Feedback of students to aligned teaching -learning and assessment.

Sir,

It is said that “assessment is the tail that wags the curriculum dog.” Students focus on learning what is asked in examination and teachers can exploit this potential of assessment to give a particular direction to student learning.[1] Currently, the undergraduate medical students have multiple lacunae in their knowledge of psychiatry, and a potential contributory fact could be the neglect of psychiatry as a discipline at the undergraduate level.[2]

The representation of psychiatry in undergraduate curriculum is very less. Currently, Psychiatry curriculum has 15–20 hours of didactic lectures and 2 weeks of clinical posting in psychiatry. There is a nominal representation of psychiatry in the undergraduate theory examinations and absolutely no representation in practical examinations.[3] In most of the medical colleges of this region, the knowledge of psychiatric illnesses is not assessed in the examinations, psychiatric cases are not kept in clinical examination and viva voce also seldom covers psychiatry.[4] Assessments should reveal how well students have learned, what we want them to learn while instruction ensures that they learn it. For this to occur, assessments, learning objectives, and instructional strategies need to be closely aligned so that they reinforce one another.[5]

We were not assessing undergraduate medical students at the end of clinical posting. We started this project to improve teaching of undergraduate students by aligning teaching-learning methods with learning objectives, starting assessment at the end of clinical posting and to collect feedback from students regarding new teaching-learning methods and assessment. This prospective study was conducted in the Department of Psychiatry, Christian Medical College and Hospital, Ludhiana. We used learning objectives for UG students as per Graduate medical education regulations 1997.[6]

We planned teaching-learning methods in alignment with learning objectives. We taught history taking, mental status examination, and communication skills by role play. Later, it was made sure that one consultant observes student's history taking and giving appropriate feedback. Actual as well as simulated patients were given to students for workup. We also showed a movie related to schizophrenia (actual patients were also shown). Handouts of the diagnostic criterion of various psychiatric illnesses were distributed to students. A blueprint of assessment was prepared for practical examination in psychiatry and students were assessed as per the blueprint.

The feedback questionnaire for collecting feedback from students regarding the introduction of aligned teaching-learning methods and assessment was prepared. Feedback from students regarding the introduction of aligned teaching-learning methods and assessment was collected after taking informed consent. Students were given the opportunity to write comments at the end of feedback questionnaire.

A total of 19 students of sixth semester were posted during the study and were taught as per plan. All the students (13) present on the last day of clinical posting filled the feedback questionnaire. All students (100%) reported increased understanding of the subject, increased confidence in communication skills, and increased performance in history taking with the introduction of aligned teaching-learning methods in clinical posting of psychiatry. All the students (100%) reported that they enjoyed learning with new teaching-learning methods. Majority (70%) students did not perceive assessment added to their burden and all the students (100%) found that assessment had a distribution of questions across all important topics, questions in alignment with teaching. All students (100%) reported that assessment increased their learning.

Verbatim comments by students

The new methods of teaching especially the role play helped to increase the communication skills

Give us more cases

All students should be given a chance to take history. Very few students could take history as it is a very short posting

The only suggestion is “please suggest similar teaching-learning methods to all clinical departments so that we can have more interest in the learning. It is best clinical posting ever. Thank you for this experience, we learned a lot.”

DISCUSSION

Our results are comparable to a study by Patil et al.,[7] in which the students felt that there was the appropriate distribution of questions across topics (77%), appropriate weightage given to topics of public health importance (65%), and examinations were fair (86%).

Students suggested that these teaching-learning methods should be used by other departments also. All students wanted to present cases but as it was a short posting all students could not present cases. Clinical posting in psychiatry in undergraduate curriculum is 2 weeks only at present whereas in the UK clinical attachments at medical schools in psychiatry may be for up to 12 weeks.[8]

Closer home, Sri Lanka and Nepal have expanded the duration of psychiatry teaching, revised undergraduate psychiatry curriculum and made psychiatry a qualifying subject for MBBS examination.[9]

Limitations

Only one batch of 19 students came for clinical posting during the study, and out of these 19 students, only 13 students were present on the day of assessment

For planning teaching-learning activities we used only first four learning objectives out of 5 learning objectives given in Graduate medical education regulations 1997. Fifth objective “identify and manage psychological reactions and psychiatric disorders in medical and surgical patients in clinical practice and in community setting” was not possible in 15-day clinical posting.

CONCLUSIONS

The feedback obtained from students depicted that aligned teaching-learning methods should be used by all the departments and students felt that psychiatry posting should be of longer duration. We also found that 2 weeks clinical posting in psychiatry is not adequate and duration of clinical posting should be increased, and psychiatry should be made a qualifying subject.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.