Evaluation of Efficacy of Tutorials in Pharmacology for 2^nd year undergraduate Medical Students in India

 

Margaret Shanthi FX^*, Blessed Winston A, Aniket Kumar, Saibal Das, Sumalya Sen, Jaya Ranjalkar, Deepasree Sukumaran

Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore

 

ABSTRACT:

Background: Tutorial is a group discussion among the students moderated by a teaching faculty followed by a short test.

Objectives: This study was done to assess the efficacy of tutorial in comparison with self-study in terms of immediate performance, in 2nd year undergraduate medical students in Pharmacology at Christian Medical College, Vellore and to assess student’s satisfaction and perspective using feedback questionnaire.

Materials and methods: Students were randomized into 2 groups: Group A (48 students) underwent tutorials and Group B (50 students) did self-study for the same topic in pharmacology. At the end of intervention, both groups underwent theory exam with same question paper. On a cross-over basis, this process was done for a total of 4 times. Analysis was done with the marks using ‘R’ program to find difference in performances. Unpaired comparison was done for every session and paired comparison was done for average scores at the end of the study and p<0.05 was considered significant.

Results: 3 out of 4 sessions conducted showed significant improvement with tutorials. Also in paired comparison, there was significant improvement in student performance (self-study vs. tutorials, mean 51.49 vs. 58.46, p=0.001). Interestingly the low-performers (on the basis of past marks) benefitted lot from tutorials (p=0.002) rather than high-performers, 90.41% students agreed for the usefulness of tutorials and 76.71% were willing to make it compulsory in the curriculum.

Conclusion: Tutorials have proved to be extremely effective in improving short-term outcome especially for the low performers in Pharmacology in 2^nd year undergraduate medical curriculum.

 

 

 

INTRODUCTION:

Tutorial is a group discussion among the students moderated by a teaching faculty followed by a short test.  This system complements the regular curriculum in undergraduate medical education as demonstrated by various studies in abroad and India including Christian Medical College, Vellore.^[1] In the era of outburst of information, students are overburdened with ever-increasing academic burden 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.^[2,3]

 

Teaching the subject of Pharmacology is a challenge not only because of the vastness of the subject but also because of the reluctance to change the older methods of teaching. A great challenge lies in the hands of the teacher who has to teach the subject such that it stimulates interest and inculcates the drive to learn.

 

The most common method of assessment includes twelve theory examinations conducted to evaluate the students at regular intervals. These theory examinations are based on the traditional pattern of essays and short answer questions. Other methods of assessment includes tutorials followed by a test consisting of long and short answers, open book tests, written assignments, multiple choice questions tests and viva – voce.

 

Considering this diversity in teaching, we thought of eliciting the opinion of students, to consider their views regarding the subject, the methodology of teaching and their learning strategies. It is a matter of great concern that towards the end of the 2^nd undergraduate medical curriculum in each academic year, the students are stressed with tutorials and tests in very rapid succession, not only in Pharmacology but in other subjects included in their curriculum as well like Pathology, Microbiology and Forensic Medicine affecting their performances. Also the time has come to re-evaluate the importance or efficacy of these tutorials vs. individual study in terms of their performance as per our regular teaching standards and practice. It was felt that the students′ feedback would reveal:

 

1.      Whether the so-called reforms are acceptable to them, and

2.      Their opinion for the betterment of teaching/ learning the subject.

 

Student feedback has been considered to be an effective methodology for the modification of undergraduate curriculum and making Pharmacology more interesting and practicable.^[4]

 

Several studies on students’ perceptions regarding learning of Pharmacology has documented students’ improvements in performance through improved teaching and learning processes.^[5] Student feedback is thus considered an invaluable tool for improving students’ performances when suggestions obtained from students are implemented.^[6] Studies regarding students’ feedback helps to provide several useful inputs for educational improvements. These studies can provide valuable inputs into the curriculum review processes, ^[7,8] helps in forming a learner-centered knowledge building process ^[9] and also improve on the implementation of recent teaching methods in Pharmacology. With this background, the present study was done with the following objectives:

 

1.      To assess the efficacy of tutorial in comparison with self-study in terms of immediate performance, in 2nd year undergraduate medical students in Pharmacology, and

2.      To assess the student’s satisfaction and perspective using feedback questionnaire.

 

MATERIALS AND METHODS:

Approval from the Institutional Review Board, Christian Medical College, Vellore and informed consent from every student who participated in this study was obtained.

 

Allocation:

Students were assigned dummy numbers and randomized into group A and B. Group A having 48 students and group B having 50 students.

 

Intervention:

On the same day, group A underwent tutorials and Group B did self-study for the same topic. At the end of intervention, both the groups underwent a theory exam with the same question paper. (Formulation of question paper and evaluation of answer sheets were done by different faculties blinded to intervention).

 

Crossover:

On the next day of intervention, Group A did self-study and Group B underwent tutorials on the succeeding topic followed by exam as described before followed by repetition of crossover for two more topics.

 

Analysis:

Marks of all the students obtained in all these topics were used for statistical analysis using ‘R’ program (3.1.0). Analysis was done to find difference in performances between tutorials and self-study. Unpaired comparison was done for every session and paired comparison was done for average scores at the end of the study. p<0.05 was considered as statistically significant.

 

Feedback:

A feedback questionnaire (Likert-type scale) was also given to the students.

 

RESULTS:

The difference in baseline characteristic of students in both the groups on the basis of their previous marks in Pharmacology and gender were found to be statistically non-significant.

 

Group A comprised of 48 and Group B comprised of 50 students. 3 out of 4 sessions conducted showed significant improvement with tutorials. Also in paired comparison, there was significant improvement in student performance (self-study vs. tutorials, mean 51.49 vs. 58.46, p=0.001). Interestingly, it was the low-performers who were benefitted a lot from tutorials (p=0.002), rather than high-performers, who did not show any significant benefit (Figures 1-3).

 

Figure 1: Session wise comparison of students’ performances

 

Figure 2: Overall comparison of students’ performances in tutorials vs. self-study

 

Figure 3: Impact of tutorials on high and low performers

According to the feedback data obtained from total 73 students, we found that 66 (90.41%) students ‘agree’ for the usefulness of tutorials in Pharmacology. On asking whether tutorials should be made compulsory, 56 (76.71%) students said ‘yes’ as their answer. When the students were asked about the importance of reading the topic before appearing for the tutorial, 68 (93.15%) students responded ‘agree’. If failed to prepare for the tutorial before appearing for it, 45 (61.64%) students believed tutorials serves ‘no’ benefit. Regarding the atmosphere during the tutorial sessions, 39 (53.42%) students considered it ‘friendly’. 41 (56.16%) students suggested that ‘both the teacher and student’ should interact during tutorials. 60 (82.19%) students felt that the tutorials should be conducted regularly ‘at the end of each system’ covered. 37 (50.68%) students felt the optimum duration of per-tutorial session should be less than 1 hour.

 

DISCUSSION:

In vast conceptual subject like Pharmacology, as per our findings, tutorials seem to be extremely effective particularly in low-performers. It gives a chance of more individual attention, one-to-one interaction, finding the problems with the students and bringing the subject more close to them. Also, tutorial can show a guided way of learning towards examination and beyond, and gives a fair insight on exploring the subject.

 

In this study, the short term outcome of tutorials was assessed and the importance of tutorials was documented. But more robust studies need to be conducted for evaluating the long term benefits as well. As of tutorials, both teacher and student friendly environment is required and the duration of tutorial time should be less than 1 hour as expressed by the students. Lack of time, difficult concepts, big topics, lack of interest and laziness to study are the common problems that are encountered with the students and tutorials can actually show some light in these aspects.

 

CONCLUSION:

Tutorials have proved to be extremely effective in improving short-term outcome especially for the low performers in Pharmacology in 2^nd year undergraduate medical curriculum.

 

ACKNOWLEDGEMENTS:

We acknowledge the intramural fluid research grant, Christian Medical College, Vellore received for the work and the support of Medical Education Unit, Christian Medical College, Vellore.

 

REFERENCES:

1.       Goldbloom RB, Jones GM. The role of a tutorial system in undergraduate medical education. Can Med Assoc J. 1967; 96(14): 1027–1031.

2.       Walton H. Medical education worldwide. A global strategy for medical education: Partners in reform. Med Educ.1993; 27:394- 8.

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.       Bhosale UA, Yegnanarayan R, Yadav GE. Attitude, perception and feedback of second year medical students on teaching learning methodology and evaluation methods in Pharmacology: a questionnaire-based study. Niger Med J. 2013; 54(1): 33-9.

5.       Lalit Mohan BC, Adiga S, Shenoy S, et al. Undergraduate medical students’ perceptions regarding personal drug selection exercise. Int J Pharmacol Clin Sci.  2012; 1(2): 61-7.

6.       Badyal DK, Bala S, Kathuria P. Student evaluation of teaching and assessment methods in Pharmacology. Indian J Pharmacol. 2010; 42: 87-9.

7.       Banerjee I, Jauhari AC, Johorey AC, et al. Medical students view about the integrated MBBS course: a questionnaire based cross-sectional survey from a medical college of Kathmandu Valley. Nepal J Epidemiol. 2011; 1: 95-100.

8.       Alefan Q, Mohamad MHN, Awaisu A, et al. Student’s perspectives on pharmacy curriculum ina malaysian university. Malay J Pharm Sci. 2009; 7(2): 125-36.

9.       Ranasinghe P, Wickramasinghe SA, Wickramasinghe R, et al. The students’ voice: strengths and weaknesses of an undergraduate medical curriculum in a developing country, a qualitative study. BMC Res Notes. 2011; 4: 256..

 

 

 

Received on 29.12.2015          Modified on 23.01.2016

Accepted on 14.02.2016        © RJPT All right reserved