Abstract
In medical education there is concern regarding the impact of stress on student well-being. This thesis explores stress, re-oriented as challenge, as potentially beneficial for learning.
The three stages of the research explore: 1. the characteristics of challenge in the work-based learning environment; 2. the associations among learning, challenge and affect in respect to specific learning episodes and specific learning environments; and 3. the association with support offered by staff and peers, within the learning environment.
A pragmatic stance to the research was taken that melded a positivist and interpretivist approach with a focus on abductive reasoning. A mixed methodology was adopted that included students in year 4 of the medical course completing surveys rating the levels of perceived challenge, learning, affect and support in specific learning attachments, as well as giving opportunities to describe and rate specific predefined and self-identified challenging learning scenarios. A question on the perceived value of challenge for learning was also asked. In addition focus groups were undertaken to explore what students found challenging in the clinical work-place learning environment, and why. Inductive, grounded theory was utilised to generate codes and themes.
Five peer-reviewed journal papers have already been published from the thesis: two introduce the confusion regarding the term stress in learning and three present some of the empirical data. A further paper has been accepted for publication, subject to revision, and one paper has been submitted and is under review.
The findings extend our understanding of what makes learning challenging and how challenge can benefit perceived learning. Some types of challenge were found to predominantly promote learning (e.g. the novelty of a learning episode), some to either promote or hinder learning (e.g. legitimacy of learning), where authentic clinical tasks were seen as promoting learning and non-authentic tasks as hindering. The results also identified the importance of self-belief of the value of challenge to enhance the perception of perceived learning.
With regard to challenge, it was found that for specific learning episodes there was a positive association with perceived learning but such an association with learning environments more generally was less clear. Challenge appears to have a positive association with perceived learning when support is rated as being high. When staff support was not evident, peer support did not increase but rather reflected the staff support. The impact of the absence of support, a strongly registered component of the focus groups’ data, hindered perceived learning and is covered in one of the published peer-reviewed paper where a framework for leaner neglect has been presented.
This work adds to our understanding about the benefits and also limitations of challenge. In presenting this work the intent is to encourage medical educators to consider how to position challenge to maximise learning. This is best met by not overloading students with too much challenge; ensuring challenge is legitimate to practice and has a social element, and embracing challenge through obvious and meaningful support of students.