Using Moodle E-learning Platform to Foster Student Self-directed Learning: Experiences with Utilization of the Software in Undergraduate Nursing Courses in a Middle Eastern University Academic research paper on "Educational sciences"

Available online at www.sciencedirect.com

ScienceDirect

Procedia - Social and Behavioral Sciences 93 (2013) 677 - 683

3rd World Conference on Learning, Teaching and Educational Leadership (WCLTA-2012)

Using moodle e-learning platform to foster student self-directed learning: Experiences with utilization of the software in undergraduate nursing courses in a Middle Eastern university

Gerald Matua Amandu*, Joshua Kanaabi Muliira, Dennis Cayaban Fronda

College of Nursing, Sultan Qaboos University, Muscat,123, Oman

Abstract

Fostering student interest in self-directed learning (SDL) requires appropriate skills and innovative strategies by the teacher. However, many teachers find motivating students for SDL a challenging expectation. This paper, based on literature and authors' experience discusses how Moodle e-learning platform (MEP) has been used to successfully promote SDL among undergraduate nursing students at Sultan Qaboos University, College of Nursing, in Oman. We conclude that MEP enhances students' pre-class preparation, post-class participation and overall motivation for learning and that it is a user-friendly and affordable innovative teaching strategy that can be used to motivate, promote and sustain student interest in SDL.

© 2013TheAuthors.Published byElsevier Ltd.

Selection and peer review under responsibility of Prof. Dr. Ferhan Odaba§i Keywords: moodle; self-directed learning; nursing; innovative teaching.

1. Introduction

Moodle (modular object-oriented dynamic learning environment) is a free e-learning software platform, originally developed to enable educators to create online courses to encourage interaction and collaborative construction of learning content. It provides several opportunities for the 'teacher' to transform from being 'the source of knowledge' to being a facilitator and role model in the process of acquiring knowledge and skills (Moodleroom, 2012). The moodle e-learning platform (MEP) has several features that make its use applicable in education and training. When used appropriately, MEP can facilitate self-directed learning (SDL), which is often a challenging goal for most teachers in undergraduate programs (Moodle, 2012). The MEP upholds the educational philosophy that learning occurs best within a social constructionist framework where learners and not only teachers, can contribute to the learning experience (Moodle, 2012; Information Technology Unit, ITU, 2012). This philosophy is consistent with the requirement and expectation that teachers at university level should promote and ensure that students engage in SDL. The concept of SDL was defined by Knowles in 1975 as a process in which individuals take the initiative, with or without the help of others in diagnosing their learning needs, formulating

* Gerald Matua Amandu Tel.: +9-689-982-8042 E-mail address: gmatua@gmail.com

1877-0428 © 2013 The Authors. Published by Elsevier Ltd.

Selection and peer review under responsibility of Prof. Dr. Ferhan Odaba§i

doi: 10.1016/j.sbspro.2013.09.260

learning goals, identifying human and material resources for learning, choosing and implementing appropriate learning strategies and evaluating learning outcomes. In this paper, SDL is visualised as students' interest and motivation towards searching for knowledge, practicing skills and continuing to actively do so beyond the physical and temporal dimensions of the traditional classroom. Cheng, Kuo, Lin, Lee and Hsieh (2010) articulate that SDL is particularly vital in nursing, because it firmly motivates students to learn, and this is critical for the development of proficiency and professionalism.

Experiential and research evidence shows that the current generation of students in higher education is unenthusiastic about and disengaged from the learning process especially if it follows only the traditional teacher-centered, classroom learning characterized by instructors dictating content (Haythornthwaite, 2008; Deslauriers & Weiman, 2011; Stowe, von Freymann, & Schwartz, 2011). This is compounded by the fact that today many undergraduate students do not fully appreciate the value of succeeding in their education (Kuh, Kinzie, Schuh, & Whitt, 2005; Felder & Brent, 2007; Kuh, 2008). This lack of motivation leaves teachers in undergraduate programs distraught with the task of keeping students interested in their lectures and other learning activities. As a remedy, Smith (1991) proposes that educators need to incorporate high-quality and highly effective information technology tools to engage students in SDL. These e-tools offer several advantages among them, being more learner-friendly, enhancing the collaborative nature of learning, motivating students to be more engaged, and most importantly, to take more responsibility for their learning (Haythornthwaite, 2008). When used appropriately by teachers, e-tools such as MEP can motivate students to remain focused in their studies and engage in learning beyond the classroom (Pea, Wulf, Elliott, & Darling, 2003). Learning beyond what the teacher offers is one of the hallmarks of SDL.

It has been recognized in nursing that corrective actions are needed because in the past limited efforts were made to provide nurses with appropriate skills to engage in SDL and in some cases this resulted in suboptimal orientation towards lifelong learning (Muliira, Etyang, Muliira, & Kizza, 2012). This lack of skills in SDL and subsequently lifelong learning has major implications because it makes the student nurses uncompetitive upon graduation and puts patients' lives at risk of poor quality nursing care. The ever changing nature of health care, treatments and technological advances require that student nurses who are being prepared to work in such dynamic environments have appropriate competencies including SDL skills to keep abreast with scientific advances. Cognizant of this shortcoming, more university based undergraduate nursing programs are now integrating SDL in their curricula and learning activities to increase student's capacity for independent learning in dynamic and challenging educational and work environments (Nolan & Nolan, 1997; Regan, 2003).

In addition to e-tools such as MEP, nurse educators have continued to promote SDL abilities of their students through problem-based learning pedagogy (Kocaman, Dicle, & Ugur, 2009), enquiry based learning and evidence based practice (Zhang, Zeng, Chen, & Li, 2011). Despite availability of these interventions, many nurse educators still find enhancing students' interest and motivation for SDL to be very challenging (Levett-Jones, 2005). The challenge faced by most nurse educators in promoting student SDL seems to be related to creating "spaces" in which SDL capacity can thrive. Creation of space for student to engage in SDL is a major challenge because nursing is much concerned with patient safety and most nurse educators feel that they must "teach" in order to ensure that students learn the "right" things to be competent and safe practitioners. This tendency diminishes the space and opportunities available for students to engage in SDL and many times it de-motivates them. Other challenges that make it difficult for nurse educators to promote SDL relate to their failure to appreciate the role of a teacher in an undergraduate program as that of a facilitator of learning, personal cultural beliefs about teaching and emphasis on student's ability to pass professional licensure examinations (Chiang, Chapman, & Elder, 2010). To effectively motivate and enhance SDL in students, Knowles (1975, p. 35) argues that teachers as facilitators of learning need to create learning environments that are conducive for collaborative learning characterized by mutual support and intellectual rigor; facilitate group decision making process without neglecting individual learning needs and curriculum requirements; diagnose student learning needs and facilitate learners' ability to diagnose their own needs; assist learners to set their own goals by translating learning needs into clear, realistic and achievable learning objectives; promote collaborative learning that allows individuals to work as a group, design learning plans and work towards common goals, and evaluate learning outcomes using methods that integrate reflection on learning and peer review. These essentials suggest that fostering student motivation and interest in SDL requires the teacher

to use innovative teaching strategies because the lecture method which most instructors use to "teach" is very limited in its output and at best only serves students who are intuitive rather than sensory learners (Godleski, 1984).

McDermott, Shaffer and Somers (1994) affirm that lectures as delivered in most colleges and universities do not help most students to grasp core concepts and skills, implying that a sizeable number is left behind in the course of their learning. Therefore SDL which is a precursor for effective learning is required in undergraduate programs because it leads to active engagement of the student and keeps the youngsters interested and motivated to learn (Pea et al., 2003). Recent reports indicating that the current generation of student nurses have a high level of readiness to exploit learning opportunities, initiative and independence in learning , informed acceptance of responsibility for one's own learning, creativity, and the ability to use basic study and problem solving skills (Klunklin, Viseskul, Sripusanapan, & Turale, 2010), highlights the opportunity for facilitating SDL.

This, in addition to the culture of "technology astuteness" is a strong impetus for including interactive e-learning applications such as MEP to engage young learners, in self-paced learning, which in turn helps to increase their motivation and mastery of the subject matter (Lazowska, 2003). This paper therefore discusses how MEP, a freely available e-learning platform has been used to promote student motivation, SDL capabilities and contribution to their educational experiences in three courses in a nursing undergraduate program.

2. Settings

The experiences reported about are based on observations from teaching and learning activities conducted at the College of Nursing (CON), Sultan Qaboos University, in the Sultanate of Oman. The CON was established in 2008 as an independent college in the university and it is the only public educational institution in the country that prepares nurses at bachelor's level. In its quest for excellence, the CON implements different quality assurance measures aimed at enhancing student teaching and learning processes such as integration of e-learning in all courses.

3. Materials and method

This paper consists of the authors' teaching experiences and conclusions supported by literature, of how MEP can be used to transform traditional lectures and clinical teaching into more active learning experiences that motivate and sustain undergraduate students' interests in SDL. The experiences shared pertain to three undergraduate nursing courses namely Health Assessment, Nursing Administration and Health Promotion.

4. Findings

4.1. Health assessment

This course is taught to second year students before they take hospital based clinical courses and mainly aims at ensuring that they acquire knowledge and skills to perform patient assessment. In this course, MEP was used to make the course available on line to all students at all times on any internet connected computer and smart phone. The versatility of the platform enabled faculty to upload and share power point slides, documents, video files and pictures about the different body systems. In addition, the MEP forum, chat and quiz features were activated and used by both students and faculty to share ideas and clarifications throughout the course. A tracking system available on MEP was used to monitor student's participation in the self-directed on-line learning activities. As the course progressed, we observed that as the number of students who watched the on line videos out of class increased, participation in the self-practice lab sessions also increased. Majority of the students took the practice quiz questions posted on MEP more than once and initiated their lab self -practice groups using the chat forum on the MEP. The students used the chat room to share information about difficult concepts discussed in class, ideas discovered during reading of the course textbook and areas which they anticipated to be very difficult during formative assessment. In the final practical examination, we observed that the students were more confident in handling the standardized patient, communicated more, often challenged the instructors about the different physical

assessment techniques studied in the course as they were being examined. Whenever the students challenged the instructor's decision on a technique, their reference point was the video watched on MEP or the technique practiced with classmates in the self-practice group or the feedback from other instructors shared during chat sessions. We also noted that previous difficulties related to expectations such as watching videos of physical assessment procedures before coming to class or lab, participating in discussion groups and confidence in performing procedures, eased when MEP was adopted in the course. Although most students benefited from utilizing the MEP, some felt disappointed about their performance because in certain cases it was not corresponding with the extensive hours they spent chatting, discussing and watching videos. This experience revealed to us that the MEP enhances students' SDL, but its use alone is not all what a student needs to effectively learn and retain knowledge and skills attained in a clinical nursing course such as health assessment. Rather, MEP increases the space for students to engage in SDL activities such as skill self-practice, student initiated collaboration with classmates on learning activities, continuous learning and sharing of knowledge everywhere anytime.

4.2. Nursing administration

This course is taught to fourth year students as they approach the end of their study program. The course has both a theoretical and clinical component that utilizes features of MEP such as online quizzes, wikis and glossary among others. In addition, the MEP was also used to make videos, website links, portable files and slides readily accessible to students to support the process of meeting course objectives. These study materials encouraged students to pace their learning. During the clinical sessions, students were able to access a wide range of course related information when in the hospital or outside of the university premises. This would not have been possible without the MEP that allows information to be accessed outside the boundaries of intranet. This facilitated students learning at all times, beyond the official designated time. The MEP feature that allows faculty to synchronize theory and clinical topics on weekly basis encouraged student to integrate theoretical knowledge with the hands-on clinical experience. This integration encouraged students to direct their own learning, because the MEP enabled them to appreciate how theoretical concepts in nursing administration are linked with patient care and hospital administration. This enhanced students' preparation for classroom and clinical learning because they were able to see clearly what is expected of them sequentially until final examinations. We noted that the feedback mechanisms availed by MEP's interactive features provided an excellent opportunity for student to gauge their areas of weakness. For instance, a number of students reported that the forums made them realize the concepts which they had not mastered because of the feedback received from classmates and faculty. Student's feedback such as "I need to read this up"; "I feel I am so behind" show that MEP increased students propensity towards SDL and encouraged them to turn their weaknesses into strengths. In the end, previously dis-engaged students became more motivated to learn and even excelled in the course.

4.3. Health promotion

This is a theoretical course and it is taught to student nurses to support their understanding of how to protect and enhance the health of individuals and populations using nursing interventions. In this course features of MEP such as discussion forums and news were used to have regular dialogue with students on course related issues. These features helped the teacher and students to keep track of the discussions. The news forum feature was particularly useful for announcements and sharing information about upcoming events. Some posts were helpful in shaping the direction of the next class and to let the teacher 'realize' what has not been understood. The online forums and messaging feature saved both students' and teachers' time because they were accessed and responded to outside official class hours. The MEP was used to distribute course materials to students in the form of lecture notes as power point slides, videos, journal articles, handouts and tracking utilization of these learning resources. This ability of MEP enabled students to direct their learning at their pace, instead of limiting their learning to the face to face sessions with the teachers only. We observed that through the tracking feature of MEP, majority of the students explored the supplementary websites which were linked to the online course content. A good number of students

reported that the supplementary website links helped them to understand and master the course content. We also used MEP to make available review questions about each topic which students would look at their own time to assess their level of understanding. Whenever they failed to answer the review questions correctly, they instantly sought for help from teachers and other participants through MEP's chat forums. This is some of the evidence of how MEP helped students to diagnose their learning needs and design learning plans, both of which are critical elements of SDL.

5. Discussion

The MEP is a powerful e-learning tool and it provides opportunities for the teacher to vary his/her teaching in a way that engages students and enhances their interest in self-directed participation in course activities. This observation among university students is true for all electronic student oriented learning management systems because when they are used properly with re-usable learning resources, they positively impact SDL and allow individuals to pace and increase their desire for learning (Idros, Mohamed, Esa, Samsudin, & Daud, 2010). Therefore MEP provides a facility for teachers to garner student interest in courses that students may find boring or unattractive (Pea et al., 2003). For instance our experiences with interspersing course materials with related YouTube videos, graphic interfaces and websites links through MEP increased student's out of class exploration of these learning resources. Barabasi (2002) explains that the interactive electronic learning platforms are a useful tool for 'shy' students who prefer to express their opinions away from the 'prying eyes of their classmates'. In the three courses considered in this paper, we observed that students who were often silent in class tended to use the discussion forums more frequently and sent more messages through MEP about concepts and content areas where they needed help or clarifications. Li (2003) asserts that these online forums create a setting that enables equitable discussions and interactions especially for introverted students who often feel left out. This interactive capacity of MEP also encourages better student and teacher preparation for upcoming classes because through message alerts and discussion forums each stakeholder is prompted on the topical issues that will be addressed in the next learning session.

The collaboration and group spirit that results from the interactive nature stimulated and facilitated by MEP promotes sharing of ideas and leads to social ties even after the course. The interaction also may result in stronger social support systems and development of vibrant learning communities within the class (Cohen & Willis, 1985). The subsequent supportive learning environment encourages better learning, increased interest to learn and academic competition (Johnson & Johnson, 1990; Tinto 1997), all of which synergistically promote SDL. Similarly, Springer, Stanne, and Donovan (1997) in their analysis of comparative studies of small-group and individual education, concluded that collaboration as facilitated by electronic tools such as MEP, promote better academic achievement, more suitable attitudes towards learning, and increased resilience in subsequent courses and throughout the study program. This implies that students who are engaged and collaborate effectively with others are more likely to perform better than those that are dis-engaged and bored by their learning experience. Therefore MEP is one of the cost effective learning tools in creating learning environments that are conducive for collaborative learning characterized by mutual support and intellectual rigor.

Utilization of the MEP in the three courses considered in this paper helped the teachers to deal with topics that elicit strong cultural or personal sensitivities and thus making it difficult for the class to freely discus them in the presence of others. Li (2003) confirms that online communication has a unique advantage of being used to discuss sensitive issues. This ability of MEP was particularly helpful in the health assessment and health promotions courses because it was used to facilitate students discussions in topics that have special sensitivities in the Middle Eastern and Muslim cultures such as examination of the breast and other organs of the reproductive systems, and issues related to sexuality and sexual health promotion. Before using the MEP in the courses of Health Assessment and Health Promotion, these sensitive issues were taught to male and female students separately and attempts to teach them to a mixed class of female and male students led to a lot of them not showing up for that particular class. The MEP facilitated vibrant online discussions and students discussed 'sensitive' issues in details and frankly without the "goose pimple" scenarios they would otherwise have elicited in face to face teaching sessions. The MEP like other online discussion forums provided a comfort zone through which a student could initiate and follow up discussions on sensitive issues, and share experiences that all classmates could relate to (Li, 2003). This would have

been difficult to achieve among the students without the MEP forums because most of the students come from conservative religious background and they are not culturally used to discussing issues related to human sexuality in public or mixed gender groups.

The MEP and other online learning tools allow the teacher to 'tailor' the educational experience and to make better instructional decisions for upcoming classes. This immediacy with the students makes the learning experience more interesting and rewarding to both the student and the teacher. The interactive sessions such as the discussion forums and chats make it possible for the teacher to monitor progress and facilitate student learning and SDL more effectively rather than relying solely on the 'traditional' mid semester in-course assessment criteria. The MEP also enables the teacher to have a glimpse into how the students are engaged emotionally, behaviourally and cognitively in the course. Emotional engagement in the course can be seen for instance from the level of enthusiasm for the course and related learning activities performed by the student beyond official class hours. The behavioural and cognitive growth can be seen from regular classroom or chat room or discussion forum attendance and confidence about course content and concepts, respectively.

The MEP also allowed us to give real-time support to students whenever they needed clarification, even outside official class hours. This was possible through the MEP's instant messaging applications that the teacher used to monitor student participation. This real time support was particularly helpful in facilitating SDL and motivating students' learning. The use of instant messaging in fostering student interest has been noted to be essential to learning because it enables exchange of information in real-time via a chat (Ito et al, 2008). The features of MEP such as chat, discussion forum and instant messaging are effective in facilitating discussions, and nurse educators should make efforts to use them as vehicles to facilitate SDL. Our experiences also show that MEP is a good tool to gauge student's understanding and tracking individual student participation. This facility enables the teacher to respond appropriately to individual and unique student learning needs (Pellegrino, 2003).

6. Conclusions

MEP is one of the most user friendly and affordable innovative strategies or tools that novice and experienced teachers can use to promote student SDL. This is because when MEP is used appropriately, it can galvanize students' interest and motivation to be actively engaged in their educational experience. MEP allows students to have an opportunity to participate actively in the course beyond the limits of the official class hours and classroom. MEP also helps to positively moderate the competition to "succeed as an individual" that often manifests among learners and instead it fosters collaborative learning through its capacity to support group learning. The abilities of MEP such as increasing access to the course, supporting shared creation, collaboration and mastery of knowledge are very essential in any university learning environment. The cooperative learning that evolves through the interactive nature of online resources such MEP, promote higher student achievement, self-reliance, collaborative culture and lifelong learning skills. Our experiences and available literature review regarding the use of technology in higher education show and support the thesis that MEP is an appropriate e-learning tool that can be easily used to improve students' pre-class preparation, post-class participation, active learning and overall motivation for learning. These ingredients in our view are some of the critical domains of SDL.

References

Barabasi, A. (2002). Linked: The new science of networks. Cambridge, MA: Perseus.

Cheng, S.F., Kuo, C.L., Lin, K.C., & Lee-Hsieh, J. (2010). Development and preliminary testing of self- rating instrument to measure self-

directed learning ability of nursing students. International Journal of Nursing Studies, 47, 1152-1158. Chiang, C.K., Chapman, H., & Elder, R. (2010). Changing to learner-centered education: Challenges experienced by nurse educators in Taiwan.

Nurse Education Today, 30, 816-820. Cohen, S., & Willis, T. (1985). Stress and social support and the buffering hypothesis. Psychological Bulletin, 98(2), 310-357. Deslauriers, L., & Weiman, C. (2011). Interactive teaching methods double learning in undergraduate physics class. Retrieved July 7, 2012 from:

http://phys.org/news/2011-05-interactive-methods-undergraduate-physics-class.html. Haythornthwaite, C. (2008).E-learning can have positive effect on classroom learning. University of Illinois at Urbana-Champaign. Retrieved

July 7, 2012 from http://phys.org/news148064009.html#nRlv. Felder, R., & Brent, R. (2007). Cooperative learning. In P.A. Mabrouk, (Ed.), Active learning: Models from the analytical sciences, ACS Symposium Series 970, (Chapter 4). Washington, DC: American Chemical Society, 34-53.

Godleski, E.S. (1984). Learning style compatibility of engineering students and faculty. Paper presented at the Annual Frontiers in Education Conference. Philadelphia: ASEE/IEEE, 362.

Idros, N.S., Mohamed, A.R., Esa, N., Samsudin, M.A., & Daud, K. A.M. (2010). Enhancing self-directed learning skills through e-SOLMS for Malaysian learners. Procedia Social & Behavioural Sciences, 2, 698-706.

Information Technology Unit, College of professional and continuing education, Hong Kong Polytechnic University (2012). Moodle: E-learning. Retrieved June 22, 2012 from http://www.cpce-polyu.edu.hk/itu/.

Ito, M., Horst, H., Bittanti, M, Boyd, D., Herr-Stephenson, B., Lange, P.,C.,... Tripp, L.(2008). Living and Learning with New Media: Summary of Findings from the Digital Youth Project. Retrieved July 3, 2012 from http://digitalyouth.ischool.berkeley.edu/files/report/digitalyouth-TwoPageSummary.pdf.

Johnson, D.,W., &Johnson, R.T. (1990). Using cooperative learning in math. In N. Davidson (Ed.), Cooperative learning in mathematics (pp.103-125). Menlo Park, California; USA: Addison-Wesley Publishing.

Klunklin, A., Viseskul, N., Sripusanapan, A. & Turale, S. (2010). Readiness for self-directed learning among nursing students in Thailand. Nursing & Health Sciences, 12, 177-181

Knowles, M. (1975). Self-directed learning: A guide for learners and teachers. Follet, Chicago, USA.

Kocaman, G., Dicle, A., & Ugur, A. (2009). A longitudinal analysis of the self-directed learning readiness level of nursing students enrolled in a problem-based curriculum. Journal of Nursing Education, 48(5), 286-290.

Kuh, G. D. (2008 ). High-impact educational practices: what they are, who has access to them, and why they matter. Retrieved June 22, 2012 from www.aacu.org/LEAP/hip.cfm.

Kuh, G., Kinzie, J., Schuh, J., & Whitt, E. (2005). Student success in college: Creating conditions that matter. San Francisco, CA: Josey-Bass.

Lazowaska, E. (2003). Next-generation educational software. [presentation]. In, Pea, R., Wulf, Wm.A., Elliott, S.W., & Darling, M.A (Eds). National Research Council Workshop Report. Retrieved July 17, 2012 from http://www.nap.edu/catalog/10789.html.

Levett-Jones, T. L. (2005). Self-directed learning: Implications and limitations for undergraduate nursing education. Nurse Education Today, 25, 363-368.

Li, Q. (2003). Integrating the Internet into teacher education: What works? Paper presented at the Annual Meeting of AERA Accountability for educational Quality: Shared Responsibility. Retrieved July 3, 2012 from http://people.ucalgary.ca/~qinli/publication/AERA03_whatworks_final.html.

McDermott, L.C., Shaffer, P.S., & Somers, M.D. (1994). Research as a guide for teaching introductory mechanics: An illustration in the context of the Atwood's machine. American Journal of Physics, 62(1), 46.

Moodle (2012). Moodle Philosophy. Retrieved June 22, 2012 from: http://docs.moodle.org/22/en/Philosophy.

Moodlerooms (2012). About Moodle. Retrieved June 22, 2012 from http://www.moodlerooms.com/resources/moodle-resources/.

Muliira, J. K., Etyang, C., Muliira, R. S., & Kizza, I. B. (2012). Nurse's orientation towards lifelong learning: A case study of Uganda's national hospital. Journal of Continuing Education in Nursing, 43(2), 90-96.

Nolan, J. & Nolan, M. (1997). Self-directed and student centred learning in nurse education: British Journal of Nursing, 6(1), 51-55.

Pea, R, Wulf, W, Elliott, S., & Darling, M, (Editors) (2003). Planning for two transformations in education and learning technology. National Research Council Workshop Report. Retrieved June 14, 2012 from http://www.nap.edu/catalog/10789.html.

Pellegrino, J. (2003). Issues in combining advances in the learning sciences with IT capabilities. [Presentation]. In Pea, R., Wulf, WM. A., Elliott, S.W., & Darling, M.A. (Eds). National Research Council Workshop Report. Retrieved July 17, 2012 from http://www.nap.edu/catalog/10789.html.

Regan, J. A. (2003). Motivating students towards self-directed learning. Nurse Education Today, 23, 593-599.

Springer, L., Stanne, M.E., and Donovan, S. (1997). Effects of small-group learning on undergraduates in science, mathematics, engineering, and technology: A meta-analysis. Madison, WI: National Institute for Science Education.

Stowe, K., von Freymann, J., & Schwartz, L. (2011). Assessing active learning and skills training through alumni and current student views. Journal of Case Studies in Accreditation and Assessment, 2: 1-13.

Tinto, V. (1997). Enhancing learning via community. Journal of Thought and Action, 6 (1), 5354.

Zhang, Q., Zeng, T., Chen, Y., & Li, X. (2011). Assisting undergraduate nursing students to learn evidence-based practice through self-directed learning and workshop strategies during clinical practicum. Nurse Education Today, doi:10.1016/j.nedt.2011.05.018.