Use of prelecture assignment to enhance learning in pharmacology lectures for the 2nd year medical students.

OBJECTIVES: Majority of teaching hours allotted by the Medical Council of India in pharmacology are utilized in the form of didactic lecture. Although these lectures are an excellent tool to deliver the information to a large group of students, it usually ends up as a one-sided teaching session with most students being the passive listeners. To make these lectures interesting and effective, we introduced the students to prelecture assignment (PLA) in the form of clinical case before the delivery of the lecture.
METHODS: This prospective educational trial was conducted in the Department of Pharmacology with undergraduate medical students in their 2nd year of their professional course. They were divided into two groups of 75 each. Group A was provided the PLA before the lecture. Group B students directly attended the lecture, sans the PLA. Multiple-choice questions-based test was conducted 2 days after the lecture. Students who failed to complete the assignment and were absent from the lecture and test were excluded from the study. Feedback from the students was obtained after the lecture. The scores in the test and responses were compiled and analyzed using Statistical Package for Social Sciences (SPSS) software version 21.0 (SPSS Inc., Chicago, IL, USA). Results were expressed in percentages and as mean ± standard deviation as applicable. P < 0.05 was considered statistically significant.
RESULTS: Fifty-six students from Group A and 42 from Group B appeared for the test. The students who were given PLA scored better. They felt more confident in answering and understood the topic better than the students of other group.
CONCLUSION: PLA is a useful teaching-learning tool. The pharmacology lectures are interactive, interesting, and easy to understand with this tool.

RCT Entities:   Population Interventions Outcomes

Pharmacology is taught to undergraduate medical students in Indian medical schools over a period of 1½ years, beginning from the 2nd year of the professional course. One of the objectives of teaching pharmacology to these students is to train students to be competent in prescribing drugs using the principles of rational use of medicines. The Medical Council of India recommends that pharmacology syllabus be covered in 300 teaching hours.[1] About one-third of these hours are dedicated to didactic lectures, in various universities across India. Although lectures are the main means of imparting knowledge to a large audience, the students are mere passive listeners. For this reason, didactic lectures are not popular among students and hence they are unmotivated.[2] Students often fail to assimilate the voluminous information provided to them. This results in their inability to integrate and apply the pharmacological knowledge into clinical situations. In the recent past, student-centered approaches are being promoted[34] to make them motivated and responsible for their own learning.[5] However, these are mostly small-group teaching methods and not feasible all the time, given the paucity of faculty.

To address these challenges, we experimented with an innovative teaching method to make didactic lectures in pharmacology more effective and student centered. We experimented with a problem-centered approach to the traditional didactic lecture by introducing prelecture assignment (PLA) before the lecture. The learning experience and outcome of students exposed to PLA followed by traditional lecture versus those exposed to traditional lecture alone was compared.

Materials and Methods

The study was designed as a randomized prospective educational trial and conducted at Rohilkhand Medical College and Hospital in the Department of Pharmacology, Institutional Ethical Committee clearance was sought before commencing the study.

After informed consent, the undergraduate medical students of the second professional year (n = 150) were randomized into two Groups A and B, of 75 students each. After peer consultation, the topic of lecture for the class was decided to be “drug therapy of peptic ulcer”. A clinical case related to the group of drugs to be taught was discussed in detail, with the students of Group A. Following this, they were given the assignment to study and plan a therapeutic approach to the particular case. This activity was considered as a prelecture assignment. The PLA was provided 5 days before the lecture on “drugs therapy of peptic ulcer”. Students were asked to submit the assignment before the lecture. Those who failed to submit the assignment were excluded from the study.

Group B student were neither given PLA, nor was the topic of the lecture disclosed to them. Care was taken to avoid any contamination between the groups by appropriate instructions to the students.

A 1-h lecture was delivered to the whole class. Test on the topic was scheduled 2 days after the lecture. Thirty multiple-choice questions (MCQs) of varying levels of difficulty were constructed and validated after peer-review. Ambiguous questions were discarded. Among the 30 MCQs, 15 questions were of simple recall type, 10 were tested understanding and application, and five tested higher levels of cognitive domain, i.e. analytical skills. Each correct response was awarded one score, and no negative marks were awarded for the wrong attempt. The test was administered to both groups of students. Only those students who appeared for both the lecture and the test were considered included for the evaluation. The mean scores obtained by both the groups were compared to evaluate the impact of PLA on the performance of students. Scores more than 50% were considered as pass marks. Both formal and informal feedback were obtained to assess the learning experience of both the groups. Prevalidated questionnaires were distributed to obtain the formal feedback of the students after the lecture. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 21.0 (SPSS Inc., Chicago, IL, USA). Independent t-test was applied to compare the data, and P < 0.05 was considered as statistically significant.

Out of 75 students from Group A, 63 submitted the assignment and attended the lecture while 56 appeared for the test. 59 students from Group B attended the lecture while 42 appeared for the test. About 82.14% students of Group A who had done the PLA before the lecture passed the test as compared to 52.38% of students of Group B who were not exposed to PLA. The marks of Group A and Group B students ranged from 27 to 6 and 26 to 5, respectively. Although the range of marks scored was similar, the mean marks scored by the Group A (PLA group) were significantly higher [Figure 1]. The mean total marks and their evaluation based on the different levels of difficulty is summarized in Figure 1.

Figure 1

A bar diagram comparing the mean total marks (standard deviation) and the mean marks (standard deviation) of different type of questions obtained by the students of both groups (P value: *< 0.01; **< 0.05; ***=0.001)

The feedback obtained from the students is summarized in Table 1. Almost all the students found the lecture topic interesting. About 84% of the students who did the PLA opined that the drugs covered in the lectures were relevant to their observations in the daily clinical. Apart from this, about 80% of the students in Group A found it easier to understand the topic, take down notes, and remember the name of the drugs. Only 40% of the students in Group B (non PLA group) found it easier to take down notes, and 35.7% were able to remember the name of the drugs. About 58.9% of students from PLA group felt confident in answering question related to the topic as compared to 45.2% from non-PLA group. Only seven percent students from the PLA group opined that they had no doubts related to the topic were at the end of the lecture.

Table 1

Response obtained from the students based on the feedback questionnaire at the end of the lecture

Discussion

Over the last few decades, the explosive proliferation of new drugs has led to information overload. It is being blamed for the shortcomings in the pharmacology training of medical graduates, especially when it comes to prescribing rationally.[67] This has warranted an urgent need to make changes in the pharmacology curricula worldwide, with more emphasis on rational prescribing. Changes in curricula also necessitate changes in the teaching methodologies.

Conventionally, didactic lectures are the ubiquitous method of teaching pharmacology in universities across India. Although lecture is an economical and efficient teaching method for dispensing vast amount of knowledge to large groups; its main drawback is that it favors passive learning in the students. This study modified these didactic lectures in pharmacology to enhance active learning. We introduced a PLA before the lecture for this purpose.

In our study, we found that students with whom the relevant clinical case was discussed before the lecture and who completed the PLA of reading and planning the therapeutic treatment were more motivated and eager to learn. We deduced this from the attendance of students which was significantly higher in both the lecture and the test for the group which completed the PLA in comparison to those who had no knowledge about the topic of the lecture and only attended the lecture without any priming. Studies have shown that student’s interest in the lecture topic had a major influence on the attendance in the lecture.[8] One of the principles of learning is that learners are more motivated and tend to learn better when they are involved in solving real-world problems.[9] The lecturer also noted informally that the students who completed in PLA were more attentive during the lecture and interacted more with the lecturer. Feedback from the students revealed that although most of the students found the lecture interesting, greater number of students from the PLA group felt that the case scenario helped them relate the pharmacology principles to their clinical posting. Similar findings were also reported by other studies employing case scenarios for promoting active learning.[41011]

Our study showed that the students who were given the PLA performed better in the test. This finding was in line with other studies which used cases as means of active learning tool.[10] Although the range of marks obtained by both groups was similar, the pass percentage and mean marks of students who completed the PLA were significantly higher. Students scored better not only in the simple memory-based questions but also in questions which involved understanding, application, and analysis [Figure 1]. This can be attributed to the fact that when students prepare in advance for a lecture, they are at a better position to comprehend the subject and assimilate the information imparted in the lecture. PLA helps in facilitating in-depth learning as opposed to superficial learning by those who attend lectures unprepared. Moreover, students who attend the lecture unprepared are usually overwhelmed by the amount of new material being taught. Significantly higher marks (P = 0.001) obtained by students from the PLA group in the analysis and evaluation-based questions proves that PLA also promotes critical thinking thus preparing the student for future rational prescribing [Figure 1]. Completing PLA drives the student to devote more time for self-study. More time spent on the topic translates into better performance in the test.

Feedback from students revealed that PLA made it easier for them to take notes from the lecture and prepare for the test. They also had no problem in memorizing the drugs in comparison to those who had no exposure to PLA. This is because learning is enhanced when previous knowledge acts as a platform for building new knowledge. While working on the assignment, the students are primed about the topic. Attending the lecture helps them to further consolidate the material and clarify key points.

From the lecturer’s point of view, going through submitted PLAs give them the opportunity to identify the misconceptions of the students and thus build the lecture around those key points instead of making the lecture a one-way traffic of information. In spite of many positives in favor of PLA from our study, we found that some students were reluctant to complete the assignment. They felt that they would not be able to complete the assignment before each lecture because of time constraints and demands of other subjects. However, they thought it could be done for some major topics in Pharmacology.

Conclusion

The introduction of a simple PLA before the lecture can help in making the pharmacology lectures less passive and teacher centered. PLA increases comprehension, analysis, active e-learning, and skills required for rational therapeutic decisions.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.