Small group discussion for medical students to learning embryology

Introduction

Education and learninghave changed and developed at different Iranian universities inrecent decades, but lecture base was used more for education of basic medical courses (1). With the increasing number of students in our universities the conventional education does not responds to all the desired and educational needs. Thus, in our department we tried to reduce the lecture in embryology course and replace it with new educational method.

For medical students the learning of the human medical embryology as a basic science is a particular importance (2) . In our university, the embryology is educated in the first semester of school training and in most cases, students complain of how to teach this course. Medical students must acquire the necessary knowledge and experience the essential skills to reduce the birth defect and should help to improve the health of women and babies (2). Knowledge of normal and abnormal prenatal human development has provided the scientific basis to the medical student to understand the birth anomaly (3).

In the past two decades, the advance technology such as three-dimensional imaging of living organisms, scanning the living body, plastic models and plastination are widely used in anatomy education (3). Despite the many beneficial of this technology, damage associated with surgery increased by doctors and surgeons due to compromising the quality of training medical courses (4). Different methods in many medical colleges, such as group discussion, problem solving and brain storming were used for medical students to learning embryology (5, 6).

Small group teaching is a low-cost, simple, repeatable, interactive, and friendly and has important effect in learning and team working (7). More study has shown that the group discussion plays an important role in the improvement of student's communication skills, active participation in class and improve the attitudes of students toward the friends, teachers and class (8). In the group discussion, students have opportunity to working together and practice course concepts during the class-time (9).

 For the success of the small group, different supplementary methods were suggested such as discussion group, brain storming, problem base learning and role playing (10). Each member must be accountable for his share of the group and is responsible for completing the assignment (11). Active participation, tasks clarification and evaluation are important for successful group (12). So, in our department this study conducted to determine whether SGT could improve attitude and the knowledge of medical embryology course in medical students in compare to the LBL.

Methods

Consent for this study was approved by the Yasuj University of Medical Sciences in Iran and informed consent of 72 medical students in embryology course, in thesecond semesterof the academic year 2014-2015. The first session was dedicated to the expectations from this method of teaching, preparation for the team discussions and role division of the members in the group.

 Seventy two medical students were participated in this study and randomized equally to the SGD (group I) vs. usual LBT (group II) in general embryology. As shown in table 1, in systems-based embryology the position displaced for both groups.

Table 1. The position of student groups in embryology course

A same pre-test were used for both group at the beginning of the term to assess the embryology knowledge of the students. Then, the SGT (n=36) was organized into permanent subgroups (for the entire term) including three equal groups of 12 students. As shown in table 2, for preparing students for each session 20 reusable learning objects (RLOs) were designed from different parts of theembryology course for both groups. Each RLOs were available before each session for the students and they were uploading by tablet and computer. Each group of SGT and LBT students attended 2 hours per week for 17 sessions for embryology course during the semester.

 For the SGT in the first stage,students started in each session of two hours with MCQ quiz (10 min)test based on content of the RLOs and text book (eleventh edition of Langman’s medical embryology) as individuals. The quizzes were scored and made available to the group facilitator and provided for observing student’s problem to provide appropriate feedback when warranted. In the second stage, participant group ask to discuss the learning issues (60 min). During this time the team facilitator observed all members participation on issue, give explanation when the participants have problem. Team facilitator (TF) was responsible to listen to the students with designed probing questions encourage opinionduring phase of free discussion in learning issues. In the third stage, each group retook second exam (15 min) and they could share information to answer the questions. The exam were scored and feedback to each team. Two exam including midterm and final exam were used respectively for general and systems-based embryology to assess the medical embryology knowledge of the SGD group compares to the LBT students. The exams were the same for both groups and included multiple choice quizzes, blank space and short answer questions. A questionnaire was designed to assess the attitude of the student about the SGD. The validity of the questionnaire was confirmed by experts’ opinions, and its reliability was measured by Cronbach's alpha.This questionnaire consisted twelve items in differentvariable including; learning (1, 2), effective interactivity (5, 11), interest (3, 4, 7), understand the clinically relevant (6, 8), student preparation (9, 10) and RLOs support learning (12). Each question had five Likert scale responses (including 5 score from 1 to 5, Scale: 1, strongly disagree; 5, strongly agree), (table 2).

Table 2. List of RLOs of embryology course

Results

From 72 students in both groups 69 participants (34 from group I and 35 of group II) completed all exams and considered for data analysis. There was not a significant difference between the group I and group II in the first exam of embryology knowledge before the beginning of the course. As shown in table 3, the scores increased 51.5% (the 20 score were considered the 100% and the other scores were compared to this score) in group I (SGD) from the pretest (32%) to 83.5% to the mid exam in general embryology course. The score increase 35% from pretest to the mid exam for the general embryology course in group II (LBT). Independent t test showed the score significantly higher in group I compared to the group II in general embryology (mid exam), (p<0.001). In the systems-based embryology course (Table 3), the score in the group II that worked as SGD was significantly higher compared to the group I that worked as LBT (p<0.05).

Table 3. Embryological knowledge (mean ± SD) scores in both groups

Pre test, at the beginning of the term; mid exam, general embryology; fail, below 10; pass, above 10; Final exam, especial embryology. ^*p¥p

Analyzing data of the questionnaire demonstrated students (90%) agreed or strongly agreed the SGD was effective in learning and they (88%) agreed it was useful to improve understanding of the medical embryology. Nearly 96% of them agreed that the SGD create favorable interactivity among student and 82% were interested to use this method in next term for other course. Ninety eight (98%) agreed or strongly agreed that the use of RLOs were easy and useful for embryology learning (table 4).

Table 4.The Descriptive and ANOVA Results (Scale: 1 = strongly disagree; 5 = strongly agree)

Discussion

Knowledge of the developmental stages during embryogenesis are the scientific basis to understand both normal and abnormal structures. Some medical colleges in Iran are young which have different problems in the infrastructures for medical students training. These colleges had experiences of thetraditional lecture method for nearly two decade.In most cases in different medical schools, embryology course is presented as a lecture-based course without laboratory. In lectures based teaching in most cases bored and fatigue was seen on the faces of the students. Therefore, change of education methods for improved learning of different medical courses seemed necessary.Hence, in our department the new educational method and e-Learning support services were used for better learning of anatomy course but less attention has been for medical embryology course. It has been shown that group discussion can be done with low-cost and high beneficial (13). For this purpose, in our department space forgroupingwas designed with access ofcomputer andliquid crystal display (LCD). All member group sat around a table so that, each student visible and verbal communication was clear to others members of the team. To prepare students in each session 25 numbers of RLOs were designed from different part of embryology and were made ​​available to students. This educational tool was free for students and they can use them whenever they like. RLOs have great benefit to learn the reuse, self-paced learning and could support student for preparing and active participation in class (14). Medical embryology has plentiful of factual content and RLOs as an information object could help the students to remembering them. So we focused on the threads of the RLOs that contain general subjects, important points and key items of each topic and these contents were supervised by our course coordinators. Other study suggested the RLOs were easy to use, low cost and is efficient to preparing the students for each session or exam (15).

Result revealed that SGD was more effective than the LBT for students to achieve higher scores in the midterm and in the final exam of medical embryology. Different factor such as improved of quality of RLOs, exam and use of clinical application in discussion group might contribute in enhanced learning and performances of the medical student in SGD. Further, the supplementary teaching materials such as, radiographic films and computerized resources were used in SGD and for self study after group teaching. We found appropriate content along with proper and shortassessment in each session have important role in improving the learning of this course.

 All participants studied the RLOs before each session and they were prepared for active participation in discussion group.Furthermore, our result revealed the SGD improved the interpersonal, interactivity and communicative skills that these features are very important for medical professionals. SGD has potential to create the academic environment, and provides appropriate time to share the responsibility and critical skills (16).

SGD method could generate to increase intellectual experiences and great deal communication which is impossible in a lecture hall (16). In small group teaching all student have opportunity to participate in the discussion and feedback from their view in the group and revise their position (17). The group facilitator sets out purposely clinical questions to create individual activity for participation and interaction between all of the students. Different questions of clinical cases werepart of agroup discussion in eachsession. For example, are cranial suture important in any abnormalities?A newborn infant has difficult in swallowing, what abnormalities might produce this problem? A child is born with ventricular septal defects, should you be concerned about any other abnormalities?These clinical problems solving generated more motivated for group discussion and the causes that they were interested to the clinical embryology.

SGD increase knowledge student of medical embryology course and understand the clinically relevant of human embryology. They discuss, tolerate and help each other to solve the problems via making decisions.Group session is efficient for learning, critical thinking, improve student’s team work and make more satisfaction of their course. Theyhad better interactivity and presentation with the increase of confidence.