(n = 113)
* Results are significantly different at p < 0.005.
Once validated the formation of the experimental and control groups, we analyzed the students’ outcomes using the Mann-Whitney U-test to validate the two research hypotheses. The results, presented in Table 3 , showed that the students’ final score grades in Human Immunology were significantly different between the two groups (p < 0.001), indicating that the hypothesis H1 was supported as the outcomes of the experimental group students were significantly higher than those of the control group students. Moreover, the improvement obtained in Human Immunology (when compared to highly related courses grades obtained in the first year) was significantly different between the two groups (p < 0.001), what could indicate that the hypothesis H2 was also supported. However, since the students who followed the experimental itinerary had a worse previous knowledge level, their margin of potential improvement was higher. Therefore, we could not state that the greater improvement was only due to the use of the competitive system.
Control group (n = 113) | Experimental group (n = 172) | U Mann-Whitney | ||||
---|---|---|---|---|---|---|
Mean | SD | Mean | SD | U | p | |
Score grades | 8.13 | 1.77 | 8.68 | 0.81 | -3.180 | |
Improvement | 2.31 | 1.98 | 3.40 | 1.76 | -4.953 |
* Results are significantly different at p < 0.001.
Finally, we analyzed the students’ level of satisfaction according to the survey data. A total of 153 experimental group students completed the survey (about 89%). In general terms, the students positively evaluated the competitive experience (with an average score of 30.86 out of 50). The students liked learning through the participation in contests and they were motivated to find information in books or Internet to improve their positions in the ranking (3.22 and 3.59 out of 5, respectively). Moreover, despite the competitive nature of the QUESTOURnament tool, most students (70%) believed that this activity facilitated their relationship with other students.
On the other hand, using Pearson’s Correlation Coefficient, the results indicated that there was significant correlation between the students’ level of satisfaction with the competitive experience and their academic improvement, but this relation was weak (r = 0.292, p < 0.01).
To conclude, we analyzed which itinerary the students would recommend to other students. Most of students of the experimental group (88%) would recommend the itinerary B (competitive learning with the QUESTOURnament system). What was more interesting was that 54% students that had chosen the itinerary A would recommended the itinerary B due to the opinions of their classmates and the good atmosphere perceived in class.
This paper reports on an experiment conducted to study the effects of the use of competitive learning methods in a medical course. We obtained some interesting conclusions: first, the students liked the QUESTOURnament tool since they regarded it as useful, motivating to participate more actively in their learning process and facilitating the learning and the relationship with other students.
During the Human Immunology course, the students felt a collaborative ambience within the classrooms, because they shared or debated about the different challenges. Although, medical students tend to be competitive [ 13 , 28 ], this activity fostered classroom relationships (according to the data of satisfaction survey).
Moreover, the results of this study indicated that the use of the QUESTOURnament tool had favorable effects on the students’ academic outcomes. The students who used the tool obtained better final grades; in addition, the increasing academic improvement was significantly higher than that of the control group. As expected, there was a correlation, although weak, between the students’ satisfaction level with this method and the obtained score. Therefore, the presented results suggested that the QUESTOURnament tool could support effective learning strategies based on competition in medical students.
The positive results obtained in this study are in concordance with other similar studies about the role of competition in medical studies. Learning with competition improves the students’ academic results [ 19 , 21 , 28 ] and is considered enjoyable and engaging by them [ 20 ]. Thus, our findings are consistent with the previous studies reporting significant improvement in the competitive learning-driven students’ acquisition of knowledge and a greater satisfaction with the learning process. In addition, our findings report that well-designed competitive learning activities may foster the cooperation among students and provide a pleasant classroom environment.
The assayed active learning method–based on the competitive proposal of challenges and the answering of classmates’ ones–has worked very nicely because it promoted a collaborative classroom ambience, with the students debating about the correct answers of a given challenge. The students choosing the experimental group thus, had to study in a daily basis, either to propose challenges or to answer those proposed by their classmates. This fact could have contributed to a better grading of this group in Human Immunology, but also in a higher difference compared to the grades obtained in related courses during the first year of Medicine. Therefore, competitive strategies can be designed to get a more uniform distribution of knowledge sessions over time and, therefore, promoting learners’ deep understanding and long-term retention [ 29 ].
Students of the itinerary B (experimental group) followed a learning approach more according to the model of “constructive alignment” [ 30 ]. The learning outcomes of Human Immunology are divided into two groups or categories: “know” and “know how to do”. Students of itinerary B could demonstrate better whether they had achieved the intended learning outcomes (ILOs), since they faced different assessment methods. They solved, proposed and evaluated challenges, which might be very different in nature and thus, they could address different ILOs. Besides, each of the four contests corresponded to a different lesson and one criteria to evaluate challenges was their relevance to the topic of the lesson. Therefore, challenges in the different contests had to be aligned with the ILOs of the lessons. Moreover, they acquired a deeper learning of the “know how to do” part because, when proposing and solving challenges, they had to extrapolate which has been learnt to new scenarios.
This study had some limitations too. We did not make a random assignment to the control and experimental groups; because the two groups are nonequivalent, selection bias may exist. It is possible that students who volunteered to participate in the competitive itinerary were the most innately competitive. A more complete evaluation of cognitive learning styles would help to demonstrate more firmly the validity of the results. Besides, the experimental and control groups were not completely homogenous as the students in the experimental group had lower scores in previous courses than the students in the control group. Therefore, the greater improvement in course grades in the experimental group could be influenced by a lower starting grade and not only by the applied competitive strategy. The students who have a higher initial level of knowledge have a narrower range of improvement than classmates with a lower initial level and they may achieve less improvement [ 31 ]. Anyway, Shadish et al. [ 32 ] establish that when the pretest-posttest trend lines of a quasi-experiment cross over, it could be postulated that the posttest mean of the experimental group is amplified because it is easier to increase when the starting point is lower; however, this one can explain the amplification of an effect but not the creation of a totally artificial effect. Thus, though that is not the most desirable outcome, this pattern shows evidence of the effectiveness of the system within the non-equivalent groups design [ 33 ].
On the other hand, it is extremely difficult to create two homogeneous groups in experimental design, since there may be known factors (age, sex…) that can affect outcomes but are not of primary interest. In fact, a randomized blocks experimental design should have been made, instead a completely randomized design, in order to guarantee the existence of homogeneous groups and reduce noise or variance in the data [ 34 ].
Moreover, the non-equivalent groups design is probably the most frequently used design in social research [ 34 ]. For example, Zhang et al. [ 35 ] did a meta-analysis about the effectiveness of problem-based learning in medical courses, where they analyzed 31 studies from 2005 until 2014. They found that only two studies described an appropriate randomization process.
In this study, a randomized experimental design was not done because of ethical issues, which, as we have already mentioned, generates validity problems. In future studies, we could minimize this effect with a quasi-experimental design that uses a double pretest or switching replications. These approaches are less likely to permit causal interpretations of observed associations, according to Harris et al. [ 36 ], who presented an interesting review of 34 quasi-experimental studies in medical informatics, classifying them into several categories and analyzing the benefits and limitations of each approach.
Finally, we would like to conduct new future experiments to study the balance between speed and accuracy when answering the challenges. Pusic el al. [ 22 ] have argued that chronometry has been underutilized in the learning of medical procedures, being very useful for instruction designs as well as for assessment methods. Besides, they have stated that chronometry can increase motivation and therefore maximize learning, but also that it can be dangerous if it is wrongly implemented. There is a need to balance accuracy with speed. Our competitive tool -QUESTOURnament system- allows teachers to define simultaneously scoring and timing parameters to get the desired balance. It gives students feedback about scoring and timing, increasing the challenge level and enhancing self-regulation of learning [ 22 ]. Future experiments would allow us to define different strategies to get the balance between accuracy and speed according to the learning context, the maturity of the students or their current level of knowledge. Moreover, according to results obtained by Lei et al. [ 19 ] about team-competition, we are planning to use it within QUESTOURnament tool, paralleling the competitive learning among groups and the cooperation between students in the same group during the Human Immunology course.
S1 appendix, funding statement.
The authors received no specific funding for this work.
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The positive results obtained in this study are in concordance with other similar studies about the role of competition in medical studies. Learning with competition improves the students' academic results [19, 21, 28] and is considered enjoyable and engaging by them . Thus, our findings are consistent with the previous studies reporting ...