The effect of mastery learning model supported with reflective thinking activities on medical students' metacognitive skills, self-regulation strategies, self-reflection skills, self-efficacy beliefs, critical thinking skills and academic achievement

Mastery learning, formulated by Benjamin Bloom and based on the view that almost all students can learn new behaviors which all schools aim at teaching, is an approach the basis of which is giving extra time and additional learning opportunities on task per learning to meet individuals needs to get all students reach high levels. The purpose of this study is to determine the effect of mastery learning model supported with reflective thinking activities on medical students' academic achievement, metacognition skills, self-regulation strategies, self-reflection skills, self-efficacy beliefs and critical thinking skills. It was also aimed at determining students? perceptions of experimental process. The research was carried out on the 5th grade students studying at Cumhuriyet University Medical Faculty in the spring semester of the 2011-2012 academic year in Sivas. The research included two groups as experiment and control groups. The study group was composed of 64 students, including 32 both in the experimental and in the control group. While conventional method was applied in the control group, mastery learning model supported with reflective thinking activities was applied in the experimental group. In teaching process, application was carried out on the subjects entitled ?Staphylococcal Infections?, ?Streptococcal Infections?, ?Malaria?, ?Pulmonary Tuberculosis?, ?Crimean-Congo Hemorrhagic Fever? and ?Influenza? in Infectious Diseases and Clinical Microbiology Course. In the research, mixed research design including both qualitative and quantitative methods was used. Quantitative research data were collected with achievement test, Metacognitive Awareness Inventory, Medical Students? Mindest for Reflective Learning- The Scale of Reflection in Learning, the Groningen Reflection Ability Scale, General Self-Efficacy Scale and the California Critical Thinking Disposition while interview forms and learning logs which were collected regularly from the students every week were used to collect qualitative data of the study. The quantitative part of the study was conducted with experimental design involving pretest-posttest control group. In qualitative part of the study, phenomenological research design was used. Therefore, after the experiment, interviews were conducted with six students, selected from the experimental group, and the faculty member working in the Department of Infectious Diseases and Clinical Microbiology and conducting the study. The achievement test, developed and used by the researcher to collect quantitative data, is composed of 29 questions. Average difficulty of achievement test was measured to be .52, KR-20 reliability coefficient was measured to be .65. In order to determine the self- regulation strategies of the students involved in this study towards Infectious Diseases and Clinical Microbiology course, ?Medical Students? Mindest for Reflective Learning- The Scale of Reflection-in Learning? developed by Sobral (2000) and for self-reflection skills, ?the Groningen Reflection Ability Scale? developed by Aukes et al (2007) were adapted to Turkish. The original and Turkish versions of the scales were administered to the 4th grade students of English Language and Literature and significant positive correlations between Turkish and English version scores were found. To determine the construct validity of the scales, exploratory and confirmatory factor analyses were employed and analyses showed a single factor solution. The KMO value of the seven-point Likert-style Medical students? Mindest for Reflective Learning scale which included 10 items, without having negative items was measured to be .858. Bartlett test result was calculated to be 718,047 and Cronbach Alpha reliability coefficient was calculated to be .831. The Groningen Reflection Ability Scale, a five-point Likert-style scale, was composed of 11 items, 10 negative and 1 positive. The KMO value of the scale was measured to be.718. Bartlett test result was calculated to be 595.901 and Cronbach Alpha reliability coefficient was calculated to be .706. One of the tools used to collect quantitative data in the research is Metacognitive Awareness Inventory which was adapted to Turkish by Akın, Abacı and Çetin (2007). This five-point Likert- style scale consists of 52 items and eight sub-scales. Cronbach Alpha reliability coefficient of the scale is .95. The other data collection tool is General Self-Efficacy Scale which was adapted to Turkish by Yeşilay (1996). This four-point Likert- style scale consists of 10 items. Cronbach Alpha reliability coefficient of the scale is .83. California Critical Thinking Disposition Inventory adapted to Turkish by Kökdemir (2003) is another scale used in this study. This six-point Likert- style scale consists of 51 items and six sub-scales. Cronbach Alpha reliability coefficient of the scale is .88. Quantitative data was analyzed by using SPSS 16 program and by statistical methods. Qualitative data, collected by interviews and learning logs, was analyzed by using NVIVO 8 program. The study results revealed that, achievement levels of both experimental group applied in mastery learning model supported with reflective thinking activities and control group, applied in conventional method, have increased. However, as a result of the comparisons, the students in the experimental group were more successful than the students in the control group. A statistically significant difference was not determined between the achievement tests of both groups. There were no statistically significant differences between the experimental and control groups in terms of achievement scores obtained from knowledge and comprehension categories of the achievement test. On the other hand, in comparison of achievement scores of application category between the two groups, the experimental group was more successful than the control group. Analyses of Metacognitive Awareness Inventory indicated that mastery learning model supported with reflective thinking activities has had a positive effect on students? metacognitive skills. Whereas, no significant differences were determined in metacognitive skills of control students. Considering the sub-scales of Metacognitive Awareness Inventory, there were no statistically significant differences between the two groups in terms of the sub-scales ?Planning? and ? Information management strategies?. However, there was a statistically significant difference in favor of experimental group in the other sub-scales of Metacognitive Awareness Inventory. When students? scores concerning with self-regulation strategies were compared, post-test self regulation scores of students in the experimental group were found to be higher than the self regulation scores of students in the control group. However, no significant differences were detected between the groups. In addition, there were no significant differences between the two groups in terms of self-reflection skills, self-efficacy beliefs and critical thinking skills. In qualitative part of the study, five themes were determined about the use of mastery learning model supported with reflective thinking activities. These themes are; the content of the method used the affective situation as a result of application, the liked aspects of application, the problematic situations in application, and the benefits of application. The themes and codes indicated that both quantitative and qualitative results of the study were in parallel with each other. The results also supported each other and showed consistency. Accordingly, it is suggested that mastery learning model supported with reflective thinking activities be used more in the teaching of both basic sciences and clinical sciences at Medical Schools. It is also suggested that more importance be given to practical applications in order to become students more experienced and skilled. In addition, similar studies are suggested be conducted in different grade levels of medical students and it was indicated that the comparisons of results would be beneficial. Keywords: Infectious Diseases and Clinical Microbiology course, mastery learning, reflective thinking activities, metacognition, self- regulation, self-reflection, selfefficacy, critical thinking.