While the evaluation of learning development interventions needs to be considered carefully and included at the curriculum design stage, there is limited literature on the actual design of interventions, especially on how these designs evolve and improve over time. This paper describes the evolution of a learning development program intended to support first-year medical students adjusting to a problem-based learning curriculum. We used a design-based research approach, articulating our theoretical grounding and incorporating students’ voices to develop an “optimal” intervention for the specific challenges in our context. We describe lessons learned around four aspects: students’ growth and development, teachers’ professional growth and development, program design principles, and the emergent components of a learning development program. Overall, our students describe the Learning Success Program as adding value by enabling the adoption of a repertoire of skills and strategies for learning management. Additionally, the incremental nature of design-based research allowed for the development of a context-specific program that considers students’ voices through needs assessment and feedback on the program offerings. It has also provided an opportunity for the professional development of teachers through feedback from classroom practice, reflection, and the literature.

Background Besides regulatory learning skills, learning also requires students to relate to their social context and negotiate it as they transition and adjust to medical training. As such, there is a need to consider and explore the role of social and cultural aspects in student learning, particularly in problem-based learning, where the learning paradigm is different from what most students have previously experienced. This article explores two significant sociocultural factors contextualized in an African setting that may conflict with effective problem-based learning implementation: the socialization of schooling before medical training and the cultural socialization relating to speaking and silence. Method We employed a qualitative case study approach using in-depth interviews with 23 first-year students. Participants ranged in age from 18 to 25 years. All students were bi/multilingual (some spoke three to five languages), with English as the learning language. We conducted an inductive thematic analysis to systematically identify and analyze patterns in the data using the Braun and Clarke framework. Results Before medical school, students worked hard to compete for admission to medical school, were primarily taught using a teacher-centered approach, and preferred working independently. At the beginning of medical school, students found it difficult to understand the problem-based learning process, the role of the case, speaking and working effectively in a group, managing a heavy workload, and taking increased responsibility for their learning. By the end of the first semester, most students were managing the workload better, were more comfortable with their peers and facilitators, and appreciated the value of the problem-based learning approach. Conclusions In the sub-Saharan African context, sociocultural factors provide another lens for understanding students' learning experiences in a problem-based learning program. Adjustment to problem-based learning requires a conceptual and pedagogic shift towards learner-centered practice, particularly concerning self-direction, the role of the case, and collaborative learning.

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