Investigating the learning value of early clinical exposure among undergraduate medical students in Dubai: a convergent mixed methods study

Abstract

Introduction: The benefits of Early Clinical Exposure (ECE) in medical education are often stated but there is limited evidence on how to effectively maximize its learning value. The challenge for medical educators lies in finding ways to enhance the quality of ECE in alignment with students' feedback, while realizing the learning outcomes. The purpose of this study is to investigate undergraduate medical students' perception of an innovative ECE intervention in Dubai, United Arab Emirates, developed using design-based research in alignment with adult, experiential learning theories.

Methods: A convergent mixed methods study design was utilized. The data was collected using a tailormade survey to solicit both quantitative and qualitative feedback. Quantitative data was analyzed using SPSS. Qualitative data analysis was inductive based on constructivist epistemology. Following the conclusion of the independent data analyses of the quantitative and qualitative datasets, the primary inferences were integrated using the iterative joint display analysis process.

Results: Out of the 68 students who attended the ECE, 54 responded. The percentage of the total extent of agreement that the ECE: familiarized them with learning in the clinical environment and brought forth the institutional values were 79.60% and 86.43%, respectively. The extent of active engagement and self-directed learning, with a mean of 6.80(2.42), was significantly associated with how much the learners reaped from the learning experience (P < 0.05). A novel conceptual model, namely: 'Early Clinical Exposure Added Value', with five interconnected themes, was developed from the qualitative analysis. Integration of findings led to six meta-inferences: Embeddedness in context of learning, System perspective, Patient-centricity, Theory-practice link, Resilience, and Proactiveness.

Conclusion: The more medical students engage in their learning, the more ECE contributes to building their academic resilience, and propels them in terms of clinical correlations, skills' development, and values reinforcement. Securing engagement opportunities for the learners, when designing and planning for the ECE, is essential. Optimizing the ECE learning value can happen systematically through continuously developing the respective intervention in alignment with the principles of design-based research and anchoring it in constructivism experiential learning theories.

Keywords: Adult learning theory; Align; Alignment; Based research; Basic medical sciences; Care; Clinical correlation; Clinical medical sciences; Design; Discovery; Dubai; Dubai Health; Early clinical exposure; Foundation of clinical medicine; Giving; Health professions education; Kolb’s experiential learning theory; Learning; Medical education; Ministry of Higher Education and Scientific Research; Mixed methods research; Outcome-based Evaluation Framework; Patient centricity; Patient first; Resilience; Resilient health professionals; SDG 17; SDG 3; SDG 4; SDG 9; Self-directed learning; Self-regulation; Social constructionism; Sustainable Development; Sustainable Development Goals; System perspective; Undergraduate medical education; United Arab Emirates; United Nations.

Fig. 1

Illustration of alignment of goals (micro-, meso-, and macro-levels). The figure shows how the pillars of Dubai Health (Care, Learning, and Discovery, and Giving) are feeding into the pillars of the Outcome-based Evaluation Framework (OEF) which in turn contribute to select Sustainable Development Goals (SDGs). Patient first, as the core value of Dubai Health [purposely located in the heart of the illustration, slightly towards the left (in Green, which is considered a balanced anchor for the other colors of the visible spectrum)]. This patient centricity is among the differentiators of MBRU from the rest of the Higher Education Institutions governed by the OEF of the UAE Ministry of Higher Education and Scientific Research

Fig. 2

Bird’s-eye view of MBBS at MBRU

Fig. 3

A visual representation of the locations of the respective centers. In terms of driving distance from MBRU, Center 1 is 14.5 KM, Center 2 is 19.1 KM, and Center 3 is 24.6 KM

Fig. 4

Mind map deployed as a tool to facilitate the qualitative analysis. This figure is meant to demonstrate a steppingstone in the analysis process. The output of respective analysis is Fig. 5

Fig. 5

Early Clinical Exposure Added Value

Fig. 6

Output of the iterative joint display analysis process, resulting in six meta-inferences: Embeddedness in context of learning, System perspective, Patient centricity, Theory–practice link, Resilience, and Proactiveness. The secondary color Green emerged by mixing the primary color Blue with the primary color Yellow (which constitutes an analogy of the lateral and critical thinking that took place to generate the meta-inferences from the integration of two sets of primary inferences). For the first five meta-inferences, integrating the quantitative with the qualitative inferences led to both: confirmation and expansion in the overall viewpoint. As for the last meta-inference, namely: Proactiveness, the integration led to: confirmation, expansion, and refinement of the overall viewpoint