Applying the Complexity Concept to Medical Education-a Randomised Controlled Trial in Thailand

Objective: To compare small group learning using a complexity concept approach compared with a competency-based approach in terms of students' satisfaction with the whole curriculum performance and cognitive competency gain. Under the complexity concepts, learning is considered a result of a recursive process that facilitates self-organisation. Recursion refers to the end of one event which gives rise to the next, unlike repetition where the next event is the same as the previous one. To facilitate such learning, teachers help students by designing curricula and learning experiences that are contextually rich, recursive (iterative variations with reflection) and relational. Relational learning means to be able to access knowledge efficiently and judiciously.

Materials and Method: One hundred and sixty students were randomly allocated into 9 small groups of 17-18. A complexity concept approach was applied to one group (intervention group) and a competency based approach which is the usual practice to 8 other groups (usual groups). Two major sets of outcomes were compared i.e., students' overall satisfaction with the curriculum and staff performance; and students' cognitive achievement according to competency-based approach. The curriculum and staff performance were assessed by students rating on 5-point Likert scale. The competency was measured by paper-based cognitive assessment of the basic knowledge of epidemiology, biostatistics and health systems. In addition, the operating cost of using a small group process was compared between the intervention group and usual groups.

Result: An outstanding rating of the curriculum performance was found in the intervention group with statistically significant differences in 3 out of 7 dimensions(68.7% vs 28.2%,81.3% vs 50.7% and 100% vs 72.1%) and similar competency scores were obtained as compared with the competency based groups(29.5(SD3.63) vs 30.5(SD4.22), p value =0.27) . The operating cost of the small group process was similar between the intervention group (351.4 USD) and the competency based groups (332.6 USD).

Conclusions: The complexity concept approach seems to positively influence changes in students' satisfaction with the curriculum and staff performance without compromising cognitive competency gain compared to the competency-based approach.