|Year : 2012 | Volume
| Issue : 3 | Page : 170-173
Assessment of impact of small group teaching among students in community medicine
Ranabir Pal1, Sumit Kar1, Forhad Akhtar Zaman1, Dilip Kumar Jha2, Shrayan Pal1
1 Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
2 Department of Physiology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
|Date of Submission||22-Aug-2010|
|Date of Acceptance||06-Mar-2012|
|Date of Web Publication||21-Aug-2012|
Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: We conducted a study to assess the impact of small group teaching (SGT) among students by feedback analysis to identify intricacy so that learning can be facilitated. Materials and Methods: This cross-sectional study was undertaken among 182 MBBS students studying at a teaching hospital at Gangtok. Students were provided with a questionnaire following an assignment on a scheduled topic. Students were asked to provide feedback on the modes of teaching-learning practiced in community medicine with the parameters of evaluation including assessment of presentation by faculty member in reference to relevance, sequencing, depth, interaction, etc., to the overall rating of presentations in different teaching-learning methods. Results: The faculty members were on the positive evaluation by the students in the SGT, which was preferred over "lectures" as the teaching-learning methods. Among SGTs "tutorials" were graded better than "practical," "seminar" and "field posting" on the basis of longer duration at a stretch. Among the parameters for evaluation, relevance, depth, and interaction in regard to scheduled topic of presentations, the rating was significantly higher in SGT than different other teaching-learning methods. Largely the students noted that the time devoted and number of hours/sessions allotted for each topic was adequate. Conclusion: All forms of SGT were on the positive appraisal by the students on their learning experience and were considered as a comprehensive tool for in-depth teacher-student interaction.
Keywords: Community medicine, small group teaching, student feedback
|How to cite this article:|
Pal R, Kar S, Zaman FA, Jha DK, Pal S. Assessment of impact of small group teaching among students in community medicine. Indian J Community Med 2012;37:170-3
|How to cite this URL:|
Pal R, Kar S, Zaman FA, Jha DK, Pal S. Assessment of impact of small group teaching among students in community medicine. Indian J Community Med [serial online] 2012 [cited 2019 Jul 23];37:170-3. Available from: http://www.ijcm.org.in/text.asp?2012/37/3/170/99920
| Introduction|| |
In the era of explosion of information, students are over burdened with ever-increasing academic load making learning painful instead of delight. The global trend toward rationalizing teaching learning is gathering momentum toward dynamic mindset instead of traditional didactic lectures. Innovative curriculum developments look afresh to work out solutions that will ensure that tomorrow's medical students will receive the need-based education. ,,, Medical schools are also changing their educational programs and teaching strategies, at national and international levels, to ensure that students have active responsibility for their learning process and are prepared for life-long, self-directed learning.  The effort toward developing active learning was based on meaningful learning which ensures understanding and applying concepts rather than memorizing only which is rote learning.  Meaningful learning involves the acquisition of "useful" knowledge so that it can be accessed from different starting points and has to correlate with previous knowledge with multiple representations (mental models).  Many medical colleges teaching conventional medical courses in India such as Dayanand Medical College, Ludhiana, engross different methods of teaching learning in the curriculum. Though the students are the true stakeholders, yet they hardly get any scope to bring forward their views. There is hardly any constructive feedback and there is no opportunity to implement what one was learnt from the feedback.  Indian medical colleges rarely collect and utilize feedback from the students for improvement of the program of study.  We conducted a study to assess the impact of small group teaching (SGT) in community medicine among students by analyzing feedback from students and to identify intricacy in this regard so that learning can be facilitated.
| Materials and Methods|| |
This cross-sectional study was undertaken among 182 MBBS students studying at a tertiary care teaching institute at Gangtok, Sikkim, during the month of May 2009. The community medicine teaching learning is done in a continuum from the 1 st term till the end of 7 th term when the students have to appear in the 3 rd Professional MBBS Part-1 examination for summative evaluation (interspersed by the formative evaluations at the end of each term that become part of internal assessment for the summative evaluations) instead of any true semester system. We attempted to summarize the experience of the students by feedback from 4 th to 6 th term.
The predesigned and pretested anonymous student's feedback questionnaire contained all modes of teaching learning practiced in community medicine with the questions relating to the evaluation and assessment of facilitator in terms of relevance, sequencing, depth, interaction, etc., to the overall rating of presentations. The questionnaire was developed at the Institute with the assistance from the faculty members and other experts in this field. A Likert scale of 0-5 (0 = useless to 5 = very good) was used to rate each assessment spell based on qualitative analytic methods. Necessary permission was granted from the Head of the Department and Head of the Institution. By initial translation, back-translation, retranslation, followed by pilot study the module was custom-made for the study. The pilot study was carried out at the department and some of the questions from the interview schedule were modified.
The students were explained about the purposes of the study and its use for academic purposes along with the scope of future intervention. Informed consent was taken from each of the participants before the study. The participants were given the options of not to participate in the study if they wanted. The students were divided into groups and each group received the time table of an assignment on a scheduled topic at the beginning of each session for the SGT. The students filled the self-administered questionnaire assessing their perceptions and attitudes about the quality and quantity of different teaching-learning methods. The students present on the days of the study were included as participants.
The principal investigator commented on the relevance of the topic initiated the interactive discussions with intricate questions and then put the students on dynamic learning. At the end of the SGT sessions, students were asked to provide feedback on the session on the questionnaire. The findings of the questionnaire were discussed with the faculty and students at the end by the principal investigator to complement the findings of the study. Moreover, the summary data were planned to be implemented in the next sessions and to be deposited to the Educational Committee. This project was undertaken within the range of the fellowship activities supervised by the Foundation for the Advancement of International Medical Education and Research Regional Institute at Christian Medical College, Ludhiana (CMCL-FAIMER).
The collected data were thoroughly screened and entered into excel spreadsheets and analysis was carried out using SPSS 11.0 for windows. Proportions and Chi-square tests were applied in this study.
| Results|| |
182 students of different semesters reflected the attitudes of the students regarding SGT. Tutorials were rated as having greater impact on learning process as compared to lectures demonstrations. As per Likert scale, 35.71% respondents rated tutorials as very good among all teaching learning methods, followed by lecture demonstration (33.52%). Practical demonstration was rated average by 24.18% of respondents. However, seminars, field posting, class test, and strictness of attendance were having a mixed response. Majority (21.43%) considered seminars as not useful as opined by 23.63% for field posting. Largely the students viewed the strictness of attendance and regular class tests as 'average' [Table 1].
|Table 1: Grading different teaching-learning methods as a means of guidance (n = 182)|
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Regarding impact of SGT, in reference to relevance of the topic, coverage, and depth of discussion, majority feel that it was average. Majority of the respondents (51.10%) rated high on the 'declaration of schedule well ahead'; clearing of their confusion by interaction was rated as very good by 23.63%. However, presentations had the popular rating (25.27%) as 'average'; 21.43 percent rated sound [Table 2].
|Table 2: Small group teaching presentations in community medicine study with reference to certain parameters (n = 182)|
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Overall 'very good' rating for the faculty members was provided by the students (30.77%). Regarding faculty, 29.12 percent opined highly on the depth of knowledge while 31.32 percent noted very good interaction and ability to clarify in depth the doubts on spot [Table 3].
|Table 3: Rating of faculty members in small group teaching sessions (n = 182)|
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The time devoted for teaching methods in community medicine was rated as optimal. Majority (59.34%) considered that the number of semesters allotted for community medicine in MBBS curriculum was most favorable; 53.85 percent opined that time slots allotted for small group sessions were adequate and needed no alteration. However, one third of them felt that the duration of seminars and field posting needs to be shortened.
Self-directed learning by students in SGT helped most respondents to augment their knowledge, attitude, and competency. Regarding sessions, few confessed that their knowledge was useless before; one-fourths accepted improvement after; the attitude also turned good. Similarly, 'very good' competency increased from 13.74 to 26.92 percent.
In the open sessions, the students suggested revision on imperative topics with the emphasis on the interactive sessions in arena of ever expanding curriculum. During the study sessions, the respondents were also asked to clarify and elaborate on the answers provided by the questionnaire as well as to suggest improvements for the following year. The faculty members suggested reorientations viz. debate, computer-based learning, focus on newer public health problems in the epidemiological transition and problem-based paradigm shift approaches.
| Discussion|| |
We hardly had any true inbuilt system of appraisal on the effectiveness of SGT either from the "sender" or the "receiver" of the teaching-learning communications. For a systematic program evaluation of the community medicine in imparting the preferred knowledge, attitudes, and competency to medical students, the first step in that direction, a study design was needed to obtain the insight and intended practices of the medical students about their curriculum. All form of SGTs were on the positive appraisal by the students and the faculty. The faculty members were on the positive evaluation by the students in the SGT, which was preferred over "lectures" as the teaching-learning methods. However, among SGTs "tutorials" were graded better than "practical," seminars, and "field posting" for lesser duration at a stretch. Among the parameters for evaluation, relevance, depth, and interaction in regard to scheduled topic of presentations, the rating was significantly higher in SGT than other methods. Greater part of students found that the time devoted and number of hours/sessions allotted for each topic was adequate with interactive revision on imperative topics.
A study in the New University of Lisbon concluded that creative methods in "problem-based leaning" (PBL) and concept map in SGT allowed for the meaningful learning.  The Ludhiana project targeted to make student feedback more acceptable to the faculty by positive input revealed that the majority considered student feedback to be a motivating factor for faculty (60% of faculty and 81% of students) and that student feedback is an important component of an academic program (65% of faculty and 90% of students).  In recent years, the use of portfolios as learning and assessment tools has become more widespread across the range of health professions, though there is no clear collated summary of the evidence for the educational effects of the use of portfolios in undergraduate education.  In the University of Calgary, study on the effects of teaching on learning outcomes of peer educators concluded that involvement in SGTs improved medical students' knowledge acquisition and retention. 
Student feedback on the curriculum and faculty is an important input for improving medical education. Feedback for improvement was encouraging as the internal assessments were observed to be improved. Moreover, our study generated awareness about further research in medical education in other departments. We had several limitations. It would have been better if we could repeat the study and identified the trend of student feedback over years.
While formal feedback strategies can be adapted to collect feedback during the teaching, there are a range of strategies suitable for gathering informal feedback from students. Perhaps the most obvious way is to ask the students questions directly. In small and interactive spells, there is mutual trust and respect of students and teachers; it may be feasible to pose direct questions. Still, students may feel uncomfortable to voice less accepted opinions openly as there is limited scope for anonymous responses.
To summarize, SGTs help increased self-identification of lacunae by student and promotion of self-directed learning by instant resolution of confusions and helps them learn the art of holistic problem solving approach. SGT had a positive impact on learning experience of the students and is a comprehensive tool for in-depth teacher-student interaction. With the encouraging results on constructive gains and acceptability by the students and faculty, we hope to continue small group teaching methods. This curriculum revision would, in addition, optimize education through a engrossing ideas from medical students. Ultimately, the revision should enhance the proficiency of the medical graduates who, as primary health practitioners, will be competent to provide health education and counseling to clients/ patients, and thus, enhance the quality of health care in India. Moreover, no study on this topic has been reported so far in this region, though research in teaching learning in undergraduate medical course is much needed in South East Asia.
| Acknowledgment|| |
The authors acknowledge the support of the Foundation for the Advancement of International Medical Education and Research Regional Institute at Christian Medical College, Ludhiana (CMCL-FAIMER) and all the participating students.
| References|| |
|1.||Walton H. Medical education worldwide. A global strategy for medical education: Partners in reform. Med Educ 1993;27:394- 8. |
|2.||Davis WK, White BAC. Introduction. In: Davis WK, Jolly BC, Page GC, Rothman AI, White BAC, eds. Moving medical education from the hospital to the community. Report of the 7th Cambridge Conference on Medical Education. Ann Arbor, Mich, University of Michigan 1997. |
|3.||Yonke AM, Foley RP. Overview of recent literature on undergraduate ambulatory care education and a framework for future planning. Acad Med 1991;66:750-5. |
|4.||Murray E, Modell M. Community-based teaching: The challenges. Br J Gen Pract 1999;49:395-8. |
|5.||West DC, Pomerory JR, Park JK, Gerstenberger EA, Sandoval J. Critical thinking in graduate medical education: A role of concept mapping assessment? JAMA 2000;284:1105-10. |
|6.||Rendas AB, Fonseca M, Pinto PR. Toward meaningful learning in undergraduate medical education using concept maps in a PBL pathophysiology course. Adv Physiol Educ 2006;30:23-9. |
|7.||Michael J. The claude bernard distinguished lecture. In pursuit of meaningful learning. Adv Physiol Educ 2001;25:145-58. |
|8.||Ananthakrishnan N. Microteaching as a vehicle of teacher training-its advantages and disadvantages. J Postgrad Med 1993;39:142-3. |
|9.||Singh D, Ahluwalia G, Kaushal SK. Increasing the acceptability of student feedback for curriculum revision. Available from: http://www.faimer.org/education/fellows/abstracts/04singh.pdf. [Retrieved on 2009 Jun 11]. |
|10.||Buckley S, Coleman J, Davison I, Khan KS, Zamora J, Malick S, et al. The educational effects of portfolios on undergraduate student learning: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 11. Med Teach 2009;31:282-98. |
|11.||Peets AD, Coderre S, Wright B, Jenkins D, Burak K, Leskosky S, et al. Involvement in teaching improves learning in medical students; a randomized cross-over study. BMC Med Educ 2009;9:55. |
[Table 1], [Table 2], [Table 3]