**5.1 Active learning as opposed to passive learning**

At the first time point, most of the students wrote that their previous experience was largely of passive learning. Thus, for example, they noted that the structure of the course was new to them and that they were used, generally, to other teaching methods:

*I'm full of anxiety about the learning because it is much easier to learn in frontal learning. I prefer getting the material from the teacher and not having to search for some of the material.*

*This is the first time that I personally am learning with this method. Usually the teacher gives us the material for the whole semester.*

*I'm already used to learning differently, used to receiving the material, learning for an exam and then for a final exam, or doing homework on the material taught and then taking a final exam.*

*My feelings about the manner of the course are complicated. They evoke various feelings because it's a new style and different from what we were used to until now.*

*The method I jibe with the most is the traditional method of frontal teaching: learning on set days and hours in a classroom facing the lecturer with exercises and an exam—unlike independent learning in which there is no set time for study and therefore I tend to procrastinate until the last minute.*

At the first time point, the students pointed out their anxiety and fear regarding the innovative teaching method and the assignments and difficulties that lay ahead, in their view, from studying in this manner.

*When we started the course I walked into the classroom with anxieties and fears. I'm a third-year student and I'm making up a course with second-year students whom I don't know. It's hard enough already … definitely with this method of learning, with many assignments in a group.*

*True, this is an opportunity for me to contend with the fear and face the commitment that the course requires, but I'm not certain I'll be able to express myself fully.*

*I was anxious because in the exam we are required to regurgitate in writing material that we've learned throughout the semester, whereas a paper requires you to gather articles from various sources and sometimes even in other languages (something that in itself frightens me).*

In the examination of this category at the second time point, it seemed that most of the students related to the course as a positive experience. They revealed that, despite their initial concerns, they succeeded in coping well with the learning processes and the assignments.

*In the beginning it seemed beyond my abilities and rather exhausting, but after we got the first assignment I discovered that it was actually a pleasant and interesting assignment. This teaching method made me remember an event and reconstruct the feelings I experience during it and thus gave me a different perspective on the event.*

*In the beginning there was anxiety over this learning format which is not necessarily for an exam, "blind learning" just to answer questions automatically, but rather, really, a true process of learning with yourself, with other students in the class as a team, and actually causes the student to be more involved in the assignments in the course of the semester and also to be more involved socially and mutually with the group members.*

The students also pointed out the difficulties; these included the level of difficulty involved in active learning, the level of involvement in the course, and the time commitment in such learning.

*It's much easier to get the material from the lecturer.*

*It was hard for me to think on my own how I should find the material.*

*Undoubtedly this course requires a greater investment than do other courses that are taught frontally. We had to invest more time.*

#### **5.2 The experience of active learning**

Already at the first time point, students with previous experience of this method noted that their prior positive experience was a mediating factor that eased their learning.

*From my past experience, when I wrote a paper it helped me to understand the material better. And like this project, it helps me because every student can say what helps them learn, more or less, and also the students have an opinion about which method is good for studying.*

*I already had experience with a course in which you had to work independently, so I was less scared.*

#### **5.3 Adopting innovative teaching methodologies**

Adapting to innovative learning methodologies often sparks antagonism and concerns, as was evident in the reflective journals and was presented above. The students wrote that they were used to relying on learning by receiving material from the lecturer. This learning process was seen as easier, in comparison to the process of active learning. This worldview is presented in the analysis of the students' reflections at the first time point:

*There's tremendous pressure of papers during the semester. Therefore I prefer not to be part of a large project but simply to write an exam.*

*It's preferable to write one exam, and that's it. I have no desire to work like this.*

*It scares me to deviate from the usual drill of an exam and to write a paper instead. True, the lecturer explained in class that the paper would be submitted in a process that she supervised, but still there is the concern that I will make a mistake and will not do things properly because I'm not used to writing papers. I think it takes more time than studying for an exam, because there's always something that [needs to be] changed or improved.*

*Students Guided Learning for Medical Students - Novel Teaching for the 21st Century DOI: http://dx.doi.org/10.5772/intechopen.98823*

At the second time point, toward the end of the semester, because of the positive experience the students had in the course, one can see a change in their attitudes and their willingness to adopt innovative methodologies. Thus, for example:

*We've come a long way, but I have the desire to learn more.*

*I feel that I want to learn like this in other courses.*

*I really loved how the course was taught. The assignments we have had thus far give us an opportunity to express ourselves and are not too burdensome.*

Nevertheless, students still note difficulties and challenges, which they ascribe to this method and which will make it difficult, in their view, to adopt innovative methods in the future.

*The planned teaching method is interesting and breaks up the routine, and in my view it will be nice and will lead to a deeper understanding of the material. In my view, when it is fun to learn, the material is absorbed better. But on the other hand, getting used each time to a different learning method can be confusing and take up a lot of time.*

#### **5.4 The learning experience**

This category appeared in the analysis of the reflections at the second time point, in which the students wrote their views of the learning experience in the course in comparison to courses with frontal teaching.

*The method of study is a breath of fresh air in comparison to the lessons that are frontal only and tend to be boring. In the lesson there is lively discussion by everyone, with personal experiences that contribute to the learning atmosphere.*

*I am very satisfied that there is a course like this in which the teaching method is different from the usual. It allows you to formulate opinions, feelings, and various reflections.*

*For example, this exercise enables me to speak freely, think, and be creative. I feel free and confident that I can speak and also recommend and suggest new ideas.*

*The course is different and I interpret this as refreshing and as a different way of learning that has thought behind it. On the one hand, it really enabled us, the students, to contend with assignments that require thought and to be active partners in the lesson and the entire course, and not just to mark our attendance. I see this as something very positive, especially since it's a very important lesson for the profession we chose and which we'll probably work in in the future.*

#### **5.5 A sense of capability**

The beginning of the course was accompanied by fears, concerns, and even hesitation regarding the capability of completing the course and meeting its goals. "I asked not to have to present." "I really didn't think I would succeed."

*Such feelings were not evident in the analysis of the reflections at the second time point.*

*Although I didn't think that I would want to present, I enjoyed it and wasn't even concerned about presenting before the president of the college.*

*I surprised myself while presenting the project.*

*I think that the time has come to work this way, to prepare both an individual paper and a group paper and to present what we prepared, and to be exposed directly to the responses and questions of the audience, lecturers, students.*

#### **5.6 Teamwork/collaborative learning**

The analysis of the reflective journals at the first time point showed that the students related also to the category of collaborative learning and to teamwork, and noted diverse attitudes toward them.

*I like to work in a group because there is support from the team members and exposure to a range of different ideas. Also, if there is something I didn't understand in a certain way, there are other people who can interpret it.*

*I see the work in groups as something slightly threatening: Beyond the grade that is given for it, it requires interaction and contending with other people. I'm a person for whom it is easy to express myself when I am not in a group. Perhaps I am different from many others and my coping is different in this respect, but I'm a little hesitant about it.*

At the second time point, too, the students addressed this category, indicating the problems and challenges in relation to it, on the basis of their experience. Their opinions regarding this category were varied. Some wrote that they prefer working on their own, whereas others wrote that the experience of learning in groups was positive for them.

*For me the work in groups was less convenient because to this day I have proved to myself that I work better on my own. I rely only on my own work … I felt that most of the work anyway fell on my shoulders so that the work didn't take less time, it took even longer than usual.*

*It's hard for me to coordinate a time that is convenient and suits everyone to sit and discuss the assignment. And in the end, even when you succeed in setting a time with everyone a lot of time is wasted on chitchat—unlike my own work in which I work according to a timetable that is convenient for me.*

*Learning in groups helps a lot in understanding the material because each one explains the material in a way that everyone can understand.*

### **6. Discussion**

The analysis of the students' reflective journals at two time points, the beginning and end of the course, showed a change in attitudes. At the start of the process, their attitudes toward adopting innovative methodologies of teaching were based on perceptions and attitudes formed in response to their acquaintance with traditional teaching methods. At this stage, the students' worldview was determined,

#### *Students Guided Learning for Medical Students - Novel Teaching for the 21st Century DOI: http://dx.doi.org/10.5772/intechopen.98823*

inter alia, by the teaching methods customary in the process of socialization, starting with the preschool, through elementary school, high school, and academe. These attitudes shaped their perception of teaching methods and contributed to their resistance and concerns regarding the adoption of other teaching methods.

During the course, while using SGL methodology, and at the end, the students displayed a change in attitudes, perceptions, and experiences in relation to adopting active teaching methodologies and the process of individual learning. Also, students who had studied in the past with this method, or who had prior experience with various methods of active learning, showed from the start less resistance and greater willingness to cooperate with this teaching method.

Support for the findings can be found in earlier studies on the student-centered class, according to which students reveal behaviors characteristic of the stages of mourning and trauma at being forced to take responsibility and a degree of independence in learning as an alternative to the use of traditional learning methodologies [29].

The students' responses are subjective. Some went through all the stages smoothly, whereas others remained a longer time in a specific stage, or in several of them. Passage through the various stages of the program is essential and constitutes a substantial part in the student's growth and turning into a lifelong learner [30, 31]. Therefore, the aim is to lower the level of resistance, on the one hand, and to ease the process of independent learning, on the other. Students should be allowed this type of learning as part of a structured, guided framework [23].

The students' attitudes toward collaborative learning also changed. In the beginning of the course many students wrote that because of the difficulties and challenges in the process, they rely primarily on themselves and prefer to carry out the assignments and learning processes on their own. At the end of the experience, the students wrote that the collaborative learning contributed to their feeling of vitality, their openness, and their ability to learn from others. As the learning process continued, the students were exposed through a collaborative learning framework to a variety of opinions of group members. This process exposed the complexity of the dilemma and the understanding that it might have various interpretations and various solutions [32].
