Outcome-Based Self-Directed Learning (OBSDL) in Pharmacology in the Indian Context: A Convergent Mixed-Method Study

The outcome-based self-directed learning (OBSDL) allows students to achieve course outcomes (COs) in pharmacology. We aimed to implement and enhance the ability of self-directed learning (SDL) among medical undergraduates. SDL can appear in the classroom. By leveraging OBSDL as an extension to SDL, we can create a more meaningful learning experience for students that will last beyond the regurgitation of memorized content. The alignment of the curricular framework, implementation of lesson plans, sharing of SLOs, guidance for resources, and robust assessment all contribute to the achievement of OBSDL. A combination of teaching methodologies should be practiced and complemented to facilitate learning among students in competency-based medical education (CBME).

This study aimed to implement SDL sessions to align the curricular framework with selected pharmacology topics among second-phase Bachelor of Medicine and Bachelor of Surgery (MBBS) students.

The nominal testing method was used to select competencies to be taught as SDL. The competencies selected were skeletal muscle relaxants (SMR), pharmacotherapy of glaucoma (PG), communication skills (CS), and management of common poisoning (MCP). SDL modules were prepared by the content experts. Kemp's instructional model was used to design the lesson plan. Validation of the lesson plan was done by the Delphi method by subject experts. Kendall's coefficient of concordance test (W)and Fleiss' kappa (K)were analyzed to indicate the consensus reached by experts. Varied teaching strategies were adopted for each SDL session depending upon the nature of the competency. Thematic analysis was conducted by a two-person analysis team. Reliability and validity of thematic analysis were done by calculating intercoder reliability statistics (Cohen's kappa) to assess the level of agreement between two coders. Robust assessments as per Bloom's taxonomy were conducted to achieve COs. Multiple-choice questions (MCQs) were framed as per Bloom's taxonomy, and objective structured practical examinations (OSPEs) were designed for assessment. Coding and thematic analysis were conducted for qualitative analysis.

Rank concordance (W) among evaluators was strong to unusually strong (0.443, 0.450, 0.445, and 0.532; p < 0.001), and the interrater agreement (K) was fair to moderate (0.370, 0.378, 0.372, and 0.435; p < 0.001) for lesson plans of SMR, PG, CS, and MCP, respectively. The outcome for each specific competency was achieved, with a significant increase in posttest scores after SDL sessions (p < 0.001 for all sessions). Cohen's kappa was 0.672, which indicated substantial agreement between the two raters for themes. Self-learning skills, metacognition, collaboration, and autodidactism were major themes that emerged from the thematic analysis.

The OBSDL effectively enhances learning outcomes in the field of pharmacology. Various SDL skills, like self-learning skills, metacognition, collaboration, autodidactism, application, and experiential learning, have emerged from thematic analysis, which are essential for lifelong learning. The qualitative method has added understanding of students' perspectives. A judicious placement of various teaching-learning methods designed based on the complexity of the topic may offer a comprehensive outcome-based approach within the Indian CBME.