Assessment of a Group Activity Based Educational Method to Teach Research Methodology to Undergraduate Medical Students of a Rural Medical College in Gujarat, India

A physician is expected to provide most rational treatment choices to the patients. This calls on the physician to regularly update his/her medical knowledge. Given the vast amount of information available making a rational choice will require considerable amount of analytical skills on part of the physician. Also, there is increasing demand on physicians to be part of research teams. Thus, a fairly intense training in research methodology is required for undergraduates to meet their research and analytical needs. Early undergraduate exposure to research helps in producing physicians who are better equipped to meet their professional needs especially the analytical skills. Also, the trainees who have an early research exposure are more likely to be involved with research in their career [1,2]. The Medical Council of India (MCI) also emphasizes and prescribes focus on self-learning methods including group based activities with hands on experience [3]. The World Federation of Medical Education also encourages the involvement of medical students in activities which promote research [4]. Several methods have been adopted globally to provide this early research exposure to the undergraduates [5–7]. Indian Council for Medical Research- Short Term Studentship (STS) and Kishore Vaigyanik Protsahan Yojana (KVPY) an on-going National Program of Fellowships in Basic Sciences, initiated and funded by the Department of Science and Technology, Government of India promote research among undergraduate medicos, but these are usually limited to a very small proportion of students [8–10]. Research methodology workshops and research promotion activities involving the entire class are arranged in very few institutes in India [11–13]. Department of Community Medicine has been conducting a research methodology workshop for MBBS III, part 1 (VI semester) based on Problem Solving for Better Health (PSBH) approach for last six years [14]. Current study was conducted to assess the effectiveness of a group activity based educational method and perceptions of students about teaching of research methodology.

Materials and Methods

The study was carried out during a research methodology workshop for III MBBS part1 (VI semester, 99) students of Pramukhswami Medical College, Karamsad, Gujarat, in May 2013. The students were exposed to research methodology by using simple 8 steps approach. These steps are Identify a Problem, Refine the Problem, Determine a Solution, Frame the Question, Develop a Protocol, Take Action, Write the Report and Share your Experience. These eight steps are based Dreyfus Health Foundations’ PSBH module [15,16]. The workshop consisted of daily two sessions by faculty of about 30 minutes, followed by group activity of about four hours and presentation by students at the end of the day lasting for around two hours. The faculty sessions were on introduction to workshop, asking the right question, literature search and protocol writing. All other sessions including clinics were cancelled and students were posted at department of Community Medicine for two days. It was a mandatory workshop and carried weightage in internal marks sent to University for the final exam. Students were divided into groups of 10 and were assigned a faculty and resident as facilitators. At the end of workshop students are expected to present a draft of research proposal. The students then further refined their proposal, got it cleared by institutional ethics committee, carried out the project and submitted a report within 6 months. The projects were carried out in groups of five students. Some projects carried out by students were:

Effect of health education on menstrual hygiene among school girls.

Knowledge, attitude, practice among nurses regarding breast cancer.

Soft drink consumption patterns among medical students.

Self-medication pattern among college students.

Knowledge, attitude, practice among hospital staff regarding hypertension.

A Pre-test and post-test assessment was carried out using a questionnaire based on the workshop contents. The test questions were based of multiple choice and small answers type. Also anonymous feedback was collected at the end of the workshop. Feedback responses were based on Likert scale (1-Highly satisfactory, 2- Satisfactory, 3- Not Sure, 4-Unsatisfactory, 5-Highly unsatisfactory) [16]. The identification details and post or Pre-test status of response sheets was masked by an opaque label with new series of codes. The response sheets were evaluated using a predesigned answer key by a blinded evaluator. Following evaluation the response sheets were decoded. The data was entered in Microsoft excel sheet and analysed using Statistical Programme for Social Sciences (SPSS) version 15. As Pre-test scores were not normally distributed, we used non -Parametric (Wilcoxon signed rank) test for comparing the scores. The study was cleared by the Human Research and Ethics Committee of the institute.

Results

There were 95 (94.8%) valid responses out of the 99 students, who attended the workshop. There were 50 (52.6%) male and 45 (47.4%) female students. The mean Pre-test and post-test scores were 4.21(95% Confidence Interval 3.73-4.7) and 10.37 (95% Confidence Interval 9.54-11.2) respectively [Table/Fig-1]. The differences were found to be significant using Wilcoxon Sign Rank test (p <0.001). Thus, there was an improvement of 6.16 (146%) over the Pre-test scores. There were no significant differences between male and female students in terms of Pre-test, post-test scores and overall gain in scores as shown in [Table/Fig-2]. All the students were able to complete the projects and submit them, though the deadline for submission had to be extended. The median feedback score regarding relevance, skill learning, quality of facilitation, gain in knowledge was four and that of experience of group learning was 5 on a Likert scale of 1-5. The detailed breakup of the feedback scores are provided in [Table/Fig-3].

[Table/Fig-1]:

Mean pre and post-test scores of the participants

[Table/Fig-2]:

Sex-wise comparison of the test score of the study population

	Males	Females	p-value
Pre-test score	4.34	4.07	0.519*
Post-test score	9.68	10.53	0.074*
Gain in score	5.34	6.46	0.063#

*-Mann Whitney U-test

^#- Wilcoxon Signed Rank Test

[Table/Fig-3]:

Distribution of the feedback scores of the students following research methodology workshop

S. No	Topic	Likert score*
		1	2	3	4	5	Mean	Median
1	Relevance of workshop	2	5	9	38	41	4.17	4.00
2	Quality of Faculty presentation	3	0	15	33	44	4.21	4.00
3	Quality of facilitation /guidance	3	2	12	32	47	4.23	4.00
4	Experience with group learning	3	1	11	30	51	4.30	5.00
5	Improvement of knowledge	3	6	14	38	35	4.00	4.00
6	Improvement in skills
	• Problem identification	5	4	14	37	36	3.99	4.00
	• Protocol development	2	1	20	40	32	4.04	4.00
	• Literature search	2	6	23	40	25	3.83	4.00
	• Project writing	2	6	17	40	31	3.96	4.00
7	Plenary sessions	3	4	17	37	34	4.00	4.00

* Total number of responses are less than 99 due to some data missing in feedback forms

Discussion

Modern physician needs to know how to conduct and interpret research as a part of his professional competencies. Including the research methodology in undergraduate medical curriculum is recommended by MCI and several other international organizations and groups [3,4]. The exact timing, duration and modality of providing research experiences to the undergraduate students are debatable. However the methods involving participatory group learning are preferred. Some authors have also advised making the students part of actual real life research projects to provide them the research exposure [5]. Also, it is advisable to get active feedback from the learners and involve them in the planning of such trainings. Our methodology is based on the PSBH approach. Following the workshop there was 146% improvement over the baseline score. Other studies have also reported similar improvement in the scores [6]. The workshop was very well received and appreciated by the students. The students also felt that including research methodology in the curriculum was relevant, improved their knowledge and research skills. Thus the students were very satisfied by experience of self-learning using group activities as evidenced by the mean and median feedback of 4 or more out of 5 for most topics. Other studies have also reported similar positive and encouraging feedbacks about including research methodology teaching in undergraduate curriculum [6,12,17,18,]. All the students were able to complete the planned projects and submit the report. However, the deadline for submission had to be extended twice. The delay in report submission was due to lack of availability of protected time to carry out the project activities. Some of the students in the group did not participate in the project activities actively. Other study had also identified these issues [18]. This issue was tackled providing weightage to attendance and participation in various project activities (from proposal writing till report submission) in the final score that was sent to the university as part of internal assessment. This was communicated well during the workshop to the students

Conclusion

The research methodology workshop based on participatory group learning can play a significant role in teaching research to undergraduate students in an interesting manner. To enable the students to complete the projects undertaken a protected time slot may be provided in the schedule. However the long term effect of such workshops needs to be evaluated.

*-Mann Whitney U-test^#- Wilcoxon Signed Rank Test* Total number of responses are less than 99 due to some data missing in feedback forms

[1]. Fang D, Meyer RE, Effect of two Howard Hughes Medical Institute research training programs for medical students on likelihood of pursuing research careers Acad Med 2003 78:1271-80.  [Google Scholar]

[2]. Solomon SS, Tom SC, Pichert J, Wasserman D, Powers AC, Impact of medical student research in the development of physician-scientists J Investig Med 2003 51(3):149-56.  [Google Scholar]

[3]. Graduate Medical Education regulations, 1997. Medical Council of India [Accessed on 2015 Apr 15]. Available from http://www.mciindia.org/Rules-and-Regulation/GME_REGULATIONS.pdf  [Google Scholar]

[4]. Basic Medical Education WFME Global Standards for Quality Improvement: World Federation for Medical Education: Copenhagen; 2005.[Accessed on 2015 Apr 15].Available from:http://wfme.org/accreditation/whowfme-policy/28-2-who-wfme-guidelines-for-accreditation-of-basic-medical-education-english/file  [Google Scholar]

[5]. Millar E, Baker MG, Howden-Chapman P, Wilson N, Dickson N, Involving students in real-world research: a pilot study for teaching public health and research skills BMC Med Educ 2009 9:45[Accessed on 2015 Apr 15].Available from http://www.biomedcentral.com/1472-6920/9/45  [Google Scholar]

[6]. Taheri H, Mirmohamadsadeghi M, Adibi I, Ashorion A, Sadeghizade A, Adibi P, Evidence-based Medicine (EBM) for Undergraduate Medical Students Ann Acad Med Singapore 2008 37:764-68.  [Google Scholar]

[7]. Mostafa SR, Khashab SK, Fouaad AS, Abdel Baky MA, Waly AM, Engaging undergraduate medical students in health research: students' perceptions and attitudes, and evaluation of a training workshop on research methodology J Egypt Public Health Assoc 2006 81(1-2):99-118.  [Google Scholar]

[8]. Short Term Studentship [Internet]. [Accessed on 2015 Apr 15].Available from http://icmr.nic.in/shortr.htm  [Google Scholar]

[9]. Kishore Vaigyanik ProtsahanYojana[Internet]. [Accessed on 2015 Apr 15].Available from http://www.kvpy.org.in/main/  [Google Scholar]

[10]. Venkatraman A, Nagpal SJ, Research opportunities for medical students in India Natl Med J India 2008 21(4):202-03.  [Google Scholar]

[11]. Kumar HN, Jayaram S, Kumar GS, Vinita J, Rohit S, Satish M, Perception, practices towards research and predictors of research career among UG medical students from coastal South India: A cross-sectional study Indian J Community Med 2009 34:306-9.[Serial online] [Accessed on 2015 Apr 15]. Available from: http://www.ijcm.org.in/text.asp?2009/34/4/306/58388  [Google Scholar]

[12]. Devi V, Abraham RR, Adiga A, Ramnarayan K, Kamath A, Fostering research skills in undergraduate medical students through Mentored Student Projects: Example from an Indian medical school Kathmandu Univ Med J 2010 8(31):294-98.  [Google Scholar]

[13]. Dongre AR, Kalaiselvan G, Mahalakshmy T, The benefits to medical under graduates of exposure to community-based survey research Educ Health 2011 24(3):591  [Google Scholar]

[14]. Dreyfus Health Foundation- Problem Solving for Better Heath [Internet]. [Accessed on 2015 Apr 15]. Available from:http://db.dhfglobal.org/who/methodology.html  [Google Scholar]

[15]. Problem Solving for Better Health India Participant's Handbook. Tiruvanantpuram: Health Action by People;2006  [Google Scholar]

[16]. Elaine AI, Seaman CA, Likert scales and data analyses Quality Progress 2007 40(7):64-5.[Accessed on 2015 May 15]. Available from:http://asq.org/quality-progress/2007/07/statistics/likert-scales-and-data-analyses.html  [Google Scholar]

[17]. Ahmad F, Zehra N, Omair A, Anjum Q, Students’ opinion regarding application of Epidemiology, Biostatistics and Survey Methodology Courses in medical research J Pak Med Assoc 2009 59(5):307-10.  [Google Scholar]

[18]. Jain A. Undergraduate medical students’ feedback on research training during Community Medicine posting at a private medical college in India. Paper presented at:2012 International Consortium for Educational Development (ICED2012) Bangkok, Thailand, 22 – 25 July 2012.[Accessed on 2015 Apr 15]. Available from:http://www.thailandpod.net/thaipod_joomla2/documents/iced2012/ID181.pdf  [Google Scholar]