Vous êtes sur la page 1sur 4

Ansari M, Mufti AUR, Khan S

Medical students' perception about teaching-learning

Open Access
Mukhtar Ansari1, Attique Ur Rahman Mufti2, Salman Khan3

Original Article

Medical students' perception about teaching-learning and academic performance at Nobel Medical College, Biratnagar, Nepal
Abstract
Background: Effective teaching-learning is an important prerequisite for academic excellence. The study was aimed at determining students perception about the effectiveness of teaching-learning methods and improving the academic performance. Methods: This cross-sectional study was carried out among 385 medical students of Nobel Medical College, Biratnagar, Nepal during February and March, 2012. The instrument used was a self-administered pretested questionnaire containing both closed and open ended questions. The questionnaire was distributed among the students and their responses were collected and entered in SPSS 11.5 for windows (Chicago Inc) for analyses. Results: Nearly two third (64%) of the students were male and majority (61%) of the students were from three zones such as Bagmati, Koshi and Janakpur of Nepal. Small group interactive discussions (64%), Problem Based Learning classes (65%) and use of multimedia were found the most effective approaches for improving the academic performance. Burden of multi-subjects (53.5%), lack of seriousness (28%), irregular study habit (17.4%) and fears of examinations (85%) were found the major causes of students poor performance in examinations. There were statistically significant association between gender and fortnightly class test as a factor for improving academic performance (p<0.001), use of transparency projector and power point projector as important means of teaching methods (p=0.010, 0.009) and studying many subjects as a reason for poor performance (p=0.030). Conclusion: Multimedia combined with Problem Based Learning and small group interactive discussions were found the most efficient approaches for better academic performance. (El Med J 2:2; 2014) Keywords: Academic Performance, Medical Colleges, Medical Students, Nepal, Teaching-learning

Introduction
Teaching-learning is a crucial component of any academic activity. It is vital to have an effective teaching-learning for better performance of students. There may be various factors contributing to the quality of teaching-learning such as teaching-learning methods and environment, class size and duration of teaching. More supportive the teaching-learning environment and satisfaction of the teachers and students, the better the outcome [1]. Class size and duration of teaching also affect the performance of students. Smaller the class size and shorter the duration of teaching, the better the quality and performance of the students [2, 3]. Apart from these, students centered factors such as difficulty in understanding, the medium of instruction, psychological pressure, background of the student and self-assessed depression also affect their performance [4]. Modern methods involve a participatory approach of teaching-learning such as Problem Based Learning (PBL) and small group discussions, which are more suitable than lecture based teaching [5, 6]. Moreover, a lecture combined with discussion is more relevant than conventional lectures. Lectures mainly facilitate to recall facts, whereas discussions not only produce higher level comprehension but also encourage students active participation and self-confidence [7, 8]. In Nepal, medical education is a highly demanded and respected field of education. Students in Nepalese medical schools are enrolled through three different mechanisms such as through passing the entrance examinations conducted either by the Ministry of Education, Nepal or the respective universities, or through direct enrollment of foreign students without entrance examinations. Hence, students
National Medical College Teaching Hospital and Research Centre, Nepal University Kebangsaan Malaysia, Malaysia 3Nepalgunj Medical College, Nepal
1 2

schooling preceding medical school matters for their medical schooling performance [9]. In general, the quality of medical education in Nepal is somewhat dubious. There may be several factors but students premedical schooling background, quality of teaching-learning and examination system are utmost. Quality of education during students life reflects the quality of care/treatment in their professional life. More effectively the students learn and grasp the things today, the better they can perform tomorrow in their professional life [10]. The objective of this study was to gather students opinion about teaching-learning activities at Nobel Medical College, Biratnagar, Nepal and to suggest improvements in the quality of teaching-learning activities.

Materials and Methods


Design The study was a cross-sectional and descriptive in nature. Study duration and location The study was carried out during February and March 2012 at Nobel Medical College, Biratnagar, Nepal. Nobel Medical College is a private medical college in the eastern region of Nepal and is affiliated to Kathmandu University (KU), Nepal. Study population The participants of the study were medical (MBBS) students of second, fourth, sixth, seventh and ninth semesters. At the time of study, first, third, fifth and eighth semesters did not exist. Therefore, students of second, fourth, sixth, seventh and ninth semesters were only
Correspondence: Mukhtar Ansari Email: mukhtaransari@hotmail.com
Vol 2, No 2

http://www.mednifico.com/index.php/elmedj/article/view/54

Ansari M, Mufti AUR, Khan S

Medical students' perception about teaching-learning

included in this study. The total duration of MBBS course is of four and half years i.e. nine semesters and each semester comprises of six months. Basic medical science subjects such as pharmacology, physiology, pathology, biochemistry, microbiology, anatomy and community medicine are taught during the first two years of the course. The latter two and half years are allocated for teaching clinical subjects such as medicine, surgery, pediatrics, obstetrics and gynecology, orthopedics, ENT, ophthalmology and dermatology. Sample size and sampling procedure A sample size of 385 subjects was recruited in the study. Nobel Medical College has a history of about five years. Only 60 seats were permitted by the Nepal Medical Council for admission in the first batch and the numbers of seats allocated were gradually increased to 100 and 150 for second batch and third batch, and onwards. Therefore, there were variable numbers of students in various semesters. Census method was adopted for sampling the subjects but responses were received only from 385 subjects. Instrument The instrument was a pretested self-administered questionnaire containing both closed as well as open ended questions concerned with the objectives of the study. Procedure The instrument was pretested among 10 randomly selected subjects and necessary amendments such addition of options and modification of questions were made. The modified version of the questionnaire was distributed among the students and their responses were gathered. Before collecting the data, students consents were taken and they were informed to express their responses independently as they perceive or think. The study received ethical clearance from the Research and Ethics Committee of Nobel Medical College, Biratnagar, Nepal. Data analyses The data for closed ended responses were pre-coded in the questionnaire, whereas data for open ended responses were coded latter. The data were entered in SPSS 11.5 for windows (Chicago Inc) and analyzed for descriptive and inferential statistics.

Table 2 illustrates students emphasis mainly on two components such as regular interactive discussions and Problem Based Learning (PBL) classes to have better impact on improving academic performance of the students. However, majority of the students did not stand in favor of any type of examinations such as surprise test, fortnightly test or monthly test. Table 1: Demographic characteristics of medical students of Nobel Medical College, Biratnagar, Nepal (n=385) Characteristics N (%) Male 247 (64.2%) Gender Female 138 (35.8%) 18-19 years 71 (18.4%) Age 20-21 years 184 (47.8%) 22-23 years 92 (23.9%) 24-25 years 38 (9.9%) Bagmati 94 (24.4%) Origin of Koshi 82 (21.3%) Students Janakpur 58 (15.1%) Sagarmatha 40 (10.4%) India 25 (6.5%) Others 86 (22.3%) Business 93 (24.2%) Parents Official Works 68 (17.7%) Occupation Farming 49 (12.7%) Teaching 44 (11.4%) Government Job 41 (10.6%) Doctor and Other 25 (6.5%) Health Professionals Others 65 (16.9%) Table 2: Medical students perception about the techniques to improve their academic performance (n=385) Particulars Yes (%) No (%) 59 (15.3%) 326 (84.7%) Surprise class test 246 (63.9%) 139 (36.1%) Regular interactive discussions 143 (37.1%) 242 (62.9%) Fortnightly class test 57 (14.8%) 328 (85.2%) Monthly class test 199 (51.7%) 186 (48.3%) Regular practical viva-voce 249 (64.7%) 136 (35.3%) Regular PBL classes

Results
Nearly two third (64%) of the students were male and majority (48%) of the students belonged to the age group of 20-21 years. Location wise, about 61% of the students were from three zones such as Bagmati, Koshi and Janakpur of Nepal. Looking over the parents occupation, most (42%) of them were involved in business and official works. About two thirds of students were from 2nd and 4th semesters and the remaining students were from 6th, 7th and 9th semesters. Details of demographic characteristics have been shown in Table 1.

Table 3 explains the students views toward teaching-learning methods. Among the five teaching-learning approaches investigated, dictating lecture notes was found not effective or the least effective. On the other hand, use of multimedia (power point projector) was opined as the most effective method of teaching-learning approach. Table 3: Medical students opinion about different teaching-learning methods (n=385) Teaching medium/methods Not Effective (%) Just OK (%) Effective (%) Most Effective (%) 66 (17.1%) 156 (40.6%) 102 (26.5%) 61 (15.8%) Use of black board & chalk 44 (11.4%) 96 (24.9%) 154 (40.0%) 91 (23.6%) Use of white board & marker 56 (14.5%) 147 (38.2%) 124 (32.2%) 58 (15.1%) Use of transparency projector 27 (7.0%) 72 (18.7%) 153 (39.7%) 133 (34.5%) Use of PowerPoint projector 158 (41.0%) 98 (25.5%) 91 (23.6%) 38 (9.9%) Dictating lecture notes
Vol 2, No 2

http://www.mednifico.com/index.php/elmedj/article/view/54

Ansari M, Mufti AUR, Khan S

Medical students' perception about teaching-learning

Table 4 illustrates students perception about teaching 150 students in a class. Although students had mixed opinion about teaching a large number of students in a class, larger fraction of students articulated that handling such a large class is difficult and students mainly of back rows have to suffer. Therefore, the class should be broken into two sections. Table 4: Medical students opinion about difficulties in teaching large class size (n=385) Particulars Yes (%) No (%) 232 (60.3%) 153 (39.7%) Handling of class is difficult 197 (51.2%) 188 (48.8%) Class becomes non interactive 229 (59.5%) 156 (40.5%) Students of back rows have to suffer 230 (59.7%) 155 (40.3%) Class should be broken into two sections Students perception about conducting fortnightly written test and seminar About 60% of the students were in favor of conducting both fortnightly written tests as well as seminars as they help in self-assessment of the students and increase their confidence level. On the contrary, about 40% of the students opined to have either fortnightly written tests or fortnightly seminars but not the both. Students perception about poor performance in fortnightly written test Although an array of views emerged out about the poor performance of the students in fortnightly written tests, the crucial factors were dealing with many subjects at a time (53.5%), lack of seriousness in study (28.1%), lack of regular study habit (17.4%), ineffective teaching (7.0%) and vast syllabus (4.2%). The association of gender, origin of the students and their parents occupation with students perception about improving academic performance, teaching-learning methods, teaching large class size and fortnightly tests and seminars respectively were calculated. However, statistically significant associations were found only in the cases depicted in Table 5.

learning activities is one of the most important factors for quality medical education [11]. Nearly two third (64%) of the students were male which indicates either males are more directed or parents promote their sons more compared to daughters towards medical education. At the time of enrolment in first year of MBBS, the minimum age of the students in general was 18 years or more and about three fourths of students were from first two years of the course. This may be the reason for large fraction of the students representing the age group 20-21 years. Although students studying at Nobel Medical College were from various part of the nation including the neighboring country India, about 61% of the students were from three zones of Nepal such as Bagmati, Koshi and Janakpur. Koshi is the zone in which Nobel Medical College is situated; Janakpur is a nearby historical zone; Bagmati zone represents the capital city. In terms of improving the academic performance, students preferences were towards experimental methods of learning rather than theoretical. This may be due to the reason that interactive discussions encourage greater participation, improve the grasping ability and self-confidence [8, 11, 12]. On the contrary, the trivial curiosity of the students towards any type of tests or examinations such as surprise test (15.3%), fortnightly test (37.1%) or monthly test (14.8%) indicates that students harbored a fear of examinations, in general. Examinations are considered as one of the important stress factors among the students [13]. However, a study conducted by Larsen et al found that tests or examinations promote better retention of information among the students [14]. While inquiring the students opinion about the effectiveness of five teaching-learning methods such as PowerPoint projectors, blackboard-chalk, whiteboard-marker, overhead (transparency) projectors and dictation, PowerPoint projectors (multimedia projectors) were found the most effective. This may be due to the reason that multimedia incorporate elements such as text, images and even audiovideo which makes it easier for the teacher to represent the things as well as it is more receptive to the students [15]. On the other hand, dictating lecture notes mainly in large class size was the least effective method of teaching-learning as lecturing lacks two way communication and may be considered boring leading to less students participation. But, lecturing (the most common form of teaching) can be made effective if the teacher or presenter is able enough to present the information in the form of text and diagrams or photos in addition to capturing the attention of students and improving their participation [16].

Discussion

The objective of this study was to explore medical students perception about teaching-learning activities and to suggest improvements in academic performance at medical schools. In Nepal, medical education is a highly attractive profession and the quality of teachingTable 5: Association of gender, origin and parents occupation with students perception about improving academic performance and teaching-learning activities (n=385) Characteristics Students Perception 2 df P value Improving academic performance Fortnightly class tests 13.562 1 <0.001* Gender Teaching methods Use of Transparency projector 11.240 3 0.010* Use of PowerPoint projector 11.641 3 0.009* Poor performance Many subjects at a time 4.688 1 0.030* Conducting fortnightly tests Both fortnightly class tests and seminars 33.226 16 Students Origin 0.007* Fortnightly written tests 34.820 16 0.004* Poor Performance Lack of a serious attitude 18.726 8 Parents Occupation 0.016*
*Association (2-tailed) was significant at level of 0.05; P-value was calculated by Pearsons chi-square test http://www.mednifico.com/index.php/elmedj/article/view/54

Vol 2, No 2

Ansari M, Mufti AUR, Khan S

Medical students' perception about teaching-learning

In general, medical schools of Nepal have a large number of students per class, which is negatively linked with students performance. Students were mostly of the opinion that class size should be reduced, as larger classes are difficult to handle, non-interactive and poorly communicative. This reflects students temptations for more participatory or problem-solving classes which are more effective than traditional, didactic lectures [17]. Reducing class size can be another suitable option but if class size is reduced, financial and technical burdens on management authority may hike up and may not be practically feasible. There can be various approaches to assess the students and their academic performance. Although the practice of fortnightly tests (FNT) is one of the popular concepts in developed nations for assessing the students, Nobel Medical College has recently introduced this concept in the form of fortnightly written test and seminar. When students were asked about the relevance of fortnightly tests, there were mixed opinions about conducting fortnightly written tests and seminar. A major fraction (60%) of the students was in favor of both with the justification that fortnightly written tests and seminars help in self-assessment of the students and increase the confidence level. Similarly, about 40% of the students expressed positive views about either fortnightly written tests or fortnightly seminars, but not the both. Although students participation and performance was good in fortnightly seminars, their performance in fortnightly written tests was poor. Although the findings of our study were interesting, there were certain limitations. The study was conducted in a single medical college of Nepal and thus the findings cannot be generalized. Therefore, it is recommended to conduct such studies at different medical schools of Nepal and other countries and make comparisons. It is further recommended that the medical colleges of Nepal and the concerned authorities should comply with and adopt the study findings in their institutions for better quality medical education.

References
1. Huang S-yL, Waxman HC: The association of school environment to student teachers' satisfaction and teaching commitment. Teaching and Teacher Education 2009, 25(2):235-243. 2. The Effects of Class Size on Student Achievement in Higher Education [http://www.ilr.cornell.edu/cheri/workingPapers/upload/cheri_wp67.pdf] 3. Ronfeldt M, Reininger M: More or better student teaching? Teaching and Teacher Education 2012. 4. Mandal A, Ghosh A, Sengupta G, Bera T, Das N, Mukherjee S: Factors affecting the performance of undergraduate medical students: a perspective. Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine 2012, 37(2):126-129. 5. Inuwa IM: Perceptions and Attitudes of First-Year Medical Students on a Modified Team-Based Learning (TBL) Strategy in Anatomy. Sultan Qaboos University medical journal 2012, 12(3):336-343. 6. Jafarey NA: Changing role of medical college teachers. JPMA The Journal of the Pakistan Medical Association 2006, 56(7):297-298. 7. Morgan RL, Whorton JE, Gunsalus C: A Comparison of Short Term and Long Term Retention: Lecture Combined with Discussion Versus. Journal of instructional psychology 2000, 27(1):53-58. 8. Yoder JD, Hochevar CM: Encouraging active learning can improve students' performance on examinations. Teaching of Psychology 2005, 32(2):91-95. 9. Shankar R, Bajracharya O, Jha N, Gurung SB, Ansari SR, Thapa HS: Change in medical students' readiness for self-directed learning after a partially problembased learning first year curriculum at the KIST medical college in Lalitpur, Nepal. Education for health (Abingdon, England) 2011, 24(2):552. 10. Ansari M: Quality of medical education in Nepal. Education for health (Abingdon, England) 2012, 25(2):130. 11. de Caprariis P, Barman C, Magee P: Monitoring the benefits of active learning exercises in introductory survey courses in science: an attempt to improve the education of prospective public school teachers. Journal of the Scholarship of Teaching and Learning 2012, 1(2):13-23. 12. Rees C, Sheard C, McPherson A: Medical students' views and experiences of methods of teaching and learning communication skills. Patient education and counseling 2004, 54(1):119-121. 13. Pereira MA, Barbosa MA: Teaching strategies for coping with stress--the perceptions of medical students. BMC medical education 2013, 13:50. 14. Larsen DP, Butler AC, Roediger HL, 3rd: Test-enhanced learning in medical education. Medical education 2008, 42(10):959-966. 15. Ahmad MI: Effectiveness of Innovative and Traditional Methods of Teaching Biology in Junior College. International Referred Research Journal 2010, 2(18):35-36. 16. Najmi RS: Lecture as a mode of instruction in undergraduate medical education. JPMA The Journal of the Pakistan Medical Association 1999, 49(2):30-33 17. Klegeris A, Hurren H. Problem-Based Learning in a Large Classroom Setting: Methodology, Student Perception and Problem Solving Skills. EDULEARN11 Conference: Barcelona, Spain; 2011.

Conclusion
The students preferences for better retention of material and academic performance were towards modern method of teachinglearning such as PowerPoint slides, combined with Problem Based Learning and discussions mainly in small groups.
Authors Contribution: Mukhtar Ansari: designed, carried out and edited the study. Attique ur Rahman Mufti and Salman Khan: designed and edited the study. Acknowledgements: The authors would like to thank Prof. Dr. J.N. Bhagawati, Principal of Nobel Medical College, Biratnagar, Nepal for facilitating this study. We are also grateful to the students for their active participation. We also would like to express our gratitude to Dr. S. P. Patel, biostatistician, National Medical College, Birgunj, Nepal for his valuable suggestions and cooperation in statistical analysis of the data. Competing interests: The authors declare that no competing interests exist. Received: 29 November 2013 Accepted: 10 January 2014 Published Online: 10 January 2014

http://www.mednifico.com/index.php/elmedj/article/view/54

Vol 2, No 2