This experimental study was taken up as part of the MSP which is a compulsory research activity for students in the third-semester of the MBBS programme, to be carried out under the guidance of their teacher-mentors. The entire batch of MBBS students was divided into groups of five and each group was allotted a research project by their respective mentors. The students were familiar with their teacher-mentor for more than a year prior to the study, since they were assigned to the mentor, as soon as they joined the institution. Students were already exposed to PBL, in the previous two semesters and had a basic knowledge of anatomy, physiology and biochemistry. All the students had to compulsorily undertake a research project, (there were no exclusions) since it was a curricular requirement for their promotion to the clinical semester. In the MSP study reported here, a control group could not be accommodated because the study design required that all students take part in the research activity. The study design was explained to the students (n=5) in the MSP group and is shown in the chart [Table/Fig-1]. Students were asked to nominate one among them as their leader to serve as a conduit between the group and the teacher-mentor. As expected by the institution, they wrote a brief description of the project and submitted it to the Institutional Research Committee (IRC) which approved the study. Since the MSP required inputs from clinical and paraclinical sciences, the teacher-mentor requested the participation of another faculty, a senior clinician, i.e., Head of the Department of Medicine, for validating the case scenarios and a medical microbiologist for designing the MCQ test for the students.

[Table/Fig-1]:

Study design.

*Institutional Research Committee

The study spanned a period of six months from January to June 2018. Various medical topics (n=50), which were somewhat familiar to the students from their curriculum in the first and second year, were chosen by the students themselves. These topics were from haematology, neurology, infectious diseases, endocrinology, paediatrics, cardiology, immunology and others. Each student selected ten topics on which to design the case scenarios. They were asked to confine themselves to authentic online sources of medical literature such as Medscape, WebMD, Mayo Clinic and PubMed and also to standard textbooks of medicine such as Robbins and Cotran-Pathologic Basis of Disease. They were also given reference articles on case scenario design [11]. Four weeks’ time was allotted for designing the case scenarios, following which the students emailed the cases to the mentor. As a guideline for vetting by the clinician, a questionnaire on a five-point Likert’s scale with 15 items was designed and was validated by a member of the medical education department of the University. Subsequently, the case scenarios (n=50) were organised as five separate files, each file consisting of 10 case scenarios designed by a single student. They were emailed to the Head of the Department of Medicine of the hospital affiliated to the University for vetting along with the questionnaire mentioned above. The clinician was also asked to give his comments on the changes to be made in the content of the case scenarios and also express his opinion on the various attributes of the activity. The five sets of case scenarios were subsequently subjected to ‘Turnitin’ analysis in the University library, to assess the similarity index to measure plagiarism. A similarity index of <15% was considered to be acceptable.

To assess student learning in the activity, an MCQ test was formulated by the faculty using the course objectives of the first and second year MBBS. To validate the construct and content of the test, it was administered to two faculty colleagues, teaching the pre and paraclinical sciences. The questions which needed modification were identified and reformulated. The final validated MCQ test was of the single best answer type with four options given. It consisted of 150 questions, with 3 questions addressing the content in each case scenario. The MCQ test was administered to students who took part in the MSP, with a time limit of 75 minutes. Students used their laptops to answer the test and results were expressed as percentages. A questionnaire using a five-point Likert’s scale was used to analyse the students’ experience with the MSP. In addition to this, individual and focus group discussions to ascertain students’ opinion on the outcome of the study were also held. These discussions were held in an informal atmosphere and no questionnaires were used. In the discussions with individual students, they were asked whether group dynamics worked, the usefulness of this activity for medical students and whether the study contributed to their personal and professional development. For the focus group discussion, all the five students were interviewed as a group and asked about their experience while using digital media for case scenario design and whether they would take up research during future academic endeavours.

The [Table/Fig-2] shows some of the cases designed by the students and subsequently vetted by the clinician along with the corresponding MCQs designed by the faculty.

The [Table/Fig-3] shows the questionnaire given to the clinician and grades given by the clinician during assessment of the case scenarios. In general, the clinician agreed that the cases were well constructed; realistic, related to the real-life situation and that the details of clinical investigations provided were adequate. Regarding the outcome of the activity in terms of benefits to students, the examiner thought that it increased knowledge, critical thinking and self-directed learning. The clinician advised a few changes in the case scenarios such as rewording titles, inclusion of X-ray reports wherever relevant, correction of some laboratory values and use of generic names of drugs instead of brand names. Checking for plagiarism in five sets of case scenarios using Turnitin software revealed a similarity index of 0-5%. Preliminary proofreading and editing were done by the students after which grammatical and syntax errors were corrected by meticulous proofreading by the faculty.

The [Table/Fig-4] shows the results of the questionnaire given to students to assess their opinion on the experience of the study. Students strongly agreed that the activity stimulated recall of prior knowledge there by promoting acquisition of new knowledge, improved critical thinking and promoted self-directed learning. The activity according to them was reasonably enjoyable and was not time consuming. Discussions with individual students revealed that, though there were sometimes disagreements regarding the distribution of work related to compiling the case scenarios and designing the poster, they agreed on keeping deadlines and finishing the task at hand on time. Thus, group dynamics was largely effective and did not have any deleterious effects on creativity and productivity. They felt that the activity usefully engaged medical students by contributing to personal and professional development. In the focus group discussion, students were affirmative that they were motivated to study the relevant topics extensively. They also stated that they had used only specific websites for gathering information as instructed earlier by the mentor. However, they confessed that they did have some degree of difficulty in familiarising themselves with the methodology of case scenario construction and understanding certain terminologies in the websites. Other concerns included not finding proper references for normal range of some metabolites, cross-referencing to find information on topics not very familiar to them and not knowing in what sequence clinical symptoms appear in a disease. In spite of these difficulties, in response to the open ended questions in the questionnaire, one student remarked that the activity could be included for internal assessment, while another asserted that if that was the case, it should be conducted only in the fourth semester. Another student was of the opinion that since case scenario design borrows more directly from real life, it was more interesting than just reading from the textbook. Students also stated that research was interesting and they would definitely include it as a part of academics in the future. In the MCQ test, students scored 60-70% marks which is testimony to the knowledge retained in the topics. Students presented a poster summarising the entire MSP experience on the day assigned by the institution for the purpose. The case scenarios with MCQs were then compiled into a handbook and presented to the audience during poster presentation. The outcome was truly novel and was appreciated by all from within the institution and outside.

Student research projects in the medical curricula have been credited with various positive attributes in previous studies [6,14]. Bridging the gap between the availability of information and comprehending it [15], enhancing critical thinking and analytical skills and encouraging self-directed learning, just to name a few. The present study addressed all these aspects of learning successfully. Participation in research projects teaches medical students that clinical care and research should go hand in hand, with the goal of providing more benefit to patients and society [16].

The present study dealt with case scenarios which represent actual clinical situations with patients and as such, it helped students understand the relevance of what was being taught in lectures. Authors are already in an era where technology drives education and information gathering in numerous ways. In this context, it is imperative that students be taught the use of technology for research [17,18]. In this study, students managed the daunting task of collecting the right information from the internet [19] and organising it in a coherent manner. Making students independent learners is the dream of any teacher and this study achieved this goal amicably. Since students had to communicate with their peers in the group and with their mentor on a regular basis, it improved interpersonal communication skills, which are assessed in medical curricula [20]. Since this project had multiple objectives, culminating in the compiling of a handbook, the role of the mentor and the other faculty who took part in the study was substantial. The task of achieving this in a short period of six months using only the free time available for students from their rigorous schedule of the third semester was challenging. Finally, this MSP exemplifies the fact that when students and teachers work in unison, novel outcomes can become a distinct reality.

In this activity, due to time constraints, the knowledge gained by students was assessed using only 3 MCQs per case scenario. It would have served the purpose better if the appraisal of knowledge was carried out in a more detailed and comprehensive manner using short answer questions in addition to MCQs.

The evidence from this study brings to light the multifaceted role that MSPs can play in the overall development of the personal and professional lives of medical students. MSPs have the power to make medical students self-learners and responsible individuals. Exposure to the basics of research methodology has the capacity to motivate them to pursue a career in research related to medicine. In this particular case, the MSP had the unique distinction of leading to the compilation of a handbook co-authored by students and faculty. It must be said here in the affirmative that, this MSP was a great success with laudable outcomes and the memory of the enriching experience will be cherished by both students and faculty for a lifetime.