effectiveness of using non-traditional teaching methods to

JBI Database of Systematic Reviews & Implementation Reports 2014;12(8) 3 – 19

doi: 10.11124/jbisrir-2014-1354 Page 3

Effectiveness of using non-traditional teaching methods to prepare student health care professionals for the delivery of the Mental State Examination: a systematic review protocol

Rajni Parasuram, RN, RMN, BSc, MEd1

Xie Huiting, RN, RMN, BHScN, PhD (Nursing)1

Jia Wang, RN, RMN, BScN1

Anouradha Thirumarban, RN1

Helen Joon Kum Eng, RN, RMN, BSc 1

Poh Chee Lien, RN, AdvDip (Gerontology), BN, MHSE1

1. Institute of Mental Health, Singapore; the Joanna Briggs Institute – Institute of Mental Health

(Singapore) Centre for Evidence-Based Practices in Mental Health Care: a Collaborating Center of

the Joanna Briggs Institute

Corresponding author:

Xie Huiting

[email protected]

Review question/objective

The aim of this systematic review is to identify the best available evidence of teaching methods used

to prepare student health care professionals for the delivery of the mental state examination. This

review has the following objectives:

1. To identify if non-traditional teaching methods leads to overall improvement in the learners’

knowledge and competency level for the conduct of the mental state examination in students.

2. To compare the effectiveness of non-traditional and traditional methods of teaching the

mental state examination on learners’ satisfaction, knowledge, skills and self-confidence.

Background

Education plays a pivotal role to the pace of social-political and economic growth of any nation;

therefore effective teaching is essential. Effective teaching does not solely revolve around getting the

vast amount of knowledge into the learner; it delves deeper into the technicalities, ensuring that

teaching is based on assisting the learner’s progress from one level to another while allowing the

learner at the same time to slowly evolve and make sense of the content independently.9 Thus,

effectiveness is not akin to having the perfect teaching session or giving a wonderful performance, but

rather, it ensures that the content delivered brings out the best in the learner. Choosing a teaching

mailto:[email protected]


doi: 10.11124/jbisrir-2014-1354 Page 4

method is best articulated by answering these questions, “What are the aims of this teaching

session?” and “What are the best ways of achieving these aims?”

The term “traditional teaching” relies mainly on a method that utilizes textbooks, lecture notes,

memorization and recitation techniques. Delivering education through a traditional format sees no

priority in catering to the rich and diverse learner population or the need to develop critical thinking,

problem solving, and decision making skills, but instead directs learners to assume a non-thinking and

information-receiving role.16

It is a largely functional procedure which focuses on skills and area of

knowledge in isolation. Assessment in the traditional method of teaching, is seen as a detached entity

and occurs only through examination, while with modern methods of teaching, assessment is seen as

an activity which is creatively embedded into teaching and learning.3

Non-traditional teaching methods are commonly known as innovative/modern teaching methods that

involve the use of technology, animation, special effects and are generally learner self-directed and

interactive in nature.22,23

Several authors within this field acknowledge that both traditional and non-

traditional teaching methods influence communication and retention of important concepts.3,5,11,18

However, the caveat is such that, the appropriateness of the method must be in line with the learning

styles of the learners and the curriculum.4,18

In the 21st century, health care education has embraced a new meaning and identity. The slow but

obvious evolution in health care education sees a drastic change of how learners’ critically think and

learn through the use of various teaching methods. With the evolution of education, there is also a shift

in the use of traditional teaching methods from didactic or lecture style teaching to non-traditional

teaching methods such as demonstration by lecturer, use of the overhead projector (OHP), viewing of

pre-recorded demonstrations on video tapes, enacting role plays to non-traditional methods such as the

use of virtual environments with avatars, masked silicone props, classroom response systems and

interactive interfaces, simulation, and live interviews with patients to engage the learners in various

ways.1,2,7,11,12,25

The extensive use of the different teaching methods are reported in a study conducted

by Johnson and Mighten in 2005. Two teaching strategies were compared: lecture notes combined with

structured group discussion versus lecture only and found that the group adopting the lecture notes

combined with the structured group discussion had better mean examination scores. Similarly in 2010,

Levitt and Adelman utilized role play in teaching nursing theory. The learners adopted the identity of a

chosen nursing theorist while interacting with other nursing theorists played by their peers. The study

found that this method engaged students and instilled active learning and interest in the topic at hand.

The mental state examination (MSE) is made up of standard concepts that assess the patient’s mood,

affect, thought, behavior, suicidal ideations, judgment and insight.14,16,17

The teaching of MSE differs

between country, academic institutions and clinical settings. In academic institutions, the information

presented to learners’ varies and is available in many traditional and non-traditional teaching methods.

Considering the depth of theory and skills necessary in the teaching of the MSE, learners would

anticipate the information to be presented in an interactive and interesting manner which would aid quick

retention and improve satisfaction with learning.12,13

The ability to conduct a MSE is an important pre-clinical competency in nursing, medical and allied

health disciplines that students are taught during their training.13

MSE augments other assessment

components such as the history of the presenting complaint and provides clues as to what is

necessary for more detailed assessment to take place, for example, cognitive assessment or

psychometric testing.17

In addition, the learner is required to elicit the correct clinical information in order


doi: 10.11124/jbisrir-2014-1354 Page 5

to gather the best mental clinical picture of the patient. Often compared to a medical diagnostic tool, it

provides the health care provider with a cross section of the patient’s mental state.14

The process of

conducting an accurate history and MSE takes practice and patience, but it is very important in order

to evaluate and treat patients effectively. Further mastery of this skill is demanded from healthcare

professionals who plan on entering the specialized mental health scene.

If MSE is not taught in the most effective manner for learners to comprehend concepts and to interpret

the findings correctly, it could lead to serious repercussions and impact clinical care for patients with

mental health conditions, such as incorrect assessment of suicidal ideation. Hence, it is important to

review and appraise how such teaching methods may have an impact on learners. A variety of

questionnaires are used in literature examining learners’ satisfaction and self-confidence; however

most of these papers report the use of self-developed surveys, examination scores and multiple

choice questionnaires, while others were adapted from previous researchers.2,6,11,12,14

One of the

questionnaires constructed by the National League of Nursing gauged students’ satisfaction with the

session and self-confidence gained.15

Students were asked to use a five-point Likert type scale to

indicate their agreement and disagreement towards the three subscales.

Previous systematic literature reviews related to non-traditional teaching methods focus on the following:

(1) constructivist aspects on problem based learning, critical thinking and team-based learning; (2)

influences of teaching methods on knowledge retention and learner achievement/grades and (3) specific

to a particular group of learners . A preliminary search of the Joanna Briggs Database of Systematic

Reviews and Implementation Reports, the Cochrane Library, OVID, PsycINFO, CINAHL, PubMed and

PROSPERO has revealed that there is no systematic review (either published or underway) that

investigated one or more non-traditional teaching method specific to teaching the MSE. This systematic

review positions itself to inform educators of determining which of the teaching methods is more

effective than the other teaching methods for MSE training, and aims to add value to the health care

profession by informing clinicians, educators, administrators and academics in Singapore, and globally,

of the effectiveness of non-traditional teaching methods. The findings from this review will help guide the

development of evidence-based curriculum which is urgently lacking in the field of mental health and

may provide grounds for further research on the teaching methods required for effective delivery of the

MSE.

Definition of terms

Teaching methods are defined as the principles and methods used for instruction to engage learners

which includes, but is not limited to, demonstration, memorization, participation, brainstorming, etc.3,10

The term is often used interchangeably with instructional methods.10

Traditional teaching methods are defined and described as methods that usually rely on lectures and

notes-taking and that are often very teacher centric without the use of any teaching aids.5,6,17,18

For

the purpose of this systematic review traditional teaching methods are considered as those that use a

didactic or lecture style technique without use of interactive interfaces.

Non-traditional methods, commonly known as innovative/modern/blended teaching methods, are

methods that involve the use of the technology, animation, special effects or are generally interactive

and blended in nature (for example, the use of computers and videos to enhance delivery content).


doi: 10.11124/jbisrir-2014-1354 Page 6

Keywords

Video/videotapes; lectures; virtual reality/simulation; avatars; computer based training; elearning; role

play; simulation; face to face interviews; mental state assessment; mental health assessment;

psychiatric assessment; mental-health; teaching; education; standardized patients; computer assisted

learning; student

Inclusion criteria

Types of participants

The review will consider all studies that include student learners in the following field: medicine,

nursing, physiotherapy, occupational therapy, speech pathology, medical radiation science, nutrition

and dietetics, oral health and podiatry and those who have received education/training on

administration of the MSE in academic settings which offer mental health education. Papers involving

qualified health care workers will be excluded.

Types of interventions

The review will consider all studies that include non-traditional teaching methods (for example role

play, computer-based delivery, standardized patients, virtual reality environments, etc.) in the delivery

and conduct of mental state examination.

Comparator

The review will consider traditional teaching methods (for example didactic teaching, classroom

teaching and lectures) as comparators. The review will also consider studies with no education as a

comparator.

Types of outcome measures

This systematic review will consider studies that measure learners’ outcome (for example learners’

satisfaction, improved knowledge and self-confidence).

Types of studies

This review will consider evidence from primary quantitative studies which address the effectiveness

of a chosen method used for the teaching of the MSE published in English. The review will primarily

consider Randomized Controlled Trials (RCTs). In the absence of RCTs, other quantitative research

designs, such as quasi – randomized controlled trials, cohort studies, case control studies,

longitudinal studies, descriptive studies and correlational design studies will be considered for

inclusion. In the absence of quantitative research studies, other texts such as opinion papers,

discussion papers and reports that meet the inclusion criteria will be considered.


doi: 10.11124/jbisrir-2014-1354 Page 7

Search strategy

The literature search seeks to find published studies and papers, limiting to English language reports

using a variety of databases. The search strategy will include the period from the inception of the

database to 2014. A three-stage search will be undertaken in this review. An initial search of CINAHL

and MEDLINE databases will be undertaken to identify the key words. A second extensive search will

be undertaken and extend to other relevant databases using the identified keywords. The third search

will involve reference lists and bibliographies of all identified articles for additional studies. Electronic

databases to be searched include:

CINAHL

MEDLINE/PubMed

Cochrane Central Register of Controlled Trials

Ovid/PsycINFO

Scopus

Web of Science

Wiley InterScience

The search for unpublished studies will include:

Google scholar

Intute

ProQuest Dissertations and Theses Database

MedNar

Dissertation Abstract Online (DIALOG)

Education Resource Information Center (ERIC)

Initial keywords:

Video/videotapes, lectures, virtual reality/simulation, avatars, computer based training, elearning, role

play, simulation, face to face interviews, mental state assessment, mental health assessment,

psychiatric assessment, mental-health, teaching: education, standardized patients, computer assisted

learning, student.


doi: 10.11124/jbisrir-2014-1354 Page 8

Assessment of methodological quality

Studies selected will be assessed by two independent reviewers for methodological validity prior to

inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs

Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI)

(Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion

or with a third reviewer.

In the absence of research studies, textual papers selected for retrieval will be assessed by two

independent reviewers for authenticity prior to inclusion in the review using standardized critical

appraisal instruments from the Joanna Briggs Institute Narrative, Opinion and Text Assessment and

Review Instrument (JBI-NOTARI) (Appendix I). Any disagreements that arise between the reviewers

will be resolved through discussion, or with a third reviewer.

Data extraction

Data will be extracted by the two independent reviewers using data extraction tools developed by the

Joanna Briggs Institute (JBI). Quantitative data will be extracted from papers using standardized data

extraction tools from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review

Instrument (JBI-MAStARI) (Appendix II). In the absence of research studies, data from expert opinion

texts and reports included in the review will be extracted using standardized data extraction tools from

the JBI-NOTARI (Appendix II). Authors will be contacted if further raw data is required. Any

disagreements that arise between the reviewers will be resolved through discussion or with a third

reviewer.

Data synthesis

For quantitative findings

Where possible, quantitative research study results will be pooled using JBI-MAStARI. All results will

be double entered. Odds ratio (for categorical data) and weighted mean differences (for continuous

data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be

assessed using the standard Chi-square.

Ordinal and measurement scale outcomes will be meta-analyzed as continuous data. Two summary

statistics used for meta-analysis of continuous data include the weighted mean difference (WMD) and

the standardized mean difference (SMD). WMD will be used if studies all report the outcome using the

same scale while SMD will be used if the studies report the outcome using the different scales.

Nominal outcomes will be meta-analyzed as dichotomous data using event rate (number that had the

outcome/number that received the specific intervention). Where statistical pooling is not possible, the

findings will be presented in narrative form.


doi: 10.11124/jbisrir-2014-1354 Page 9

For expert opinion texts and reports

In the absence of research studies, where meta-synthesis of text is possible, conclusions in papers

will be pooled using JBI-NOTARI. This will involve the aggregation or synthesis of conclusions to

generate a set of statements that represent that aggregation, on the basis of similarity in meaning.

These categories will then be subjected to a meta-synthesis in order to produce a single

comprehensive set of synthesized findings that can be used as a basis for evidence-based practice.

Where textual pooling is not possible, the conclusions will be presented in narrative form.

Conflicts of interest

There are no conflicts of interest regarding this systematic review.

Acknowledgments

The reviewers acknowledge Institute of Mental Health, Singapore, for its support in this review.


doi: 10.11124/jbisrir-2014-1354 Page 10

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Appendix I: Appraisal instruments

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Appendix II: Data extraction instruments

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effectiveness of using non-traditional teaching methods to

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