Reem Rachel Abraham

Students' perceptions regarding educational environment in an Indian dental school

Background: As one of Indias premier dental schools, the Manipal College of Dental Sciences, Manipal, has strived to be in the forefront of dental education ever since its inception in 1965. But one of our main drawbacks has been the lack of students’ perceptions about the educational atmosphere in our institution. Aim: (1) To understand the students’ perceptions of the educational environment. (2) To compare the results with those of other dental/medical schools. Methods: Dundee Ready Education Environment Measure (DREEM) was used to gather information about the environment in our institution. The same was administered to first year and final year students (63 each). Results: The main area of convergence of both groups was that the social atmosphere was not very congenial. But the thought provoking finding was that both groups felt that the teachers were authoritarian. Conclusion: The lack of congenial atmosphere in our institution seems to be due to the attitude of the course organizers. A need for makeover in attitudes and approach on the part of the teachers to make the learning experience more pleasant for the students was made obvious by this study.

Learning approaches of undergraduate medical students to physiology in a non-PBL- and partially PBL-oriented curriculum

Melaka Manipal Medical College (Manipal Campus; Manipal, Karnataka, India) conducts the Bachelor of Medicine and Bachelor of Surgery program, for which the admission intakes are during the months of March and September. The present study was undertaken to study the differences in learning approaches to physiology of undergraduate medical students in a partially problem-based learning (PBL)- and non-PBL-oriented curriculum. PBL was introduced as a curricular reform for the September 2006 batch of students (partially PBL group), whereas it was not incorporated for the March 2006 batch of students (non-PBL group). Learning approaches to physiology of both groups of students were compared using the short inventory of approaches to learning. Mean scores for deep and strategic approaches were found to be significantly higher for the partially PBL group compared with the non-PBL group. The results of the present study support the earlier observation that PBL promotes a deep approach to learning.

Exploring first-year undergraduate medical students' self-directed learning readiness to physiology

Medical students are expected to possess self-directed learning skills to pursue lifelong learning. Previous studies have reported that the readiness for self-directed learning depends on personal attributes as well as the curriculum followed in institutions. Melaka Manipal Medical College of Manipal University (Karnataka, India) offers a Bachelor of Medicine and Bachelor of Surgery (MBBS) twinning program that is of 5 yr in duration. Keeping in mind the amount of time that the curriculum has devoted for self-directed learning, we explored the self-directed learning readiness of first-year MBBS students (n = 130) using a self-directed learning readiness scale (SDLRS) and explored the correlation between SDLRS scores of high achievers, medium achievers, and low achievers with their academic performance in physiology examinations. Students were requested to respond to each item of the SDLRS on a Likert scale. Median scores of the three scales of the SDLRS were compared across the three groups of students using a Kruskall-Wallis test. SDLRS scores of the students (n = 130) were correlated with their marks in theory papers of first, second, and third block-end examinations using Spearmanns correlation coefficient. The mean item score for desire for learning was found to be higher followed by self-control and self-management. Data analyses showed significantly high (P < 0.03) median scores for self-control for high achievers compared with medium and low achievers. Between the groups, high achievers had a higher score for all the three scales of the SDLRS followed by low and medium achievers. SDLRS scores and academic performance of the three groups of students were found to exhibit a weak correlation. This study threw light on the fact that despite having a high desire for learning and ability of self-control, students need to be supported in their self-management skills.

Effects of problem-based learning along with other active learning strategies on short-term learning outcomes of students in an Indian medical school

Background: Problem-based learning (PBL) is reported to improve general competencies such as problem solving. It also fosters the development of a scientific attitude in medical students. The present study explored perceptions of students at Melaka Manipal Medical College (MMMC), Manipal Campus, India regarding the extent to which PBL along with other active learning strategies has succeeded in improving a few short-term learning outcomes. We also determined graduation and attrition rates of seven and six batches of first- and second-year students, respectively, who were enrolled in MBBS program before and after the implementation of PBL. Materials and Methods: Students (n = 120) were requested to indicate their responses on a Likert scale in a questionnaire focusing on the 12 short-term learning outcomes. Additionally, a retrospective analysis of graduation and attrition rates of seven batches of first year and six batches of second-year students who were enrolled in MBBS program was done. Results and Conclusion: Out of the 12 learning outcomes, all were found to have a median score of 4, except time management, motivation for lifelong learning, and interest in pursuing medical profession. The graduation and attrition rates were found to be significantly high and low respectively for PBL students compared to non-PBL students in first year. In the second year too, PBL students outnumbered non-PBL students in terms of graduation rate. The attrition rate was found to be low for PBL students compared to non-PBL students. The present study revealed that PBL along with other active learning strategies such as self-directed learning (SDL) sessions employed in the curriculum right from first year culminated in improvement of almost all short-term outcomes.

Validating the effectiveness of Clinically Oriented Physiology Teaching (COPT) in undergraduate physiology curriculum

BackgroundIt has been proved that basic science knowledge learned in the context of a clinical case is actually better comprehended and more easily applied by medical students than basic science knowledge learned in isolation. The present study intended to validate the effectiveness of Clinically Oriented Physiology Teaching (COPT) in undergraduate medical curriculum at Melaka Manipal Medical College (Manipal Campus), Manipal, India.MethodsCOPT was a teaching strategy wherein, students were taught physiology using cases and critical thinking questions. Three batches of undergraduate medical students (n = 434) served as the experimental groups to whom COPT was incorporated in the third block (teaching unit) of Physiology curriculum and one batch (n = 149) served as the control group to whom COPT was not incorporated. The experimental group of students were trained to answer clinically oriented questions whereas the control group of students were not trained. Both the group of students undertook a block exam which consisted of clinically oriented questions and recall questions, at the end of each block.ResultsComparison of pre-COPT and post-COPT essay exam scores of experimental group of students revealed that the post-COPT scores were significantly higher compared to the pre-COPT scores. Comparison of post-COPT essay exam scores of the experimental group and control group of students revealed that the experimental group of students performed better compared to the control group. Feedback from the students indicated that they preferred COPT to didactic lectures.ConclusionThe study supports the fact that assessment and teaching patterns should fall in line with each other as proved by the better performance of the experimental group of students compared to the control group. COPT was also found to be a useful adjunct to didactic lectures in teaching physiology.

Mentored student project for inculcating research skills

Context and setting Most medical schools in India do not emphasise the importance of scientific research skills in the undergraduate medical curriculum despite the fact that it is essential for students to understand scientific methods of critically evaluating the evidence that will assist their decision making during their medical careers. In recognition of this need on the part of medical students, a mentored student project (MSP) programme was implemented in an Indian medical school in 2008 for a batch of medical students. Why the idea was necessary It is essential to inculcate critical thinking and reasoning skills and to develop a positive attitude among medical students towards scientific research from the beginning of their medical careers. As scientific research is rapidly evolving from its status as a largely individual endeavour to that of a highly collaborative, interdisciplinary activity, research training for undergraduate medical students should also inculcate the spirit of teamwork. At present, there is no formal path by which medical students in India can become doctor-scientists or academicians. What was done In the MSP programme, students (n = 113), guided by a teaching faculty member (mentor), were required to undertake a project involving in-depth study of an area of their interest, write a scholarly report and present the work as a poster presentation. To encourage the spirit of teamwork, students were grouped (n = 3–5) and each group was asked to select a research project in the form of a library study, laboratory research, medical records study, case study or field project. To examine the students’ perceptions regarding improvements in their research skills after participating in the MSP, a questionnaire consisting of 16 items related to the research skills gained by undertaking projects and the guidance received from the mentor (using a 5-point Likert scale) was developed. Students were requested to indicate their responses on the questionnaire and to describe their previous research experience, if any. Student responses were summarised using percentages. The median grade and interquartile range were reported for each item. A comparison of overall research skills gained with those based on previous research experience was performed using the chisquared test. Evaluation of results and impact The median grade for all items related to improvements in research skills was 4, which indicates that the majority of students felt the MSP had increased their research skills. Type of project and previous research experience were not significantly related to the improvement in overall skills. It was encouraging to find that 80% of the respondents had received appropriate guidance from their mentors. A total of 61% of students agreed that the MSP should be a mandatory requirement for the completion of the MBBS degree at our institution, which suggests that the non-funded MSP programme was successful in fostering a positive attitude towards scientific research. The present study provided scope for the further refinement of the MSP programme based on students’ perspectives.

Heutagogic approach to developing capable learners

Abstract The twenty-first century higher education sector has come a long way after undergoing continuous metamorphosis from pedagogy to andragogy. Most of the educational approaches adopted in medical schools are directed towards developing more of competencies and less of capability, which is the ability to use competencies in novel contexts. Competencies alone are not sufficient to thrive in the present day work place as medical profession subsumes complex contexts; it is in this scenario that, medical educators are entrusted with the challenging task of developing “capable learners”. In the heutagogical approach, learners are required to decide upon what to learn and how to learn and therefore the control of the learning process is on the learner and the role of the teacher becomes that of a navigator. This paper highlights the current higher educational practices based on heutagogy, considers its application in the context of Problem-based learning and also discusses a few challenges in incorporating this approach in the existing undergraduate medical curriculum. The article proposes the use of social media in order to support learner autonomy, which in turn improves learners’ cognitive engagement with content and tasks, thereby assisting the development of attributes associated with capability.

Teaching and assessing reflecting skills among undergraduate medical students experiencing research

INTRODUCTION Reflection is the integral component of lifelong learning. Hence, there is a need for incorporating opportunities for students in the curriculum, to develop these skills. AIM To evaluate the feasibility of incorporating teaching-learning activity on reflection early in the undergraduate medical curriculum using research experience as a context, and, to determine whether the reflective skills of students improve upon training. MATERIALS AND METHODS The study was experimental with test and control groups and was conducted at Melaka Manipal Medical College, India. Senior batch of medical students in the second year of the course, about to complete their research project were considered as the test group and subsequent junior batch which was in middle of the research activity was the control. The test group was provided with a teaching-learning activity on reflection. Following this, students were asked to write reflective summary on experience of doing research. The control group who did not receive any training on reflection were also requested to write reflective summaries. Reflective summaries were graded by two authors independently using a newly developed rubric. Later, the grades were designated with scores. Perspective regarding this teaching-learning activity was collected from the test group. Feasibility was examined during teaching-learning activity and assessment. Mean reflective summary scores of control and test groups were expressed as mean±standard deviation and compared using independent samples t-test. A p-value of <0.05 was considered as statistically significant. Inter-rater reliability of the rubric was analyzed using Kappa statistics. RESULTS The teaching-learning activity lasted for two hours. It took an average of five minutes for researchers to assess each reflective summary. There was a statistically significant (p<0.001) difference in the mean reflective summary scores between control (26.45±9.43) and test (51.66±6.56) groups. Kappa for inter-rater reliability was 0.784 denoting substantial agreement between two raters. Perceptions revealed acceptability of module (median 4, scale 1-5). CONCLUSION Teaching and assessing reflecting skills among students using research experience as context was feasible. This study demonstrated that students acquire better reflecting skills after undergoing training.

Collaborative learning in PBL.

At Melaka Manipal Medical College (MMMC), India, PBL was introduced in the curriculum in 2006 in accordance with the Maastricht ‘seven jump’ process (Wood 2003). Recently, the PBL committee at MMMC took initiative to explore students’ experience of engaging in collaborative learning prior to presentation session. Out of 10 PBL groups (n1⁄4 110), five groups were considered experimental groups (EG) and the remaining, control groups (CG). We encouraged EG to involve in collaborative learning prior to presentation session. Each PBL group (EG) was sked to meet two times prior to presentation session. After a brainstorming session, in the first meeting, each PBL group met and discussed the learning objectives which were identified in brainstorming session. Each member of the group volunteered to discuss about one objective when they meet for the second time prior to the presentation session. One or two members of the group took up the responsibility to retrieve additional information about the topic from other resource materials. After the first meeting, each PBL group was involved in self-directed learning, during which they had the freedom to interact with their team members. One week prior to the presentation session, students met for the second time and each one discussed about one learning objective and tried to solve the problem in a collaborative manner. At the end, each PBL group was asked to reflect on the collaborative learning process by responding to a questionnaire. Later, both CG and EG students were assessed by different facilitators using the PBL evaluation form and the scores were compared using paired t test. There was no significant difference in the scores between the groups; CG (Mean 13.98) and EG (Mean 13.60). However, EG students reflected that they enjoyed the collaborative learning process, and it made them more confident to present in the presentation session. They also felt that they could appreciate the multifarious modes of understanding a topic among the team members and the freedom of face to face interaction in the small group. Even though quantitative confirmation of the success of collaborative learning was not evident in our setting, students were urged to consciously get involved in collaborative learning prior to pbl presentation sessions.

Factors influencing academic success of high achievers and low achievers in physiology

Introduction: Academic success of medical students is influenced by several factors. Aim: To determine whether academic success of high as well as low achievers in physiology in the present academic context is influenced by pre-reported factors. Materials and Methods: Focus Group Discussion (FGD) sessions were conducted to explore perceptions of high as well as low achievers in physiology, regarding seven pre-reported factors influencing academic success. These factors were: attitude towards medical school, attitude towards teachers, interest in subject, time-management, strategic studying, academic self-perceptions and test competence. First year students (n=13) who had scored distinction (>75%) in physiology, in three block-end examinations and second year students (n=7) who had distinction in all four block-end examinations when they were in first year, were categorized as high achievers. Students (n=14) who were unsuccessful in first year final summative examination, were grouped as low achievers. Results: The FGD data which was analysed using a deductive analysis framework revealed a positive link between responses for all pre-reported factors with the academic success of high achievers, except time management and strategic studying. Even though the responses from low achievers regarding medical profession, teachers, and interest in subject were positive, these could not be linked to their academic performance in first year. The low achievers in the present study believed that with continuous teacher support, their understanding of physiology could be improved, which in turn could lead to an increased interest in the subject which could motivate them to work hard and improve their academic performance. Conclusion: To conclude, academic success of both high and low achievers in the present academic context were influenced by pre-reported factors. Through this study, students were provided with an opportunity to reflect upon the learning process which is reported to be a learning supportive process. This study also gathered evidence for the fact that medical students need to be made aware of and has to be trained in effective time management skills.