The monotony of conventional didactic lectures makes students less attentive toward learning, and they tend to memorize isolated facts without understanding, just for the sake of passing exams. Therefore, to promote a habit of gaining indepth knowledge of basic sciences in medical undergraduates along with honing of their communication and analytical skills, we introduced this more interactive way of learning. The present study was performed on 99 first-semester medical students. After conventional didactic lectures, students were asked to prepare small conceptual questions on the topic. They were divided into two teams, which were made to ask questions to each other. If a team failed to answer, the student who questioned was supposed to answer to the satisfaction of the other team's student. Data were then obtained by getting feedback from the students on a 10-item questionnaire, and statistical evaluation was done using MS Excel and SPSS. To draft questions, students went through the whole system comprehensively and made questions from every possible aspect of the topic. Some of the questions (30%) were of recall type, but most judged higher cognitive domains. Student feedback revealed that they were satisfied, motivated to read more, and were confident of applying this learning and communication skills in future clinical practice. Students also expressed their desire to implement this activity as a regular feature of the curriculum. The activity resulted in an increase in student perceptions of their knowledge on the topic as well as communicative and analytical skills. This may eventually lead to better learning.
- medical education
- indepth learning
didactic lectures are by and large the most common mode of teaching in the majority of medical colleges in India. While this conventional pattern of teaching has some obvious advantages, such as the delivery of large information to a large audience, cost effectiveness, and useful for those who learn by hearing, this mode also has many disadvantages. To mention a few, lectures fail to keep the attention of students for a longer time, are a passive mode of teaching, are devoid of feedback and interaction, and are not suited for teaching complex topics and higher orders of thinking such as analysis, application, or synthesis, and, above all, fail to address people having different learning styles and preferences in the same manner. Moreover, the packed curriculum in medical colleges leaves little time for students to acquire a deep understanding of the subject or to develop skills such as critical and analytical thinking, problem solving, and communication. Students tend to just memorize the content without understanding for the sake of passing exams (11).
Andragogy, coined by Malcolm S. Knowles, differs from pedagogy in some aspects, such as relevance, congruence with student's needs, interactivity, and connection to student's previous knowledge and experience (9). Among the various teaching models forwarded for andragogy, one is active learning, where the learner actively participates in his/her learning (19).
Active learning implies that learners are involved in higher-order thinking (analysis, synthesis, and evaluation) rather than passive learning. More emphasis is placed on developing students' skills and engaging them in activities, e.g., reading, discussions, and writing (14).
Enthusiastic and trained teachers are now trying to make lectures more interactive and interesting by innovative interventions to encourage deep learning in students (17). The present study is an effort at exploring the use of such an intervention as a tool toward deep learning.
Many methods have been developed over time to make teaching more interactive and motivate a student for indepth learning, such as broken lectures, crossword puzzles, confusion techniques, quizzes, think-pair-share activities, etc. (13, 17). The literature states that students who are actively involved in learning retain information longer than when they are merely passive recipients of instructions (6, 12). Learning is likely to be more efficient when students are actively engaged in a discourse in which they are coconstructors of meaning (4, 16). One such activity is to invite students to pose thought-provoking questions to their peers and to clarify their understanding, summarize, and answer text-related questions (1). Question making is an art that requires a lot of analytical skill along with a deep understanding of the topic.
We hypothesized that encouraging students in a question-making activity will enhance their deep understanding of the concepts of physiology along with honing of their analytical and communication skills.
MATERIALS AND METHODS
After obtaining approval from the Scientific Review Committee and the Institute Ethics Committee to carry out the project, the present study was conducted with MBBS First Professional students (preclinical year, first semester) in the Department of Physiology at All India Institute of Medical Sciences, Jodhpur.
Students were given an explanation about the project in detail, and written informed consent was obtained. Ninety-nine students participated in the study.
Sensitization of faculty members was done by discussing with them the proposed plan of study.
Conventional didactic lectures on “Blood and the Immune System” were delivered to the students, during which time they were also sensitized to the question-making technique by giving them sample conceptual questions.
Students were asked to prepare small conceptual questions on the topics taught in 3–4 didactic lectures and were divided into 3 groups of 33 students each. Each of the three groups (groups A–C) of 33 students was further subdivided into 2 teams of 16 or 17 students, who were made to ask questions to each other. If a team failed to answer, the student who questioned was supposed to answer to the satisfaction of the other team's student.
Each quiz session of a group lasted for 1 h, i.e., 3 h for 99 students.
A faculty member acted as a facilitator, who encouraged and motivated the students to participate and to clarify any discrepancies occurring during the discussion. She/he also ensured the participation of each of the students in questioning as well as answering.
A record of the questions asked by different groups along with their source was also kept.
At the end of each session, students were given general feedback about their performance as well as the type and format of the questions made by them. Students were continually stimulated to make more conceptual rather than factual questions. They were promised to get some best-selected questions made by them in their semester assessments.
A total of four such quiz sessions was held every fortnightly on the topics that covered whole of the system (“Blood and the Immune System”).
At the end of the entire activity, i.e., after ∼10 wk, when all four quiz sessions had taken place, a feedback questionnaire was administered to the students, and their responses were recorded. Students were asked to complete the survey during class time and in the presence of the tutors. However, they were asked not to record their names, to preserve anonymity. All 99 students completed the survey.
The questionnaire that had two types of questions: 1) questions with a 5-point Likert scale to assess changes in learning, perception, analysis, communication, and satisfaction before and after the activity and 2) open-ended question directed at suggestions/changes made in teaching and the effect of interactive quiz session on the individual.
RESULTS AND DISCUSSION
A total of 99 students enrolled and completed the project. Questions were reviewed by the authors and judged as to whether they were simple recall or required analytical thinking. Some of the questions (30%) were of recall type, but most judged higher cognitive domains. Students made questions that tested all levels of Bloom's taxonomy.
Feedback from students about the various aspects of the learning activity using a Likert scale is shown in Table 1.
The average rating of 8–10 items in the questionnaires came out to be 4 or more. The minimum average score was 3.56 for item 6, which stated that the activity ingrained teaching skills; a maximum mean score of 4.30 was obtained for item 1, which stated that the activity was useful in comprehending the given topic.
With regard to the total scoring of each student, the minimum score obtained was 26 and the maximum was a full 50, with only 5 students scoring 30 or less.
The satisfaction index for each item was calculated using the following formula: [(n1 × 1) + (n2 × 2) + (n4 × 4) + (n5 × 5)] × 20/(n1 + n2 + n4 + n5), where n is the total number of students gaining the score mentioned in the subscript for that particular item. It was highest (88.04) for item 1 and lowest (76.9) for item 6 on a 1–100 satisfaction index scale. All 10 items showed satisfaction indexes of >75.
Table 2 shows some of the responses to the open-ended question in the student feedback questionnaire, which asked them to specify any changes or suggestions toward this activity and the effects (beneficial or otherwise) that they perceived.
Overall, students expressed satisfaction with the activity, and most of them expressed a desire to have this activity every fortnightly in not only the other topics of physiology but for anatomy and biochemistry also. Thirty-four students did not comment on the open-ended question.
Some students felt that although the activity was very effective, it was a time-consuming process, so it should be restricted to only difficult topics of the subject.
Some salient points of the interactive quiz session were as follows:
The interactive sessions were in marked difference with the conventional lecture-based approach, which generally ends up as a monologue.
Students were enthusiastic about the quiz sessions.
Students came up with different types of short questions, testing mostly the conceptual part of the topic. The questions were “explain why” types, flowchart formation, small calculations, “match the following” choices, and small case scenario types.
The quality of questions improved in successive quiz sessions, wherein the recall and factual questions were replaced by questions testing higher cognitive domains.
In successive quiz sessions, students not only tried different types of questions but also consulted different reference books, the internet, and research papers to advocate their explanations.
Most of the students felt that it was easier to ask questions from their peers and that this activity was useful in overcoming shyness and hesitation in the class.
This study was an attempt to inculcate the habit of questioning in students by means of interactive quiz sessions based on topics taught in the form of lectures, and it was judged as an effective way of learning by both students and the staff.
These quiz sessions were different from the conventional quiz sessions, where the questions are made by the quiz master and participants have to answer. Here, the participants themselves prepared the questions. It is clear from previous studies that when efforts are made to implement student-centered learning the students respond positively (5).
Asking good questions is fundamental to learning, particularly when the questions encourage students to think critically. “Skill in the art of questioning lies at the basis of all good teaching” (3). For effective questioning, one needs to have the skills of reasoning, analysis, and comprehension as well as an indepth knowledge of the topic. Moreover, when done in a fun-filled fearless environment of a small group of peers, this positive interaction can be instrumental in efficient learning.
Physiology is a constructivist science, in which the essential part is the ability to apply basic physiological principles and concepts for solving problems related to the integrated living organism (2). In other words, physiology is the answer for most of the “whys and hows” of human body functioning. Mastering this basic science enables the clinician to distinguish abnormal from normal functioning; the first step toward making a diagnosis.
The present study emphasizes that it is rewarding to ask questions to peers in small groups, as students can become proficient in the topic. Peer teaching and learning have been studied extensively and acknowledged positively (7, 8, 10, 15, 18). Hurley et al. (7) performed a study in 2003 to determine whether student-delivered supplemental instruction is beneficial and acceptable to first-year medical students and concluded that it was effective.
Since the students were asking as well as answering questions, explaining, convincing, and making the other students understand the concept, they potentially developed not only the skills of verbal and nonverbal communication but also active listening. Questioning poked the students to express themselves lucidly. Communication skills were refined during the subsequent quiz sessions. These skills are vital for establishing doctor-patient communication.
Students appreciated this interactive activity. They viewed question making as an opportunity to comprehend the topic and understand the nuances of it. They also felt that they were now less hesitant in asking questions during the classes, and, because of this, their learning increased. Some faculty members supported the activity very well, and this project renewed team spirit and the bond among the teachers and students within the department.
This intervention does not require any elaborated logistics or module/schedule; hence, one single motivated, dedicated faculty member can also perform it!
We also generated a question bank!
Thus, question making in an innovative way may be successful in inculcating an analytical vision to look and apply learning clinically.
However, the limitations of this study are that it was performed on only one topic (“Blood and the Immune System”) of physiology. It would have been worthwhile if we had applied it to more topics. A big obstacle, however, was to convince some faculty members for such an intervention because it would demand extra efforts and their time.
In addition, some students tended to choose an easier way of asking factual questions, a practice that decreases the very purpose of the study, i.e., to reinforce learning. A similar approach could have been applied to other disciplines, which would have further validated the study results and the fact that its effectiveness is agnostic to the topics and discipline.
The project was done as a part of FAIMER fellowship from CMC Ludhiana.
No conflicts of interest, financial or otherwise, are declared by the author(s).
B.M. and B.B. conception and design of research; B.M. analyzed data; B.M. interpreted results of experiments; B.M. prepared figures; B.M. and B.B. drafted manuscript; B.M. and B.B. edited and revised manuscript; B.M. and B.B. approved final version of manuscript.
The authors acknowledge the guidance and help provided by the faculty members, senior colleagues, and batch mates of CMCL-FAIMER family.
- Copyright © 2016 The American Physiological Society