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SREEVANI - BIOCHEMISTRY - SIDDHARTHA VIJAYAWADA
Improvement
of Quality Education in Biochemistry
INTRODUCTION
Quality
in medical education is reaching high standards with transforming force for
fulfilling the vision and mission of an institute in the delivery of health
care. Standards can be achieved in education by complete transformation of an individual
who can possess good morals, ethics, ideal human being qualities and developing
passion towards course. Syllabus which is being followed now should have
different curriculum. Biochemistry for medical students should be divided into
basic Biochemistry and clinical Biochemistry. Basic Biochemistry can taught as
1st year MBBS curriculum and clinical Biochemistry should be taught
in part -1 final year so that students
will be able to correlate the biochemical test values with the clinical
conditions. As the students of 1st year are unaware of the clinical
conditions, students are not in a position to correlate the test values with
the clinical condition which is the most important part in the clinical
diagnosis and in the management of the disease. In my view stress on clinical biochemistry
should be done in part -1 final MBBS for a better correlation and understanding
the importance of the different tests in the clinical diagnosis.
MATERIALS AND METHODS
The present
study enrolled 200 students from Siddhartha Medical College, Vijayawada. All
the students selected were divided into two groups. In group A, 100 students were
selected from 1st year and in group B, 100 students were selected from
final year batch. The students were explained about the purpose of the study
and importance of inclusion of clinical Bio-chemistry in final year. All the
200 students were asked to give their opinion to questionnaire provided to
them. The same questionnaire was provided for both groups. The feedback from
both groups was collected and results were analysed.
Questionnaire for 1st & final year
students
|
Variables
|
Agree
|
Moderately Agree
|
Disagree
|
|
Importance
of biochemistry in clinical diagnosis
|
|
|
|
|
Change
of curriculum
|
|
|
|
|
Inclusion
of clinical biochemistry in final MBBS
|
|
|
|
|
Clinical
lab postings in diagnostic wing
|
|
|
|
|
Interpretation
of test values in clinical diagnosis
|
|
|
|
|
Improves
patient outcome
|
|
|
|
|
Strength
and learning abilities
|
|
|
|
|
Interesting
|
|
|
|
|
Waste
of time
|
|
|
|
|
Develops
passion for course
|
|
|
|
|
Reasoning
skills
|
|
|
|
|
Self
study skills
|
|
|
|
RESULTS
The study
included 200 students. Out of which 100 students were selected from 1st
year and 100 students from final year batch. The same questionnaire was
distributed among both groups of students. Among the students 98% in group A and 95% in
group B agreed the importance of Biochemistry in clinical diagnosis. Regarding
the change of curriculum, 84% in group A and 93% in group B has agreed for
change of curriculum. The importance of
including clinical Biochemistry in 1st part of final year
MBBS was assessed among the students. As most of the students forget the
procedure of doing the biochemical tests and at that level students not aware
knowing the importance of correlation of test values with clinical diagnosis,
the above parameter was assessed among both groups of students. The study
showed 80% of students in group A and 98% of students in group B students
wanted the inclusion of clinical Biochemistry in part 1 final year as it may be
useful in correlating the values with clinical diagnosis. Moreover 97% group A
and 90% group B are interested to attend diagnostic wing to perform laboratory
tests rather than doing tests only in medical college laboratory as they may
get better exposure. Students of both groups had a opinion of better interpretation
of test values in clinical diagnosis if they were taught clinical Biochemistry
in part 1 final MBBS rather than teaching in 1st year MBBS and none
disagreed. As most of the students are new to the subject at that level they
may not be knowing all the clinical conditions and the importance of test
values in diagnosing the clinical condition hence they thought 80% in group A
and 99% in group B will be interesting to know the subject if they were taught
clinical Biochemistry in part 1 final MBBS. Most of the students agreed that
change in curriculum may increase the learning and interpretation abilities and
they thought that there is no question of waste of time. 100% of students in
both groups thought that if the subject was taught in interesting manner by
audio visuals and by microteaching, there is every chance for improvement in
reasoning skills and developing passion for course.
DISCUSSION
Quality
education in the subject Biochemistry is essential in the medical education as
this subject in taught for 1st year MBBS students. The present
practice of teaching entire Biochemistry in 1st year is not a good
idea as most of the students are unable to understand the subject. Moreover by
the time students enter final year most of students either forget the subject or
unable to interpret the test values which is essential in the diagnosis of
clinical disease. Hence it is the time to change the curriculum in the medical
education. In my opinion the clinical part and how to interpret the test values
in clinical practice has to be taught in part 1 final MBBS. The present study
also revealed the importance on inclusion of clinical Biochemistry in final
year.
Advantages:
1. Better
understanding of the subject in final MBBS curriculum
2. Better
interpretation of subject in clinical diagnosis
3.
Less burden on students as some
part of subject is taught in final MBBS.
4.
Develops the reasoning skills and
strengthens the learning abilities
Disadvantages:
1. Entire
subject may not be covered in 1st year MBBS
CONCLUSION
Teachers
should play a role model in obtaining skills and increasing the aptitude toward
the subject which are vital. The majority of students showed interest in
changing the curriculum and it should be done as early as possible. Though
modern medicine has placed additional demand but that should not be the reason
to abandon traditional teaching methods. Facilitators should increase their
efforts to inculcate the curiosity for acquiring additional knowledge and also
improve skills by playing as a role model. Teachers should assess the students
IQ and adjust their teaching plans accordingly. Teachers should teach with
dedication and make them understand the subject rather than just completing the
class. Standard/ Quality of education is possible only by microteaching.
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P.G. DEOTALE - ASRAM - ELURU
A study on restructuring of existing MBBS curriculum in India
Dr.
P.G. Deotale, Professor
& HOD, Department of Community Medicine, ASRAM Medical College, Eluru, West
Godavari Dist. Andhra Pradesh, Email: Deotale.spm@gmail.com
ABSTRACT
Student’s opinion regarding any
curriculum is a recommended part of its evaluation. So a cross sectional
Study was conducted among the interns of
Alluri Sitarama Raju Acadamy of Medical Sciences, Eluru, West Godavari
District, Andhra Pradesh. The study objective was to assess the opinion of the interns
regarding various aspects of MBBS
Curriculum and to identify lacunae. Out of 128 interns, majority (89%)
thought MBBS Duration is sufficient. 53% feel that sociology, demography,
Environment health and computer learning is essential in first MBBS, 88% satisfied
with the Internship one year duration, 93% wants to restructuring the
curriculum.
Key words: medical
curriculum,
assessment, restructuring.
INTRODUCTION:
The word curriculum derives from
the Latin Currere meaning ‘to run’. Curriculum refers to a series of planned
activities that are intended to bring about specific learning outcomes. It is
the blue print that entails the goal of any educational activities and
endeavors to achieve the goal1. Curriculum development is a
comprehensive term that includes the processes of curriculum design,
implementation and evaluation2. It is also specialized task
which requires systematic thinking about the objectives to be achieved,
learning experiences to be provided, evaluation of changes brought out by the
curricular activities. Today the definition is much wider and includes all the
planned learning experiences of a school or educational institutions1.
In recent years, medical educations in developed and developing countries have
undergone profound changes. To cope with these changes, medical schools around
the world have attempted to make their curricula more meaningful and relevant
to the needs of the time and to produce doctors oriented to the real needs of
the community.
Medical
education in MBBS has undergone radical changes, in its volume, content, course
duration and students‟ evaluation (examination) but not
judiciously3. Students‟ opinion regarding any
teaching curriculum is a recommended part of the evaluation of teaching
learning process and is aimed at achieving the desired objective(s)4. The medical colleges in
India have traditionally followed a curriculum stuffed with a large body of
knowledge pertaining to basic science and clinical disciplines. Once qualified,
students are expected to synthesize this information and apply it to the care
of the patients. With the expanding body of knowledge, there is over-burdening
of the student with the content information. In order to grapple with this
problem, it is essential to define the core content which every student ‘must
learn’, things that are ‘useful to learn’ and ‘nice to learn’ but do not need
the same emphasis.
Medical
colleges in India have adopted a pattern of one year of basic sciences, 1 ½ years
of para-clinical sciences and 2 years devoted entirely to clinical disciplines.
A move towards integrated teaching is likely to reduce the fragmentation of the
medical course, and motivate students of the medical course, and motivate
students for better learning. Problem based learning approach has been found to
be a useful and effective educational strategy to produce graduates who are
good problem solvers. This approach also underlines ‘learning how to learn’ and
stimulates self-directed learning as a central, pervasive objective of the
teaching –learning process in undergraduate medical education. Every medical graduate should appreciate that
learning is a continuous process and one should periodically update one’s
knowledge.
The
development of these skills needs to be strengthened by introducing a clinical
clerkship (where students actively take part in the management of patients) and
reinforces during the internship. It is commonly observed that the period of
internship is not effectively utilized to develop and refine these skills. This
period is more often utilized for preparation of postgraduate entrance
examinations.
MATERIALS & METHOD
Total
128 interns were included in the study. A self administered questionnaire was prepared
based on the basic process of medical curriculum i.e. learning objectives,
course content/syllabus/ learning methods. The house surgeons were explained
the purpose and method of the study. Analysis was done by the simple proportions.
RESULTS: Out of 128
house surgeons 86 were girls and 42 were boys.
Chart
1:
Distribution of study subjects according
to their main responses:
Sl. No.
|
Topic
|
Responses
|
No.
|
%
|
1
|
Duration of MBBS
|
More
|
10
|
7.5
|
Sufficient
|
114
|
89
|
||
Less
|
2
|
1.5
|
||
No comment
|
2
|
2
|
||
2
|
Need to study MBBS
|
To serve Community
|
47
|
37
|
To earn Money
|
13
|
10
|
||
To have good social status
|
61
|
48
|
||
Unknown
|
7
|
5
|
||
3
|
Need for restructuring
the curriculum
|
Yes
|
119
|
93
|
No
|
9
|
7
|
||
4
|
Commercialization of medical
profession will affect the quality
|
Yes
|
119
|
93
|
No
|
9
|
7
|
||
5
|
Syllabus / course
content
|
Excess
|
28
|
22
|
Irrelevant
|
4
|
3
|
||
Satisfied
|
93
|
73
|
||
Inadequate
|
3
|
2
|
Regarding
the need of studying MBBS course, the important responses were to serve the community
(37%), to earn money (10%) and to achieve a good social status (48%), 5 % could
not specify any reason. When asked about the duration of MBBS, 7.5% said that
duration of 51/2 years was more, 89% said it was sufficient, 1.5% said duration
was less and 2% did not say anything. When asked about the restructuring of the
curriculum 93% said yes and 7% said there is no need to restructure. Regarding
the commercialization of medical profession will affect the quality, 93% said
yes and 7% said no. when asked about the syllabus / course content 73% were
satisfied, 22% said excess, 3% said irrelevant and 2% said inadequate.
Distribution of study subjects according
to their opinion regarding inclusion of topics in the present syllabus:
Sl.No.
|
Topic
|
Responses
|
No.
|
%
|
1
|
Subject in first year
|
same
|
58
|
45
|
should change
|
70
|
55
|
||
2
|
sociology, demography, environmental health and computers essential
in first year
|
yes
|
68
|
53
|
No
|
60
|
47
|
||
3
|
early clinical exposure of surgery and OBGY essential
|
yes
|
127
|
99
|
No
|
1
|
1
|
||
4
|
case discussion essential
|
yes
|
125
|
98
|
no
|
3
|
2
|
||
5
|
Duration of Case discussion
|
1 hour
|
9
|
7
|
45 min
|
100
|
78
|
||
30 min
|
19
|
15
|
||
6
|
Duration of second year
|
1 1/2 year
|
37
|
29
|
1 year
|
91
|
71
|
||
7
|
Second year integration with clinical cases
|
yes
|
128
|
100
|
no
|
0
|
0
|
||
8
|
Duration of final MBBS
|
1 1/2 year
|
45
|
35
|
1 year
|
83
|
65
|
||
9
|
Duration of internship
|
1 1/2 year
|
6
|
5
|
1 year
|
113
|
88
|
||
9 months
|
9
|
7
|
When asked about the topics in the first
year syllabus, only 45% did not want any change while 55% opined the necessity
of change in the syllabus. 53% feel that sociology, demography, Environment
health and computer learning is essential in first MBBS. When asked about the
early clinical exposure of surgery and OBGY 99% were said yes, 98% were preferred
case discussion, 78% of house surgeons preferred at least 45 minutes time for case discussion, when asked about the
duration of second year 71% opined one year time is enough, 99% want
integration with clinical cases in second year. When asked about the final MBBS
duration 65% feel that 2 years is long. 88% house surgeons prefer one year
duration of internship.
Discussion:
Evaluation
of any curriculum by students is extremely logical and integral part of
teaching –learning process3. Altogether 128 interns were
interviewed from Alluri Sita Ramaraju Academy of Medical Sciences. The
commonest reason stated for joining the MBBS course was to have good social
status in the community (48%) and closely followed by the intension to serve
the community (37%), and followed by expected financial reward (10%), Similarly
a study done earlier revealed that (23.3%) thought that it improves the social
status by being a doctor. 70% students joined medical course to serve the
community and 57 % said that it offers good financial reward5.
This study revealed that majority (73%) of the interns are satisfied with this curriculum in
similarly the studies done previously reported in favour of present MBBS curriculum6-9. Opinion of majority interns
were same about duration of MBBS, they feels the present duration is sufficient as in studies done by earlier8,9. Rest of the intern’s i.e feels course duration is more. Majority of
interns were satisfied (73%) with syllabus / course content. The study reveals
that 93% of interns were in favour of need for restructuring the curriculum.
The study done by Abu Syed Md Mosaddek et.al (2012)10revealed that 51% of intern doctors were in favour of need
changes of MBBS curriculum.
Conclusion:
Health
care service cannot be improved unless the educational process of the medical
education that produces the doctors and other health personnel are improved.
The physicians and students today are more concerned about the existing
undergraduate curriculum. So evaluation of curriculum periodically and
restructuring is necessary to the needs of the students and the community.
References:
1.
Prideaux D. Clinical
review: ABC of learning and teaching in medicine curriculum design, B M J 2003;
326: 268-70.
2.
Wong AK. Curriculum
development in anesthesia: basic theoretical principles. Canadian Journal
ofAnesthesia 2006 (53) 950-60.
3.
Biswas R. Training in Community
Medicine. Indian Journal of Public Health, 2006; 50(3), 135.
4.
Srinivasa DK, Curriculum planning, In:
Medical Education: Principles & practice; Consulting editor: Srinivasa DK.
1995; 165-171.
5.
World Health Organization. Aspects of
medical education in developing countries. Public Health Papers,1992; 47,17.
6.
Ali T, Begum N, Begum AA,
Shamim KM, Ferdousi S, Bennoor KS. Summative Assessment (Written) in
Undergraduate Physiology Curriculum in Bangladesh: Refelction of educational
objective. J Bangladesh Soc Physiol. 2008;3:61-65.
7.
Talukder MHK, Hossain MZ,
Hanif MA, Akther N, Perveen IA. Reviewing and Updating of MBBS Curriculum 2002:
Intern Doctors' Views. Bangladesh Journal of Anatomy January 2011; 9(1): 35-40.
8.
Alam KK, Nargis T, Khan
TF, Kasem MA, Faruque M. Need Assessment for Undergraduate Medical Curriculum of
Bangladesh Through exploring the views of government primary health care
doctors. Bangladesh J.Anat.2009;7(2):87-93.
9.
R Nazneen, HK Talukder, MZ
Hossain. Student's Opinion towards the Assessment System of Revised
Undergraduate Medical Curriculum An Experience in A Private Medical College. J
Bangladesh Coll Phys Surg 2010; 28: 151-156.
10.
Abu Syed Md. Mosaddek, Waheed Nargis.
Views of Medical Educators and Interns Doctors on the Existing MBBS Curriculum.
Bangladesh Journal of Medical Education.Vol.-3, Issue-01, 2012.
Acknowledgement:
I thank the management and Interns for their cooperation for the work and Mr.
Rama Mohan Chandrika, Statistician Cum Lecturer, and Uma Mantena, Medical
Social Worker for their support.
********************HIMABINDU - RIMS ONGOLE -
NOVEL
APPROACH IN UNDERGRADUATE PHARMACOLOGY TEACHING
Hima
Bindu Gujjarlamudi, Asst.Professor,
Dept.of Pharmacology, Rajiv Gandhi Institute
of Medical Sciences, Ongole
Background:
Teaching clinical pharmacology to undergraduate medical students improves
rational prescribing of medicines. As pharmacy and animal experiments are
slowly finding their way out, pharmacology is becoming more of passive
learning. It emphasizes more on knowledge rather than on the acquisition of
skills. To make the subject attractive and useful, drug display album (DDA) was
started. The main objective is to involve students actively in learning the
subject.
Method: This
was conducted in dept. of pharmacology, Rajiv Gandhi Institute of Medical
Sciences, Ongole, Andhra Pradesh. 3rd semester MBBS students were
asked to prepare Drug display album (DDA) which consists of three sections. Students
can select any drug of their choice. In the first section the selected drug
package is well displayed on a sheet with one of the tablets/capsules opened up
so as both sides are visible showing monogram/ division mark. The complete information
given on the drug label, including abbreviations are expanded along with its
relevance. The second section deals with drug chemistry, mechanism of action,
pharmacodynamics, indications and adverse effects. In the last section they
mention various dosage forms in which the drug is available along with its
doses.
Observation: A questionnaire was given to know usefulness
of this exercise. 84 students participated in this questionnaire
Poor
|
Average
|
Good
|
Very good
|
|
Stimulated interest
|
1
|
11
|
39
|
33
|
Motivates learning
|
2
|
9
|
39
|
34
|
Understanding subject
|
12
|
46
|
26
|
|
Retention of subject
|
22
|
38
|
24
|
Maximum students found this
exercise useful.
SU: slightly useful; MU: moderately useful; VU:
very useful
Will you recommend this exercise?
Discussion: As
pharmacology is treated as one of the driest and boring subjects to read and
memorize, significant learning environment must be created to enhance the
interest. When all the albums are presented by the students in the class, each
student is exposed to all the preparations. . The information on first section enhances
their familiarity to the label instructions drug schedule, precautions,
pharmacopoeias. The second section increases the knowledge of pharmacology of
particular drug and also the entire category.
In the last section various formulations are added. Knowing the
availability of various drug formulations of the same drug like extended
release enteric coated, helps in selecting the appropriate one to the patient
and the disease.This exercise stimulated the interest in learning and
understanding the subject. 89% students found this exercise very useful and
recommended to repeat once in fortnight with different drugs.
Conclusion: Undergraduate
pharmacology teaching is now becoming demonstrations which lack actual
involvement of students in learning process. This can be reduced by various
possible new teaching tools of which DDA may be one.
Picture showing Drug Display Album
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