Page 86 - Journal of Special Operations Medicine - Winter 2014

define specific strengths and weaknesses within the edu- as exempt from IRB oversight, as it focused on program
cational climate. Responses to survey items with mean improvement and not human subject research. US Na-
scores of 3.6 or higher are considered positive responses, tional Institutes of Health human rights guidelines were
any item with a mean score of 3.5 or lower indicates a followed to ensure human safety and rights during this
potential problem area, and items with a mean score investigation.
between 2 and 3 are aspects of the educational that can
be enhanced. Although not specific to this project, the
DREEM provided information from participants about Results
academic dishonesty, instructor effectiveness, social life Differences in participants’ perceptions of the traditional
during training, and learning styles. curriculum and the modified reflective practice curricu-
lum showed a positive trend in respondent preferences
Procedures toward the modified, reflective curriculum in most cate-
Surveys were collected from participants and secured gories. Although the trends were mostly positive, statisti-
until analysis occurred. Of 50 surveys distributed, 34 cal analysis showed that between several mean scores, the
(68%) were returned, and 24 (71% of the original 34) probability was not significant at levels of either p < .05
of the returned surveys were analyzed. Participants com- or p < .10. Tables 1–5 present study results, divided into
pleted the DREEM survey, which queried their percep- subscales. The p values indicate the probability of obtain-
tions of their learning environment, instructors, learning ing the result by chance alone and the strength of the evi-
styles, and curriculum during SOF medic training. Sur- dence; for instance, p < .05 indicates moderate strength of
veys were shredded after results were entered into sta- evidence favoring the hypothesis that SOF medics prefer
tistical software and double-checked by two separate curricula based in their own reflections, p < .01 indicates
consulting research scientists. stronger strength of evidence, and p < .001 indicates very
strong strength of evidence. 72,73
Analysis
The DREEM’s 50 questions were entered into the Sta-
tistical Package for the Social Sciences version 17.0 Discussion
(SPSS; IBM Corp, Armonk, NY, USA; http://www-01 Although the DREEM scores trended positively toward
.ibm.com/software/analytics/spss/) and coded to match the reflection-based curriculum, lack of statistical signif-
the Likert scale of the instrument. The questions were icance in some areas limits the extent to which the find-
then re-ordered to reflect the DREEM’s subscales, and ings can definitively confirm the hypothesis that SOF
variables were named to match the first survey and the medics view a reflection-based curriculum more highly
second to enable comparison of mean scores between than their traditional curriculum. The largest positive
the pre- and postcurricular presentation to the partici- differences favoring the reflection-based curriculum in
pants (i.e., Survey1/Survey2). Incomplete surveys that perceptions of learning were “the teaching time is put
did not answer all the questions were shredded and not to good use” (+0.56), “the curriculum encouraged me
included in analysis, which reduced the number of sur- to be an active learner” (+0.53), and “long-term learn-
veys analyzed from 34 to 24. The remaining 24 surveys ing was emphasized over short term” (+0.78). This is
were analyzed with the Student t test. reinforced by longitudinal studies of students and ed-
ucators who have used reflective practices in teaching
Timeline to increase engagement and long-term learning. Ad-
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Survey distribution occurred over 3 months, from De- ditionally, multidimensional learning is enabled when
cember 2012 to February 2013. Data analysis was per- reflective practices are used in teaching. 75
formed in March 2013; variable and data entry in SPSS
was reviewed and confirmed by a university-affiliated Positive trends toward reflection-based curriculum were
statistician in March 2013. Statistical results were then seen in gains in perceptions of instructors, most notably a
reviewed by an independent research scientist, and score one-point change in perceptions that instructors ridiculed
computation and comparison of means was doubly con- students, which reflection-based curriculum decreased
firmed by identical analysis in Microsoft Excel (Micro- (−1.00). Similar phenomena occurred in stressed-out
®
soft Corp, Redmond, WA, USA; www.microsoft.com) educators; when presented with opportunities to use re-
by the PI. flective practices, their sense of burnout decreased. Re-
76
flective curriculum increased perceptions of instructors’
Institutional review board approval patience with patients (+0.56) and instructors’ feedback
The research proposal and protocol was submitted to to students (+0.55). This corresponds to the du Plessis
Loyola University New Orleans’ institutional review and Muzaffar 2010 study of educators, in which us-
77
board (IRB) on 17 October 2012, and approval was ing reflective practices increased feedback and guidance
granted on 30 October 2012. This project was approved to students; though not specific to instructors’ patience

76 Journal of Special Operations Medicine Volume 14, Edition 4/Winter 2014