|Year : 2015 | Volume
| Issue : 1 | Page : 83-86
Let's 'play' with molecular pharmacology
Supriyo Choudhury1, Richeek Pradhan2, Gairik Sengupta1, Manisha Das1, Manojit Chatterjee1, Ranendra Kumar Roy1, Suparna Chatterjee2
1 Department of Pharmacology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
2 Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
|Date of Web Publication||31-Jul-2015|
Department of Pharmacology, 244 A.J.C Bose Road, Kolkata - 700 020, West Bengal
Source of Support: None, Conflict of Interest: None
Background: Understanding concepts of molecular mechanisms of drug action involves sequential visualization of physiological processes and drug effects, a task that can be difficult at an undergraduate level. Role-play is a teaching-learning methodology whereby active participation of students as well as clear visualization of the phenomenon is used to convey complex physiological concepts. However, its use in teaching drug action, a process that demands understanding of a second level of complexity over the physiological process, has not been investigated. We hypothesized that role-play can be an effective and well accepted method for teaching molecular pharmacology. Methods: In an observational study, students were guided to perform a role-play on a selected topic involving drug activity. Students' gain in knowledge was assessed comparing validated pre- and post-test questionnaires as well as class average normalized gain. The acceptance of role-play among undergraduate medical students was evaluated by Likert scale analysis and thematic analysis of their open-ended written responses. Results: Significant improvement in knowledge (P < 0.001) was noted in the pre- to post-test knowledge scores, while a high gain in class average normalized score was evident. In Likert scale analysis, most students (93%) expressed that role-play was an acceptable way of teaching. In a thematic analysis, themes of both strengths and weaknesses of the session emerged. Discussion: Role-play can be effectively utilized while teaching selected topics of molecular pharmacology in undergraduate medical curricula.
Keywords: Role-play, pharmacology education, active learning, antimicrobial action, undergraduate medical education
|How to cite this article:|
Choudhury S, Pradhan R, Sengupta G, Das M, Chatterjee M, Roy RK, Chatterjee S. Let's 'play' with molecular pharmacology. Educ Health 2015;28:83-6
| Background|| |
Pharmacology is a key subject in medical curricula worldwide, forming the basis for understanding of therapeutic strategies. However, perceptions of this subject among undergraduate medical students vary, with many finding it quite complex in spite of also being interesting.  A clear understanding of the mechanisms of action of many drugs requires concepts of two kinetic processes - (i) physiological functions of the targeted pathways and (ii) drug-target interactions. Individual complexities of the two molecular processes compounded with the need to visualize them as a sequential continuum puts the medium of traditional "chalk and talk" lecture at a disadvantage. To combat these difficulties, educators have attempted to supplement traditional didactic lectures by active learning methods. These strategies comprise of "instructional activities involving students in doing things and thinking about what they are doing".  Active learning methods include discussions, visual-based instructions, cooperative learning, debates, dramas, role-playing and simulations, and peer teaching.  Role-play is an important method of teaching-learning; it promotes active learning where students take on the roles of specific characters in a safe and supportive environment.  While application of role-play is widely acknowledged as appropriate in helping students develop communication skills in clinical medicine,  not many published studies have explored the effectiveness of role-play in teaching molecular mechanisms of drug action. Hence, we explored the effectiveness of role-play in teaching the mechanism of action of antimicrobial drugs inhibiting bacterial protein synthesis in an undergraduate pharmacology class. We also qualitatively assessed students' perceptions of this method.
| Methods|| |
This single group observational cross-sectional study was conducted in a fourth semester class for undergraduate students in a public medical college of Kolkata, India. This college received regulatory permission from the Medical Council of India (MCI) in 2011 and currently has four batches of medical students, a majority of whom come from West Bengal, India.  The structure of medical curriculum followed in the school adheres to MCI recommendations, which presently do not include role-play methodology in its pharmacology courses. 
All students had some prior understanding of protein synthesis in mammalian cells through their Biochemistry classes held in the first and second semesters. The sampling strategy was non-probability convenience based. Ethical approval was obtained from the Institutional Ethics Committee. All 46 students present on that day participated in the study. The topic taught in the session was "mechanism of action of antimicrobials inhibiting bacterial protein synthesis".
Structure of session
The structure of the class is shown in [Figure 1]. One facilitator conducted the session. Anonymous test quetionnaires were circulated among the students for their responses. After explanation of the role-play session structure, students were assigned specific roles and given corresponding identification placards. Pre-session test questionnaire were re-administered following the role-play to assess knowledge gain. Students' level of agreement to the statement that role-play was acceptable as a teaching method was recorded on a 5-point Likert scale.
Description of the role-play
The necessary resources are listed in [Table 1]. Three students played the roles of the acceptor site, peptidyl site and exit site on the 50S ribosomal subunit. Four students represented t-RNA, each holding a placard (for an amino acid). Four students played the roles of aminoglycoside, tetracycline, macrolide and chloramphenicol. 30s ribosome and m-RNA was symbolized by an inverted chair and a rope, respectively. All along, the facilitator directed the sequential activities.
Preparation of test questionnaire
The test questionnaire comprising seven multiple choice questions were prepared from Goodman and Gilman's Pharmacological Basis of Therapeutic, 12 th edition (2010).  The construct validation of the test questionnaire was performed by six qualified Pharmacology teachers.
The pre- and post-session test scores were compared by Wilcoxon signed-rank test using IBM SPSS, version 20 (IBM corporation). The following measurements were performed: Absolute learning gain = %post-test score - %pre-test score; relative learning gain [(%post-test score - %pre-test)/%pre-test score]; and class-average normalized gain [(%post-test score - %pre-test score)/(100 - %pre-test score)].  The class-average normalized gain was classified as low gain (0.1-0.29), medium gain (0.3-0.69) and high gain (0.7-1.0).  As per Hake's criteria for the analysis of effectiveness of an educational intervention, a class-average normalized gain of 0.3, that is, 30%, was considered to be significant. , Written responses by the students regarding success and weakness of this role-play session were analyzed using qualitative descriptive approach as described by Braun et al.  After electronic transcription of the texts, two investigators independently familiarized themselves with the responses by repeated assessments. Interesting features of the data were coded. Initial codes were then collated to generate themes. Later, both investigators reviewed the themes generated collectively to refine and finalize them. 
| Results|| |
Out of 46 participants, 27 (58.69%) were male. None of them had prior experience of attending role-play sessions. A significant improvement was noted from median pre-test score (2, Interquartile range [IQR] 2-2) to post-test score (6, IQR 5-6, P value = 0.0001). The absolute learning gain was 0.52 while the relative learning gain was 1.86. The class average normalized gain was calculated to be 0.72, which is categorized as high gain.
Likert scale analysis
The students were requested to express their level of agreement on a 5-point Likert scale to the following statement: "This role-play session was acceptable as a teaching method to improve your understanding of the topic taught". The responses of 43 students (3 students did not respond) were analyzed as follows: 23 students (53.49%) strongly agreed to the statement while 17 students (39.54%) agreed to the statement. Three students (6.98%) wrote that they neither agreed nor disagreed to the statement. None of those who responded disagreed to any extent to the statement.
For the thematic analysis, several themes of effectiveness and weaknesses of role-play were identified. Students expressed that 'it was an interactive process' and that 'understanding was easy' because they could 'visualize' the phenomenon. Some believed that the concepts taught might be 'retained for a longer time'. This 'innovative' process with active involvement of the students made it 'interesting' and 'not monotonous'. Thus, the themes encompassing (i) interaction, (ii) easy comprehension, (iii) probability of greater retention and (iv) non-monotonous presentation emerged from the responses made by 24 of the students. A number of students expected to see similar efforts in future classes. One student commented: "Something out of box rather than reciting a few monotonous lines from foreign books, internet or power point presentations. Much appreciated" .
Students also pointed out specific weaknesses of the session. One student requested "one round of rehearsal" prior to the main session and another wrote "role-play is a good way of teaching. I liked the innovative concept. Although teaching through power point animation may also be used while teaching similar topics". "The duration of a lecture class is too short for an effective implementation of role play for all relevant topics in the curriculum" was an apprehension expressed by a student. The themes of (i) importance of rehearsal, (ii) necessity to supplement with power-point presentation, and (iii) lengthiness, emerged from a total of seven students.
| Discussion|| |
Use of role-play in medical training is varied. Published literature depicts its application in medical education with a focus on enhancing the interactive skills of students in communication program classes, palliative care and sexual health clinics.  Role-play has also been utilized to facilitate clinical pharmacy and patient interaction efforts in many studies, ,,, while only rarely in teaching drug action mechanisms.  The objective of this study is to assess the applicability of role-play in medical and pharmaceutical education beyond the purview of interactive programs to more intricate topics like molecular mechanisms of drug action. To have an understanding of mechanisms of drug action students require comprehension of a microscopic phenomenon, a task that might be daunting at an undergraduate level. Role-play has been effectively used in biological sciences to teach mechanisms of protein synthesis, respiratory cycles, cell division, muscle contraction as well as enzyme action.  We thus hypothesized that this method might have a role in teaching drug action mechanisms in Pharmacology. Adding to the work by Richardson and Maddock  in this area, we also intended to investigate the effectiveness of this method through a pre-post knowledge evaluation of the students.
Significant improvement in scores from pre-session test to post-session test confirms the effectiveness of role-play as a teaching method for mechanism of drug action. Additionally, the class-average normalized gain is a parameter that is utilized to measure the effectiveness of an intervention, the advantage of this being the fact that it is independent of the pre-test knowledge group of the group. A high class-average normalized gain indicates that educational intervention in the form of role-play in molecular pharmacology was effective in our setting. The satisfaction of the students after attending this session was revealed from the analysis of their Likert scale responses. Most students agreed that role-play was an acceptable method of teaching in the current setting. The study result is encouraging as the session did not overshoot the allotted time. Hence a common criticism of role-play approach of time constrain did not hold true in this case.
Success of role-play as a method depends on various factors ranging from the topic of discussion, to the academic background of students as well as efficiency of the facilitator. In a pedagogical research Stevenson and Sander reported that most medical students perceive role-play as an ineffective technique of teaching.  However, in other studies, the method has been found to enhance student engagement and satisfaction in the class. In our study, most students gave a positive feedback to the experiment in spite of being naïve to this form of teaching. The responses not only suggested their appreciation toward the method, but many also came up with constructive criticisms and suggested ways to improve future efforts of similar kind, a fact that highlights their enthusiasm for the method.
Some limitations of our study merit discussion. First, our study was not a comparative one where we could prove the superiority of role-play over conventional chalk and talk lecture. Also, we are unable to comment on the anticipated advantage of the role-play session in better retention of the concepts as follow-up data was not collected.
| Conclusion|| |
Our research is a proof of concept study of the efficacy of role-play as a teaching method in molecular pharmacology with a high level of acceptability among students. The method is easy to perform, does not require expensive technologies and thus can be utilized in medical schools with resource constraints. Further research in this field may compare conventional teaching methodologies with role-play in terms of efficacy in conveying concepts of molecular pharmacology and device modules for role-play for the undergraduate pharmacology curriculum subsequently.
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