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ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 3  |  Page : 215-219

Students attitude towards newer methods of medical education teaching in CBME phase-1 (Anatomy) in a Government Medical College, Andhra Pradesh


1 Department of Anatomy, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
2 Department of Community Medicine, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
3 Department of General Surgery, Rangaraya Medical College, Kakinada, Andhra Pradesh, India

Date of Submission15-Dec-2021
Date of Decision05-Jan-2022
Date of Acceptance07-Jan-2022
Date of Web Publication26-Dec-2022

Correspondence Address:
Dr. J S. Surya Prabha Kona
Department of Community Medicine, GGH, Kakinada - 533 001, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrntruhs.jdrntruhs_163_21

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  Abstract 


Background: In the era of new competency based medical education (CBME) curriculum, teaching and learning anatomy is considered as most challenging part both for students and teachers.
Objectives: The aim of this study was (1) to assess the attitude of students towards newer methods introduced in competency-based medical education curriculum and (2) to know the opinion of students regarding knowledge gained & skill acquired in anatomy through CBME.
Materials and Methods: A descriptive cross-sectional study was conducted among second-year MBBS students who had just passed their first year in the month of August 2021 by using a pre-designed and pretested questionnaire sent through google forms to their mails. The inclusion criteria of the study were students who are willing to participate and gave consent were included. The exclusion criteria of the study were students who were absent and refused to give consent were excluded. Data were entered and analyzed in MS-Excel and descriptive statistics like simple frequencies and percentages were used.
Results: Approximately 76% of the students were below 20 years of age. Female students (63%) were more when compared to male students (37%). Regarding newer methods, 83% of students agreed with introduction of AETCOM (Attitude, Ethics & Communication skills) whereas only 58% agreed with Vertical integration. Mean score was highest for introduction of Ethics & Communication skills (2.8). Majority (88%) of students marked good for opinion regarding knowledge in gross structure of anatomy and 82% for skill in identifying and locating gross anatomical structure.
Conclusion: Importance of newer methods in medical education curriculum has to be addressed to students to make learning active. Evaluation of students attitude regarding effectiveness of newer teaching methods will improve quality of the teaching–learning process.

Keywords: Anatomy, medical curriculum, vertical integration


How to cite this article:
Veerraju AN, Prabha Kona J S, Babu GK, Sesi DA, Babji K. Students attitude towards newer methods of medical education teaching in CBME phase-1 (Anatomy) in a Government Medical College, Andhra Pradesh. J NTR Univ Health Sci 2022;11:215-9

How to cite this URL:
Veerraju AN, Prabha Kona J S, Babu GK, Sesi DA, Babji K. Students attitude towards newer methods of medical education teaching in CBME phase-1 (Anatomy) in a Government Medical College, Andhra Pradesh. J NTR Univ Health Sci [serial online] 2022 [cited 2023 Feb 7];11:215-9. Available from: https://www.jdrntruhs.org/text.asp?2022/11/3/215/365016




  Introduction Top


The role of the medical graduate go beyond the traditional knowledge and skill components as per competency-based medical education (CBME) curriculum. It adds four roles for medical graduate as clinician, communicator, leader of health-care team, life-long learner and professional––which was not addressed by the old traditional syllabus.[1] Indian Medical education requires training in various domains like human interactions and interpersonal relationships in different settings like hospital, and community.[2] The students enter a new environment of medical college at an early age of around 17 years directly from school which could be challenging. Therefore, to create a period of acclimatisation and familiarization to that new environment a dedicated 1 month exclusive “Foundation Course”, at the beginning of the MBBS course has been developed. At appropriate stages during this course, emphasis will be laid on various roles that are essential for the “Indian Medical Graduate”.[2]

In the current era of teaching of “competency-based medical education curriculum curriculum”, more importance is being given to integration & clinically relevance, problem-based learning, and much of student-centred teaching.[3] Integration in medical education is best described by Harden as 'the organization of teaching matter to interrelate or unify subjects frequently taught in separate academic courses or departments'.[4] Shoemaker also defined an integrated curriculum as “education that is organized in such a way that it cuts across subject-matter lines, bringing together various aspects of the curriculum into meaningful association to focus upon broad areas of study”.[5] Horizontal Integration means that occurs across disciplines/subjects but within a finite period of time. For example, integration among subjects of first phase of undergraduate curriculum in India.[6] However, vertical integration across time breaks the traditional divide among the basic science and clinical subjects and brings them together. For example, integration among subjects of different phases.[6]

New competency-based medical education curriculum also includes early clinical exposure (ECE), which fosters exposure of the medical students to patients during the first year of medical college.[7] It is an early exposure to the students to develop the clinical skills with the knowledge of basic sciences.[8] This helps the student to socialize with the profession and encourages to learn professional behavior. AETCOM (Attitude, Ethics and Communication) sessions were also a part of new CBME curriculum. AETCOM module has been prepared as a guide to facilitate institutions and faculty in implementing a longitudinal program that helps students to acquire necessary competence in the attitudinal, ethical and communication domains. It offers framework of competencies that students must achieve and approaches to teaching–learning methods.

In the background of new CBME curriculum, teaching and learning anatomy is considered as the most challenging and important subject in the preclinical phase and mastery over it is essential for laying a strong foundation for clinical excellence. Most of the current problems are due to the extra content that has been embedded in the curriculum.[9] Proper utilization of newer technologies along with the traditional teaching methods will lead to better understanding of gross anatomy and will improve educational values.[3] So, Feedback by the students is a sound basis for improving and modifying medical education and can help to recognize areas of strength and weakness in newer teaching methods.[10] Keeping in mind with these ideas, the present study was conducted in a Government Medical college of Andhra Pradesh to know attitude of students towards newer methods introduced as a part of new CBME curriculum and opinion of medical students regarding knowledge gained/skill acquired by them through CBME in anatomy during their studentship.


  Materials and Methods Top


A descriptive cross-sectional study was conducted among second-year MBBS students who had just passed their first year in the month of August 2021. Data were collected using a pre-designed, pre-structured questionnaire which was prepared by literature review of previous articles[3] and then peer-reviewed and expert reviewed in the department of anatomy. Questionnaire was sent through google forms to their mail. Pilot study was done to check the validity of the questionnaire. Pilot study was done among 20 paramedical students attending dissection classes to test the comprehensibility, appropriateness and consistency of parts of the questionnaire. Subjects of pilot study were not included in the main study.

The students were briefed about the study and questionnaire prior to circulation of questionnaire to their mails. Questionnaire was sent to their mail ids through google forms. They were informed that the information furnished by them will be kept confidential. Out of 250 students in total 214 students have participated in the study. Informed consent was taken from the participants and Ethical committee clearance was obtained from Institutional Ethics Committee. (IEC/RMC/2021/747).

The inclusion criteria of the study included students who are willing to participate and gave consent were included.

The exclusion criteria of the study included students who were absent and refused to give consent were excluded.

Data were entered and analyzed in MS-Excel and descriptive statistics like simple frequencies, percentages were used.

Regarding questions related to attitude related to newer methods the individual score of each question is considered three for 'agree' response, two for 'neutral' and one for 'disagree'. So, the maximum overall mean score would be 21 in seven approaches and three in each statement.[3]


  Results Top


In our study, 76% of the students were below 20 years of age with a mean age of 19.94 ± 0.89. Female students (63%) were more when compared to male students (37%) in the study [Figure 1].
Figure 1: Age-wise and sex wise distribution of study population

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Majority (83%) of the students agreed with introduction of AETCOM (Attitude, Ethics & Communication skills) in curriculum. In first professional year total five AETCOM modules were discussed and their competencies were also addressed through discussions, real-life scenarios, self-directed learning, demonstration and report writing based on reflection of sessions conducted by students.

Whereas only 58% agreed with vertical integration, integration of anatomy with other professional year subjects (not much welcomed by the students when compared to others). [Figure 2] It was found that the mean score was highest in introduction of Ethics & Communication skills (2.8) and for Introduction of e-learning/multimedia for anatomy teaching in Bedside classes (2.7) and Horizontal Integration (2.7) of anatomy with physiology, biochemistry [Table 1].
Figure 2: Opinion regarding newer methods in first year of medical teaching (n = 214)

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Table 1: Attitude scoring among students regarding newer techniques of teaching

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Opinion regarding knowledge in main topics of anatomy, 88% of students marked good in gross structure of anatomy followed by osteology but only 50% gave good in basic structure of CNS. [Figure 3] Regarding opinion of students in acquiring skill in various anatomical domains 82% of students marked good for identifying and locating gross anatomical structure domain whereas only 48% of them were good in identifying microscopic structures in anatomy [Figure 4].
Figure 3: Opinion of students regarding knowledge of topics in anatomy

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Figure 4: Distribution of subjects according to skill acquired in respective fields of anatomy

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  Discussion Top


The mean age of the medical students of present study was 19.94 ± 0.89 which was almost similar to study done in West Bengal,[3] but a study done in Thrissur showed the mean age of 21.58 ± 1.51 years.[11]

Introduction of AETCOM (Attitude, Ethics & Communication skills) in curriculum was agreed by majority of students but Vertical integration was not much agreed in our study. Mean score was highest in introduction of Ethics & Communication skills followed by Introduction of e-learning/multimedia and Horizontal Integration for anatomy teaching. In Bandyopadhyay R et al.[3] study the mean score is highest in introduction of early clinical exposure (2.72) and e-learning field (2.61) and vertical integration was not welcomed by the students which was similar to our study findings.

Unlike traditional curriculum an integrated curriculum provides platform for contextual learning. Theory of 'constructivism' lies behind integration of basic sciences and clinical sciences and states that learner needs to understand the concepts in basic sciences and should apply in clinical sciences.[12] Long-pending demand of medical students for integration of basic and clinical sciences can be achieved with this new approach.[13] This promotes a holistic approach to patient problems and also promotes interdepartmental collaboration and rationalization of teaching resources.[14],[15]

Regarding students opinion about knowledge in main topics of anatomy, most of them marked good in gross structure of anatomy. Longevity of basic science knowledge learned in medical school is always a cause of concern.[7] Detailed knowledge of normal morphological and functional structure of the healthy human body is essential in order to know the pathological disorders. It is prerequisite to teach the basic medical knowledge to be used during diagnostic procedures, clinical practices and treatment planning.[16]

Most of the students expressed difficulty in learning basic structure of CNS and embryology which includes sequence of developmental processes. In study done by Karmer B and Soley JT in 2002, 64% students had problems in understanding embryology, due to an inability to visualize, comprehend the sequence of events in developmental process, and inadequate time allotted for lectures[17]

Opinion of students in acquiring skill in various anatomical domains, revealed that most of the students (82%) marked good for identifying and locating gross anatomical structure domain followed by radiological anatomy (65%) whereas only 48% of them were good in identifying microscopic structures in anatomy. The skill in reading and explaining radiological anatomy can be improved by integrating with radiology and by integrating pathology with histology can improve the skill of identifying microscopic structures. Integration of subjects will make learning active and guides the students in applying the knowledge of basic sciences in clinical subjects. In Bandyopadhyay R et al.[3] study 72.8% of the students were most comfortable in gross anatomical structure and marking topography but 64.9% of them were good in identifying organs 58.8% in radiological anatomy.

Medical students of Maastricht University, Netherlands expressed problems in application of theoretical knowledge in clinical context like knowledge of musculoskeletal system while examining and diagnosing a patient or interpreting related X-Rays, CT scans or MRI.[18] Students also suggested that both lectures and practical sessions in anatomy could be made more effective by correlating with radiology or pathology. They also said that they had mastered the broad outlines, but not in detail.[18] Chariker JH et al.[19] suggested Efficient learning, good long-term retention, and successful transfer to interpretation of biomedical images indicated that computer-based learning using adaptive exploration can be a valuable tool in instruction of neuroanatomy and similar disciplines.


  Conclusion Top


Introduction of newer methods in medical education curriculum as a part of CBME like vertical integration and their importance has to be addressed to the students so that it allows the students to understand the association between basic and clinical sciences. Evaluation of students perception regarding effectiveness of newer teaching methods will improve the quality of teaching–learning process.

Limitation

Due COVID-19 lockdown period, the students had only 8 months of offline classes for anatomy.

Acknowledgements

We sincerely thank Dr. Swarna, post graduate in Community Medicine in conducting this study and also thank all the the students for their participation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Available from: https://www.nmc.org.in/information-desk/for-colleges/ug-curriculum/. [Last accessed on 2021 Sep 09].  Back to cited text no. 1
    
2.
Medical Council of India. Foundation Course for the Undergraduate Medical Education Program, 2019. p. 1-46.  Back to cited text no. 2
    
3.
Bandyopadhyay R, Biswas R. Students' perception and attitude on methods of anatomy teaching in a medical college of West Bengal, India. J Clin Diagn Res 2017;11:AC10-4.  Back to cited text no. 3
    
4.
Malik AS, Malik RH. Twelve tips for developing an integrated curriculum. Med Teach 2011;33:99-104.  Back to cited text no. 4
    
5.
Shoemaker BJE. Integrative education: A curriculum for the twenty-first century. OSSC Bulletin 1989;33:n2.  Back to cited text no. 5
    
6.
Husain M, Khan S, Badyal D. Integration in medical education. Indian Pediatr 2020;57:842-7.  Back to cited text no. 6
    
7.
Gupta S, Gupta AK, Verma M, Kaur A, Singh K. The attitudes and perceptions of medical students towards basic science during their clinical years: A cross-sectional survey. Int J App Basic Med Res 2014;4:16-9.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Kachur EK. Observation during early clinical exposure is an effective instruction tool or a bore. Med Educ 2003;37:88-9.  Back to cited text no. 8
    
9.
Dent JA, Harden RM. A Practical Guide for Medical Teachers. 2nd ed. London: Churchill Livingstone; 2005. p. 171-83.  Back to cited text no. 9
    
10.
Govender S. Students' perceptions of teaching methods used at South African higher education institutions: Part 1. South Afr J Higher Educ 2015;293:23-41.  Back to cited text no. 10
    
11.
Jayanthi A, Sarjna MV, Benjamin B. Students' perception of teaching learning method in dissection and histology lab. IOSR Journal of Dental and Med Sciences 2014;13:24-8.  Back to cited text no. 11
    
12.
Badyal DK, Singh T. Learning theories. The basics to learn in medical education. Int J Appl Basic Med Res 2017;7(Suppl 1):S1-3.  Back to cited text no. 12
    
13.
Badyal DK, Singh T. Teaching of basic sciences in medicine: The changing trends. National Med J India 2015;28:137-4.  Back to cited text no. 13
    
14.
Schmidt HG, Machiels-Bongaerts M, Hermans H, ten Cate TJ, Venekamp R, Boshuizen HP. The development of diagnostic competence: Comparison of a problem-based, an integrated, and a conventional medical curriculum. Acad Med 1996;71:658-64.  Back to cited text no. 14
    
15.
Nagdeo N. Integrated teaching. J EducTechnol Health Sci 2014;1:23-6.  Back to cited text no. 15
    
16.
Kurkcuoglu A, Pelin C, Zagyapan R, Ogus E. Opinions of medical students about phase I anatomy education: A preliminary study. Rev Arg de Anat Clin 2015;7:26-33.  Back to cited text no. 16
    
17.
Karmer B, Soley JT. Medical student perception on problems in Anatomy. East Afr Med J 2002;79:408-14.  Back to cited text no. 17
    
18.
Bergman EM, De Bruin AB, Herrler A, Verheijen, IW, Scherpbier AJ, Vleuten VD. Students' perceptions of anatomy across the undergraduate problem-based learning medical curriculum: A phenomenographical study. BMC Med Educ 2013;13:152.  Back to cited text no. 18
    
19.
Chariker JH, Naaz F, Pani JR. Computer-based learning of neuroanatomy: A longitudinal study of learning, transfer, and retention. J Educ Psychol 2011;103:19–31.  Back to cited text no. 19
    


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