The 6D-approach provides a novel strategy to improve UME. Under the following subheadings, we explore the different cognitive and non-cognitive skills that are beneficially affected, when this approach is implemented.
Deep vs surface learning
Didactic teaching rarely facilitates potentiation of long-term memory [34]. When students go-over lecture materials or tutorial problems, maintenance rehearsal or rote memorization occurs leading to “Surface-learning” [35]. In the 6D approach in Steps corresponding to Design and Delivery, elaborate rehearsal is facilitated, accelerating “Deep-learning” [35], as the student repeatedly applies the concepts delivered in the Didactic step, in analyzing the details of the article as well as reflecting on the data presented in the article in light of the concepts delivered. (Fig. 3).
The exercise of rote memorization is more passive and leads only to short-term retention, whereas elaborative rehearsal is an active learning practice advantageous for transmitting the information into long-term memory [36]. Unlike working memory, long-term memory is limitless in capacity and stores information perpetually in forms of systematized schemas [37]. The 6D approach addresses this goal as repeated retrieval and encoding of data is required in the Designate, Design, Delivery and Discuss steps of the approach, which is illustrated in Fig. 3.
Aiding metacognition
Metacognition is awareness and control of one’s learning or the knowledge and thinking about one’s own or another’s thoughts, feeling, and values [38]. It can be catalogued into: knowledge of cognition and regulation of cognition. Knowledge of cognition relates to what individuals comprehend about their own knowledge base. Regulation of cognition denotes to a set of essential skills that help students control their learning, including planning, monitoring, and evaluation [39].
The 6D approach allows the student to consolidate information in the articles according to a definite concept map. The student designs this concept map, during which s/he requires to assimilate the concepts, which helps in the development of the understanding of “how to learn” not only “what to learn”.
Encouraging autonomy in learning
Learning autonomy refers to the student’s ability to set learning goals and take charge of his or her learning [40]. The perception of autonomy is founded on three principles: perceived internal locus of causality, volition, and perceived choice. The 6D approach supports the three principles of perception of autonomy. In the 6D-approach, the student selects the article and presents it, in line with the first principle of perception of autonomy. Design, Deliver and Discuss steps allow the student independence to design, deliver and appraise the presentation/article in a non-threatening environment amongst his peers. Additionally, these steps also allow the student to set his/her own learning and evolvement goals, addressing the second and third philosophies of learning autonomy.
Promoting critical-thinking
Critical thinking is an indispensable cognitive aptitude for the individuals involved in different healthcare domains [41]. The 6D approach builds up student’s critical thinking skill by providing a reliant teaching-learning environment wherein Design, Deliver and Discuss steps encourage reasoning and analytics, problem solving abilities and welcome new ideas and opinions. Case in point, during Discussion following Group 1’s presentation, one of the students indicated that CRISPR technique of gene editing could be used to effectively treat Fanconi anemia. This new thread of information was not indicated in the article and provided a new dimension to the discussion.
Development of leadership skills
Larry L. Mathis once commented “Nothing in a doctor’s medical education qualifies him to be a leader” [42]; Yet, physicians are expected to be a leader, to bear accountability, and to provide pivotal medical decisions facing a heterogeneous environment. Therefore, it is imperative that activities exploring group dynamics, that promote the development and cultivation of leadership skills are implemented in UME. These include activities focusing on team-leadership abilities, relationship management, emotional intelligence, situational leadership, and the capacity for reflection. The Designate, Design, Deliver and Discuss steps of 6D-approach, help train students in the above competencies.
Facilitating self-evaluation and peer feedback
Self-evaluation and peer-feedback are essential obligations of medical professionals in the improvement and continuance of professional competencies [43, 44]. In the 6D approach, the Design step allows the students to reflect on the concepts delivered in the Didactic step. This helps them to self-evaluate their gaps in learning. The Discuss step allows the students to involve in an elaborate discussion with their peers, during which they receive a detailed feedback with regards to not only the presentation but also on their understanding of the concepts with respect to the topic being addressed through the presentation. Although, we did not obtain a formal feedback from the students, we did informally ask them to evaluate the presentations of their peers following Pendleton’s approach of obtaining feedback [30]. This approach emphasizes on the following aspects:
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Ask the student what went well
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Tell them what went well
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Ask the student what could be improved
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Tell them what could be improved
Benefits to the instructor in implementing 6D-approach in UME
The 6D approach provides the instructor with opportunities to inculcate novel pedagogical techniques in the curriculum. One of our future aims will be to employ technology enhanced learning (TEL) through the 6D approach. TEL can be defined as an innovative pedagogical approach, that aims to combine learning design and leverage digital technologies to deliver active and engaging, student centered learning [45]. Our endeavor will focus on the effectiveness of one specific social media tool (Twitter) in terms of its application of the 6D approach and impact on groups of undergraduate medical students. It will assess how the medium supports the online group discussion, the efficiency of article dissemination, the selection of articles for the active in-classroom discussions, how group members deal with resistance to participation and over contribution. Conclusions will be drawn around the areas of participation, over saturation of information and the building of a community of practice amongst the group of ‘digital natives’.
Practice points
Designers of UME need to address the exponentially expanding volume and variability of scientific knowledge, where by didactic teaching methods need to be augmented by innovative student-centric pedagogical strategies. Such pedagogical strategies need to be informed by focused teaching principles, and should integrate information, communication and technology-enabled tools to promote lifelong information gathering, assimilation, integration. One of these approaches is to employ mentored journal clubs, which are scholarly congregations in which individuals convene regularly to critically assess/appraise current/recent articles in the scientific literature, especially in basic science courses in UME, as these courses provide a platform allowing students to develop their personal critical decisional framework as well as define the understanding of normal human physiology, pivotal for the identification, categorization and management of pathophysiology. Such journal club integrating pedagogical strategies will encourage retention of knowledge, critical thinking, metacognition, collaboration and leadership skills in addition to self-evaluation and peer feedback.
Limitations of the present study
We successfully implemented the 6D-Approach in UME, and the approach was favorably received by the students. However, our study has specific limitations:
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Due to the exploratory nature of this educational approach, we decided to publish and share our approach before we embarked on a larger more formally structured program. We therefore are unable to present a well-designed and executed evaluation of the expected improvements in knowledge retention as well as enhanced non-cognitive skills and competences.
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We explored the benefits of the 6D-Approach in a course on Molecular Biology and Principles of Genetics. The nature of the chosen topic is characterized by mechanistic and structural aspects of medical science. Topics that require the development of other skills and competencies such as analytical prowess, emotional intelligence and emphatic aptness could improve by implementing the 6D-Approach. However, we cannot extrapolate the results from our pilot project to courses of a distinctly different nature.
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The positive feedback received from the course participants are an indication that the implementation of the 6D technique can incite enthusiasm in students. However, a formal and more robust measurable outcome need to be formulated and analyzed as to provide an overall accepted scientific proof of the expected superior end results.
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The successful implementations of the 6D approach builds on the technical and practical implementation of the model. However, like all teaching situations, success depends on the enthusiasm, knowledge and communication skills of the course directors - teachers as well.