Advan. Physiol. Edu. 28: 51-58, 2004;
doi:10.1152/advan.00013.2003
1043-4046/04 $5.00
ADV PHYSIOL EDUC 28:51-58, 2004
© 2004 American Physiological Society
How We Teach
Pedagogical effectiveness of innovative teaching methods initiated at the Department of Physiology, Government Medical College, Chandigarh
K. Sri Nageswari,
Anita S. Malhotra,
Nandini Kapoor and
Gurjit Kaur
Department of Physiology,Government Medical College, Chandigarh 160014, India
Address for reprint requests and other correspondence: K. Sri Nageswari, H.No.1119, Govt. Medical College Quarters, Sector 32-B, Chandigarh 160030, India
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Abstract
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Modern teaching trends in medical education exhibit a paradigm shift from the conventional classroom teaching methods adopted in the past to nonconventional teaching aids so as to encourage interactive forms of learning in medical students through active participation and integrative reasoning where the relationship of the teacher and the taught has undergone tremendous transformation. Some of the nonconventional teaching methods adopted at our department are learning through active participation by the students through computer-assisted learning (CD-ROMs), Web-based learning (undergraduate projects), virtual laboratories, seminars, audiovisual aids (video-based demonstrations), and "physioquiz."
Key words: vertical orientation program; undergraduate projects; computer-assisted learning; video-based demonstrations; physioquiz
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Introduction
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IT IS WELL KNOWN THAT STUDENTS LEARN MORE when they are involved actively in learning than when they are passive recipients of instruction (1). Active learning strategies can be designed to target visual learners through models and demonstrations, auditory learners through discussion, debates and games and kinesthetic and tactile learners through models and role playing (5). It has been observed that, in every group of 30 students, an average of 22 are able to learn effectively as long as the teacher provides a blend of visual, auditory, and kinesthetic activities. The remaining eight students differ in their preferences for modalities of learning and fail to understand the subject matter unless it is presented in their mode of preference. To meet these needs, teaching should be multisensory and filled with variety (2).
There is very little documentation of the effectiveness of various active learning strategies, and often faculty are reluctant to incorporate such new strategies into the teaching curriculum (5). We have been fortunate enough at the Department of Physiology, Government Medical College, Chandigarh, a budding institution of a developing nation, India, to introduce a number of innovative teaching techniques emphasizing the interactive form of learning for making the subject of Physiology more interesting.
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METHODS
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Educational Settings
It should be mentioned here that medical students in India are undergraduates and join after the 10 + 2 system and spend 4.5 years in medical education (1 yr preclinical, 1.5 yr paraclinical and clinical, and 2 yr purely clinical). The basic medical degree awarded is the MBBS, whereas the MD is a postgraduate degree. In the subject of physiology there are 200 hours of didactic teaching in the form of theory classes taken for an hour each, daily, six days a week. Once a week there is a tutorial in the topics covered as conventional lectures. Besides this, there are 280 hours of practical teaching, which include human, mammalian, hematology, and amphibian experiments and the innovative techniques mentioned above. Regular tests are taken after completion of a system in theory (subjective type), completion of experiments for a particular lab (hematology, human, mammalian, and amphibian, etc.). A promotion test (half yearly) and a "send-up" examination before students appear for final examination are held for both theory and practical.
Students in the United States complete four years for the BS and then join medical schools. The students thus hold a baccalaureate degree at the entry level. The basic medical degree awarded is the MD.
The examination pattern as per the Medical Council of India guidelines is of short-answer type where the evaluation procedure is subjective and variable. The evaluation of student performance is done by four different examiners (2 external and 2 internal). Assessment in later clinical years is also subjective; hence, performance in these exams is not a reliable index to test the effectiveness of teaching-learning strategies. Objective examination through multiple-choice questions is a perfect evaluation instrument to compare the effectiveness of teaching methodologies. The evaluation/assessment pattern in India being quite different, the objective type of evaluation could not be applied to test the pedagogical effectiveness in our studies.
However, performance of the students in various entrance exams conducted for postgraduate studies (akin to United States Medical Licensing Examination) is of the objective type and can be taken as a test for judging the efficacy of innovative techniques in terms of the number of students who qualified and gained admission to postgraduate programs and their ranks. All the innovative techniques started in toto with the 2002 batch of students. This batch will appear for their postgraduate entrance tests only after December 2007. For these reasons, the effectiveness of the innovative program initiated by us could not be evaluated objectively. However, subjective evaluation of each of the programs was done through administering a questionnaire (feedback form) to the students at the end of the program.
The innovative teaching techniques employed by us are described below.
Vertical Orientation Program
The medical students undergo a vertical orientation program so as to understand in a better manner the pathophysiology of various clinical ailments. The students are taken to clinical departments to learn about sophisticated techniques and live demonstrations and are encouraged to learn actively in clinical settings through student-patient interaction.
As per the Medical Council of India guidelines, interaction of the basic departments with clinical departments during the preclinical phase of medical education is mandatory. Horizontal integration, i.e., integrating the teaching curriculum with the basic departments like Anatomy and Biochemistry has long been in practice. The Vertical Orientation program is a new concept and was introduced by us into the medical curriculum since the 2000 batch. The academic session runs from July to June of each year, and the batch of medical students specifies the year in which they joined.
The students visit various departments like the Department of Haematology and Transfusion Medicine to learn safe blood transfusion procedures and live demonstrations, the Department of Pulmonary Medicine to be introduced to the latest techniques and sophisticated equipment available for pulmonary function tests, and the Department of Medicine to become familiarized with Holter, stress electrocardiogram, and echocardiography through patient studies. The students become well acquainted with hospital surroundings and also understand the pathophysiology of various clinical ailments in a better manner through live demonstrations. This facilitates their learning process and reduces the adjustment period to clinical settings during the paraclinical and clinical phases of medical curriculum.
Undergraduate projects.
To encourage computer-assisted learning, the students access the Web and prepare undergraduate projects. The Internet as a medium of learning is explored to the maximum for the creative use and positive impact of such knowledge on the learning process. Topics from recent advances in the subject are allocated to them. Through Internet search the students acquire the latest knowhow on the assigned topics and compile the projects in the form of a brochure.
The projects prepared by the first batch were individual and were on a voluntary basis. Later on, it became a group effort so as to involve more and more students. Also, the students gradually became very interested in the undergraduate projects, and most of them participated.
Students are directed to procure the latest information and recent advances on various topics allocated to them. The students do a thorough Web search and compile the knowhow in the form of a brochure. This practice started with the 1999 batch of students, and 33 projects have been submitted since then (Table 1). The students of the 1999 batch prepared the projects in January 2000, the 2000 batch in 2001, and so on. Thus each batch submits the projects in the month of January of the subsequent year.
The undergraduate projects are kept as archives in the departmental library for ready reference.
Computer-assisted learning (learning through CD-ROM).
The opportunities associated with the development of computer-based technology in contributing to effective life science education have grown exponentially within the past decade. The multimedia software available on CD-ROM can play a powerful role with applications in labs and lectures, tutorials and project work. A number of CDs are available in the department. They are Fundamentals of Human Neural Structure, Sylvius 2.0, which is a CD-ROM interactive atlas of the human brain consisting of six modules featuring realistic color-enhanced, high-resolution brain images, functional and connectional information of labeled structures, 3-D images, animations, self quiz, etc.; a CD-ROM consisting of the figures from the textbook Principles of Physiology by Robert M. Berne; and a customized slide show on the respiratory system through animation.
Seminars.
Weekly seminars are held, and all the students are required to participate actively. The best speaker of the seminar from the entire batch is given an award. The awards are given to inculcate a competitive spirit in the students and bring the best out of the students.
Virtual laboratories.
Virtual laboratories detail the preparation, essential equipment, and method relevant to the practical, and students then actively perform experiments themselves with simulated tissue responses to stimuli or pharmacological agents as they would in an animal practical or clinical scenario, monitoring and recording data with on-screen oscilloscopes, chart recorders, and other apparatus (3). Software, which includes a virtual laboratory, presents a range of equipment on-screen and may offer a very high degree of interactivity. Typically, such programs simulate classical animal preparations and experiments within physiology, pharamacology, and critical care. These disciplines lend themselves well to multimedia because of the need to correlate multiple and simultaneous events and to gain an understanding of the interplay between complex and related phenomena (3). Thus the concept of the virtual laboratory is encouraged in our department. The available software on the Internet is downloaded for offline experimentation where the students perform specific experiments under the guidance of a tutor. The students learn the principles and laws governing physiological phenomena through animal experimentation. However, due to restrictions imposed on animal experiments and availability of animals, currently there is a reduction in the number of animal experiments. Through the software available on the Internet, the students are trained to conduct some of the amphibian experiments on the computer and plot the dose-response curve. The virtual laboratory sessions are conducted in two practical sessions and cover the recording of blood pressure, heart rate, skeletal muscle recording in Virtual Cat, blood pressure and heart rate monitoring in Virtual Rat and nerve muscle physiology experiments using various drugs and ions in amphibian preparations.
Training through audiovisual aids can play an important role in medical education. At the department, some of the practical demonstrations are taken by the tutors through video-based teaching resources.
Students as project coordinators.
The department inculcates leadership qualities in students. The students actively participate as coordinators of the on-going departmental research projects. Two such projects were conducted during the years 2000–2001 and 2001–2002 to assess the stress in medical students and to evaluate the impact of relaxation therapy through yogic exercises and Brahmkumari’s way of Rajyoga meditation practices, respectively, on medical students. On the basiss of the results of the preliminary studies conducted in 2000–2001, the students of the 2002 batch were given relaxation training through the Brahmkumari way of Rajyoga meditation (n = 15), 15 students participated in yoga training, and 14 students served as controls. The various sympathetic [cold-induced change in systolic and diastolic blood pressure (cold pressor response), recovery time, heart rate, postural changes in blood pressure] and parasympathetic cardiovascular prarmeters (Valsalva ratio, expiration-to-inspiration ratio on deep breathing, 30:15 ratio) and psychological variables (general health questionnaire, major hassles, minor hassles, coping checklist, and quality-of-life questionnaire) were recorded after their admission to medical school (baseline values) and after completion of the relaxation training program (Brahmkumari way of Rajyoga meditation/yoga training) and during follow-up.
The results revealed the beneficial effect of Rajyoga meditation in relieving stress in first-year medical students (unpublished observations). One of the medical students who was involved in the project presented a paper at a National conference and won the award for Best Undergraduate Paper.
Physioquiz.
After completion of a few systems in physiology theory, a quiz is conducted. On average, three quiz competitions are conducted per academic year.
The Physioquiz is conducted for each system in which 12 students (4 teams, 3 each) participate actively. Six students also take part as quiz masters for marking scores and monitoring times (2 each). There are six rounds consisting of Question-Answers and Definitions, Jumbled-Words and Multiple-Choice Questions (MCQs), Graphs and Flow Diagrams (indicate the missing link), Match the Columns, Clinical Problems, and Rapid-Fire Round. These are described below.
Round I: Normal Values, Definitions, Precise Terms, Question-Answers, Give Reasons, Name the Reflex, Applied Physiology, Methods of Measurement, Work Done by Scientists, State the Law, etc. (Tables 2– 10).
Round II: Jumbled Words and MCQs (Tables 11 and 12).
Round III: Graphs and Flow Diagrams to indicate missing link (Figs. 1, 2, and 3).
Round IV: Match the Column, Trace the Path, Arrange in Order (Tables 13, 14, and 15)
Round V: Clinical Problems (Table 16)
Round VI: Rapid-Fire questions (True/False) within 1.5 minutes time (Table 17)
The various rounds (six) of the quiz are prepared on the basis of the taxonomy classification that refers to the complexity-of-thought process required while the item is being answered. The first round, consisting of question-answers, is based on simple recall of factual information (taxonomy level 1). Rounds II and III, consisting of Jumbled Words, MCQs, and Graphs and Flow Diagrams to indicate missing links, are based on interpretation of information from charts, graphs, or flow diagrams or interpretation from two concepts that have a relationship (taxonomy 2). Rounds IV, V, and VI, having Match the Following, Ascending Order, Clinical Problems, Trace the Path, and Rapid-Fire Questions are based on testing primarily the application of knowledge to the solution of a specific problem and the fitting together of a variety of elements into a meaningful whole (taxonomy 3). The quiz conducted by students inculcates in them team spirit, leadership, better organizing abilities and interest, and better comprehension of the subject.
The time allocated, the marks, and whether the round is to be passed to the next team or not are indicated in the figures concerned.
The Quizzes help in improving memory power, scientific nomenclature, and vocabulary and active learning through integrative reasoning, which helps in improving intellectual power.
Clinical case presentation.
We also have one hour of clinical case presentation wherein clinical cases are presented and discussed with students.
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RESULTS
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The students were asked to give numerical rating to a series of questions concerning each of the innovative program and its overall impact (Tables 18 and 19). The students were also encouraged to write their comments. The rating was provided on a four-point scale ranging from 1 (strongly disagree) to 4 (strongly agree). The overall impact for each of the programs was given a numerical rating on a scale of 1 (poor) to 4 (excellent). The students were also asked to give individual comments, especially if they had given a rating of 2 or below. The students mostly agreed that the vertical-orientation program helped them understand the pathophysiology of various clinical ailments, that live demonstrations improved their comprehension in relating physiology to clinical problems, and that the program helped acquaint them with hospital surroundings (scores of 2.9, 2.96, and 2.98, respectively, Table 18). However, the overall impact was given as a score of 2.66, i.e., higher than average. The points of disagreement were that there were no earlier apprehensions to hospital surroundings, that it was difficult to comprehend advanced techniques like Holter, echocardiography, etc., that the students could not think about the pathophysiology of diseases with seriousness at that stage, and that a more interactive approach should be applied.
For the undergraduate projects, the students gave a rating of 3 and above, agreeing to all the items mentioned (Table 18). The overall impact of the program was good (2.96). The individual comments were that the projects should be assigned earlier and not in the month of January, that more projects should be given, that students should work in front of the teachers, that discussion should follow upon completion of the projects, and that marks should be given for assessment and more time given for these projects. The positive comments were that the projects were simply encouraging and excellent, that more projects should be given and continued for other batches, and that they are a good way of learning physiology.
The quiz program was the most appreciated by the students, getting a score well above 3 for all the items and a very good overall impact (3.28). Most of the students were of the opinion that Physioquiz formed an excellent means to increase their knowledge about the subject, that quizzes should be conducted more frequently, and that preparation for the quiz helps in preparing for the forthcoming examination. Some comments of the students contradicted each other, such as "more emphasis should be given to clinical problems" and "application of knowledge to diagnose a particular disease was difficult as we have little knowledge about the clinical problem." Some of them expressed the opinion that audience participation should be maximized.
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DISCUSSION
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In some studies (6) that have evaluated active learning in terms of classroom performance, methods of teaching and methods of performance evaluation were not always matched. In some cases, a similar evaluation instrument, an objective examination, was used to compare students taught by different methods.
In the aforementioned studies (6), there was subgrouping among the students, with one group being subjected to active-learning strategies and didactic lectures and the other group only to didactic lectures. We administered the active-learning strategies to all our students, as the aim was to benefit all students. The pedagogical effectiveness of the various programs is revealed through student feedback on the active-learning strategies developed by us.
Unlike in other studies, our study group is uniform and consisted of all first-year medical students. The "VARK" technique describes visual, aural, read-write, and kinesthetic modes of learning. It is well documented that many of the learning strategies employ application of more than one form of these learning modes simultaneously. In vitro labs explore kinesthetic (click of the mouse) and visual (observing the effects in the form of a graph) forms of learning. Learning during the quiz is multimodal. Many of the students could recall the spellings or other information or jumbled words after confirmation of the same through writing. Probably, during the learning procedure the spellings were learned through writing, and thus writing formed the basis for memorization at a later stage. The practical skills are learned through the kinesthetic form of learning. Learning through videos, CD-ROMs, Powerpoint presentations, demonstration of experiments, undergraduate projects, didactic lectures, etc., employs the visual and auditory forms of learning.
In the study of Richardson and Birge (6), the students belonged to various streams. In our studies, the students were from one stream, i.e., medical. They conducted their study to compare the students with a study group. We designed our undergraduate program to benefit all the students, as dividing them into control and test group would have deprived some of them from deriving the benefits of such a program.
As stated by Odenweller et al. (4), dry laboratories using virtual laboratories eliminate obstacles inherent in animal experimentation such as inadequate budgets, avoiding important animal rights issues, lack of animal facilities and equipment, and limited experience of the teachers. To overcome these obstacles, they developed the dry laboratory by use of virtual rats. On similar grounds, we conducted the virtual laboratory sessions in two practical classes and covered the recording of blood pressure, heart rate, and skeletal muscle recording in Virtual Cat, blood pressure and heart rate monitoring in Virtual Rat, and nerve muscle physiology experiments using various drugs and ions in frogs.
In conclusion, all of the programs initiated by us had good pedagogical effectiveness as revealed through student ratings. The quiz program was the one that was highly appreciated with the highest scores, followed by the undergraduate projects and the vertical orientation program in that order. Further improvements in these programs will be brought about as per the comments of the students.
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Acknowledgments
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We are thankful to stenotypists Satinder Kaur, and Parminder Kaur, Department of Physiology for secretarial assistance.
Received for publication May 19, 2003.
Accepted for publication December 19, 2003.
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REFERENCES
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- Jukes N and Chiuia M. From Guinea Pig to Computer Mouse (2nd ed.). Leicester, UK: InterNICHE, 2003, p. 13.
- Odenweller CM, Hsu CT, Sipe E, Layshock JP, Varyani S, Rosian RI, and DiCarlo SE. Laboratory exercise using "virtual rats" to teach endocrine physiology. Am J Physiol Adv Physiol Educ 18: S24–S40, 1997.
- Rao SP and DiCarlo SE. Active learning of respiratory physiology improves performance on respiratory physiology examinations. Adv Physiol Educ 25: 127–133, 2001.[ISI]
- Richardson D and Birge B. Effects of an applied supplemental course on student performance in elementary Physiology. Adv Physiol Educ 24: 56–61, 2000.[Abstract/Free Full Text]
Copyright © 2004 by the American Physiological Society.
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Abstract
Introduction
