Figure 5.10 Test results over three years according to facilitator background PGStu: Postgraduate (Masters/Doctoral) students Sci: Scientists
MedDr: Medical doctors
All the students – and one member of staff – feel strongly that facilitators should be medical personnel.
From my experience in the past, I‘ve really enjoyed and participated and quite felt I should really do my work for the tuts because these are doctors that ideally we‘re talking about. Most of the time they give an approach, and then in the tutorials they normally have the ‗Why?‘ question – ―Why would you say that?‖ – d‘you understand? But those who are not doctors tend to just come and they listen to you. They come and they just
―Say out whatever you know‖ – it‘s more about – to us – to most of us students, we find that we end up knowing things but nobody understands them. Matlodi 4;130-135
The lectures and the facilitators should be medical clinicians. I‘ve had brilliant clinicians, and our tuts are ten times more rewarding, as compared to a basic science facilitator –
‘cause they just don‘t have the whole over-picture. Kevin 7;163-165
That is where the general approach comes in – the intra-disciplinary general approach comes in; and that can only be done by a clinically qualified person.
Dr Patel 12;226-228
The reasons advanced for preferring medical rather than non-medical facilitators are not always well articulated. In the main, medically qualified staff members are thought to
50 55 60 65 70
1.1 1.2 1.3 1.4 1.5 1.6 2.1 2.2 2.3 2.4 2.5 2.6 3.1 3.2 3.3 3.4 3.5 3.6
Mean group marks (%)
Tests over three years
Assessment marks according to
have a greater understanding of the subject and thus be more capable of effectively guiding and stimulating the students. Dr Patel, on seeing a graph that shows no difference in test results between those who had medical or non-medical facilitators, concedes that the graph does not support the idea that only doctors can train doctors.
So these results indicate that they‘re kind of parallel to the performance results, first of all, but, more importantly, they don‘t indicate any difference at all in a medical or a non- medical facilitator. I find that highly surprising. [So do I!] Because it destroys my whole
hypothesis! Dr Patel 12;1068-1070
A number of responses indicate a possible reason for the equally good marks of those students who had non-medical facilitators: the fact that students have to make sure that they themselves understand the subject matter since they feel they cannot rely on their facilitators to help them achieve that understanding.
I‘m at stake here. This person‘s not going to be writing the ETT so in the process, personally, I work extra hard to achieve a good mark if I don‘t have a good facilitator.
Zodwa 1;655-656
I still think it‘s student-dependent. It doesn‘t matter who the facilitator is. But that includes students and staff – you don‘t need a medical degree to do that. Krish 5;699-700
Zodwa and Krish state a truism of PBL, namely that learners have to drive their own learning and that the facilitator should be of less importance. Dr Kathrodia agrees that maybe the facilitator‟s background does not make a difference.
... if you‘ve got your facilitators trained as you‘ve already done before they become facilitators then I think there won‘t be much of a difference. I think there won‘t be much of a difference, because they‘ve got a good grasp of the situation, so I don‘t think there will be much of a difference. [Despite the fact that some of them are likely to understand the medical material –] – better than others; yes; a lot of facilitation is just general aspects of learning, and if they get that right, it‘s OK. Dr Kathrodia 10;385-9
Some respondents pointed out that having a medical facilitator could be a disadvantage, inasmuch as he/she might be tempted to teach the group and thereby short-circuit the
process whereby the students search for knowledge on their own and reason it out for themselves.
…it may in fact be that these facilitators who are not medical, the students will have to go to the library and find out for themselves because they are not actually being taught, and it may be that the medical facilitators maybe may find themselves helping the students a
little bit. Dr Hlubi 13;566-569
The doctor will tutor. We are used to tutoring, and that‘s what students love. They sit back, even in small groups, and it‘s very difficult, when you‘ve learnt in a didactic background, and you come from a training like we‘ve had, where I‘m an expert in my field, that I cannot stay away – that is the kind of learning I‘ve had, and that is the kind of
learning I will instill. Dr Pillay 11;319-323
Some respondents, exemplified by Dr Milner, think more laterally about the implications of the test results, making the sensible point that numerical test marks do not necessarily provide information about the process by which the marks were generated.
... is it saying that they were more dependent on their non-small-group activities? [That‘s – yes] You know, what is actually – is the PBL process actually reflecting in the test results, or is it the lecture attendance and the prac attendance that is reflected? [Ja] So it doesn‘t – is it actually then a big deal that they‘ve got medical or non-medical facilitators?
Dr Milner 8;703-706
So, despite medical students‟ desire to be educated by medical doctors, the strongly- expressed feelings about non-medical facilitators received no backing from the marks.
Indeed, there may be good reasons for doctors not being better facilitators. Zodwa‟s comment – “I work extra hard to achieve a good mark if I don‟t have a good facilitator”
– makes the point exactly. Facilitators who know enough to teach their groups may be doing the latter a disservice by short-circuiting those students‟ active search for knowledge and meaning. Alternatively, as I stated at the beginning of this chapter, using test marks as a surrogate indicator of learners‟ engagement with the pedagogy may not have strong validity. The understanding and information manipulation skills learned from facilitators may not be appraised by the formats used in this faculty‟s
assessments. One would like to think that, because assessment material does not reflect only what was covered in lectures, students‟ assessment marks do indirectly reflect the intellectual activities engendered by all aspects of PBL. The fact of the matter remains that no definite conclusion can be drawn from the studies conducted to date as to what quantity or quality of expert knowledge a facilitator should ideally have. Certainly, this study is unable to settle the debate. Learners‟ strongly-held opinions notwithstanding, facilitator background was not significant when inserted in the GEE.
Summation
Numerical analysis of possible influences on learners‟ performance in assessments through the first three years of the MBChB programme shows some congruence and some surprising contrasts with the literature. The type of high school attended, learners‟
previous tertiary education experience, year of study, and school-leaving exam results were significant factors, while sex, facilitator background, „race‟, language, age and financial need were not, despite general perceptions to the contrary. It is intriguing that, compared to so many demographic variables that have been shown to be influential in various settings (chiefly in primary and secondary education in South Africa and elsewhere), the majority of the variables turn out not to be independently influential on the performance of this select group of tertiary-level students.
I have indicated that it is not surprising that the small number of demographic characteristics studied has, when analysed in terms of their mutual interaction, condensed down to even fewer, probably because of their interdependence. Thus Ahmed pointed out (p. 112-3) that, in the circumstances prevailing at present, the racial quotas aimed at redressing past inequities of access to higher education may themselves result in racial inequities due to the need to dip deeper down the pool of applicants in those race groups requiring larger quotas. A little thought reveals that in fact this stems
quality of schooling, their academic achievements would be broadly equal. In other words, the different pools of applicants from which to select different racial quotas would vary in width, not depth. Selecting numbers of students proportionate to their representation in the general population would then yield students of equal academic ability in each race group (see Figure 5.11).
Figure 5.11 Illustration of the influence of racially-based school inequality (a) or equality (b) on academic prowess of students selected according to proportionate racial quotas
This serves as one example of the interaction of students‟ demographic characteristics (and of the importance of qualitative findings to help explain quantitative data). With this numerical appraisal of influences on the academic performance of the whole cohort of students as background, I now turn to constructing accounts of my selected respondents‟ perceptions and experiences of PBL.