Authors

1. Parasuram, Rajni RN, RMN, BSc, MEd
2. Huiting, Xie RN, RMN, BHScN, PhD (Nursing)
3. Wang, Jia RN, RMN, BScN
4. Thirumarban, Anouradha RN
5. Kum Eng, Helen Joon RN, RMN, BSc
6. Lien, Poh Chee RN, AdvDip (Gerontology), BN, MHSE

The aim of this systematic review is to identify the best available evidence of teaching methods used to prepare student health care professionals for the delivery of the mental state examination. This review has the following objectives:

 

1. To identify if non-traditional teaching methods leads to overall improvement in the learners' knowledge and competency level for the conduct of the mental state examination in students.

 

2. To compare the effectiveness of non-traditional and traditional methods of teaching the mental state examination on learners' satisfaction, knowledge, skills and self-confidence.

 

 

Background: Education plays a pivotal role to the pace of social-political and economic growth of any nation; therefore effective teaching is essential. Effective teaching does not solely revolve around getting the vast amount of knowledge into the learner; it delves deeper into the technicalities, ensuring that teaching is based on assisting the learner's progress from one level to another while allowing the learner at the same time to slowly evolve and make sense of the content independently.9 Thus, effectiveness is not akin to having the perfect teaching session or giving a wonderful performance, but rather, it ensures that the content delivered brings out the best in the learner. Choosing a teaching method is best articulated by answering these questions, "What are the aims of this teaching session?" and "What are the best ways of achieving these aims?"

 

The term "traditional teaching" relies mainly on a method that utilizes textbooks, lecture notes, memorization and recitation techniques. Delivering education through a traditional format sees no priority in catering to the rich and diverse learner population or the need to develop critical thinking, problem solving, and decision making skills, but instead directs learners to assume a non-thinking and information-receiving role.16 It is a largely functional procedure which focuses on skills and area of knowledge in isolation. Assessment in the traditional method of teaching, is seen as a detached entity and occurs only through examination, while with modern methods of teaching, assessment is seen as an activity which is creatively embedded into teaching and learning.3

 

Non-traditional teaching methods are commonly known as innovative/modern teaching methods that involve the use of technology, animation, special effects and are generally learner self-directed and interactive in nature.22,23 Several authors within this field acknowledge that both traditional and non-traditional teaching methods influence communication and retention of important concepts.3,5,11,18 However, the caveat is such that, the appropriateness of the method must be in line with the learning styles of the learners and the curriculum.4,18

 

In the 21st century, health care education has embraced a new meaning and identity. The slow but obvious evolution in health care education sees a drastic change of how learners' critically think and learn through the use of various teaching methods. With the evolution of education, there is also a shift in the use of traditional teaching methods from didactic or lecture style teaching to non-traditional teaching methods such as demonstration by lecturer, use of the overhead projector (OHP), viewing of pre-recorded demonstrations on video tapes, enacting role plays to non-traditional methods such as the use of virtual environments with avatars, masked silicone props, classroom response systems and interactive interfaces, simulation, and live interviews with patients to engage the learners in various ways.1,2,7,11,12,²⁵The extensive use of the different teaching methods are reported in a study conducted by Johnson and Mighten in 2005. Two teaching strategies were compared: lecture notes combined with structured group discussion versus lecture only and found that the group adopting the lecture notes combined with the structured group discussion had better mean examination scores. Similarly in 2010, Levitt and Adelman utilized role play in teaching nursing theory. The learners adopted the identity of a chosen nursing theorist while interacting with other nursing theorists played by their peers. The study found that this method engaged students and instilled active learning and interest in the topic at hand.

 

The mental state examination (MSE) is made up of standard concepts that assess the patient's mood, affect, thought, behavior, suicidal ideations, judgment and insight.14,16,17 The teaching of MSE differs between country, academic institutions and clinical settings. In academic institutions, the information presented to learners' varies and is available in many traditional and non-traditional teaching methods. Considering the depth of theory and skills necessary in the teaching of the MSE, learners would anticipate the information to be presented in an interactive and interesting manner which would aid quick retention and improve satisfaction with learning.12,13

 

The ability to conduct a MSE is an important pre-clinical competency in nursing, medical and allied health disciplines that students are taught during their training.13 MSE augments other assessment components such as the history of the presenting complaint and provides clues as to what is necessary for more detailed assessment to take place, for example, cognitive assessment or psychometric testing.17 In addition, the learner is required to elicit the correct clinical information in order to gather the best mental clinical picture of the patient. Often compared to a medical diagnostic tool, it provides the health care provider with a cross section of the patient's mental state.14 The process of conducting an accurate history and MSE takes practice and patience, but it is very important in order to evaluate and treat patients effectively. Further mastery of this skill is demanded from healthcare professionals who plan on entering the specialized mental health scene.

 

If MSE is not taught in the most effective manner for learners to comprehend concepts and to interpret the findings correctly, it could lead to serious repercussions and impact clinical care for patients with mental health conditions, such as incorrect assessment of suicidal ideation. Hence, it is important to review and appraise how such teaching methods may have an impact on learners. A variety of questionnaires are used in literature examining learners' satisfaction and self-confidence; however most of these papers report the use of self-developed surveys, examination scores and multiple choice questionnaires, while others were adapted from previous researchers.2,6,11,12,14 One of the questionnaires constructed by the National League of Nursing gauged students' satisfaction with the session and self-confidence gained.15 Students were asked to use a five-point Likert type scale to indicate their agreement and disagreement towards the three subscales.

 

Previous systematic literature reviews related to non-traditional teaching methods focus on the following: (1) constructivist aspects on problem based learning, critical thinking and team-based learning; (2) influences of teaching methods on knowledge retention and learner achievement/grades and (3) specific to a particular group of learners. A preliminary search of the Joanna Briggs Database of Systematic Reviews and Implementation Reports, the Cochrane Library, OVID, PsycINFO, CINAHL, PubMed and PROSPERO has revealed that there is no systematic review (either published or underway) that investigated one or more non-traditional teaching method specific to teaching the MSE. This systematic review positions itself to inform educators of determining which of the teaching methods is more effective than the other teaching methods for MSE training, and aims to add value to the health care profession by informing clinicians, educators, administrators and academics in Singapore, and globally, of the effectiveness of non-traditional teaching methods. The findings from this review will help guide the development of evidence-based curriculum which is urgently lacking in the field of mental health and may provide grounds for further research on the teaching methods required for effective delivery of the MSE.

 

Definition of terms

 

Teaching methods are defined as the principles and methods used for instruction to engage learners which includes, but is not limited to, demonstration, memorization, participation, brainstorming, etc.3,10 The term is often used interchangeably with instructional methods.10

 

Traditional teaching methods are defined and described as methods that usually rely on lectures and notes-taking and that are often very teacher centric without the use of any teaching aids.5,6,17,18 For the purpose of this systematic review traditional teaching methods are considered as those that use a didactic or lecture style technique without use of interactive interfaces.

 

Non-traditional methods, commonly known as innovative/modern/blended teaching methods, are methods that involve the use of the technology, animation, special effects or are generally interactive and blended in nature (for example, the use of computers and videos to enhance delivery content).