Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
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It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : February | Volume : 5 | Issue : 1 | Page : 20 - 23

Readiness For Self Directed Learning Among First Semester Students Of A Medical School In Nepal

SUDESH GYAWALI*, AKHILESH C JAUHARI**, P RAVI SHANKAR***, ARCHANA SAHA****, MERAJ AHMAD***** Correspondence Address :
Mr. Sudesh Gyawali
Department of Pharmacology
Manipal College of Medical Sciences (MCOMS)
P.O. Box: 155
Deepheight, Pokhara, Nepal
E-mail: sudeshgy@hotmail.com
Phone: 00977-9848032051, 00977-61-440260 (Fax)



Abstract

Background: Self directed learning (SDL), a central theme in adult education, is considered to be associated with the management of lifelong learning for better outcomes. Certain learning situations help to strengthen SDL. Medical science changes rapidly and there is an information explosion; so, it is important to train doctors for SDL.

Aims: The aim of this study was to measure the readiness for SDL of students at the beginning of the undergraduate medical course.

Methods: The readiness for SDL was measured among 121 first year undergraduate medical students at Manipal College of Medical Sciences, Pokhara, by using the Self-directed Learning Readiness Scale (SDLRS), an instrument developed by Australian researchers.

Results: The observed mean score was 157.8 (range 103 – 190). According to Fisher and coworkers, the developers of the scale total scores greater than 150 indicate readiness for SDL. Most of the students (72.7%) scored more than 150 and so, they could be considered as ready for self directed learning. The mean scores were not significantly different among the male and female students as well as among the self-financing and the scholarship students.

Conclusions: Most of the first semester students had a high degree of readiness for self directed learning. Studies correlating the SDL score and the students’ academic performance are lacking and so, the scores of the students could not be used to predict their success in the forthcoming exams. Therefore, more research is required in this field. Similar studies can be done in other medical schools.

Keywords

Adult learning, Integrated medical teaching, Medical education, Self-directed Learning

How to cite this article :

SUDESH GYAWALI, AKHILESH C JAUHARI P RAVI SHANKAR, ARCHANA SAHA, MERAJ AHMAD . READINESS FOR SELF DIRECTED LEARNING AMONG FIRST SEMESTER STUDENTS OF A MEDICAL SCHOOL IN NEPAL. Journal of Clinical and Diagnostic Research [serial online] 2011 February [cited: 2019 Aug 25 ]; 5:20-23. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=February&volume=5&issue=1&page=20-23&id=1130

INTRODUCTION
Self directed learning (SDL) is considered as a central theme in adult education. It is expressed in terms of the readiness of the learner to assume the increasing responsibility for his or her own learning.(1) SDL is defined as ‘a process in which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, in formulating learning goals, in identifying human and material resources for learning, in choosing and implementing appropriate learning strategies and in evaluating learning outcomes’.(2) It can occur in a wide variety of situations and is required in a formal learning setting, in the workplace and in one’s personal life.(3) Learning readiness exists in all individuals innately along a continuum(1), but certain learning situations help it to flourish.(3)

Lifelong SDL skills are now, more than ever, a necessity for survival, especially in the medicine and health sciences. Medical science in general and therapeutics in particular, changes rapidly, the life span of useful information is short and there is an information explosion; so, it is important to train doctors for SDL.(4) Many schools have been emphasising the practice of Evidence Based Medicine (EBM) so that their students’ ability to evaluate clinical literature is improved and so that lifelong learning skills in medical practice after graduation is enhanced. (5) Medical educators are exhorted to adopt SDL with the principal aim of producing learners who can manage their own learning throughout their careers.

Increased curiosity, critical thinking, quality of understanding, retention and recall, better decision making, achievement satisfaction, motivation, competence and confidence are associated with SDL.(6) These are all important qualities in doctors. The SDL friendly academic environment reduces the numbers of demotivated doctors who stop learning in their professional life.(6)

Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal, which was established in 1994, at present admits 130 students annually, mainly from Nepal, India and Sri Lanka for the Bachelor of Medicine and Bachelor of Surgery (MBBS) course. The college is affiliated to the Kathmandu University (KU) whose curriculum emphasizes integrated medical teaching and problem-based learning.(7) Within the health care disciplines, problem based learning (PBL) has been identified as a method to facilitate the development of SDL.(2)

Many learning environments for adults are still designed around the listen to the teacher-memorize and regurgitate model. Plutarch expressed the idea that a learner is not a vessel to be filled, but a fire to be lighted.(3) Evidence suggests that not all learners are equally skilled in and/or willing to make decisions about what to learn, and to what depth and breadth.(8) There are two opposite types of learners, pedagogical (teacher or other directed) and andragogical (self directed). Pedagogical learners are dependent on the teacher to identify their learning needs, to formulate objectives, to plan and implement learning activities and to evaluate learning, while andragogical learners prefer to do things by themselves or may take occasional help from others. These two categories require different learning environments for better learning.(1)

Self-directed learning readiness is defined as ‘the degree to which the individual possesses the attitudes, abilities and personality characteristics which are necessary for self directed learning’.(9) Measuring the SDL readiness of students and using the results to develop teaching and learning methods for them is a new concept in Nepal, especially in medical education.

The present study was carried out to obtain the baseline data on SDL readiness among medical students. The objectives of the study were to:
1. Obtain relevant demographical information on the first year medical students of MCOMS.
2. Measure their readiness for SDL and to note differences if any, in the SDL scores among the subgroups of respondents.

Material and Methods

Purpose and design:
The purpose of this study was to examine the self directed learning readiness of the August 2010 batch of students at the beginning of the MBBS course at MCOMS, Pokhara.

A cross sectional descriptive study was carried out by distributing a questionnaire to all the first semester students (130) of MCOMS in second week of September 2010. One hundred and twenty one (93.1%) students successfully completed the questionnaire and their responses were analysed.

Instrument:
The questionnaire which was used was divided into two parts. The first part consisted of demographical data of the students e.g. Age, Gender, Nationality and Scheme (Scholarship or self financing). The second part of the questionnaire was the Self directed learning readiness scale (SDLRS). The SDLRS is a self report questionnaire with 40 Likert type items (1= strongly disagree, 2= disagree, 3= unsure, 4= agree and 5= strongly agree) which was designed by Fisher and coworkers to determine the extent to which individuals perceive themselves as possessing the skills and attitudes which are associated with SDL. The students were asked to encircle the appropriate number according to their degree of agreement with the statements. The scale’s construct validity, internal consistency (reliability) and uni-dimensionality were measured by the developers(1) and they appeared to be homogeneous and valid. (1),(10) The scale has recently been validated among medical students. (10) The permission to use the scale for this study was obtained from Fisher et al. Though the scale was originally developed to measure the readiness for SDL among the nursing students, it can also be used among other adult students.(1)

Data analysis:
The data which was collected was analyzed by using SPSS (Statistical Package for the Social Sciences) version 11.5 for Windows. SPSS is among the most widely used computer programmes for statistical analysis, especially in educational research involving numbers. To avoid bias, certain scores were reversed while calculating the total and subscale scores. The median total scores were compared among different categories of respondents by using appropriate statistical tests. Unpaired student’s t test was used for dichotomous variables and analysis of variance (ANOVA) for others. ANOVA is a method of statistical analysis to detect if there is any difference in the mean scores among three or more groups. If a difference is noted, then post hoc tests can be applied to detect among which specific groups the difference in the mean scores exists. A p value of less than 0.05 was taken as statistically significant.

The approval for the study was granted by the Ethics and Research Committee, MCOMS, Pokhara. Written informed consent from each student who participated in the study was obtained. The students were assured about the confidentiality of their identity; so, they had the opportunity to answer all the questions honestly.

Results

A total of 130 students were enrolled in the first year of the MBBS Program in the August 2010 batch. One hundred and twenty one (69 females and 52 males) students completed the questionnaire, giving a 93.1% response rate. Out of the 121 students, 71 (58.7%) were Nepali, 45 (37.2%) were Indian, 4 were Sri Lankan and 1 was from Maldives. In the study group, 95 students were admitted under the self finance quota and 26 students (4 females & 22 males) were admitted under the Scholarship quota. The students ranged in age from 17 to 23 years, with a mean age of 18.8 (SD = 1.14). The SDL readiness score ranged from a low of 103 to a high of 190, with a mean score of 157.8 (SD= 15.8) and Mode 154. The self directed learning readiness score of most of the students (72.72%) was more than 150, which according to Fisher et al., indicated the readiness for SDL. Out of eighty eight students securing more than 150, 54 were females and 34 were males. Similarly, 73 students were from the self-finance scheme and 15 students were from the Scholarship scheme.

Female students (Table/Fig 1) and self-financing students (Table/Fig 2) had higher SDL scores. Although the mean SDL readiness score of the females was higher (159.64) than that of the males (Table/Fig 1), the difference between the total mean score of the males and the females was not statistically significant (p = 0.1424).
Twenty six (20%) students were admitted in the batch under the government scholarship quota and all of them were included in the study. The mean SDL readiness score of the students who were admitted in the self-financing stream was 158.79 (SD= 14.92), which was higher than the score of the scholarship students (Table/Fig 2), but there was no statistically significant difference (p = 0.1907) in the total mean SDL scores.

The bar diagram compares the number of students of different age groups securing the >150 and < 150 SDL readiness score. Even though most of the students securing more than 150 fell under the age group of 18 years (Table/Fig 3), there was no statistically significant difference (p = 0.2065) in the mean SDL scores among the different age groups.

Discussion

The most basic, natural response to newness, problems or challenges in our surroundings, is self directed learning.(3) This study investigated the readiness for SDL among the first semester medical students by using SDLRS which was developed by Murray Fisher et al.(1) According to Fisher et al, total scores greater than 150 indicates the readiness for SDL. We found that the scores of 72.7% students were more than 150. This suggests that most of the students were ready for self directed learning. SDL ultimately reflects on their learning process and its outcomes.(11) The students who are ready for SDL can manage their own learning throughout their career.(12)

The mean age of the students was 18.8 years (SD = 1.14). One of the eligibility criteria for the candidates to get admission in Kathmandu University, to which the college is affiliated, is that the age should be 17 years (minimum), so the mean age of the respondents was close to it. The number of students of 18years of age, were more (51).

A previous study suggested that the students of the scholarship quota rated themselves as highly ready for engaging in SDL, which may reflect their high SDL score as compared to the students from the general quota.(10) But in our study, there was no significant difference in the total mean scores of the students under the scholarship and the self financing schemes. In our study, the number of scholarship students was low.

SDL, which is a prerequisite for life-long learning,(12) can flourish in certain learning environments.(3) Self-directed learners need motivation and self identity. They devalue their work if they (mean work) are not validated by some external authority and so, the facilitator must support and reassure them for better outcomes.(6) In PBL, the problem case triggers the students to do independent self directed learning.(13),(14) In one study, students who learned by using a PBL approach described the development of the character of self directed learning in them.(2) PBL motivates students, encourages them to set their own learning goals and gives them a role in decisions that affect their own learning.(3) At MCOMS, a hybrid approach with didactic lectures and PBL has been followed to teach MBBS students.(15),(16) This approach may help in developing SDL in our students, but facilitator training and capacity building may be required, as shown in a study in the United Kingdom.(17) Most of our faculty members have been trained in conventional curricula and may have difficulty in reorienting themselves to the requirements of PBL.

Thirty three students (27.3%) were having an SDL score which was less than 150. Students scoring less than 150 would have to depend on the teacher for the management of their studies, especially to formulate learning objectives and for evaluating the outcomes. According to Murray Fisher et al., these students may not perform well if they are not given opportunities to learn in highly structured situations. We anticipate that the majority of students near the group mean will adapt to our hybrid teaching-learning style. However, students with scores at the extremes may find the adjusting to certain learning environments more problematic.

Students having low SDL scores at the beginning of the course does not mean that they are unable to exhibit or master the behaviours; rather, they may not be given the opportunity to do so.(18) To develop SDL, the learner must have an opportunity to develop and practice skills which include asking questions, critically appraising new information, identifying their own knowledge and skill gaps and reflecting critically on their learning process and outcomes.(11),(14) Special care should be given to these students by the facilitator during the teaching- learning sessions to help them develop their SDL Skills.

SDL development could be purposely integrated into the curriculum.(19) The students who are exposed to a PBL curriculum take greater initiative and control over their learning activities and hence, develop SDL Skills.(14) So in MCOMS, by following the Kathmandu University curriculum, we have enormous potential to help our new medical students in developing SDL skills.

Though only few studies show a positive correlation between the SDL readiness scores and academic grades in students who are trained in the PBL curriculum(14), more research is required to provide evidence of the ability of SDLRS to predict student performance.(1),(12) This study can be planned among the same batch of students after two years (before entering into clinical curriculum) to see the correlation between their SDL readiness scores and their academic performance, as well as the change in their SDL scores after exposure to PBL.
Our study had limitations. Since the study was done in only one medical college, the results cannot be generalized to other medical schools. The study was self responding and so, the recall bias might be present in the study. Some of the first semester students (nine) did not participate in the study and were not forced to respond because the study was planned for voluntary participation.

Conclusion

Most of the first semester students are ready for self directed learning. Special care should be given to the few students having low SDL scores so that they can develop and practice SDL skills. Studies correlating the SDL score of the students and their academic performance are lacking. It may be necessary to study the correlation of the SDL scores with forthcoming University and licensure examinations before definitive major conclusions could be drawn. More research is required in this field.

Key Message

1. Self directed learning (SDL) which is associated with the management of lifelong learning, is considered as a central theme of adult learning.
2. Readiness for SDL can be improved among students.
3. Measuring the SDL readiness of the students and using the results to develop teaching and learning methods for them is a new concept in Nepal.
4. Studies which have been done to find the relationship between the SDL readiness score and the academic performance of the students are lacking.

Acknowledgement

We acknowledge the help of Ms. Murray Fisher, Lecturer and her team of The University of Sydney, New South Wales 2006, Australia, for permitting us to use the self-directed learning readiness scale developed by them. One time permission to use the scale was given without any charge. The help of Faculty members of department of Pharmacology, MCOMS especially Dr. Binay Shrestha is also gratefully acknowledged

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