|ORIGINAL RESEARCH ARTICLE
|Year : 2017 | Volume
| Issue : 2 | Page : 126-132
Reforming pathology teaching in medical college by peer-assisted learning and student-oriented interest building activities: A pilot study
Sumit Grover1, Neena Sood1, Anurag Chaudhary2
1 Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Social and Preventive Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
|Date of Web Publication||19-Sep-2017|
Department of Pathology, Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana - 141 001, Punjab
Source of Support: None, Conflict of Interest: None
Background: Peer-assisted learning (PAL) is a teaching–learning method in which students act as peer teachers and help other students to learn while also themselves learning by teaching. PAL through modified interest building activities (MIBAs) is seldom tried in teaching pathology in medical colleges. This study aimed to evaluate the usefulness of peer teaching using MIBA, obtain feedback from students, and compare different activities with each other and with traditional teaching–learning methods. Methods: An interventional pilot study was conducted in 2 months on the 2nd MBBS undergraduates learning pathology at a medical college in North India. Students acted as peer teachers and performed different MIBAs including role plays, demonstration of pathogenesis through props, student-led seminars such as PowerPoint teaching, blackboard teaching, multiple choice question seminars, case-based learning (CBL) exercises, and quizzes before teaching sessions. Feedback was obtained through structured questionnaires on a 5-point Likert scale. Paired t-test was used to compare traditional teaching with MIBAs, and Friedman test was used to compare among different MIBAs. Results: Students found ease of understanding and the interaction and involvement of students as the most important benefits of PAL. MIBAs increased voluntary participation, coordination, teamwork, shared responsibility, and group dynamics among students. Quiz sessions followed by PowerPoint seminars and prop demonstrations received highest mean scores from students on most of the parameters. Quizzes, blackboard teaching, prop activities, and CBL helped students understand topics better and generated interest. Learners advocated for making MIBAs and PAL compulsory for future students. Discussion: PAL complemented by MIBAs may be adopted to make teaching–learning more interesting and effective through the active involvement and participation of students.
Keywords: Comparison, interest building, pathology, peer-assisted learning, peer teaching, play, PowerPoint, blackboard teaching props, quiz, seminars, student led
|How to cite this article:|
Grover S, Sood N, Chaudhary A. Reforming pathology teaching in medical college by peer-assisted learning and student-oriented interest building activities: A pilot study. Educ Health 2017;30:126-32
|How to cite this URL:|
Grover S, Sood N, Chaudhary A. Reforming pathology teaching in medical college by peer-assisted learning and student-oriented interest building activities: A pilot study. Educ Health [serial online] 2017 [cited 2020 Jul 14];30:126-32. Available from: http://www.educationforhealth.net/text.asp?2017/30/2/126/215093
| Background|| |
Conventional lecture-based teaching practiced in many Indian medical colleges lacks a student-oriented approach. Students generally find lecture-based teaching passive and boring, in which students are able only to repeat things told to them rather than more fully understand the material. Peer-assisted learning (PAL) has been described as “people from similar social groupings who are not professional teachers helping each other to learn and learning themselves by teaching.” Peer teachers are at a similar stage in their education as the learners. Learning by participation complimented by PAL enhances interest, engagement, commitment, order, coordination between students, and understanding of the topic. Peer teachers thus reinforce their own medical knowledge, support other students, share their experiences with other students, and provide feedback. Previous studies have individually assessed PAL, peer teaching, seminars led by students, multiple choice question (MCQ)-based teaching, teaching through quizzes, the use of plays, and case-based learning (CBL), which are modified interest building activities (MIBAs). There have been few comprehensive evaluations of the benefits of these MIBAs over traditional teaching in pathology and few comparisons of these many methods against one another in medical education more broadly. We sought to implement a teaching–learning module in pathology using PAL and MIBAs intended to generate interest, understanding, collaboration, and coordination among students and to enhance their teamwork, communication skills, leadership, and clinical reasoning. This study aims to evaluate the usefulness of peer teaching using MIBAs as a teaching–learning tool and compare different MIBAs with each other and traditional teaching–learning methods.
| Methods|| |
A prospective interventional pilot study in the subject of Pathology was undertaken with 70 2nd year medical students at a medical college and hospital of North India. The students were exposed to a modified teaching–learning program distributed in 13 h over a period of 2 months emphasizing PAL, peer teaching complemented by MIBAs while learning the topic of anemia. The aims and general and specific outcomes of the course were defined. An educational module was prepared with meticulous planning, validated, and finalized with other senior faculty and Head of Department of Pathology. One faculty member and seven resident doctors were involved. The senior faculty member and involved residents were taught the details of module. Permission was obtained from the research committee and ethics committee for this study.
The students were acquainted with the aims, methodology, and module in an introductory session, and informed consent about participation was obtained. The entire class of seventy students was divided into seven small groups of ten students each. Each student group was assigned to one of the seven resident doctors who acted as a mentor to assist the group in planning and execution of the assigned activity. Seven pre- and post-teaching MIBAs including play activity, prop activity, case-based discussion, student-led PowerPoint seminars, blackboard teaching seminars, MCQ-based student-led seminar, and quiz sessions were allotted to different groups in the introductory session by random assignment. The different tasks assigned to students in different MIBAs were based on explaining the etiopathogenesis, clinical features, and pathological findings in different types of anemia [Table 1]. The quiz sessions were conducted by one of the peer teaching groups for the remaining students and assisted by one faculty member and one resident doctor in the form of designing the questions and control the smooth conduction of the same. Participating students were also exposed to seven traditional teaching sessions by five different faculty members on different topics. Post-teaching questionnaire and feedback forms were provided to students who acted as peer teachers as well as to the rest the students to evaluate the various interventional MIBAs and traditional teaching sessions. Quantitative feedback was obtained on Likert scale from all the students regarding teaching–learning methodology, and separate quantitative feedback was obtained from performing groups on similar scale regarding their participation, communication, cooperation, and self-learning and benefits of peer teaching over passive learning in traditional teaching [Table 2]. The students' performances in MIBAs, including student interactions within a performing group and with the audience, coordination among performing group members, content delivery, creating interest in audience about the topic discussed, and capturing their attention throughout the session, were evaluated by two faculty members and two resident doctors and scored from 5 to 1 from excellent to worst. Students' overall gain in knowledge was evaluated by structured MCQ tests, essay type and long-answer questions, and practical examinations at the end of teaching module. Intercomparison of overall student feedback for interventional activities was done, and a separate comparison of individual activity feedback with traditional teaching feedback was also attempted. Statistical analysis of feedback data was done using descriptive statistics as percentages and frequencies. Responses to study variables were expressed as mean Likert scores and compared among the various MIBAs using Friedman test and with traditional teaching seminars using paired t-test.
|Table 1: Various modified interest building activities allotted to the seven student groups for discussing different types of anemia|
Click here to view
|Table 2: Student and performers feedback questions to be rated on Likert scale from 1 to 5|
Click here to view
| Results|| |
Of the seventy participants, the response rate was variable due to absenteeism. The maximum participation was in play activity and prop activity (n = 66) followed by quiz-based teaching (n = 64) and CBL (n = 62). Feedback to compare the various MIBAs was asked from all participants. Individual groups that did the task of peer teaching after random assignment to the various MIBAs also submitted feedback regarding the perceived benefits of peer teaching to them over learning in a traditional lecture. The feedback was based on students' perceptions of the benefits of MIBA and peer teaching. However, feedback forms were not returned by all students that attended the MIBA for various reasons leading to difference in documented feedback from learners [Table 3],[Table 4],[Table 5].
|Table 3: The intercomparison and statistical analysis of student (other than performing group) feedback regarding teaching–learning methods in different modified interest building activities by Friedman test|
Click here to view
|Table 4: Comparison of peer teacher group feedback of play activity, prop activity, PowerPoint teaching seminar, and blackboard teaching seminar with traditional teaching using paired t-test|
Click here to view
|Table 5: Comparison of learner feedback of case-based learning activity, multiple choice question seminar, and quiz-based teaching seminar with traditional teaching using paired t-test|
Click here to view
In general, six of the ten student participants of each activity came prepared. Four of the seven groups prepared their presentations on their own while three groups asked for partial help of their mentor resident doctors.
| Student led Play and Prop Activities|| |
Both play activity and prop session helped increase interaction among students and understanding in innovative ways which ultimately lead to maintained student participation in the activities performed later. The parameters which got the highest mean scores in both play and prop session were content of presentation, creating interest, involvement of audience, and session adding value to teaching [Table 3]. A total of 73.5% of students admitted that the content was adequate to enhance learning and it helped create interest in teaching session. Furthermore, 79.2% and 96% of students stated to look forward to present play and prop activity, respectively. When compared to traditional teaching, participants admitted to have improved communication skills, better cooperation with peers, and they did self-directed learning with enjoyment [P < 0.05; [Table 4]. Prop activity was graded as the best exercise for understanding pathogenesis by most of students. Half of students advocated making it compulsory for all students. Only 7 of 52 students discouraged this method and instead preferred routine teaching.
| Student-led PowerPoint Seminar|| |
Student-led PowerPoint seminars gained the maximum mean scores for content, methodology, way of presentation, coordination, and involvement of performers while blackboard seminars generated more interest among listeners with better involvement [Table 3]. All students agreed that both forms of student-led seminars before teaching session helped them understand the topic better but one-quarter preferred PowerPoint teaching and suggested the addition of videos to better understand pathogenesis. All presenters stated that preparing for blackboard teaching for student-led seminars increased their academic work to some extent because it required effort, memory, and retention (P = 0.038). Still, all actively participated and acknowledged enhancements of their communication skills and self-directed learning in both types of student-led seminars [Table 4].
Three-quarters of students strongly supported and others were neutral about the use of clinical cases before traditional teaching to enhance understanding of a topic [mean score 4.2, [Table 3]. Six out of 48 students were afraid to present the case and discouraged this way of teaching. However, all presenters agreed that CBL helped them in self-directed learning, and all found it more enjoyable than conventional learning [Table 5]. However, they preferred simulators and real patients over theoretical cases.
Multiple choice question teaching by peers
Teaching session by faculty followed by student-led MCQ seminar was appreciated for methodology and way of presentation and audience involvement [Table 3]. However, the content was found to be inadequate by 12/50 students, and they wanted prolongation of the MCQ session with more questions and explanation by faculty instead of students. The presenting group also agreed that it increased their academic burden to prepare the MCQ although they enjoyed it thoroughly, P < 0.05 [Table 5].
Quiz session by peer teachers
This session was attended by maximum students with active participation and got more than 4 average scores in almost all parameters including self-directed learning, enjoyment, cooperation, and communication skills, P < 0.05 [Table 3] and [Table 5]. More than fifty students admitted to look forward to similar quiz sessions in the future and found it much more interesting than conventional teaching. Thus, MIBA increased voluntary participation, coordination, teamwork, shared responsibility, and group dynamics among students as compared to traditional teaching.
On comparing various MIBAs, quiz session followed by PowerPoint seminar and prop activity obtained the highest mean scores in most of the parameters. Quiz, blackboard teaching, and prop activity generated maximum interest. Similarly, quiz, blackboard teaching, and CBL helped understand the topic clearly. MCQ seminar and prop activity enjoyed maximum audience involvement. Maximum students agreed waiting eagerly for their turn to participate in play and prop activity [Table 3].
On evaluation of student interaction, coordination, content delivery, creating interest and capturing attention of students, faculty members, and residents scored play and prop activity 4 or 5 on most parameters. Similarly, quiz-based teaching was assessed to show greatest student interaction and interest with scores of 5 each. On assessing student knowledge with MCQs and long answer tests, 57% students scored more than 60% marks.
| Discussion|| |
In medical colleges, there is a paradigm shift in education methodology internationally from teacher-centered to more learner-centered methods, from passive to active learning, and also from individual to group learning. New methods have students bear greater responsibility for their learning and are helped become lifelong learners and better able to identify their learning gaps. In our study, students were given responsibility of peer teaching using MIBA. We compared different activities in terms of student involvement and knowledge gained and compared these teaching–learning methods with traditional teaching.
Students found ease of understanding and interactions and involvement of students as the most important benefits of PAL and interventional activities. In PAL, the low-power differential between peer teacher and learners may make learners more receptive to instruction. In all MIBAs, the peer teachers reported having a better understanding and recall of the topic which they have taught because of their preparation for teaching. Peer teaching promotes collegiality, socialization, and offers effective long-term learning for peer teachers, with enhanced self-esteem, empathy, and preparation for future roles as faculty teachers.,, The participating students were divided into small groups of ten and given additional time to prepare and rehearse their presentations under supervision of their mentors. Students in small groups report greater motivation, fun, and interactions while learning, thus have better recall of information taught.
When comparing individual MIBAs, role play was liked by both participants and performers. Students and their peer teachers felt that play and prop activities enhanced understanding and retention of the topic, with self-directed learning and improved communication skills. Manzoor et al. and Buch et al. in their study in community medicine and pathology had similar findings., Group role play encourages students self-direction because it resembles the professional environment where teamwork is the norm. Learners thus develop critical thinking skills in an engaging and supportive environment and learn to work collaboratively as a team to approach and solve challenging problems commonly encountered in practice.
Our findings about student-led PowerPoint seminars were consistent with the few other studies that found these seminars widely appreciated because of their ease of preparation, availability of material on the internet, the ability to integrate text and images, and ease of presenting and distributing soft copies as well as handouts before the MIBA.,, Similar to findings by Mohit et al., 63% of our learners advocated for the use of audio and video in PowerPoint seminars. However, nearly two-thirds of our participants still preferred blackboard teaching as stated by many other authors, due to reasons such as its spontaneity, flexibility, nonlinearity, and better flow of thought supported by natural breaks by the peer teacher (e.g., while writing or cleaning the blackboard), allowing peer learners to more easily follow the material and make notes., A good lecturer can motivate the students on a journey of discovery, exposing students to one interesting fact after another with the blackboard teaching method. Students have better retention of the subject afterward if the notes are written with the lecturer's explanation., Similar to study by Panda et al., we found that overall interactive student-led seminar made the topics interesting for learners as well as peer teachers allowing for better participation and understanding. However, authors have questioned this because there is less involvement of learners and only presenters get an opportunity to speak.
The CBL session was appreciated for its student involvement, better understanding of topic, and ability to enhance diagnostic skills; however, many students recommended instead teaching with real subjects or using simulation software and videos. Compared with didactic lectures, CBL was found to promote self-directed learning and critical thinking, and aroused interest, and motivation. Other studies have had similar observations about the use of CBL in teaching basic sciences including pathology, microbiology, biochemistry, and pharmacology.,,,,
In MCQs-based teaching by peers, four out of five students found it interesting and appreciated the way of presenting information, which contributed to their enthusiasm about the course. Performers admitted active participation with self-directed learning but with increased academic burden to prepare MCQs. More than half of students felt that they would choose not to present the student-led MCQ seminar as it requires a lot of preparation, and many admitted to using the internet to find ready questions instead of spending the time required to learn more of the topic and craft their own questions. Buch et al. similarly reported that participants found that MCQ seminars break the monotony of lectures and act as a preparation tool for postgraduation entrance exams.
Quiz seminar was rated as best in all parameters of our study by most of participants who enjoyed the maximum participation, interaction, teamwork, and group dynamics. Other authors also found quiz as an effective teaching learning tool with the enhancement of teamwork spirit among participants.,,
PAL in medical education helps fulfill competencies such as collaboration and communication which are advocated by organizations such as the Accreditation Council for Graduate Medical Education and the Academy of Medical Royal Colleges. PAL and peer teaching conveys a number of benefits to the peer learner, the peer teacher, and the institution as a whole. Thus, peer teachers are a significantly underutilized resource available to educators and can be used to effectively achieve educational outcomes that may otherwise be difficult based on funds or faculty availability.
| Conclusion|| |
We found PAL and MIBA as an effective alternative to traditional teaching, providing rewarding educational engagement for both students and residents. It helped overcome barriers to student involvement in their learning and enhanced teamwork, professionalism, and interpersonal skills. PAL with MIBA has begun to enhance our pathology teaching, and we aim to pursue more studies on peer teaching to identify the best model for pathology undergraduate training, interprofessional teaching, and even teaching–learning for pathology residents.
This is a pilot study of short duration and involves a small study population.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kassebaum DG. Change in medical education: The courage and will to be different. Acad Med 1989;64:446-7.
Burgess A, Nestel D. Facilitating the development of professional identity through peer assisted learning in medical education. Adv Med Educ Pract 2014;5:403-6.
Bulte C, Betts A, Garner K, Durning S. Student teaching: Views of student near-peer teachers and learners. Med Teach 2007;29:583-90.
Bardach NS, Vedanthan R, Haber RJ. 'Teaching to teach': Enhancing fourth year medical students' teaching skills. Med Educ 2003;37:1031-2.
Burgess A, Clark T, Chapman R, Mellis C. Senior medical students as peer examiners in an OSCE. Med Teach 2013;35:58-62.
Wolff M, Wagner MJ, Poznanski S, Schiller J, Santen S. Not another boring lecture: Engaging learners with active learning techniques. J Emerg Med 2015;48:85-93.
Murad MH, Varkey P. Self-directed learning in health professions education. Ann Acad Med Singapore 2008;37:580-90.
Tunstall-Pedoe S, Rink E, Hilton S. Student attitudes to undergraduate interprofessional education. J Interprof Care 2003;17:161-72.
Prins FJ, Veenman MV, Elshout JJ. The impact of intellectual ability and metacognition on learning: New support for the threshold of problematicity theory. Learn Instr 2006;16:374-87.
Gregory A, Walker I, McLaughlin K, Peets AD. Both preparing to teach and teaching positively impact learning outcomes for peer teachers. Med Teach 2011;33:e417-22.
Hoffman SJ, Rosenfield D, Gilbert JH, Oandasan IF. Student leadership in interprofessional education: Benefits, challenges and implications for educators, researchers and policymakers. Med Educ 2008;42:654-61.
De Grave WS, Schmidt HG, Boshuizen HP. Effects of problem-based discussion in studying a subsequent text: A randomized trial among first year medical students. Instr Sci 2001;29:33-44.
Manzoor I, Mukhtar F, Hashmi NR. Medical students' perspective about role-plays as a teaching strategy in community medicine. J Coll Physicians Surg Pak 2012;22:222-5.
Buch AC, Chandanwale SS, Bamnikar SA. Interactive teaching: Understanding perspectives of II MBBS student in pathology. Med J DY Patil Univ 2014;7:693-5. [Full text]
Whitehair L, O'Reilly M. Media supported problem-based learning and role-play in clinical nurse education. In: Steel CH, Keppell MJ, Gerbic P, Housego S, editors. Curriculum, technology & transformation for an unknown future: Proceedings ascilite Sydney; 2010. p.1056-67.
Brandler TC, Laser J, Williamson AK, Louie J, Esposito MJ. Team-based learning in a pathology residency training program. Am J Clin Pathol 2014;142:23-8.
Patel JR, Patel DS, Desai R, Parmar J, Thaker R, Patel ND. Evaluation of student seminar in medical education: Students' perspective. Int J Curr Res Rev 2015;7:6-9.
Mayer RE, Anderson RB. The instructive animation: Helping students build connections between words and pictures in multimedia learning. J Educ Psychol 1992;84:444-52.
Seth V, Upadhyaya P, Ahmad M, Kumar V. Impact of various lecture delivery methods in pharmacology. EXCLI J 2010;9:96-101.
Mohit, Saxena R, Shankar P, Sachan AK, Dixit RK. Perception of MBBS students about their teaching and learning process of pathology and gynecology: An analytical study. World J Pharm Sci 2016;4:403-4.
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;1:95-100.
Petimani MS, Adake P. Blackboard versus PowerPoint presentation: Students opinion in medical education. Int J Educ Psychol Res 2015;1:289-92. [Full text]
Panda S, Bharathi DV, Babu RS, Rao KB. Perception of 2nd
year MBBS students towards student-led seminar as small group teaching method. Int J Curr Res Rev 2016;8:6-8.
Dawane JS, Pandit VA, Dhande PP, Sahasrabudhe RA, Karandikar YS. A comparative study of different teaching methodologies used for developing understanding of cardiac pharmacology in undergraduate medical students. IOSR J Res Method Educ 2014;4:34-8.
Datta A, Ray J. Case based learning in undergraduate pathology – A study to assess its efficacy and acceptability as teaching-learning tool. IAIM 2016;3:93-100.
Tathe SS, Singh AL. Case based lecture versus conventional lectures for teaching medical microbiology to undergraduate students. Int J Curr Res Rev 2014;6:35-41.
Joshi KB, Nilawar AN, Thorat AP. Effect of case based learning in understanding clinical biochemistry. Int J Biomed Adv Res 2014;5:516-8.
Vora MB, Shah CJ. Case-based learning in pharmacology: Moving from teaching to learning. Int J Appl Basic Med Res 2015;5 Suppl 1:S21-3.
Fatima N, Shameem M, Nabeela, Khan HM. Evaluation of case-based lectures for teaching medical microbiology. Int Res J Eng Technol 2015;2:272-5.
Gomathi KG, Shaafie IA, Venkatramana M. Student-led seminars as a teaching-learning method- effectiveness of a modified format. South East Asian J Med Educ 2014;8:82-4.
Jaiprakash H, Ghosh S, Nasir BM, Chow SS, Mohanraj J. Students' perception of an integrated quiz in a Malaysian medical university. Saudi J Med Med Sci 2015;3:130-4. [Full text]
Devi K. Quiz as an innovative approach in teaching community medicine to medical students. Natl J Community Med 2014;5:182-5.
Lehrer MD, Murray S, Benzar R, Stormont R, Lightfoot M, Hafertepe M, et al.
Peer-led problem-based learning in interprofessional education of health professions students. Med Educ Online 2015;20:28851.
Preece R, Dickinson EC, Sherif M, Ibrahim Y, Ninan AS, Aildasani L, et al.
Peer-assisted teaching of basic surgical skills. Med Educ Online 2015;20:27579.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]