Creativity in Higher Education: Teaching Activities during Student Groups’ Idea Evaluation Process ()
1. Introduction
The recent COVID-19 pandemic emphasizes the demand for skilled medical professionals capable of solving complex societal problems and generating innovative solutions. Higher education plays a fundamental role in meeting this demand by equipping medical students with the competencies necessary to tackle increasingly complex problems in healthcare that cannot be addressed by individuals alone, such as ageing and the speed with which patient needs and disease patterns are changing (Lechler, 2017; WEF, 2020; Ten Haven et al., 2022) . Higher education provides opportunities for lifelong learning and skills development, essential for staying competitive and adapting to new challenges in the rapid changing modern economy (Bain & Cummings, 2021) .
To foster creativity, medical education has implemented student-centered approaches, such as project-, design- and challenge-based learning (Badwan et al., 2018) . While these didactic approaches are frequently implemented to provide medical students with the opportunity to develop creative ideas (i.e., novel and useful), medical students often experience these creative solutions as risky and the projects as very difficult to navigate through. According to the novelty-usefulness tension, students perceive their novel ideas to be infeasible or ineffective because they are, by definition, untested (Frederiksen & Knudsen, 2017) . Subsequently, while medical student groups are able to generate creative ideas, the evaluation and improvement of creative ideas is not likely to happen without guidance of teachers, and, therefore, teachers need to help student groups to navigate the challenges triggered by the risky nature of creative ideas (Fredagsvik, 2023; Keith et al., 2023; Van Broekhoven, 2023) . This study aims to explore challenges faced by medical student groups during the process evaluating and improving their creative ideas, and to identify the teaching activities that help them to overcome these challenges.
While the concept of creativity is debated (Liu et al., 2023) , a recently developed definition postulates that creativity is the competence to engage productively in the generation, evaluation and improvement of ideas that can result in novel and useful solutions, advances in knowledge, or impactful expressions of imagination (OECD, 2021) . This definition underlines the iterative nature of generating, evaluating and improving ideas that are both novel and useful. Novelty can be understood as being uncommon in terms of a task or social context, while usefulness can be seen as feasibility and effectiveness (Litchfield et al., 2015; Runco & Jaeger, 2012) . To develop novel and useful solutions, students often evaluate ideas through a process that includes idea appraisal, forecasting and refinement (Mumford et al., 2002) . During the idea appraisal, relevant standards such as novelty and feasibility are used to judge the viability of an idea (Medeiros et al., 2017) . Forecasting involves simulating the consequences of implementing an idea, and refinement involves discarding or changing elements of an idea, elaborating on key details, or combining new elements to improve it (Byrne et al., 2010) .
Several studies have identified teaching activities that foster creativity in terms of generating ideas, such as encouraging students to ask questions and think in different ways, or inviting them to provide multiple solutions (Belio & Urtuzuastegul, 2013; Liu & Wang, 2019) . For the cultivation of creativity, however, there is a need to focus on the idea evaluation process as well. Students have different needs in this process due to the inherent tension between novelty and usefulness (Mueller et al., 2012) . Teachers may need to promote self-evaluation, delay judgment, and teach students how to cope with frustration and failure, so that they have the courage to try new approaches and use flexible thinking to evaluate and improve their ideas (Cropley, 2018) .
The socio-cultural theory of creativity suggests that students’ idea evaluation is influenced by their interactions with their environment and culture (Csikszentmihalyi, 1999) . Groups vary in their response to ideas based on their beliefs, attitudes, and experiences. Students’ assessments are also shaped by their material and social environments, which may either limit or foster idea development (Glaveanu et al., 2021) . For example, a lack of financial resources can prevent the pursuit of a new idea. The social environment refers to the discipline that acts as a gatekeeper, deciding which ideas or products endure (Kupers & van Dijk, 2020) . The acceptance of novel ideas by the community is uncertain, and the classroom (or course) culture also affects idea evaluation and enhancement.
In light of the above, the present study seeks to address the following two research questions:
1) What challenges do student groups in medical undergraduate education face in evaluating and improving upon creative ideas, according to teachers?
2) What kind of teaching activities do teachers report using when student groups experience the above challenges?
2. Methods
2.1. Setting
We conducted this study in the context of a project-based learning environment at Radboud university medical centre in the Netherlands. During the eight-month “innovation project”, first-year medical and biomedical sciences students work in groups to define a health(care) problem and develop an innovative solution to it (i.e., a novel and useful solution). During this project, students participate in workshops—like problem validation, project management, and prototyping- and collaborate with industries leading to the development of new products, services, and processes that potentially drive economic growth (Vaaland & Ishengoma, 2016) . Guidance is available from teachers with some expertise on the students’ topic. The teacher also grades the final project report.
2.2. Design
Consistent with the exploratory nature of our research, we held semi-structured interviews. Such interviews are particularly instrumental in facilitating detailed descriptions of the understanding and experience around an unclear topic (Britten, 1995; Horton et al., 2004) . Following the socio-cultural theory of creativity, the teachers reconstructed descriptions of the student groups’ idea evaluation process that were grounded in a particular time and place (Bearman, 2019) . We developed an interview guide based on the consistent literature finding that students tend to avoid original and risky ideas (Johnson & D’Lauro, 2018; van Broekhoven et al., 2022) . This interview guide was tested in several pilot interviews, and unclear questions that caused confusion were reworded. The final interview guide consisted of an introduction, five open-ended questions with follow-up probing questions to elaborate on some responses, and the closure of the interview (see Supplementary Appendix 1).
2.3. Sampling and Participants
In the period spanning October to November 2021, we conducted semi-structured interviews with 14 teachers involved in the “innovation project”. Each interview lasted approximately one hour. Based on purposive sampling, teachers were selected using the following criteria: 1) at least two years of teaching experience in the innovation project, 2) guided at least two groups of students each year, and 3) willing to participate in the research project1. The fifth author was part of the organisation of the “innovation project” and recommended teachers who would fulfil our sampling criteria. Participants were invited to take part in the study through an email outlining the purpose of the research. The participants’ teaching experience in the “innovation project” ranged from two to seven years, with an average of five years. They each guided two or three student groups each year. The participants consisted of six male and seven female teachers.
2.4. Procedure
The interviews were held by the first author. With participants’ written informed consent, all the semi-structured interviews were audio-recorded and transcribed verbatim. In the interview, each teacher was asked to provide multiple concrete examples of the student group’s process of evaluating and improving ideas.
2.5. Analysis
The concrete example descriptions, provided by interviewees, are the unit of analysis, identified using the following criteria (Miles et al., 2020) :
· The interviewee describes the students’ identified health (care) problem in some level of detail.
· The interviewee describes the students’ idea or solution in some level of detail.
· The interviewee explicitly describes the students’ challenges that led to the teaching activities.
· The interviewee explicitly describes the teaching activities related to the students’ process of evaluating and improving ideas.
Together, the teachers reported 38 examples, with an average of three per teacher. The researchers used ATLAS.ti (version 9.0; Scientific Software Development, Berlin, Germany) to conduct a qualitative analysis of the interviews using primary, secondary and tertiary coding and constant comparison (Watling & Lingard, 2012) . They first read through the interviews several times, then coded the individual lines or sentences descriptively. During this primary coding, the authors remained open to many possible conceptual and theoretical directions (Charmaz, 2006) . This initial detailed mining of data led to a secondary coding, where broader categories were developed that encompassed a number of conceptually related ideas by going back and forth between coding and the literature. This meant that codes were grouped into categories, which, in turn, were systematically checked against new data and arranged into broader overarching themes (Boeije, 2010) . The first author analysed all the transcripts, and the second author cross-checked the codes. Both researchers compared and discussed the codes until they reached consensus.
To answer the first research question, we created an analysis framework based on the novelty-usefulness tension (Mueller et al., 2012) 2:
· Student groups evaluating ideas low in novelty and usefulness (NovLo_UseLo)
· Student groups evaluating ideas low in novelty and high in usefulness (NovHi_UseLo)
· Student groups evaluating ideas high in novelty and low in usefulness (NovLo_UseHi)
We identified an additional challenge, problematic group dynamics, which was included as a separate code.
To answer the second research question, we created an analysis framework based on Vermunt and Verloop’s (Vermunt & Verloop, 1999) classification of teaching activities to support students’ learning:
· Cognitive: Presenting and clarifying the subject matter for students
· Affective: Creating and maintaining a positive motivational and emotional climate for students
· Metacognitive: Regulating the problem-solving process of students
We identified an additional teaching activity, which seemed to refer to socio-communicative teaching activities (Vermunt et al., 2018) . This was included as a separate code.
3. Results
1) Research question 1: What challenges do student groups in medical undergraduate education face in evaluating and improving upon creative ideas according to teachers?
We found that the teachers reported that medical students face two main challenges in the context of creativity in higher education:
· Novelty-Usefulness Tension: Students often struggled to balance the goals of novelty and usefulness when generating creative ideas. They tend to select either novel ideas that are infeasible or ineffective, or useful ideas that are unoriginal and already exist.
· Problematic Group Dynamics: This study also highlighted issues with group dynamics during the idea evaluation process. Some students may dominate the discussion and push through their ideas, while others may withdraw if their contributions are ignored or ridiculed.
a) Novelty-Usefulness Tension
The majority of the example descriptions (29 of 38) could be characterised by student groups trying to find a way to manage the twin goals of novelty and usefulness. We discuss three example descriptions representative for each of the three categories: NovLo_UseLo, NovHi_UseLo and NovLo_UseHi (Table 1). The teachers reported 10 cases where student groups evaluated novel but ineffective or infeasible ideas to implement in practice (NovHi_UseLo). The socio-cultural theory of creativity argues that the evaluation of ideas takes place in the collaboration between students, the material and social environment, and is intertwined with culture. In line with this theory, we found that teachers reported several reasons for the impracticality of ideas (idea is not feasible or effective):
· The student group has insufficient knowledge and expertise to further develop an idea (i.e., collaboration between students).
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Table 1. Overview of each of three main novelty-usefulness tensions reported by teachers, and the frequencies of each.
Note: See Supplementary Material (Appendix 2 for all quotes). *Example descriptions of student groups who evaluated highly novel and useful ideas are beyond the scope of this article.
· The task or project has insufficient budget (i.e., material environment) to further develop an idea.
· There is a lack of collaboration from the social environment, such as pharmaceutical companies or research groups (i.e., social environment).
· The existing legal law inhibits the further development of an idea (i.e., culture).
An example is a student group who worked on reducing the reactions to misophonia (a disorder in which emotional or physiological reactions occur to a sound with a specific pattern) but found their solution of noise-cancelling headphones for these specific sounds unworkable without financial resources. Secondly, the teachers reported 12 cases where student groups evaluated feasible or effective ideas that lacked novelty (NovLo_UseHi). In these cases, the groups often sought consensus around a digital solution for their healthcare problem, with over half focusing on apps or websites. Finally, the teachers also reported seven cases in which the student groups evaluated ideas that were low in both novelty and usefulness (NovLo_UseLo). An example is a student group who worked on preventing dehydration in the elderly but found their solution of an “E-teach” smart bottle unworkable due to its high cost and prior existence.
b) Problematic Groups Dynamics
Furthermore, teachers reported challenges with group dynamics during the idea evaluation (6 of 38), often with some (dominant) students suggesting ideas and other group members tending to accept them without question (4 of 6). In the other two examples with group challenges, a student proposed an idea but was abruptly ignored or ridiculed by the others. For example, a student group worked on the problem of tinnitus (a hearing disorder), but one student who suggested some ideas withdrew from the group after being ignored by the others.
“Once, I had a student group that worked on preventing noise-induced hearing loss during festivals, and these students were stuck at one point, but they had come up with a nice questionnaire to measure noise-induced hearing loss. […] This was a student group with one man and four women. The man was completely overshadowed by the women. He did not get a single chance to advocate ideas with these women, although I noticed that he had very good ideas. He also became very frustrated in the process because his ideas were not heard” [T13 tinnitus].
2) Research question 2: What kind of teaching activities do teachers report using when student groups experience the above challenges?
We found that the teacher responses were contingent on the student groups’ reactions triggered by the novelty-usefulness tension. Some student groups reacted positively and were still motivated to continue with their idea, while other groups reacted with negative emotions, such as anxiety, frustration and fear. These groups often had trouble letting go of their idea and embracing alternative ideas. Finally, teachers also reported several teaching activities to address problematic group dynamics.
a) Teaching activities related to positive student emotions
Teachers responded both with cognitive and metacognitive teaching activities to student groups that were motivated to continue with their idea (see Table 2). The teachers asked detailed questions about the problem or the students’ proposed idea (cognitive level) and helped groups take the next step, such as seeking feedback from stakeholders. They also encouraged students to explore alternative ideas with stakeholders (metacognitive level). In this way, teachers tried to let student groups revisit or improve their proposed idea without directly instructing them to do so. Once teachers noticed that student groups were highly motivated to continue with their proposed idea, the teachers reported that they supported the student groups with their chosen idea.
b) Teaching activities related to negative student emotions
Teachers responded to negative reactions by using affective teaching activities to create a positive motivational climate, acknowledging and normalising failure (see Table 2). This was done by asking student groups about their motivation after rejection from stakeholders in the field, acknowledging declining motivation, and reducing fear and anxiety among students through reassurance. The teachers then also used metacognitive teaching activities to guide the students in finding alternative ideas or modifying their existing ideas with stakeholders.
c) Teaching activities related to problematic group dynamics
Finally, teachers reported using several activities to address problematic group dynamics, such as informing students of the importance of diversity in perspectives and encouraging students to contribute ideas. They focused on improving communication skills, including informing students of group dynamics, encouraging idea sharing and building, complimenting students, and encouraging individuals to speak up (see Table 2).
4. Discussion
This study explored the challenges faced by medical student groups when evaluating and improving their creative ideas and identified teaching activities to address these issues. Two major challenges were identified in student groups’ idea evaluation process: the tension between the novelty and usefulness of creative ideas and problematic group dynamics.
First, the tension between the novelty and usefulness of creative ideas stems from the fact that highly novel ideas are more likely to be judged as less feasible because, by definition, they involve a step into the unknown. Yet, both are important in defining a creative solution for medical problems. A novel but useless idea cannot be implemented in healthcare, while a useful but not novel idea already exists and, therefore, does not solve the medical problem. We also found that student groups feel unable to select novel ideas because of a lack of financial resources, knowledge, expertise and/or collaboration with stakeholders in the field. These findings are in line with the socio-cultural theory of creativity, which
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Table 2. Representative quotes illustrating teaching activities contingent on student groups’ reactions.
Note: See Supplementary Material (Appendix 2 for all quotes).
postulates that the evaluation of creative ideas is dependent on and embedded within the material and social environment.
Second, we identified two group dynamics that impaired student groups’ attempts to evaluate and improve upon creative ideas. The teachers reported that student groups converged on or accepted ideas proposed by the more dominant students without further elaborating on it, and that sometimes a student suggesting an idea was ignored or even ridiculed by the others. The first problematic group dynamic can be explained by the social comparison theory (Festinger, 1954) . According to this theory, group members are aware of the activity level of each other, and some members may be more active than others. The type or category of ideas shared by active members is then used to determine the appropriate level of performance (Brown & Paulus, 2002) . This, in turn, causes groups to accept ideas proposed by the more active group members without further elaborating on them (Ziegler et al., 2000) . The second problematic group dynamic can be explained by the idea evaluation apprehension theory (Cottrell, 1972) . This theory postulates that group members are apprehensive about others’ reaction to their ideas because most people want to be seen in a positive light. This, in turn, causes individual group members avoiding advocating novel or “weird” ideas because these ideas deviate from the status-quo and are likely to trigger a response from others. Group members are likely to withdraw from the group process even further when they are ignored or ridiculed by others.
As a result of these two challenges in their idea evaluation process, the student groups tended to seek consensus around ideas which were low in novelty. This is in line with literature on bias against original ideas (Mueller et al., 2012) . The most original ideas are often those that are radically different from existing solutions or practices, which often cause people to have ambivalent feelings towards both the ideas and the person suggesting them as people often prefer the status quo. This bias against original ideas highlights the importance of teaching activities to guide students in the idea evaluation process.
The teachers reported that several student groups reacted negatively to the discomforting nature of creative ideas and, subsequently, discarded their ideas, while other student groups reacted positively and were motivated to continue with their idea. The teachers addressed the negative reactions through affective teaching activities, accommodating emotional outbursts, and creating a psychologically safe environment by supporting and encouraging risk-taking. By contrast, student groups’ positive reactions were addressed with both cognitive and metacognitive teaching activities. The teachers asked detailed questions about the problem or the students’ proposed idea (cognitive activities), and helped the groups determine their next steps, such as seeking feedback from stakeholders in the field, including patients, the industry, or healthcare management (metacognitive activities). Finally, teachers also reported several teaching activities to address problematic group dynamics. They responded with socio-communicative teaching activities to help students resist peer pressure, informing them of the importance of diversity in perspectives and encouraging students to contribute ideas.
4.1. Practical Implications
The results presented here have implications for teachers in undergraduate medical education. Medical undergraduate students working in groups are likely to discard creative ideas and seek consensus around more conventional ideas due to the novelty-usefulness tension and may display group dynamics that inhibit the further development of creative ideas. This study highlights the need for teachers to support medical students in evaluating and developing their creative ideas, as this feels like a risky undertaking for students. To help medical students overcome bias against original ideas, a multifaceted approach could be effective. One could introduce, for example, a workshop that focusses on the importance of original thinking and how bias can hinder innovation. The workshop could create a safe space for sharing unconventional ideas and simultaneously teach students to critically evaluate ideas based on merit rather than conformity and encourage self-reflection and the use of tools like the Attitude Towards Implicit Bias Instrument (ATIBI) to help students recognize their own biases and attitudes towards original ideas (Gonzalez et al., 2021) .
Furthermore, the results of this study provide valuable information for professional development programmes for teachers in undergraduate medical education, as they shed light on the challenges students face in the idea evaluation process and offer practical teaching activities. Teachers should be aware of students’ tendency to choose familiar ideas over creative ones and be able to discuss this with students to encourage the selection of creative solutions. It’s crucial to create a supportive environment that acknowledges the emotional challenges students face when generating and evaluating creative ideas. Teachers should normalize the experience of failure and encourage resilience.
4.2. Limitations
This study had several limitations. First, it was conducted at a specific time and place and may not be generalisable to other contexts. In addition, using only semi-structured interviews with teachers may not fully capture their perceptions and activities in the idea evaluation process. Further research with a larger sample size and observations of teacher-student interactions is needed to deepen our understanding of these challenges. This study highlights the importance of affective teaching activities in addressing student insecurities triggered by the novelty-usefulness tension. We suggest researchers to carry out a more in-depth exploration of affective teaching activities.
5. Conclusion
In this study, we explored the challenges faced by medical student groups when evaluating and improving their creative ideas and identified teaching activities to address these issues. Medical students working in groups are likely to discard creative ideas and seek consensus around more conventional ideas. Yet, the healthcare system is changing rapidly, and students need to be prepared for increasingly complex problems that cannot be solved anymore by conventional solutions. To meet this challenge, medical students need to learn to overcome their bias against original ideas and skilfully manage the twin goals of novelty and usefulness in their search for creative solutions. Teachers are advised to provide a balance between safety, freedom and structure, giving opportunities for risk-taking and explorations while simultaneously providing student groups with necessary direction.
Acknowledgements
We would like to thank all the teachers that participated in this study. This study has been made possible thanks to their generosity in sharing beliefs and opinions about their pedagogical approach.
Ethics Approval and Consent to Participate
The study was conducted in accordance with the Declaration of Helsinki, and it was approved by the Ethics Committee of the Radboud Teachers Academy of Radboud University. The voluntary nature of participants’ participation and informed consent statements were included in the protocol and informed consent statements were obtained from all participants.
Availability of Data and Materials
The dataset analyzed during the current study is available from the corresponding author on reasonable request.
Authors’ Contributions
KB made substantial contributions to the study design, acquisition of data, analysis and interpretation of data. She conducted semi-structured interviews, analyzed the data and drafted the conclusions. She has also been involved in writing the manuscript and has also given final approval of the version to be published. PM contributed to the study design; MU participated in the qualitative data coding and analysis process; KB and MU carried out coding and analysis of the data independently, then discussed and agreed themes jointly; MU, PM and JH also have been involved in writing parts of the manuscript, revising it critically and giving the final approval of the version to be published. EK has been involved in revising the manuscript critically for important intellectual content and has also given final approval of the version to be published.
Supplementary Material
Appendix 1. Semi-Structured Interview Guide
Introduction
· A brief explanation of the research and why we are here.
· Explain the process of a semi-structured interview.
Key questions
· Can you tell me about your current role in the innovation project?
• Role as teacher (the so-called innovation expert)
• Teaching experience (number of years; average number of groups)
· I would like to zoom in on the process of when student groups start evaluating and improving upon their ideas. Do you have an example of a student group who found it difficult to evaluate and improve upon creative ideas?
• What happened?
• Why did that happen? What inhibited student groups?
• What did you do as a teacher? And why?
• How did student groups respond on your teaching activities?
· Do you have another example of a student group who found it difficult to evaluate and improve upon creative ideas?
· Do you have an example of a student group who evaluated and improved upon creative ideas?
• What happened?
• Why did that happen? What inhibited student groups?
• What did you do as a teacher? And why?
• How did student groups respond on your teaching activities?
· Do you have another example of a student group who evaluated and improved upon creative ideas?
Closure
· Ask participant whether there are any further topics that have not been discussed yet.
· Thank the participant for their willingness to contribute to the research.
Appendix 2. Overview of Quotes Illustrating Student Groups Challenges and Teaching Activities
High novelty-Low usefulness (NovHi_UseLo): total 10
High novelty-Low usefulness (NovHi_UseLo) including negative student emotions
High novelty-Low usefulness (NovHi_UseLo) including positive student emotions
Low novelty-High usefulness (NovLo_UseHi): total 12
Low novelty-High usefulness (NovLo_UseHi) including negative student emotions
Low novelty-High usefulness (NovLo_UseHi) including positive student emotions
Low novelty-Low usefulness (NovLo_UseLo): total 7
Low novelty-Low usefulness (NovLo_UseLo) including negative student emotions
Low novelty-Low usefulness (NovLo_UseLo) including positive student emotions
Group dynamics: total 6
NOTES
1This sample was part of a total of 88 teachers in the innovation project.
2We identified four cases in which a student group evaluated an idea high in novelty and usefulness, but these cases are beyond the scope of this paper.