Background

The self-directed learning (SDL) ability of medical students plays a vital role in the development of medical education [1, 2]. Medicine is a discipline closely related to life safety and health benefits, and hence medical students are required to be able to update their knowledge quickly and remain engaged in lifelong learning [3, 4]. For medical students, SDL ability is the foundation for lifelong learning [5, 6]. Therefore, one of the important tasks of higher medical education is to develop SDL abilities in students.

SDL is the process of students to constantly monitor and adjust their cognitive state, observe and apply various learning strategies, adjust their learning behaviors, and make efforts to create and use physical and social resources that facilitate learning [7,8,9]. Furthermore, SDL ability is considered the ability to learn while actively realizing the responsibility of learning [10, 11]. In the blended teaching process, teachers allow students to design teaching materials for course delivery, stimulating students’ SDL abilities [12, 13]. Notably, to cultivate the SDL ability of students, educational researchers have also explored this. Padugupati et al. found that a blended learning environment was a dynamic learning space that could effectively improve students’ learning behavior, including SDL ability [14]. A blended learning approach involving Indian medical students found that curriculum design should improve learning activities to promote SDL ability [15]. Develo** a favorable education and learning environment by using modern educational technologies is prioritized in many universities to improve the SDL abilities of medical students.

A number of methods are available to assess the SDL ability of students, including the survey method, the interview method, teacher evaluation, and behavior observation [16,17,18]. Since the SDL definition varies among different researchers, there are subtle differences in the indicators used to assess the SDL ability of medical students. Garrison proposed a comprehensive model for SDL ability where the SDL ability was divided into three dimensions: learning motivation, self-monitoring, and self-management [19]. Wang ** SDL ability.

In this study, blended teaching method was implemented for the development of SDL ability in medical students before, during, and after classes, and students are constantly prompted to self-examine, self-monitor, and self-adjust during class interactions, quizzes, case discussions, and other teaching sessions. When EG students were categorized further into categories, comprehensive type students demonstrated clearer motivation and learning goals during the blended teaching method, with improvements in all six dimensions of SDL ability. Further, interactive type students did not experience changes in two factors of SDL abilities including setting learning goals and plans and self-monitoring and regulation. For passive students, only the interactive ability has improved after blended teaching experiment. Further statistical research is needed to correlate the data on the learning behaviors of different types of learners with the improvement of the SDL ability.

Teaching design improves students’ SDL ability

The development of SDL ability is a long-term process, and the key factors include motivation and monitoring [33].In this study, When CG students were categorized further into categories, comprehensive type students too, all six dimensions of SDL ability has no difference.

We also clustered the students into comprehensive, interactive, and passive types according to their learning behavior data, and there were no significant differences in SDL ability between these three categories of students in the CG. Students in the CG only followed the teacher’s lecture content to master the knowledge but did not apply thinking and discussion, which are precisely the learning behaviors that blended teaching is designed to address in contrast to traditional didactic teaching. The learning behaviors that made the difference between the SDL ability of the two groups were thinking and discussion. Learning from lectures or downloaded material from the instructional website with no learning purpose did not improve the SDL abilities of the students. Our research showed the effectiveness of cultivating SDL ability under the teachers’ systematic teaching design. The teacher’s systematic teaching design is also a crucial factor in the development of SDL ability.

The assessment of SDL ability includes several dimensions and factors, with the core of the evaluation mainly involving self-motivation and the ability to self-monitor and self-adjust. Self-motivation is key to SDL. Self-monitoring represents the responsibility to maintain a socially required level of clinical competence, and is also related to the responsibility of setting, achieving, and maintaining self-determined goals. Self-adjustment includes the ability to self-check, provide feedback, and control and regulate actions. It also refers to the students’ ability to regulate task-operating factors, such as learning objectives, tasks, materials, and methods [30]. To develop self-adjustment and self-monitoring qualities, teachers should provide encouragement and guidance to students that allow them to check, control, and regulate their own learning according to subjective psychological factors, such as learning interests and motivation.

We also clustered the students into comprehensive, interactive, and passive types according to their learning behavior data, and there were no significant differences between the SDL ability of these three categories of students in CG. Students of CG just followed the teacher’s lecture content to master the knowledge but lacked thinking and discussing, which are precisely the learning behaviors that designed in the blended teaching but not in the traditional didactic teaching. The learning behaviors that made the difference between the SDL ability of the two groups were thinking and discussion. The lecture learning and download learning behaviors of comprehensive students in CG which recorded by the instructional website without the learning purpose did not lead to the improvement of students’ SDL ability. Our research shows that the process of cultivating SDL ability is the process of students’ SDL ability culturing under the teachers’ systematic teaching design. The teacher’s systematic teaching design is also a very crucial factor in the process of develo** SDL ability.

The assessment of SDL ability includes several dimensions and factors, and the core of the evaluation mainly includes self-motivation, self-monitoring ability, and self-adjustment ability. Self-motivation is the key to SDL. Self-monitoring is the responsibility to maintain a socially required level of clinical competence, and it is also related to the responsibility of setting, achieving, and maintaining self-determined goals. Self-adjustment includes the ability to self-check, provide feedbacks, and control and regulate the actions. It also refers to the students’ ability to regulate task-operating factors, such as learning objectives, tasks, materials, and methods [30]. In order to develop self-adjustment and self-monitoring qualities, teachers provide encouragement and guidance to students that allow them to check, control, and regulate their own learning according to subjective psychological factors, such as learning interests and motivation.

According to the present findings, the blended teaching method was used more popular during and after the covid-19. In their study, Chen M et al. stated that blended teaching can be made to address low student engagement and poor classroom participation during covid-19 [34]. In another study conducted during the COVID-19 pandemic, David O Obada et al. argued that blended online teaching and learning strategy was a new pedagogy for adapting classrooms in develo** countries [35]. In a study conducted after this pandemic, Xue-Tao Fu et al. argued that blended teaching is beneficial to students’ learning and stimulates their enthusiasm, cultivates clinical thinking ability, and improves teaching quality [36]. The blended teaching method was used in medical education in develo** countries such as China more and more deeply. Moreover, our study was just benefic research for the blended teaching method.

There is no unified approach for cultivating independent SDL ability. Different specialties, different courses, and different lecture subjects have their own methods of cultivating SDL ability. The cultivation of SDL ability not only requires teaching design but also a diverse and complex evaluation system to assess SDL ability. This preliminary study on medical students’ SDL ability using a blended teaching method lays the foundation for the cultivation of SDL ability in medicine discipline students.

Conclusion

In conclusion, the blended teaching model may be effective for improving medical students’ SDL ability compared with the traditional didactic method. The blended teaching model effectively enhanced students’ SDL ability factors of self-motivation, learning beliefs, setting learning goals and plans, self-monitoring and regulation, information processing, and communication and cooperation.