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A study on medical students' satisfaction and effectiveness of teaching methods in community medicine in a rural medical college at Anand, Gujarat with specific focus on non-classroom teaching.

Introduction

Community medicine is one of the important subjects taught in MBBS course. The students are in touch with the subject for the maximum duration. The subject comes in first year, second year, first quarter in third year, and again in internship. Feedback and opinion remains a very important part to improve and to do necessary changes in the curriculum or teaching learning practices at the local level. In Pramukhswami Medical College some unique exposures are provided to students in community medicine such as village stay and "Problem solving for better health" (PSBH). In village stay, the students are living in the village for duration of three nights and four days and are going through a mix of activities in public health. Actual village stay comes two times, one in second year and the other in third year. In first year there is village visit with different themes of 2-day duration with activities and presentation thereafter. Such inclusions in the subject will give the practical exposure in the field settings and also make the subject interesting. In PSBH, the students are exposed to the research workshop for duration of 2 days and in a total period of 2-3 months the students are supposed to carry out a research activity in group. These are the activities which are there in addition to field visits, practicals, case discussion, and theory lectures. We did this study with an objective to assess students' satisfaction and effectiveness of current teaching methods in community medicine with specific focus on non-classroom teaching and how they can be improved upon based on their suggestions and feedback.

Objective

To assess students' satisfaction and effectiveness of different teaching methods in community medicine and to know the usefulness of different methods adopted in the field of teaching from students' perspective.

Materials and Methods

This study is a cross-sectional study to assess students' satisfaction and effectiveness of different teaching methods in community medicine and to know the usefulness of different methods adopted in the field of teaching. Students of third year I quarter were taken in the study and total students who were present during the study were 83 and this forms the total sample of this study. In this batch of students, all the lectures and all the field visits were over, so every student can opine on the opinion-based questionnaire. The questionnaire was made in the Epi Info software and the students were asked to fill in the questionnaire one by one maintaining due confidentiality as name was not entered. The study is "opinion-based study" wherein all the students were requested to opine on 11 questions put to them. The questions responses were in Likert scale as well dichotomous (yes/no). They were asked to fill in the most correct appealing response to each question. Other students of second year were not taken in the study as these students had not undergone any field visits and so they have no idea about the same which were there as a question to opine. Questionnaire sheet was prepared in Epi Info 7 and students directly entered their responses one after another for 11 questions in Epi Info. We did it in two different laptops having the same questionnaire in Epi Info. Eight questions were in Likert scale having three responses. Two questions were having affirmative and negative response (dichotomous). Last question was an open-ended question seeking for responses about the teaching methods and improvement. Prior permission and approval for the research project was taken from the institute HREC. Overall the results were seen and also seen for differences in the opinion of males and females. Proportions were calculated for different options and among male and female differences in opinion Mann-Whitney U test was applied.

Result

Of all, 83 students participated in the study and 69% students (60% boys and 76% girls) opined that community medicine cannot be taught without any classroom teaching. 84% students (77.5% boys and 91% girls) replied that there needs to be a blend of classroom teaching and non-classroom teaching [Table 1].

Three-fourth (76%) of students said that field visits add a significant contribution to their practical skills and knowledge. About two-third (66.3%) students were of the view that a significant contribution is made by family studies and case studies to their practical skills and knowledge. Almost same number of students (61.4%) told that practical classes helps a lot to understand the subject better and adds extra to their knowledge. Mann-Whitney U test was applied to see the significance of differences in opinion, but for all the responses the results were not significant [Table 2]. When asked about the satisfaction with the current curriculum practices 55.4% students opined that some changes can be made for better approach [Table 3].

Discussion

This study tried to have the opinion of the students in community medicine from different perspectives. We tried to assess their satisfaction level regarding the subject teaching and the use of different methods in teaching. The subject has undergone radical changes in its content, course duration, and system of student evaluation. [11] For a better evaluation of teaching learning process students' opinion regarding the teaching curriculum is recommended. [2] Hashmi et al. [3] also mentioned in his article regarding the importance of getting students' opinion in formulating the medical education curriculum though it is not mandatory to keep the suggestions. Graduate medical curriculum is oriented toward training students to undertake the responsibilities of a physician of first contact who is capable of looking after the preventive, promotive, curative, and rehabilitative aspect of medicine. The publication mentioned the importance of the community aspects of health care and of rural health-care services. It also laid stress on community-oriented teaching and not only curative aspects. The article also mentioned about studying the social factors in relation to the problem of health and diseases. [4]

There are not enough literature available related to satisfaction level among medical students with regard to academic activities and especially for some particular subject such as community medicine, the literature is scarce. This is supported by a study from Pakistan by Manzar and Manzar [5] for medical education in developing nations. In our study, majority of the students opined that community medicine cannot be taught without any classroom teaching and there needs to be a blend of classroom teaching and non-classroom teaching. There was a great emphasis by majority of the students to include more and more practicals and the likes in teaching of community medicine subject.

One study from Banerjee et al. [6] from Nepal suggested that teaching hours should be decreased in community medicine as said by study participants. Field visits, family studies, case studies, and practical classes helps a lot in understanding the subject better and adds extra to their knowledge as said by majority of the students in our study. Almost two-third students opined that village stay is absolutely important and it is a different experience from classroom learning. Almost half the students replied that PSBH is making a significant contribution for better understanding of subject. When asked about the satisfaction with the current curriculum practices more than half of the students opined that some changes can be made for better approach whereas 41% students told that the current system is effective and as such no changes are required. A study by Gopalakrishnan and Ganesh Kumar [7] suggested about self-directed learning modules and talks about incorporation of problem-based learning, seminars, group discussion methods, and others. In this study, students suggested that there should be interactive classes instead of power point and seminars, more practical classes should be added and more of applied aspect of community medicine in field should be taught and some time should be given for self study. Except for the power point, the findings are same as study by Asia and Warkar [8] where the medical student's favored interactive lectures, shorter duration, self-study, and clinical orientation. In the same study students' appreciated audiovisual aids that we did not find in our study. In this study, power point was not seen as a good method and this is a dissimilar finding from the study by Asia and Warkar. [8] We also found the usefulness of multimedia in the form of showing videos and pictures as suggested by the students and this is in line with the finding by Hashmi et al. [3] We found that students opined more for practicals rather than for purely lectures and in suggestion also they mentioned about the boring lectures be replaced by more practicals in the subject. Similar results were also compounded from a study from Pakistan by Hashmi et al. [3] wherein they inquired about the reasons as to why medical students miss lectures and in responses they found it to be because of long duration of lectures and that the lectures are boring. We also got the literature support from the study by O'Neil [19] in having similar findings which emphasized on more of practicals and hands on training and more of experiential training rather than purely lecture teaching. Study by Trevena [10] also supported self-study to be more effective.

Mandal et al. [11] studied the opinion of 210 participants and found that majority thought this subject is necessary to study medicine in real community situation. 59% students were not satisfied with the syllabus. The most common topic they wanted to exclude was environmental sanitation and maximum new inputs were in favor of private and public health-care delivery. Tutorial and family study learning were the two most favored teaching methods. We found that PSBH is welcomed by the students and the same findings are of Soudarssanane et al. [12] who in her article studied the relevance of research as a tool for teaching epidemiology in different years. In the first year students conducted case control studies and in second year students' involvement was seen in community-based epidemiological studies. So more and more of practical approach is required for teaching the subject.

Conclusion

Students stressed that theory lectures are as important as practicals. Practicals in different forms are actually perceived as more beneficial than lectures and as per the students' forms a very important part of curriculum and to understand the subject. Students gave more weightage to field training which includes field visits and village stay.

Recommendation

Efforts should be focused on how to make the practicals more and more informative so that the actual concepts of public health become clearer and of more applied one rather than just mugging of values and facts.

DOI:10.5455/ijmsph.2016.02032016419

References

[1.] Biswas R. Training in community medicine. Indian J Public Health 2006;50(3):135.

[2.] Srinivasa DK. Curriculum planning. In: Srinivasa DK, editor. Medical Education: Principles and Practice; Consulting. CBS Publishers & Distributors; 1995. pp. 165-71.

[3.] Hashmi NR, Daud S, Manzoor I. Medical education: views and recommendations of final year MBBS Students of a Private Medical College in Lahore. J Coll Physicians Surg Pak 2010;20(2):93-9.

[4.] Regulation on graduate medical education. Salient Features of Regulations on Graduate Medical Education, 1997 (Published In Part III, Section 4 Of The Gazette Of India Dated 17th May 1997 *. Amended up to February 2012. New Delhi: Medical Council of India, 1997.

[5.] Manzar B Manzar N. To determine the level of satisfaction among medical students of a public sector medical university regarding their academic activities. BMC Res Notes 2011;4:380.

[6.] Banerjee I, Jauhari AC, Bista D, Johorey AC, Roy B, Sathian B. 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(3):95-100.

[7.] Gopalakrishnan S, Ganesh Kumar P. Community medicine teaching and evaluation: scope of betterment. J Clin Diagn Res 2015;9(1):JE01-JE05.

[8.] Asia DDAA, Warkar DA. Learning experience and expectations of first MBBS students: a questionnaire based survey. NJIRM 2014;5(1):116-20.

[9.] O'Neill BJ, Wyness MA. Student voices on an interprofessional course. Med Teach 2005 b;27:433-8.

[10.] Trevena L. What medical student's value in a population health tutor: characteristics for consideration in staff recruitment and development. Educ Health 2003;16:51-8.

[11.] Mandal PK, Chatterjee C, Joardar GK, Sadhukhan SK, Sardar JC, Ghosh P. Community medicine teaching in West Bengal: an opinion survey of the students Indian J Prev Soc Med 2010;41(1):42-46

[12.] Soudarssanane MB, Rotti SB, Roy Gautam, Srinivasa DK. Research as a tool for the teaching of Epidemiology. World Health Forum 1994;15(1):48-50.

Deepak Balram Sharma, Vidushi Gupta, Utkarsh Milan Shah, Kanupriya Saxena, AbdulHamid Sabbir Mavli, Uday Shankar Singh

Department of Community Medicine, Pramukh Swami Medical College, Karamsad, Gujarat, India.

Correspondence to: Deepak B Sharma, E-mail: drdeepak1105@gmail.com

Received March 02, 2016. Accepted March 23, 2016
Table 1: Opinion about overall effectiveness of teaching in
community medicine

Gender    Opinion                            Tests for significance

         Do you think that community medicine
         can be taught without any classroom teaching

            No          Yes        Total      [chi square] = 2.701
Male     24(42.1)    16(61.5)    40(48.20)         p = 0.100
Female   33(57.9)    10(38.5)    43(51.80)             NS
Total    57(100.0)   26(100.0)   83(100.0)

Gender   There needs to be a blend of classro [chi square] = 2.73
         teaching and non-classroom teaching

Male      9(69.2)    31(44.3)    40(48.20)         p = 0.098
Female    4(30.8)    39(55.70)   43(51.80)             NS
Total    13(100.0)   70(100.0)   83(100.0)

Table 2: Opinion about usefulness of different methods adopted in
field teaching and theoretical teaching

Study Questions                               Total      Tests for
                                                         significance

How useful do you think theory lectures are for gaining
knowledge of the subject

Not              Sometimes     Very           83(100.0)  Mann-Whitney
important        important     important,                U -754.00
at all                         cannot do                 Z = -1.19
                               without them              p = .230

1(1.2)           57(68.7)      25(30.1)

Do you think field visits add to your practical skills and
knowledge

No, not          Yes, but not  Yes, very      83(100.0)  Mann-Whitney
at all           much          important                 U 800.00
                 contribution  contribution              Z = -.735
                 is made       is made                   p = .463

3(3.6)           17(20.5)      63(75.9)

Do you think family studies and case studies contribute to your
knowledge of the subject

No, not          Yes, but not  Yes, very      83(100.0)  Mann-Whitney
at all           much          important                 U -791.00
                 contribution  contribution              Z = -.766
                 is made       is made                   p = .444

1(1.2)           27(32.5)      55(66.3)

Do you think practical classes adds extra to your knowledge

No, just         Yes, but not  Yes, helps a   83(100.0)  Mann-Whitney
duplication of   important     lot to                    U -708.00
knowledge        contribution  understand                Z = -1.626
                               the subject               p = .104

3(3.6)           29(34.9)      51(61.4)

How important do you think village stay in your curriculum

No, not          Yes, it does  Yes,                      Mann-Whitney
important        add to our    absolutely                U -817.500
                 knowledge,    important,                Z = -.451
                 but can do    different                 p = .652
                 without it    experience
                               from
                               classroom
                               teaching

2(2.4)           32(38.6)      49(59.0)

Do you think PSBH is useful to you, does it add to your research
knowledge and better understanding of subject?

No, just time    Yes, it adds  Yes, have      83(100.0)  Mann-Whitney
consuming; no    to our        good                      U -701.50
benefit          knowledge,    contribution              Z = -1.572
                 but not       for better                p = .116
                 required at   understanding
                 our level     of subject

14(16.9)         30(36.1)      39(47.0)

Do you think classroom teaching can be replaced by practical
classes and field visits?

No, classroom    Yes and the   Yes, but may   83(100.0)  Mann-Whitney
teaching is      change will   lead to                   U -791.00
must, can't do   lead to       poorer                    Z = -.702
without it.      better        results                   p = .483
                 results

30(36.1)         44(53.0)      9(10.8)

Table 3: Overall students' satisfaction for current curriculum practices

Are you satisfied with the current              Statistical Inference
curriculum practices

No, not         Yes, but       Yes, very       Mann-Whitney U -754.00
helping us      some changes   effective;          Z = -1.19 p = .230
much; lot       can be made    no changes
needs to be     for better     required
changed         approach

   3(3.6)         46(55.4)      34(41.0)            83(100.0)

Table 4: Suggestions given by students

Suggestions by students (response to an open-ended question on
suggestions for improvement)

Students mentioned that Biostatistics & Epidemiology should be
taught by applied knowledge. Students suggested to decrease the
days of village visit stay, to put efforts to make classroom
teaching more enjoyable apart from lecture which are boring, to
start Epidemiology classes in third year, for practical classes of
mosquitoes and other insects microscopic view should be included,
there should be interactive classes instead of power point and
seminars, more practical classes can be added, less field visits to
sewage dumps and all the types of hospitals and only theory classes
about them, less of theory class and more of practical and give
students time to read on their own, more of images and videos
should be included, more of practical knowledge and association of
practical knowledge with theory, PSBH should be made more
professional, as they would be doing in future, to stop memorizing
data which ultimately keeps changing every year.
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Article Details
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Title Annotation:Research Article
Author:Sharma, Deepak Balram; Gupta, Vidushi; Shah, Utkarsh Milan; Saxena, Kanupriya; Mavli, AbdulHamid Sab
Publication:International Journal of Medical Science and Public Health
Article Type:Report
Geographic Code:9INDI
Date:Oct 1, 2016
Words:2880
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