British Joitrrial of Medicul Erlttcarioti, 197 I , 5, 2 I 3-2 16

Student awareness of behavioural objectives: the effect on learning T. VARAGUNAM Per ad en i y a, Ceylon

Department of Medicine, University of Ceylon,

Behavioural objectives are statements which describe precisely the specific observable activi- ties that the student should be capable of per- forming on completion of his training. The practice of stating intended educational out- comes in this form was first advocated by Tyler (1934) for the purpose of using the statements as standards against which student performance could be judged. They are also now used as the first step in the construction of programmed learning materials and less commonly in the planning of conventional teaching procedures.

Logically, student knowledge of behaviouml objectives should enhance learning because they provide direction to the student’s learning efforts. Empirical data obtained in experiments in teaching engineering (Mager and Clark, 1963) and economics (Tiemann, 1967) seem to support this contention, but there are no data available in the literature on medical education to validate it . The purpose of the present study was to determine the effect of student awareness of behavioural objectives on learning in the medical school setting. This was done by designing and carrying out an experiment to test the following hypothesis. Medical students who are given printed lists of behavioural objectives before receiving instruction in a topic by lectures will perform better in achievement tests administered after instruction than will students who attend the same lectures but are not given specific objectives.

Subjects Fifty-eight students agreed to participate in the experiment. All of them were in the first month of their fourth year of a five-year training in medical school. None of the students had attended systematic lectures on the clinical aspects of cardiovascular diseases previously.

They were divided at random into two groups, designated as group A and group B, each containing 29 students. Since five students in group A and three in group B had voluntarily dropped out at various stages of the experiment, final analysis was done on the scores of 24 and 26 students respectively.

Material The behavioural objectives The topic areas used were acute rheumatic fever and its sequelae (Rh HD) and ischaemic heart disease (Isch HD). The author formulated 44 behavioural objectives in Rh HD and 37 in Isch HD all of which were in the cognitive domain as defined by Bloom (1956). About half the number in each topic called for the intellectual skill of recall and the rest were distributed equally into those which called for comprehension and problem solving. The following are illustrative of the behavioural objectives used in this experi- ment: The student should be able to . . .

1. . . . list the major criteria for the diagnosis of acute rheumatic fever (recall);

2 . . . . describe and diagrammatically repre- sent the heart sounds and murmurs in incompetence of the aortic valve (recall);

3. . . . describe the gross anatomy of the coronary arteries (recall);

4. . . , detect and correctly attribute the radio- logical changes when presented with a dia- gram of the P-A view chest x-ray of a patient with mitral stenosis (comprehension);

5. . . . prescribe the treatment when presented with a description of a patient with the classical features of angina pectoris (com- prehension) ;

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214 T. Varclgiinarn

6. . . . infer the valvular abnormality from a description of the physical signs in a patient with chronic rheumatic heart disease (problem solving);

7. . . . arrive at a tentative diagnosis from a description of the clinical features that are present in a patient who had acute onset of chest pain (problem solving).

Tests used Multiple-choice questions were used to measure achievement of objectives. Each question had five alternative answers with one or more than one answer being correct. The test on Rh HD had 16 questions and the test on Isch HD had 14. The maximum possible raw scores on the tests were 36 and 41 respectively. Raw scores were expressed as percentages. Representation of the three categories of intellectual skills was in the same proportion as in the objectives.

The questions were designed to test achieve- ment of the stated objectives. For example, the following questions test the achievement of objectives 5 and 6 above.

A previously healthy elderly patient complains bf pain in the centre of the chest which comes on only when climbing up a flight of stairs. The pain lasts one to five minutes, is sometimes felt in the throat, and is relieved when he stops climbing. He smokes 20 cigarettes a day. On physical examination apart from obesity he has no abnormal physical signs. The ECG at rest is normal.

Which of the following will help relieve his pain? 1. Correction of anaemia (if present on blood

2. Avoidance of smoking. 3 . Reduction of weight. 4. Aspirin 600 mg tds daily for two weeks. 5. Trinitrin sublingually before starting to climb

examination).

stairs.

A patient IS found to have the following physical signs: pulse 1 lO/min, irregular; blood pressure lOOj80; first heart sound is loud; second heart sound widely split; mid-diastolic murmur at the apex; early diastolic murmur at the left sternal edge.

Which of the following abnormalities would account for these signs?

1. Aortic stenosis. 2. Aortic incompetence. 3. Mitral stenosis. 4. Pulmonary incompetence. 5. Sinus tachycardia.

Method The experiment was conducted in three phases in chronological sequence.

Phase 1 Each student in group A was given a printed list containing all the objectives on Rh HD. They were told not to show it or discuss its contents with anyone until the test on the topic was over. They were also advised to refer to the list when studying material related to the subject. Students in group B were not given this list of objectives. Both groups together attended two lectures on the topic. Each lecture lasted 40 minutes and they were given one week apart. One week after the second lecture the test was given to both groups. (Immediate trial on Rh HD.) Notice of this test was given to all the students at the commencement of the first lecture.

Phase 2 The same procedure as in the previous phase was repeated using Isch HD, except that on this occasion each student in group B was given a printed list containing all the objectives on the topic while the students in group A were not given the lists. The test was administered to both groups. (Immediate trial on Isch HD.)

Phase 3 One week later the lists of objectives on both topics were given to all the students who par- ticipated in the experiment and each objective was discussed in a class which was attended by both groups. Three months later the two tests were readministered without warning to both groups (delayed trials).

The significance OF differences between pairs of means was computed using the Newman- Keuls sequential range test. A three-way analysis of variance with repeated measures on two Factors was done. Only P values less than 0.01 were considered to be educationally significant.

Results Mean scores of the two groups and the sig- nificance of the differences between pairs of means are represented in Table 1. The groups with objectives had significantly higher mean scores.

Stiidetit awareness of behavioirral objectives: the qffkct otr Ieartiiw 215

Table 1. Mean scores ofindividualgrorips (%) Groups Groups

with without Sigiiifi- Topic Trial objectives objectives cance

Rh H D Immediate 62.12 (A)’ 52.73 (B) P<O.OI Delayed 66.79 (A) 53.07 (B) P<O.Ol

Significance P iO.01 NS lsch H D Immediate 65.46 (B) 61.08 (A) P<O.OI

Delayed 62.73 (BJ 54.79 (A) PtO.01 Significance NS PcO.01 - ~~

*Letters in parentheses refer to the groups.

The difference between mean scores of the groups with and without objectives in the immediate trial on Rh HD is more than twice the comparable difference on Isch HD. On com- paring the performances of the groups without objectives on the two immediate trials of the topics, the group without objectives on Isch HD had a significantly higher mean score (P<O.OI). It is of interest to note that this group had previous experience in studying a topic with objectives in the first phase of the experiment before performing on a topic without objectives.

In Rh HD the mean score of the group with objectives increased significantly from im- mediate to delayed trial while the mean score of the group without objectives did not change. In Isch HD the mean score of the group with objectives did not change while the mean score of the group without objectives decreased sig- nificantly.

Analysis of variance (Table 2) did not reveal any significant variation between group A and group B or between the two topics. This suggests that the differences in mean scores were due neither to bias in assignment of students to the two groups nor to a difference in difficulty of the topics. The significant interaction betweengroups and topics is consistent with the data in Table 1. The significant interaction between topics and trials is clarified in Table 3 which shows a sig- nificant decrease in mean score for both groups combined on Isch HD.

Table 2. Aiialysis of variance summary table

Degrees of Mean Sigrriji- Source of variution j’ierriom squares F cance

Groups 1 362.37 < 1.0 N S Topics 1 359.75 7.10 NS Trials I 49.0 1.37 NS Groups x top^ 1 3917.13 77.32 P<O.Ol Groups :i trials I 2.75 I- 1.0 NS Topics Y trials I 590.87 27.09 Pt0.01 Groups :i topics rrinis I 192.62 8.83 P<O.Ol

Table 3. Mean scores of both groups combined (%) ~~

Immediutc Delayed Sigtiifi- Topic trial trial catice

Rh H D 57.24 59.66 NS Isch H D 63.36 58 92 PiO.01

Discussion The data in Table 1 indicate acceptance of the research hypothesis, that student knowledge of behavioural objectives enhances learning. Also the experience of thinking in terms of behavioural objectives when studying a topic appears to facilitate the learning of subsequent topics in which objectives were not available.

Conclusions from the data on the changes in mean scores from immediate to delayed trial can be made only after reviewing the activities in which the students were involved during the three months that elapsed between trials. These activities were not within the control of the investigator. There was no detailed record of the teaching to which the students were exposed, but a general idea of the activities was obtained by interviewing them after the experiment was over. All students had done the clinical clerkships that were on the schedule that is normally followed at the Peradeniya medical school during the first quarter of the fourth year of training. This consists of one month on the paediatric firm and two months on the obstetric firm. Patients with acute rheumatic fever and its sequelae are frequently seen in the paediatric wards of Ceylon and frequently discussed during the clerkships. The students were not involved in any activity where ischaemic heart disease is normally discussed.

The data on the changes in mean scores (Table 1) indicate that students when they initially studied the topics with objectives retained the knowledge better than when they studied the topics without objectives. In Rh HD, on which they were taught in the paediatric firm, the group with objectives made a significant gain while those without objectives showed no change. [n Isch HD, on which they had no subsequent instruction, the group with objectives had no significant change while the group with- out objectives had a significant decrease in mean performance. The data on the changes in mean scores on Rh HD also suggest that the ability to benefit from subsequent instruction appears to be increased if the topic is initially studied with

216 T. Varagrrrtarn

knowledge of behavioural objectives. The changes in mean scores of both groups combined (Table 3) probably reflect the effects of subsequent instruction on Rh HD and the lack of it on Isch HD.

The present state of knowledge on the learning process allows only for speculation on possible reasons for the favourable effect on learning that was associated with the provision of behavioural objectives. An explanation given by some educationists who hold views against the use of behavioural objectives is that students when made aware of such objectives are really being given the questions that they would be asked at the end of instruction and their superior per- formance reflects their ability to memorize the answers. This is not the explanation in this instance because the questions asked were not simple replicas of the objectives and they cannot be replicas when testing objectives that call for comprehension and problem solving. A more plausible explanation is that these students per- ceive the material that is being presented during instruction in a more meaningful manner. Empirical research data (Guilford, 1952; Kimble and Garmezy, 1963) have established the fact that more meaningful material is more rapidly learned and retained for a longer period of time.

The practical implication of the conclusions that were derived from this experiment will be

apparent to teachers. The extra effort involved in laying down behavioural objectives for the subjects they teach pays off in a clearer conception of goals and in improved student achievement.

In the present study the objectives tested were in the cognitive domain only. It would also be worthwhile including objectives in the attitudinal and psychomotor domains in future studies which set out to investigate the effects of awareness of objectives.

This paper was written during a Fellowship a t the Center for Educational Development in the College of Medicine a t the University of Illinois, Chicago, USA. I would like to thank the World Health Organization for granting m e a fellowship in medical education for one year commenc- ing in June 1970; Mr. Thomns 3. Bligh for the statistical analysis; a n d Dr. William R. Crawford and Dr . George E. Miller for their encouragement and guidance.

References Bloom, B. S. (Editor) (1956). Taxonomy o/ Educational

Objectives, Handbook I . Cognitive Domain. David McKay Company Inc.: New York.

Guilford. J. P. (1952). General Psychology. Van Nostrand: Princeton, NJ.

Kimble, G. A.. and Garmezy, N. (1963). Principles of Genertrl Psychology. Ronald Press: New York.

Mager, R. F., and Clark, C. (1963). Explorations in student controlled instruction. Psychological Reporrs, 13, 71-76.

Tiemann, R. W. (1967). Outcomes in a Televised College Economics Course with Variable Student Knowledge of Objectives. (Unpublished.) Thesis submitted for the degree of Doctor of Philosophy in Education in the University of Illinois, Urbana, Illinois, USA.

Tyler, R. W. (1934). Constructing Achievement Tests. Ohio State University: Columbus, Ohio.