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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 2  |  Page : 81-84

Prediscussion and Postdiscussion Assessment Scores in a Self-directed learning module implemented in the department of biochemistry: A comparative study


1 Department of Biochemistry and Member Medical Education Unit, Dr. Baba Saheb Ambedkar Medical College, New Delhi, India
2 Department of General Medicine and Member Medical Education Unit, Army College of Medical Sciences, New Delhi, India

Date of Submission18-Dec-2019
Date of Decision29-Dec-2019
Date of Acceptance30-Jan-2020
Date of Web Publication28-Feb-2020

Correspondence Address:
Prof. Poonam Agrawal
Department of Biochemistry, Member Medical Education Unit, Baba Saheb Ambedkar Medical College & Hospital, Rohini, New Delhi - 110 085
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJMS.INJMS_153_19

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  Abstract 


Background: Self-directed learning (SDL) is an important tool for transforming medical students into lifelong learners so that they are competent to identify their learning needs, allocate resources, and evaluate the learning process throughout their career. Recently, the Medical Council of India has introduced SDL as an essential component of the competency-based medical education curriculum and has allocated fixed hours for SDL in all undergraduate MBBS students. Regarding the role of facilitators in SDL program, there are controversial reports and there are even studies which have shown that the role of a facilitator is not important. Aim: The proposed study aimed to assess students' performance before and after discussion in an SDL module in small-group teaching–learning method and compare the performance scores. Methodology: A total of 117 students responded and were included in the study. Batch A had 59 students and Batch B had 58 students. The topic selected for the SDL module was “Heme degradation and Jaundice.” The module was conducted over two contact sessions, Session 1 and Session 2, which were conducted 5 days apart. The prediscussion and postdiscussion assessment questionnaire was also prepared. Session 1 was conducted during a 1-h SDL slot. A gap of 4 days was given to students for doing self-study and to learn the topic. The prediscussion questionnaire consisting of five multiple-choice questions related to the topic was shared with the students a day before the second contact session. Session 2 was conducted during the 2-h tutorial slot (over 2 consecutive days for two batches of the class, Batch A and Batch B, respectively). Fishbowl method of small-group teaching–learning was done followed by postdiscussion questionnaire. Results: The questionnaire was analyzed, and it was observed that the overall mean performance of students improved considerably (78.3%–87.7%) in the questions related to core concept (Q1, Q2, and Q3). Similarly, in the questions related to clinical aspects of the topic, the mean performance of students showed considerable improvement from prediscussion to postdiscussion assessment (86%–93.5%). Conclusion: We conclude that the SDL module should be meticulously planned keeping in mind the topic selected and the availability of infrastructure and workforce. Peer discussion is a very important aspect of the SDL module, and it shows improvement in learning outcomes in an SDL module.

Keywords: Curriculum, education, learning, medical education


How to cite this article:
Agrawal P, Verma N. Prediscussion and Postdiscussion Assessment Scores in a Self-directed learning module implemented in the department of biochemistry: A comparative study. Indian J Med Spec 2020;11:81-4

How to cite this URL:
Agrawal P, Verma N. Prediscussion and Postdiscussion Assessment Scores in a Self-directed learning module implemented in the department of biochemistry: A comparative study. Indian J Med Spec [serial online] 2020 [cited 2020 Sep 25];11:81-4. Available from: http://www.ijms.in/text.asp?2020/11/2/81/279786




  Introduction Top


In self-directed learning (SDL), learners take the initiative for their own learning to deal with an educational challenge. In SDL, the learners are primarily responsible for identifying their learning needs and formulating learning objectives.[1]

SDL is an important tool for transforming medical students into lifelong learners so that they are competent to identify their learning needs, allocate resources, and evaluate the learning process throughout their career. This will allow them to keep abreast with the latest advancements in the world of medicine and help them to become a better doctor.[2],[3] However, in spite of the proven advantages of SDL over the conventional teaching in medical education,[4],[5] educationists have found it very difficult to precisely define SDL and implement SDL modules within the existing framework of medical education in India.

Recently, the Medical Council of India has introduced SDL as an essential component of the competency-based medical education curriculum and has allocated fixed hours for SDL in all undergraduate MBBS students. This has led to a lot of apprehension among medical faculty regarding “When” the SDL is to be implemented, for “What” topic it is to be implemented, and more importantly “How” it is to be implemented for it to be most effective.

Regarding the role of facilitator in SDL program, there are controversial reports and there are even studies which have shown that the role of a facilitator is not important.[6]

Aim

The proposed study aimed to assess students' performance before and after discussion in a SDL module in small-group teaching–learning method and compare the performance scores.


  Methodology Top


This study was done in the department of biochemistry in a North Indian medical college. Out of the total 125 students, a total of 117 students responded and were included in the study. Batch A had 59 students and Batch B had 58 students. As per the departmental teaching plan, students were in two batches, and this facilitated small-group discussion. The topic selected for the SDL module was “Heme degradation and Jaundice.” The module was conducted over two contact sessions, Session 1 and Session 2, which were conducted 5 days apart.

Before the start of Session 1, the sensitization of facilitators was done, and the topic and mode of implementation of SDL module were discussed. The faculty/facilitators were asked to identify the key points of the topic to be given. Next, a “challenge” (case scenario to be given to the students) was formulated by the joint effort of all the facilitators in such a manner as to incorporate all the necessary points to be learned by the learners. The prediscussion and postdiscussion assessment questionnaire was also prepared during this discussion and validated by faculty members of the department and also by medical education unit members.

Session 1 was conducted during a 1-h SDL slot. The students were sensitized about SDL, the case scenario (challenge) was presented to them, and they were encouraged to identify their learning needs. The students were asked to formulate learning objectives under the guidance of the facilitator as to bridge the knowledge gaps identified by them. As reported in previous studies, it is essential to have well-defined learning objectives to ensure that the students have a clear idea of what they have to learn.[7] Resource materials (textbooks and links to articles related to the topic) were identified with the guidance of the facilitator and were shared with all the students.

A WhatsApp group was created including all the students and faculty facilitators involved in the SDL module after getting the consent from the participants. This platform was used to motivate students to do SDL and to share additional learning resources.

A gap of 4 days was given to students for doing self-study and to learn the topic.

The prediscussion questionnaire consisting of five multiple-choice questions related to the topic was shared with the students a day before the second contact session. Out of the five questions asked, three questions (Q1, Q2, and Q3) were related to the core concept of the topic and two questions (Q4 and Q5) were clinical correlation questions. The students were asked to respond before attending the second session and the responses were compiled.

Session 2 was conducted during the 2-h tutorial slot (over 2 consecutive days for two batches of the class, Batch A and Batch B, respectively). Fishbowl method of small-group teaching–learning was utilized for this session. The discussion was guided by the facilitator. At the end, a summary of the topic was given by the facilitator to fill the gap of knowledge, if any.

The postdiscussion questionnaire was then distributed among the students and their responses were collected and compiled.

The assessment of prediscussion and postdiscussion questionnaire responses was done, and the results were compiled.


  Results Top


The percentage of students scoring below 50% marks was seen to decline from 6% to 2% in postdiscussion assessment compared to prediscussion assessment. It means that the low scorers were reduced in postdiscussion group, and they were shifted to high-score groups.

There was a considerable increase in the percentage of students scoring in the 50%–60%, 70%–80%, and also in >90% score range in the postdiscussion assessment compared to the prediscussion assessment (18% vs. 7%, 46% vs. 30%, and 6% vs. 3%, respectively). However, the percentage of students scoring in the 60%–70% score range showed a sharp decline, and those scoring between 80% and 90% does not show any change in percentage. Similarly, if one focuses on the percentage of students performing below 60%, there seems to be increase in this percentage of such students in postdiscussion group (20% vs. 13%); this may be because of redistribution of students in the 50%–60% score group from <50% score group and also may be because of the factual nature of questions asked, which may not have been reinforced during discussion [Table 1].
Table 1: Percentage of students scoring within specified score ranges in pre- and postdiscussion assessments

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The questionnaire was analyzed, and it was observed that the overall mean performance of students improved considerably (78.3%–87.7%) in the questions related to the core concept (Q1, Q2, and Q3). On further observation, we noted that the percentage of students who correctly answered questions 1 showed a slight decline in the postdiscussion assessment as compared to the prediscussion assessment, but in questions 2 and 3, the percentage of students who answered correctly shows a sharp increase from 84% to 91% and from 54% to 81%, respectively [Table 2].
Table 2: Classification of assessment questions into two groups and comparison of the number (percentage) of students who answered each question and both groups of questions correctly in pre- and postdiscussion assessments, respectively

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Similarly, in the questions related to the clinical aspects of the topic, the mean performance of students showed considerable improvement from prediscussion to postdiscussion assessment (86%–93.5%). Individually also, the percentage of score increased in the postdiscussion assessment as compared to the prediscussion assessment in clinical questions (Q4 and Q5) (91%–96% and 81%–91%, respectively) [Table 2].

The open comment section received many comments, some of which are presented verbatim below:

“Learning in this kind of atmosphere where we find our fellow colleagues discussing the topic confidently motivate us to learn better.”

“I was not well prepared for the topic before coming to discussion and was quite apprehensive, but the conduct of session was so well organized that I have learned a lot towards the end of it and I will learn more after going back to the hostel.”

“It was the best session of my life because in this session everyone got the opportunity to speak, those who did not read the topic had opportunity to listen and learn from fellow colleagues.”


  Discussion Top


On comparing the scores of the postdiscussion assessment with the prediscussion assessment, we noted that there was an improvement in the overall mean scores of the students after attending the fishbowl discussion. This signifies improved learning outcomes. However, there was a considerable variation when the scores are classified into discrete score ranges. As shown in [Table 1], the percentage of students scoring low marks (<50%) reduced considerably from 6% to 2% after attending the fishbowl discussion. It shows that low scorers were benefitted from the discussion in the peer group, which must have clarified many important concepts related to the topic. Many a times, low-scoring students are afraid to ask and clarify doubts from the faculty. However, in the fishbowl discussion, they felt comfortable in discussing the topic with their peers, and this must have given them the confidence to seek the help of their classmates to clarify all their doubts related to the topic.

The percentage of students scoring >70% marks showed an increase from 40% to 59%, whereas those scoring >90% increased from 3% to 6%. This shows that even the high-scoring students were benefitted by attending the small-group discussion because many of their concepts got clearer after discussion with their peers, thus improving their performance.

The improved learning outcomes among both low and high scorers can also be due to the fact that the group discussion allows revision and reinforcement of the important concepts and is a more interesting way of learning than simply reading the resource materials. While the self-learning component allows both read/write and visual learners to gain knowledge, the discussion component allows even aural learners to understand the topic by listening and participating in the discussion.[8]

The performance of students in clinical correlation questions (questions 4 and 5) showed significant improvement in the postdiscussion assessment. This shows that the fishbowl method of teaching–learning is a useful method to introduce clinical integration in 1st-year MBBS students.

We are of the opinion that while the core concepts of any subject can be theoretically learned by the students through self-study during the SDL sessions, group discussion in a small-to-medium group setting is essential to understand the clinical correlation of the core concepts of preclinical and para-clinical students. Similar findings have been reported by many other studies in the past;[9],[10] however, more studies are required across the country and across multiple MBBS students to corroborate this assumption.

Ironically, the percentage of students who correctly answered question 1 showed a slight decline in the postdiscussion assessment. The fact that fewer students answered this question correctly after attending the fishbowl discussion means that the concept was either not discussed sufficiently or was a simple recall-based question which has given inconsistent score result.

In question 3, we noted that only 54% of the students were able to answer correctly in the prediscussion assessment. The authors assume that the concept involved in this question was either difficult for the students to understand on their own or the resources were probably insufficient to cover the concept asked in this question. However, it is heartening to note the sharp rise in the number of students who answered this question correctly after the fishbowl discussion (81%), which shows the beneficial effect of peer discussion in clarifying the concept asked in this question.

Rather than dividing the students into smaller subgroups and conducting tutorials, the fishbowl method of discussion employed in Session 2 of the SDL module gave an equal opportunity to all students to discuss the topic in peer-group interaction. It maintained uniformity of teaching–learning, and the students had the opportunity to learn from their fellow classmates at the same time.


  Conclusion Top


We conclude that the SDL module should be meticulously planned keeping in mind the topic selected and the availability of infrastructure and workforce. Peer discussion is a very important aspect of the SDL module, and it shows improvement in learning outcomes in an SDL module.

Incorporation of a group discussion among peers is beneficial not only for the low-scoring students who show promising results post discussion, but also for high scorers who show better performance in the postdiscussion assessment. Clinical concepts can be explained better in such sessions, and aural learners can learn better by listening to and discussing the topic. Perhaps, increased awareness of the learning styles of our students is the need of the hour. While we have included fishbowl discussion technique in our module, we encourage faculty members across the country to incorporate different innovative small-, medium-, or large-group teaching–learning methods to facilitate discussion and improve learning outcomes from SDL. If possible, short PowerPoint presentations and/or patient encounters can also be included as they will ensure better participation of visual and kinesthetic learners and make the SDL modules even more inclusive and interactive.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Knowles M. Self-Directed Learning: A Guide for Learners and Teachers. Chicago, IL: Follett Publishing; 1975. p. 1-135.  Back to cited text no. 1
    
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Greveson GC, Spencer JA. Self-directed learning the importance of concepts and contexts. Med Educ 2005;39:348-9.  Back to cited text no. 3
    
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Abraham RR, Upadhya S, Ramnarayan K. Self-directed learning. Adv Physiol Educ 2005;29:135-6.  Back to cited text no. 4
    
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Arroyo-Jimenez Mdel M, Marcos P, Martinez-Marcos A, Artacho-Pérula E, Blaizot X, Muñoz M, et al. Gross anatomy dissections and self-directed learning in medicine. Clin Anat 2005;18:385-91.  Back to cited text no. 5
    
6.
Pai KM, Rao KR, Punja D, Kamath A. The effectiveness of self-directed learning (SDL) for teaching physiology to first-year medical students. Australas Med J 2014;7:448-53.  Back to cited text no. 6
    
7.
Ainoda N, Onishi H, Yasuda Y. Definitions and goals of “self-directed learning” in contemporary medical education literature. Ann Acad Med Singapore 2005;34:515-9.  Back to cited text no. 7
    
8.
Fleming N. VARK: A Guide to Learning Styles. Available from: http://www.vark-learn.com/english/index.asp. [Last accessed on 2019 Dec 27].  Back to cited text no. 8
    
9.
Anderson SM, Helberg SB. Chart-based, case-based learning. S D Med 2007;60:391, 393, 395, 397, 399.  Back to cited text no. 9
    
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Holmboe ES, Prince L, Green M. Teaching and improving quality of care in a primary care internal medicine residency clinic. Acad Med 2005;80:571-7.  Back to cited text no. 10
    



 
 
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