In accordance with the trigger questions listed above, four distinct themes emerged during focus group discussions. These were related to teaching quality, perceptions of evaluation, evaluation tools and data collection, and consequences that might be drawn on the basis of evaluation results. Main aspects arising during discussions are summarised in Table
Main aspects arising during discussions (sorted by category); see text for details
Teaching quality (trigger question: “How would you define good teaching?”)
According to students, teaching quality was dependent on content, process (including examinations), teacher and student characteristics as well as learning outcome.
Regarding content, students felt that teaching should be aligned to their current level of knowledge and skills. Topics should be prioritised according to clinical/practical relevance and weighted as proposed by the learning objectives of the institution. Notwithstanding the need for a reasonable amount of repetition, excessive redundancy should be avoided by negotiating content between modules. Finally, high congruence between the content taught and the content covered in end-of-course examinations was perceived as important.
"“To me, good teaching is something that can be transferred to clinical practice.” (Year 4, male student)"
As far as procedural aspects of teaching were concerned, students preferred interactive teaching over traditional didactic lectures and wanted free and easy access to teaching materials. In addition, they valued teacher feedback on their practical skills.
"“I think that interactive, small-group teaching is the best way to teach and learn.” (Year 4, female student)"
Students preferred dedicated teachers who view educational activities as an integral part of their professional role. Ideally, teachers should be knowledgeable, clinically experienced, well-prepared and enthusiastic. The role of teacher training was discussed, and some students doubted that current training programmes were effective for teachers with low motivation to engage in medical education.
"“Teaching completely hinges on the teacher.” (Year 4, female student)"
In addition to being fun, participation in teaching sessions should result in manifest learning outcomes which are not restricted to the content area of a specific subject but also encompass general skills such as life-long learning. Students were well aware of their own responsibility for achieving favourable learning outcomes, and acknowledged the need to prepare for courses and the importance of their own motivation in achieving a desired outcome.
"“My own learning outcome is crucial to me.” (Year 3, female student)"
A number of comments addressed the weight attributed to teaching as compared with research activities within medical schools. Students felt that teaching was not perceived as a priority by many physicians and asked for consultants to prioritise teaching and promote this attitude within their departments.
"“A professor of casual surgery has to do and publish good research, needs to have patients who are satisfied with his work and spread the word – and teaching comes last. He does not get any extra money, external funds or great renown – he gets nothing for teaching.” (Year 4, female student)"
Perceptions of evaluation (Trigger questions: “In your opinion, what is the purpose of evaluation in medical education?” and “How do you arrive at an overall course rating?”)
This section summarises perceptions of the purpose of course evaluation as well as the approach of the student towards completing evaluation forms. A number of statements indicated that the overall goal of evaluation was to improve teaching processes and their outcome. Students felt that participation in the evaluation process enabled them to express their views on courses. In addition to providing specific feedback to teachers, evaluation was considered a means to assess whether learning objectives had been met in a specific course.
"“In general, I would give a positive rating for courses in which I got the feeling to have learned a lot in a pleasant manner.” (Year 3, female student)"
Evaluation activities that occurred during lectures were perceived as distracting, and some students were confused by the large number of evaluation forms they were asked to complete. Another barrier to participation was a lack of feedback regarding the possible consequences of the evaluation results.
Students acknowledged that individual preferences and definitions of ‘good’ teaching may considerably impact overall course ratings. According to some comments, global ratings were difficult to generate and dependent on gut feelings, i.e. whether they liked and were motivated by a course. In addition, perceived quality and difficulty of end-of-course examinations were likely to mediate a halo effect on overall course ratings.
"“If something really annoys me about a particular module, my overall rating will be generally lower (…) Even if I was not happy with 10% of the module and the rest was OK, I will give a lower rating since the bad aspects tend to linger in my memory.” (Year 4, male student)"
Evaluation tools and data collection (trigger question: “What do you think about the evaluation tools currently used at our institution?”)
Comments regarding evaluation tools and methods of data collection were related to targets of the evaluation process and preferred question formats, as well as the frequency and practical aspects of evaluation.
According to students, evaluation tools should capture actual learning outcome and judge procedural and organisational aspects of teaching. The adequacy of examination questions and their relation to course content were also suggested as evaluation targets. Finally, emphasis was placed on individual and specific evaluation of teachers.
"“I think, as a teacher, if I received a ‘3’ rating from all students – how am I supposed to make sense of that?’ However, if the comment read ‘good overall but – whatever – presentation slide design was not ideal’ that would be a particular point I could try to improve on.” (Year 3, female student)"
With respect to the format of evaluation tools, students preferred open questions on evaluation forms as well as interactive discussions with module representatives. Scaled questions received considerably less support as they were not believed to provide useful information.
"“Overall ratings may be easy to analyse statistically but I don’t think they really tell you anything.” (Year 3, female student)"
Students suggested a maximum of 15 questions on any single evaluation form. Online evaluations were preferred over paper-and-pencil forms although students admitted to postponing or forgetting the completion of online evaluations as they were not given high priority. Students were unsure about the ideal time-point of evaluation, but many favoured completion of forms following end-of-course examinations. Others suggested providing constant access to an online platform in order to be able to enter any comments as they emerged. This was consistent with a general claim for evaluation tools to be simple and easy to use. In addition, most students agreed that participation in course evaluation should be voluntary. At the same time, they acknowledged that minimum response rates are needed to obtain reliable and valid results. Comments on how evaluation results might be used to improve teaching are described in the following section.
Proposed consequences of course evaluation (trigger question: “What kind of consequences would you like to see to be drawn from course evaluations?”)
Regarding the handling of evaluation results, students suggested all data be published within their medical school; some felt that official course rankings could be used as motivators. However, students also acknowledged the need to protect individual teachers’ data. One option to resolve this could be to discuss individual evaluation results with teachers in a protected environment (e.g., in an ‘evaluation committee’).
The majority of comments addressed feedback for individual teachers and possible consequences of positive or negative ratings. Students felt that the principal goal of providing individual feedback was to facilitate improvement in teaching skills; therefore, free text comments were preferred over scaled ratings. Individual characteristics and a lack of motivation were mentioned as potential barriers against changing individual teaching behaviour.
"“If someone is simply not interested in teaching, nothing is going to change at all because his job is safe – he’s just not interested.” (Year 4, male student)"
When asked about potential consequences for individual teachers, students generally preferred incentives over punishments. There was some debate on the ideal type of incentives with half of the students favouring extra time off and others suggesting monetary rewards for good teachers. There was also disagreement regarding the approach to teachers with particularly negative evaluation results. One option would be to implement a compulsory training programme. Alternatively, bad teachers could be excluded from teaching activities. However, as physicians working in medical school hospitals are obliged to teach even if they do not like this part of their job, exemption from teaching duties based on negative evaluations may even be interpreted as a reward.
"“If I take someone who is definitely not up for teaching, I will never motivate him to deliver good teaching – so maybe the whole system behind it needs to be changed slightly.” (Year 4, female student)"
A considerable number of students stated that they wished to receive feedback on the consequences drawn from evaluation results:
"“I believe that more students would be willing to evaluate if they knew that it is of some avail.” (Year 4, female student)"