were included in the study guides for the second-and third-years courses and modules.

Fortunately, the overall participants in this study were satisfied with the different

components of the study guides apart from the inclusion of teachers’ personal comments on

the various topics. Most of the participants in this study were satisfied with being able to

access the relevant study guide before starting a course. This was supported by Kozen et al.

(2006), whose study directs practitioners in the design and use of anticipation guides, a pre-

reading strategy can be used to simultaneously increase students’ content, knowledge, and

reading comprehension.

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It has been known for a long time that the retrieval of information is enhanced if it requires

the same kind of mental processing as that used during studying, implying that a study

guide with multiple-choice questions should strongly enhance performance on multiple-

choice exams (Herrmann et al., 1993). A more recent study by Dickson et al. (2005)

investigated the effect of required textbook study guides on undergraduates’ multiple-

choice exam performance. The results of this study support the effectiveness of a study

guide for courses that use multiple-choice exams; however, more exercises may not

enhance performance. Unfortunately, the present study showed low satisfaction among the

participating students regarding the use of study guides as logbooks and the inclusion of

self-assessment exercises. They were also not satisfied with using the study guides as

notebooks. This can motivate the course instructors to improve this defect in study guides

for their courses.

It was found that most of the participants in this study were not satisfied with the

educational resources included in the study guides apart from the references to up-to-date

textbooks and links to helpful electronic resources. This dissatisfaction was higher among

the third-year students. Again, this is an area for improvement that needs to be highlighted

so that course instructors can address it. Among the overall participants, a large number

preferred to have soft copies of the study guides, specifically the third-year student. A study

by Harden and Smyth (1994) revealed that computer-based study guides offer advantages

over print-based guides as they allow students to move quickly and easily from one section

to another. Furthermore, the students can individualize them for their personal needs, such

as adding more information. They can also include colour, pictures, and sounds; can

embrace computer-mediated communications; and are easy to update. In another study

conducted by Rasheed and Cohen (1990), students using computer-based instruction study

guides for dental courses performed significantly better than students using printed study

guides.

There was a statistically significant difference between the second- and third-year students’

satisfaction with some aspects of the study guides. The satisfaction of the third-year

students was, in most of cases, less than that of the second-year students, which could be

attributed to their additional experience with learning as well as expectations.

It was found that a considerable number of students who participated in this study reported

that the study guides for some courses and modules were not useful for their learning. In a

study by McKillop (1997), a number of traditional students were asked if they had ever

used a study guide and if they had found it to be helpful. All the students who indicated that

they had used a study guide had found it to be helpful. This may point to a need to improve

the study guides so that they are perceived as “helpful” by their end users—the students.

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In conclusion, although the participating students were not fully satisfied with the study

guides, they reported that some were useful for learning while others were not. More effort

is therefore needed to improve the study guides so that they can serve as helpful logbooks

and notebooks that include self-assessment exercises and updated helpful educational

resources.

Acknowledgments

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Bin Abdulrahman KA, Harden R, Patricio M. Medical education in Saudi Arabia: An

exciting journey. Med Teach 2012; 34: S4–S5.

Dickson K. L, Miller MD and Devoley MS. Effect of Textbook Study Guides on

Student Performance in Introductory Psychology. Teaching of Psychology 2005; 32 (1):

34-39.

Dodds AE, Lawrence JA and Patrick C. University students' perceptions of influences

on external studies. Distance Edu. 1984; 5(2): 174-185.

Harden RM and Smyth JJ. Computer-based study guides II: educational components

and advantages. Med Teach 1994; 16(4):315-322.

Harden RM, Crosby j. AMEE guide no 16 study guide their uses and preparation. Med

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Harden RM, Crosby J. AMEE Guide No 20: The good teacher is more than a lecture:

the twelve roles of the teacher. Med Teach 2000; 22 : 334 – 347.

Harden RM, Sowden S, Dunn WR. Educational strategies in curriculum development:

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Herrmann D, Raybeck D and Gutman D. Improving student memory. Seattle, WA:

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therefore, acknowledge with thanks DSR technical and financial support.

Declaration of Interest:

The authors report no declarations of interest.

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