|Ahead of print publication
The need of modifying current undergraduate curriculum in pathology subject from student's perspective
Vandna Yadav1, Vinod Kumar2, Rimjhim Shrimal1, Abhay Vilas Deshmukh3
1 Department of Pathology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
2 Department of Surgery, JLN Medical College, Ajmer, Rajasthan, India
3 Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
|Date of Submission||30-Jul-2020|
|Date of Decision||15-Sep-2020|
|Date of Acceptance||25-Sep-2020|
Abhay Vilas Deshmukh,
Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha - 442 102, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: The main goals of second professional MBBS pathology teaching are to provide a framework for the description of disease and to provide students with knowledge of the functional and structural changes in disease in order that clinical signs and symptoms are often understood and interpreted. Aims: It was a cross-sectional, descriptive study which aimed to find out the importance of pathology subject in MBBS curriculum as well as to assess the students perception regarding subject understanding, teaching methodology, and assessment criteria. Materials and Methods: Two hundred and sixteen students of 2nd MBBS who had already completed 1st year and were about to appear in the university examination in the year 2020 were included. An extensive questionnaire was prepared regarding 2nd year pathology teaching. The feedback from the students was obtained and analyzed the SPSS software version 17.0. Results: 30.05% students found pathology subject as an interesting, 46.75% found it to be lengthy, whereas remaining (13.80%) found it as not only interesting but also lengthy as well and 9.4% found it boring and difficult. 70.8% students were able to apply the knowledge gained in the 1st year while studying pathology. 76.7% students responded that knowledge gained in pathology helped them in clinical postings. 53.2% students opined that combination of teaching methods helped them for better understanding of subject. Written and viva voce examination was helpful for 74.14% and 79.62%, respectively, to evaluate them. Conclusion: Our study has emphasized the importance of pathology as a subject for understanding the clinical subject. As competency-based curriculum is starting from 2019 batch and onward, this elaborative study can act as a baseline to get access to the effectiveness of new curriculum in coming years.
Keywords: Integrated teaching, pathology, perception, 2nd year MBBS
|How to cite this URL:|
Yadav V, Kumar V, Shrimal R, Deshmukh AV. The need of modifying current undergraduate curriculum in pathology subject from student's perspective. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2021 Jun 12]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=316423
| Introduction|| |
During MBBS curriculum, a sound knowledge of pathology is important for the clinical practice. Second professional MBBS is a crucial period in undergraduate education as this is a stage when the students are taught the etiology and pathogenesis of various disease processes, and simultaneously, they start interacting with patients in the clinical postings. Understanding the basics of pathology helps in bridging the gap between basic sciences and clinical medicine. It is vitally important for proper understanding of pathological processes in the medical practice.
The main goals of undergraduate pathology teaching are always to provide a framework for the description of disease and to provide students with knowledge of the functional and structural changes in disease so that the clinical signs and symptoms can be understood and interpreted. As pathology is a vast subject, and teaching hours have decreased over the years, meticulous and fine planning is needed for effective and productive learning.,
Teaching medical curriculum is not an easy task both for students and teachers. As students they have to learn many subjects at a time and as teachers having multiple roles to perform apart from teaching such as administrative work, reporting, and research work. Subsequently, in most of the medical colleges, teachers impart knowledge in conventional way than in integrated way. Therefore, the Medical Council of India (MCI) desires the integration of medical curriculum for teaching undergraduate students with the specific aim of providing knowledge in a holistic ways rather than fragmented learning ways.,
Over years undergraduate medical curriculum has evolved from being teacher centered to student centered, from discipline based to integrated core and options based and from passive acquisition of knowledge imparted by real teachers to active problem-based learning., This implies the significance of students' perceptions and feedback on academic progress as its easily available, inexpensive, and reliable if done with planning at regular intervals, with accountability and implemented with necessary modifications.
It is important to know the students' perception regarding adequate knowledge from pathology teaching in Phase 1 before entering in clinical subjects which will be helpful in their clinical teaching., Based on the findings, pathology teaching can further be upgraded by reviewing contents and teaching strategies. Thus, the present study was aimed to search the need of modifying current undergraduate pathology teaching in second MBBS professional phase at Medical Teaching Institute in North India.
Aims and objectives
1. To understand the importance of pathology as a subject in students perceptive
2. To find out the combination of best teaching methodology that can improve students understanding and engagement for future references
3. To get a closer look in the assessment methods and criteria and upgrade them if required
4. To implement students feedback and suggestions for the betterment of next batches.
| Materials and Methods|| |
It was a cross-sectional, descriptive study conducted at a tertiary care medical institute in North India. A total of 216 students of 2nd MBBS who had already completed 1st year MBBS and were about to appear in the university examination in the year 2020 were included in this study. Students having <75% of attendance were excluded from the study. An extensive questionnaire was prepared comprising of questions related to subject understanding, teaching methodology, content and quality of the lecture, quality of practical classes, and assessment criteria to gather the maximum possible required information. The students were asked to respond all statements based on their own judgment.
The study protocol was approved by the Institute Ethics committee of S.M.S. Medical College, Jaipur, letter number 656/MC/EC/2020, dated 29/09/2020.
Data were recorded using Microsoft Excel and analyzed using the IBM Corp. Released 2011. IBM Statistics for Windows, Version 20.0, Armonk, New York, United States Categorical variables were expressed in terms of number and percentage.
| Results|| |
Among 216 eligible students for the study, 137 (63.4%) were male and 79 (37.6%) were female. In our study, (30.05%) students found pathology subject as an interesting, (46.75%) found it to be lengthy, while remaining (13.80%) found it as not only interesting but also lengthy as well. Although marginally, but more (56%) students found general pathology easier over systemic (44%). Furthermore, 83.8% students accepted that they were able to implement the general pathology knowledge while studying diseases in systemic pathology. Majority (70.8%) of students were able to apply the knowledge gained in the 1st year (anatomy and histology mainly) in pathology. However, 29.2% students disagreed for the same. Similarly, majority (76.7%) of students agreed to the fact that knowledge gained in pathology helped them in clinical postings. However, 23.3% students disagreed to the same [Table 1].
53.2% students opined that a combination of teaching methods such as chalk, power point presentation (PPT), group discussions, case-based learning, demonstrations, and question answer form helped them for better understanding of subject. However, 48.8% were satisfied with chalk board n PPT lectures. Majority (74.1%) found the number of lectures allotted to the individual chapters were adequate. Vast number of students (87.9%) felt that one topic must be covered before starting another topic/chapter [Table 2].
Regarding content and quality of lectures, most students (71%) convinced that topic was thoroughly covered. 85.3% students were agreed that diagrams, flow charts, and clinical applications were used while teaching and 66.2% felt that satisfactory answers were given for the queries. Almost equal number of students answered in favor (55.09%) and against (44.90%) when asked whether students were encouraged to ask questions, whether delivery and pace of delivering lectures were suitable to the level of your understanding (54.62% and 45.38%) and were lectures taken in a way that stimulated their interest in the topic (42.60% and 57.40%) [Table 3].
Regarding assessment mode and criteria, 72.22% agreed that 50% passing criteria are sufficient while 27.77% did not agreed for the same. Written and viva voce examination was helpful for 74.14% and 79.62%, respectively, to evaluate them on the subject and in the clinical application. 85.25% students found assessment taken after each topic as beneficial. 65.74% students reported that pattern of examination should be modified. 78.7% students found discussions over questions after the examination as useful. 54.17% students suggested that the number of internal examinations should be increased while 27.78% suggested decreasing it [Table 4].
Regarding overall 2nd year overview, 56.94% students suggested that the number of theory lectures should be increased while 36.57% suggested decreasing it. Almost 90% students felt to incorporate integrated teaching mode with more emphasis on case-based learning (97.22%) and discussion based (88.42%). Almost 90% students also suggested periodic interstate or intrastate quiz to be conducted [Table 5].
| Discussion|| |
Rocket engineers developed the concept of feedback in the 1940s where the system used information to reach its goal. Feedback drives learning and progress and is essential in allowing both student and teacher to remain on course in reaching a goal. Feedback presents information and not judgement.
Teaching is a task that requires enthusiasm and time, and if done with commitment, is greatly rewarding. If pathology teachers do a good job of imparting knowledge, then, there is hope that newly qualified doctors will understand the mechanisms of disease, use laboratories properly, and be stimulated to become pathologists themselves. If not, there is the danger of producing doctors who cannot explain disease to their patients, who abuse laboratories and who have no interest in pursuing pathology as a career, leading to a slow and possibly irreversible decline in pathology as a medical profession,
In our study, 30.05% students found pathology as an interesting while 46.75% students found it as a lengthy subject. The different studies showed different results, 68.5% students were interested in pathology subject by Shah et al., 96.6% by Vijayan and Ponniah Goyal et al. found that among all subjects of 2nd year, 43% students found pathology as interesting while 36% students found it as difficult. The subject helps them to understand the disease pathogenesis in better way while studying cases in clinical postings. Although 70.8% students expressed that they were able to implement histology knowledge gained in 1st year while studying pathology but this percentage can be increased further by briefing the normal histology just before teaching pathology. This will help in better understanding, engagement, and performance of students. In a study done on 214 students, Al Khader et al. observed that 87% students were in favor of teaching histology and pathology together rather than in two different years. Moxham et al. also favored integrated teaching of histology and pathology.
A large number of students (72.8%) responded that conventional lectures are one sided and a combination of methods must be used for teaching. Although adequate number of lectures was delivered for a topic with diagrams, charts, pictures, etc., there is limited active participation by only few front bench students. Others found it boring and one sided and the pace of delivery, understanding of students, number of lectures, level of difficulty for each topic, are some of the many variables behind this boredom. There has been many studies which encouraged new innovative methods such as case discussions, problem-based learning, group discussions, demonstrations, and role play over didactic lectures.,,,
Assessment is one of the most important driving factors of students learning, as students tend to mainly focus on the material to be assessed. Research shows that in the context of medical education, the type of assessment method adopted can influence student learning., A large number of students want different changes in assessment ranging from patterns and interval period between examinations to increasing the weightage to internal marks.
Only 30 marks (15 marks each for theory and practical) after conducting three assessment examinations before university examination are added to final examination marks. Students (49%) suggested that weightage of internal assessment marks must be increased. They found the idea of paper discussion once after completion as beneficial for future examination in many ways. Even after an extensive search, we could not find any Indian study which took an elaborated feedback on assessment, its importance, and required modifications. However, we strongly recommend that the weightage of internal assessment marks must be increased to a considerable number for better evaluation of students, as these are not only the average of the three part term examinations but also daily class activity. In our study, a total of 54% students proposed a frequent bimonthly/monthly assessment instead of three part term examination which is large enough. Vijayan and Ponniah found that 10% students want monthly topic wise exams. A total of 84.2% students also opined that examination after each chapter is useful as it compel them to read the chapter as soon as it's over. Furthermore, the pressure of immediate grading by teachers motivates students to perform well. It also indicate them how to prepare for next examination and where they exactly fail to achieve appropriate knowledge.
When asked for suggestions to improve their existing performance, most of the students suggested increasing the case-based studies over didactic lectures, integrated teaching for more effective learning, group discussion for active participation of as many students as possible and conducting quizzes to have a healthy competitive environment and fun filled learning. There have been numerous studies,,,,,, which favored above-mentioned methods of teaching, which are widely prevalent in Western n developed countries. In India, even after 4 decades, problem-based learning is still in its infancy, and it use is limited to particular subject or topics of a few premier institutions. Departmental autonomy, attitude of faculty members, faculty shortage and lack of resources are few among many reasons behind a slow change in the direction of active, student oriented and competency-based learning. According to the medical educationist, Ananthakrishnan the shortage of medical teachers throughout India are 30% to 40% below the optimum level, which leads to unethical practices that do not meet the prescribed norms at the time of MCI inspections.
Mentor allotment is one of the old but not well-implemented concepts. We observed that 56.5% students had no idea about it and those who knew the term, could not explain its importance. It was not beneficial for them. Similarly Goyal et al. observed that 77% students did not have any idea about mentor allotment. In this fast growing and competitive era (superadded/complicated by corona pandemic in current situation), mentors can help students in answering questions, giving advice, listening to their problems and difficulties. As a more experienced person, mentors can act as critical references during medical student's journey, thereby fostering their well-being, personal and professional growth.
| Conclusion|| |
Our study has emphasized the importance of pathology as a subject for understanding clinical subjects, significance of different teaching modalities, few much needed changes in assessment criteria, and importance of an experienced mentor for an undergraduate.
Recent and rapid advancement in technology has offered many changes and challenges in medical education. We must keep exploring the innovations and modify our approach of teaching according to students need. However, such pedagogic shift from traditional didactic lectures to a need-based approach requires a fundamental change of the roles and commitments of not only educators but also planners and policy-makers.
As MCI has implemented its competency-based curriculum from 2019 batch and onward, this elaborative study can act as a baseline to access the effectiveness of new curriculum in coming years.
We would like to thank Dr. Kusum Mathor, Senior Professor and Head, Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India, for her unconditional and constant support and providing the opportunity of being with students as class in charge.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shah A, Shethwala N, Parmar B. Perception of undergraduate medical students towards the subject of pathology at one of the medical colleges of Gujarat, India. Int J Med Sci Public Health 2014;3:863.
Domizio P. The changing role of pathology in the undergraduate curriculum. In: Hall PA, Wright NA, editors. Understanding Disease: A Centenary Celebration of the Pathological Society. London: Wiley; 2006. p. 137-52.
Dick F, Leaven T, Dillman D, Torner R, Finken L. Core morphological concepts of disease for second-year medical students. Hum Pathol 1998;29:1017-20.
Vijayan P, Ponniah A. A survey study based on undergraduate medical students' feedback regarding pathology and the teaching-learning methodologies employed. Trop J Pathol Microbiol 2017;3:149-54.
Toppo NA, Lazarus M, Seth RJ, Bhargava OP, Yadav KS, Kasar PK. Introduction of integrated teaching learning module in second M. B. B. S. curriculum. Int J Contemp Med Res 2016;3:1275-9.
Bhardwaj P, Bhardwaj N, Mahdi F, Srivastava JP, Gupta U. Integrated teaching program using case-based learning. Int J Appl Basic Med Res 2015;5:S24-8.
Emerald NM, Han TZ, Oo SS. Students perception on effectiveness of pathology teaching in phase 1 medical programme at UCSI University. Int J Med Sci Educ 2016;3:264.
Al Khader A, Obeidat FN, Abu Shahin N, Khouri NA, Kaddumi EG, Al Qaqa, et al
. Medical students' perceptions of pathology and a proposed curricular integration with histology: A future vision of curricular change. Int J Morphol 2020;38:38-42.
Chowdhury RR, Kalu G. Learning to give feedback in medical education. Obstet Gynaecol 2004;6:243-7.
Goyal M, Bansal M, Gupta A, Yadav S. Perceptions and suggestions of 2nd
professional MBBS students about their teaching and learning process: An analytical study. Natl J Integr Res Med 2010;1:20-4.
Moxham BJ, Emmanouil-Nikoloussi E, Brenner E, Plaisant O, Brichova H, Kucera T, et al
. The attitudes of medical students in Europe towards the clinical importance of histology. Clin Anat 2017;30:635-43.
Epstein RM. Assessment in medical education. N Engl J Med 2007;356:387-96.
Rafique N. Introducing integrated practical examination for 2nd
year MBBS class. Proceedings in the 7th
GCC Medical Colleges Conference by Saudi society. J Fam Community Med 2009;17:17-9.
Quadri SS, Srujana S, Mahesh S, Bheeshma B. Undergraduate medical students' feedback and perceptions on teaching learning methodology in Pathology at Government Medical College. Int Arch Integr Med 2016;3:28-35.
Dandannavar VS. Effect of integrated teaching versus conventional lecturing on MBBS phase I students. Recent Res Sci Technol 2010;2:40-8.
Nikam LH, Chopade SV. Introduction of horizontal integration and comparison with traditional teaching methods in physiology. Int J Basic Med Sci 2012;3:143-7.
Bhattacharya N, Shankar N, Khaliq F, Rajesh CS, Tandon OP. Introducing problem-based learning in physiology in the conventional Indian medical curriculum. Natl Med J India 2005;18:92-5.
Singh A. Student performance and their perception of a patient-oriented problem-solving approach with audiovisual aids in teaching pathology: A comparison with traditional lectures. Adv Med Educ Pract 2011;2:9-15.
Ananthakrishnan N. Medical education in India: Is it still possible to reverse the downhill trend? Natl Med J India 2010;23:156-60.
Bellodi PL. Mentors, students, and the undergraduate medical course: A virtuous circle. Rev Bras Educ Med 2011;35:382-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]