This systematic review aims to evaluate the effectiveness of systems-based practice (SBP) curricula from the perspective of health professions students and workers. A total of 8468 citations were sourced from six electronic databases and manual searches conducted independently by two researchers, of which 44 studies were eventually included. A meta-analysis using a random effects model and a meta-synthesis using the thematic synthesis approach were conducted. Most studies targeted medical students, residents, and resident physicians from various clinical specialties. Almost half of all studies focused on didactic or knowledge-based interventions to teach SBP. About a third of all studies measured non-self-evaluated knowledge change, clinical abilities, and clinical outcomes. Both meta-analysis and meta-synthesis results revealed positive outcomes of increased knowledge of SBP, increased recognition of SBP as a core competency in one’s profession, and increased application of SBP knowledge in one’s profession. Meta-synthesis results also revealed negative outcomes at the institutional and teacher/health professions level. This review highlights the importance of SBP education and supports the effectiveness of SBP curricula. There is a need to address the negative outcomes at the institutional and teacher/health professions level. Moreover, future studies could investigate the integration of self-assessment outcomes with comparison to some external standard.
Based on 34 studies and to the best of our knowledge, this is the first systematic review consisting of a meta-analysis and a meta-synthesis to illustrate the various self-reflection formats used in public health higher education. Through this review, we aimed to (1) describe the range of self-reflection formats used in public health undergraduate education, (2) compare the level of reflectivity and outcomes of self-reflection according to the common formats of self-reflection used, and (3) compare the facilitators and barriers to deep self-reflection based on the common formats of self-reflection used. Most students were not engaging in reflection at a deep level according to the Mezirow's model of reflexivity. Both meta-analysis and meta-synthesis results revealed self-reflection enhanced self-confidence, professional identity, and professional development as well as improved understanding of public health related topics in these students. Future educational programmes should consider the common facilitators to deep self-reflection, i.e., advocacy on the importance of reflection by instructors and provision of guidance to students and the common barriers, i.e., perception by instructors/students to be time consuming and the imbalance in power relationship between instructors and students. Because perceptions of learning environments varied between institutions, programs, teachers and students, efforts to evaluate the implementation feasibility of these facilitators and barriers need to take place across the different levels. As a start, peer ambassadors or champions could be appointed at the student level to change the common perception that performing deep self-reflection was time consuming. Similarly, at the teacher level, faculty learning communities could be set up for like-minded educators to advocate on the importance of reflection and to share their experience on balancing the power relationship between instructors and students.Systematic Review Registration: PROSPERO, identifier: CRD42021255714.
Despite the wide implementation of self-reflection in higher education, the body of literature has predominantly focused on students from the clinical health sciences rather than public health. The objective of this study was to evaluate the correlates as well as to explore the motivating factors and barriers of engaging in regular self-reflection among public health students in higher education. We used a mixed methods approach (explanatory sequential design), comprising a cross-sectional survey (quantitative phase) followed by in-depth interviews (qualitative phase). We evaluated the association between reflection frequency as well as the perceptions and facilitators in reflection using the modified Breslow-Cox proportional hazards regression model. Prevalence ratio (PR) was generated. Thematic data analysis was carried out to analyse the qualitative data. Quantitative findings revealed being a regular reflector was positively associated with being more motivated to learn when one applied self-reflection (adjusted PR 1.60, 95% CI 1.17–2.20), the perception of being more prepared for a public health career in the future (adjusted PR 1.28, 95% CI 1.02–1.60), as well as being given enough opportunities to carry out self-reflection in the public health modules (adjusted PR 1.24, 95% CI 1.05–1.45). Qualitative findings revealed most students started their self-reflection mainly due to extrinsic factors such as institutional support, social support, teacher influence and environmental influence. Of these, the most prominent was teacher influence, indicating that they are key agents in promoting self-reflection. Students expressed that it would be important to cultivate intrinsic motivation to sustain their practice of self-reflection along the learning journey such as for the development of career-related professional skills. Other than intrinsic motivation, environmental influences were also important to promote continual reflection among students such as the availability of ample opportunities. Prominent barriers to address included external student factors such as the imbalanced power relationship between teacher and student, and internal student factors such as the perception that self-reflection was too cumbersome and time consuming.
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