|Year : 2016 | Volume
| Issue : 7 | Page : 83-88
Student-led objective tutorials in Pharmacology: An interventional study
Anupama Sukhlecha, Shilpa P Jadav, Tushar R Gosai, Divakar Balusamy
Department of Pharmacology, MP Shah Medical College, Jamnagar, Gujarat, India
|Date of Submission||30-Aug-2016|
|Date of Acceptance||05-Oct-2016|
|Date of Web Publication||2-Nov-2016|
Department of Pharmacology, MP Shah Medical College, Jamnagar, Gujarat
Source of Support: None, Conflict of Interest: None
Objectives: Students learn in a better way if they are involved in active learning. Hence, the study was designed to introduce student-led objective tutorials (SLOTs) as an alternative to conventional tutorials (CTs) in pharmacology and to compare SLOT and CT on outcomes such as improved score in tests, active involvement of students, and faculty requirement of each.
Materials and Methods: Didactic lectures taken on a topic in pharmacology were followed by a preintervention test for a batch of the 2nd year medical undergraduates. They were allotted either in SLOT or CT group. For a SLOT session, students of Group A (interventional group) were divided into teams and each team prepared five multiple choice questions on the given topic in PowerPoint format, which were presented to other teams and audience. The proceedings were facilitated by two lecturers. Group B undertook CT (controls). A postintervention test was then taken for both groups. Feedback was sought from students and teachers on SLOT.
Results: The total marks for the test were 20. The mean marks in Group A improved by 31% (from 5.1 to 11.2). In Group B, they improved by 11% (from 5 to 7.2). Academic performance following SLOT was better than CT. Students (63%) favored SLOT as it stimulated their interest in the topic, improved self-learning skills, and teamwork. The teachers also favored SLOT for similar reasons.
Conclusion: SLOT leads to greater satisfaction and better performance in tests. SLOT is an effective alternative to CT to promote active learning among students through group work. It helps overcome the logistic difficulties due to faculty shortage.
SLOT is an effective alternative to conventional tutorials to promote active learning among students through group work. It helps overcome logistic difficulties due to faculty shortage.
Keywords: Active learning, audiovisual aids, teaching-learning methods, tutorials
|How to cite this article:|
Sukhlecha A, Jadav SP, Gosai TR, Balusamy D. Student-led objective tutorials in Pharmacology: An interventional study. Indian J Pharmacol 2016;48, Suppl S1:83-8
|How to cite this URL:|
Sukhlecha A, Jadav SP, Gosai TR, Balusamy D. Student-led objective tutorials in Pharmacology: An interventional study. Indian J Pharmacol [serial online] 2016 [cited 2020 Mar 28];48, Suppl S1:83-8. Available from: http://www.ijp-online.com/text.asp?2016/48/7/83/193310
In India, pharmacology is taught during the 2nd and 3rd professional year of medical curriculum (for three semesters). As a tradition, didactic lectures are taken to teach large groups. In addition, tutorials are conducted for medical students so that the material presented in lectures gets clarified; the students solve problems applying general concepts and improve their self learning skills. Unlike pedagogy, where the responsibility for teaching lies on the teacher, in andragogy, the instructor’s role shifts from being a lecturer to that of a facilitator.
Students should be engaged in activities that produce a deeper understanding of course content through skill development. They learn in a better way if they are involved in active learning rather than when they are mere passive recipients of instruction. Group learning exercises, role plays, simulations, and debates are some of the active learning strategies that can be used very effectively in large group teaching. Game format approach is yet another method of learning that arouses student interest, enhances participation, and improves grades. Group discussion can promote the interest of the student in the subject matter under discussion. Group interaction has also been reported to stimulate student learning. In tutorial groups, there is a reinforcement of prior knowledge, information recall, reasoning, theory building, conceptual change, and collaborative learning. Student learning is influenced by the quality of discussion and this ultimately brings success in studies. On the contrary, an unorganized discussion in tutorial groups inhibits student learning.
At present, due to faculty shortage, it is becoming very difficult to conduct conventional tutorial (CT). In CT, there is a lack of active and complete participation by students. Further, in CT, the learning strategy is mainly passive, and there is a very minimal opportunity for teamwork. Audiovisual aids provide variety and stimulate interest in learning, but there is minimal use of them in CT. Hence, there was a need of tutorials that involved teaching learning through limited faculty, promoted active learning among students by learning in small groups, and utilization of visual aids as a presentation tool. Keeping the shortcomings of CT in mind, the Pharmacology Department of our medical institute initiated an interesting method of conducting tutorials. This type of tutorial, “Student Led Objective Tutorial” (SLOT), was designed to overcome certain lacunae of CT and also added to its advantages.
| » Materials and Methods|| |
This prospective study was conducted at the Pharmacology Department of our medical institute. The study was carried after approval by the Institutional Ethics Committee. The study participants were the second professional year medical undergraduates. The participation was voluntary. Written informed consent of participation was obtained from students. The students were assured that scores obtained by them in this study would not be counted for internal assessment of university. A sample size analysis was done at the initiation of the study. As per our pilot study, the standard deviation of marks was estimated to be approximately two. Based on a two tailed a of 0.05 and power of 80%, it was determined that 64 students were required to detect 1° of difference in the outcome variable. On the assumption of an overall rate of loss to follow up of about 10%, a sample size of seventy was calculated for each group.
The topic for the tutorial was “Chemotherapy.” As per institute timetable and distribution of students, of total students (n = 171), roll numbers 1–70 were in Group A and 71 onward were in Group B. After the completion of series of lecture classes on chemotherapy, a preintervention test on the topic was taken for all the students. This was a short answer question test of twenty questions. The total marks for this test were twenty and time allotted was 40 min. The groups were allotted either SLOT intervention or CTs controls, following toss of a coin.
Students from interventional group (SLOT) were divided into small teams, each team having five or six students. Each team selected a team leader who was to collect the subtopic(s) of the preceding lecture topic (chemotherapy) for their team. The subtopics were allotted a week in advance. Each team was given instructions to study the given subtopic(s) and prepare five multiple choice questions (MCQs) in PowerPoint format so that they could be presented in the SLOT session. The students were to contact the lecturers (who had a prior training in preparing MCQs) for any clarification regarding the preparation of MCQs for SLOT. A flowchart depicting division of group to teams and allocation of subtopic for the first SLOT session is shown in [Figure 1]. A format of MCQ slides given as a guide to the teams who were preparing for their SLOT session is illustrated in [Figure 2].
|Figure 1: Model flowchart depicting division of interventional group into teams and allocation of respective subtopics for the first session of student-led objective tutorial|
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|Figure 2: Format of multiple choice question slides for student-led objective tutorial session|
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On the allotted day of the tutorial, students of all the teams of interventional group (SLOT) assembled in the department lecture hall. A computer and projection system was kept ready for SLOT session. A computer operator managed the projection and the slide sequence. A tutor was responsible for seating arrangement and smooth conductance of proceedings. Session for team 1–4 was conducted on the 1st day of tutorials (teams 5–12 represented audience). Session for team 5–8 was conducted on the 2nd day of tutorials (teams 9–12 and 1–4 represented audience). Session for team 9–12 was conducted on the 3rd day of tutorials (teams 1–8 represented audience). The teams were randomized to seat numbers I–IV in the lecture hall. Randomization of seat allotment was done through lots. The teams were invited to take their seats as per their number got through lots. The students of Group A were communicated in advance that individual and team winners would be appreciated at the end of SLOT session so that they would come prepared for the topic of that day.
Team 1 got a chance to display the first MCQ to other teams. The first MCQ was posed by the leader of team 1 directly to team 2. The other teams, namely, 3 and 4 observed. The time given for direct question was 1 min and indirect question was 10 s. The marks given were 15 for direct correct answer. If the question was unanswered by team 2, the question was passed on to subsequent teams in pursuit of getting correct answer. It passed to team 3, and if team 3 answered it right, 10 marks were given. If team 3 did not answer it correctly, it passed to team 4, and if they answered it right, they got 5 marks. The next slide displayed the correct answer even if team 4 gave the wrong answer. The third slide showed the explanation of the MCQ. There was a decrease in the award of marks as question passed because the subsequent teams could exclude the previous distractors. Team 1 continued the second question starting from team 3 and the third question from team 4 so that each team had a chance to get direct question. Then, team 1 also posed two questions for the audience. These were open for any student in the audience. The name of the student who raised hand first and correctly answered was noted.
SLOT continued until all the four teams got a chance to complete their presentations. All the teams had an equal opportunity of posing and answering the MCQs. Two lecturers had monitored, intervened, and assisted the proceedings. Wherever needed, explanations were provided by lecturers on the MCQs. These MCQs also formed the basis for further discussion on that topic. The SLOT session went on for 60–80 min. At the end of SLOT session for that particular day, the individual and team winners were called on the dais and appreciated with a round of applause. Similar sessions went on for three consecutive tutorial classes and all the seventy students of Group A got a chance to be in groups who prepared and presented MCQs. The scores achieved by teams in SLOT were only to enhance learning and develop competitive spirit. They were neither counted in the analysis of this study nor for internal assessment of university.
At the end of the third SLOT session, a prevalidated and pretested anonymous questionnaire was distributed to the students to know their perceptions on SLOT. The responses were obtained on a 5 point Likert scale (1 for strongly disagree to 5 for strongly agree). Open ended questions, for example, the best aspects and areas for improvement of SLOT were also included in the questionnaire.
The controls, i.e. Group B (n = 71) undertook CT. The topic of the tutorial (chemotherapy) was allotted a week in advance. The students were divided into 5 teams with 14 or 15 students in each team. There was a teacher (cum facilitator) for each team who divided each team further into 3 subteams containing 4 or 5 students in each subteam. The teacher posed short questions on the allotted topic which the subteams had to answer in turns. The CTs also went on for 60–80 min. They were mainly teacher centric.
At the end of all tutorial sessions (both SLOT and CT) for chemotherapy, a postintervention test was taken for both A and B Group students. The pattern and questions were same as preintervention test. In all, our study went on for five tutorial classes which included a preintervention test, three SLOT sessions (or three CT for controls), and a postintervention test.
The opinion of the faculty was also taken through focused group discussion. The scores obtained by the Groups A and B students were compared. Mann–Whitney test was used for comparing differences between Groups A and B, and Wilcoxon matched pairs signed ranks test was used to compare pre and post intervention scores. GraphPad Prism version 5.0 software (GraphPad Software, Inc., San Diego, California, USA) was used for statistical analysis.
Students should not be deprived of the benefits of a successful intervention. Hence, for ethical reasons, SLOT was conducted for control group also, after the completion of our study. However, their results were not included for analysis.
| » Results|| |
All the 2nd year undergraduates (n = 141) consented for participating in the study. The interventional group SLOT (n = 70) was Group A while control group CT was Group B (n = 71). The median age of the respondents was 20 years in both groups. There was no difference in preintervention marks of both groups (5.1 ± 2 vs. 5 ± 2, P = 0.97). There were some students who were absent in preintervention test and some in postintervention test. On pairing, it was found that 65 students of Group A (interventional group) were present in both tests while 66 from Group B (control group) were in both tests. Hence, only these students were considered for analysis. The mean marks of students in Group A improved considerably (from 5.1 ± 2 to 11.2 ± 1.8, P < 0.0001). In Group B, they improved only to some extent (from 5 ± 2 to 7.2 ± 2, P < 0.001) as shown in [Table 1].
|Table 1: Mean marks obtained by students in pre- and post-intervention tests|
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The total faculty requirement for CT was five, while for SLOT, it was three (one tutor and two lecturers). Feedback was taken from students (n = 67) who were present in the third session of SLOT [Table 2]. Students (78%) agreed that they learned better in SLOT when compared to CT and that it involved active learning in groups. A majority of students (63%) wanted to have more of SLOT sessions. The opinion of teachers (n = 12) on SLOT is presented in [Table 3]. Feedback on SLOT was also positive from teachers, but they opined that preparation for SLOT is time consuming and needs costly equipment.
|Table 2: Students' feedback (positive)$ on student-led objective tutorial (n=67)|
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| » Discussion|| |
An interesting method of conducting tutorials-SLOT was introduced in our department. It was compared with CT in terms of improving the academic performance of students. In our pilot study, we had randomized all the students of interventional group to various teams. However, it created a chaos among students. Hence, in the present study, students of Group A (n = 70) were divided into teams in line with their roll numbers. The seating arrangement (on seats I–IV) of four teams who presented MCQs for that particular SLOT session in the lecture hall was randomized.
In our study, the mean marks of students in Group A improved by 31% (from 5.1 to 11.2). In Group B, it improved by 11% (from 5 to 7.2). Our study is similar to a study which also states that knowledge retention improves with interactive teaching learning. It is also similar to a study, in which group activity was strongly correlated with students’ grades in exams. However, it differs from another study that shows no differences in outcomes for directed and self directed learning. Our study also differs from another study which states that small group tutorials can lead to more satisfaction but may not give better exam results. In our study, there was an improvement in control group (CT) also, probably, because of self learning skills of students and possibly because of some motivated students who had prepared the topic that was given a week in advance.
In our study, student learning occurred not only during SLOT preparation (intragroup) but also during the presentation (intergroup). As there were teams and audience, the content reached all of them uniformly. The students (61%) enjoyed working with a team and contributed to teams’ success. In another study, the physicians in small group session performed better than the lecture or in large groups. Another study mentions that students’ self directedness was more in small and medium size groups but not in large groups. In yet another study, learning accounted for 80% of the interactions in group tutorials. This shows that group learning improves academic performance.
In our study, during SLOT sessions, the lecturers guided the discussions and intervened if there was a need for clarification. A majority of students (60%) agreed that guidance by lecturers during SLOT sessions was useful. In another study in Australia, students had an intragroup discussion and the tutor facilitated discussions and clarified their queries but did not lead it or take it over. In another study in Sri Lanka, scenarios were used for subject discussion while faculty only moderated and guided the discussion. A study mentions that a good tutor needs to have qualities such as establishing rapport with students, allowing adequate time for discussion, has content expertise to guide the students well. In our study, in their feedback on SLOT, students mentioned of such qualities in teachers and were satisfied with their guidance.
Whenever a new teaching method is introduced, difficulties can arise initially. Our students also faced a few difficulties in the first SLOT session, for example, in preparing MCQs, preparing PowerPoint slides, etc. Some students (39%) complained that all the team members did not actively contribute to MCQ preparation or cooperate out of the classroom. Motivational factors can also influence the function of tutorial groups. Difficult personalities, lack of cooperation or interaction can inhibit group function. A study shows that about 96% of graduates, who were student tutors previously, were active participants of academic programs. A study mentions that groups could use principles of group dynamics and reflection. This could help the groups analyze and learn from their behaviors.
In our study, students (78%) agreed that they learned better in SLOT when compared to CT. In yet another study, students (79%) perceived that modified tutorials improved understanding as compared to traditional teaching methods which is similar to our study. In our study, 63% students wanted to have more SLOT sessions which is less than another study, in which most of the students (79%) wanted similar sessions in future. Looking at the enthusiasm of students, we conducted SLOT sessions for subsequent batches in our department, whenever it was feasible.
In open ended questions, SLOT induced active participation by the students. The best aspects of SLOT, as mentioned by students (76%), were that it improved learning skills. The areas where SLOT can be improved, as mentioned by students, were either to reduce the time allotted for SLOT or to have them when there was at least a month for their terminal exams. The academic benefit of SLOT sessions was that the teams prepared MCQs related to their subtopic, and to score more, they also prepared other subtopics. Intergroup interactions and competitive spirit were also distinctly observed in yet another study at Wardha.
In CT, if group size is large, they become mini lecture sessions. In such situations, the students hardly get a chance to reply to questions posed and improve communication skills. Some students who do not come prepared for the tutorial and could easily go unnoticed. In CT, tutors with different experience and knowledge, conduct tutorials on the same topic, so students are subjected to some amount of bias. In contrast, in SLOT, there is uniformity in sharing of information by the entire class. SLOT also helps students in improving skills for answering MCQs which could help them in future competitive exams. Skills such as teamwork, communication, and preparing PowerPoint slides improve through SLOT. Short video and audio clips can be hyperlinked to make SLOT, a multimedia tutorial.
The strength of the study is that intervention (SLOT) has been compared with control (CT) prospectively. SLOT is student centric and an active learning method involving group work, while in CT, learning is mainly passive and teacher centric. SLOT can be conducted even when there is a scarcity of medical teachers. Academic performance of students was found to have improved following SLOT. The limitation was that the study was carried out only in the Pharmacology Department. This study can serve as a base to conduct similar studies at multiple centers.
| » Conclusion|| |
SLOT is an interesting method of conducting tutorials that promote active learning through group work. The students get actively involved in preparing and presenting MCQs. Scoring in SLOT sessions inducts competitive spirit among students. It involves visual aids in teaching learning that arouses interest among students. Teachers act as facilitators but do not take over the discussion. Information reaches uniformly to all students. SLOT overcomes faculty shortage and can be adopted in pharmacology.
We thank the faculty and junior residents of our department for helping us conduct the tutorials. We also thank the students for participating in the study.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]