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Ansari M, Mufti AUR, Khan S Medical students' perception about teaching-learning…

http://www.mednifico.com/index.php/elmedj/article/view/54 Vol 2, No 2

Open Access Original Article

Medical students' perception about teaching-learning and academic performance at Nobel Medical College, Biratnagar, Nepal Mukhtar Ansari1, Attique Ur Rahman Mufti2, Salman Khan3

Introduction Teaching-learning is a crucial component of any academic activity. It is vital to have an effective teaching-learning for better performance of students. There may be various factors contributing to the quality of teaching-learning such as teaching-learning methods and envi-ronment, class size and duration of teaching. More supportive the teaching-learning environment and satisfaction of the teachers and students, the better the outcome [1]. Class size and duration of teaching also affect the performance of students. Smaller the class size and shorter the duration of teaching, the better the quality and performance of the students [2, 3].

Apart from these, students’ centered factors such as difficulty in un-derstanding, the medium of instruction, psychological pressure, background of the student and self-assessed depression also affect their performance [4]. Modern methods involve a participatory ap-proach of teaching-learning such as Problem Based Learning (PBL) and small group discussions, which are more suitable than lecture based teaching [5, 6]. Moreover, a lecture combined with discussion is more relevant than conventional lectures. Lectures mainly facili-tate to recall facts, whereas discussions not only produce higher level comprehension but also encourage students’ active participation and self-confidence [7, 8].

In Nepal, medical education is a highly demanded and respected field of education. Students in Nepalese medical schools are enrolled through three different mechanisms such as through passing the en-trance examinations conducted either by the Ministry of Education, Nepal or the respective universities, or through direct enrollment of foreign students without entrance examinations. Hence, students’

1National Medical College Teaching Hospital and Research Centre, Nepal 2University Kebangsaan Malaysia, Malaysia 3Nepalgunj Medical College, Nepal

schooling preceding medical school matters for their medical school-ing performance [9]. In general, the quality of medical education in Nepal is somewhat dubious. There may be several factors but stu-dents’ premedical schooling background, quality of teaching-learn-ing and examination system are utmost. Quality of education during students’ life reflects the quality of care/treatment in their profes-sional life. More effectively the students learn and grasp the things today, the better they can perform tomorrow in their professional life [10].

The objective of this study was to gather students’ opinion about teaching-learning activities at Nobel Medical College, Biratnagar, Ne-pal and to suggest improvements in the quality of teaching-learning activities.

Materials and Methods

Design

The study was a cross-sectional and descriptive in nature.

Study duration and location

The study was carried out during February and March 2012 at Nobel Medical College, Biratnagar, Nepal. Nobel Medical College is a private medical college in the eastern region of Nepal and is affiliated to Kathmandu University (KU), Nepal.

Study population

The participants of the study were medical (MBBS) students of sec-ond, fourth, sixth, seventh and ninth semesters. At the time of study, first, third, fifth and eighth semesters did not exist. Therefore, stu-dents of second, fourth, sixth, seventh and ninth semesters were only

Correspondence: Mukhtar Ansari Email: [email protected]

Abstract Background: Effective teaching-learning is an important prerequisite for academic excellence. The study was aimed at determining students’ perception about the effectiveness of teaching-learning methods and improving the academic performance. Methods: This cross-sectional study was carried out among 385 medical students of Nobel Medical College, Biratnagar, Nepal during February and March, 2012. The instrument used was a self-administered pretested questionnaire containing both closed and open ended questions. The questionnaire was distributed among the students and their responses were collected and entered in SPSS 11.5 for windows (Chicago Inc) for analyses. Results: Nearly two third (64%) of the students were male and majority (61%) of the students were from three zones such as Bagmati, Koshi and Janakpur of Nepal. Small group interactive discussions (64%), Problem Based Learning classes (65%) and use of multimedia were found the most effective approaches for improving the academic performance. Burden of multi-subjects (53.5%), lack of seriousness (28%), irregular study habit (17.4%) and fears of examinations (85%) were found the major causes of students’ poor performance in examinations. There were statistically significant association between gender and fortnightly class test as a factor for improving academic performance (p<0.001), use of transparency projector and power point projector as important means of teaching methods (p=0.010, 0.009) and studying many subjects as a reason for poor performance (p=0.030). Conclusion: Multimedia combined with Problem Based Learning and small group interactive discussions were found the most efficient approaches for better academic performance. (El Med J 2:2; 2014) Keywords: Academic Performance, Medical Colleges, Medical Students, Nepal, Teaching-learning



included in this study. The total duration of MBBS course is of four and half years i.e. nine semesters and each semester comprises of six months. Basic medical science subjects such as pharmacology, phys-iology, pathology, biochemistry, microbiology, anatomy and com-munity medicine are taught during the first two years of the course. The latter two and half years are allocated for teaching clinical sub-jects such as medicine, surgery, pediatrics, obstetrics and gynecol-ogy, orthopedics, ENT, ophthalmology and dermatology.

Sample size and sampling procedure

A sample size of 385 subjects was recruited in the study. Nobel Med-ical College has a history of about five years. Only 60 seats were per-mitted by the Nepal Medical Council for admission in the first batch and the numbers of seats allocated were gradually increased to 100 and 150 for second batch and third batch, and onwards. Therefore, there were variable numbers of students in various semesters. Cen-sus method was adopted for sampling the subjects but responses were received only from 385 subjects.

Instrument

The instrument was a pretested self-administered questionnaire con-taining both closed as well as open ended questions concerned with the objectives of the study.

Procedure

The instrument was pretested among 10 randomly selected subjects and necessary amendments such addition of options and modifica-tion of questions were made. The modified version of the question-naire was distributed among the students and their responses were gathered. Before collecting the data, students’ consents were taken and they were informed to express their responses independently as they perceive or think. The study received ethical clearance from the Research and Ethics Committee of Nobel Medical College, Biratnagar, Nepal.

Data analyses

The data for closed ended responses were pre-coded in the ques-tionnaire, whereas data for open ended responses were coded latter. The data were entered in SPSS 11.5 for windows (Chicago Inc) and analyzed for descriptive and inferential statistics.

Results Nearly two third (64%) of the students were male and majority (48%) of the students belonged to the age group of 20-21 years. Location wise, about 61% of the students were from three zones such as Bag-mati, Koshi and Janakpur of Nepal. Looking over the parents’ occu-pation, most (42%) of them were involved in business and official works. About two thirds of students were from 2nd and 4th semesters and the remaining students were from 6th, 7th and 9th semesters. De-tails of demographic characteristics have been shown in Table 1.

Table 2 illustrates students’ emphasis mainly on two components such as regular interactive discussions and Problem Based Learning (PBL) classes to have better impact on improving academic perfor-mance of the students. However, majority of the students did not stand in favor of any type of examinations such as surprise test, fort-nightly test or monthly test.

Table 1: Demographic characteristics of medical students of Nobel Medical College, Biratnagar, Nepal (n=385) Characteristics N (%) Gender Male 247 (64.2%)

Female 138 (35.8%) Age 18-19 years 71 (18.4%)

20-21 years 184 (47.8%) 22-23 years 92 (23.9%) 24-25 years 38 (9.9%)

Origin of Students

Bagmati 94 (24.4%) Koshi 82 (21.3%) Janakpur 58 (15.1%) Sagarmatha 40 (10.4%) India 25 (6.5%) Others 86 (22.3%)

Parents’ Occupation

Business 93 (24.2%) Official Works 68 (17.7%) Farming 49 (12.7%) Teaching 44 (11.4%) Government Job 41 (10.6%) Doctor and Other Health Professionals

25 (6.5%)

Others 65 (16.9%) Table 2: Medical students’ perception about the techniques to improve their academic performance (n=385) Particulars Yes (%) No (%) Surprise class test 59 (15.3%) 326 (84.7%) Regular interactive discussions 246 (63.9%) 139 (36.1%) Fortnightly class test 143 (37.1%) 242 (62.9%) Monthly class test 57 (14.8%) 328 (85.2%) Regular practical viva-voce 199 (51.7%) 186 (48.3%) Regular PBL classes 249 (64.7%) 136 (35.3%)

Table 3 explains the students’ views toward teaching-learning meth-ods. Among the five teaching-learning approaches investigated, dic-tating lecture notes was found not effective or the least effective. On the other hand, use of multimedia (power point projector) was opined as the most effective method of teaching-learning approach.

Table 3: Medical students’ opinion about different teaching-learning methods (n=385) Teaching medium/methods Not Effective (%) Just OK (%) Effective (%) Most Effective (%) Use of black board & chalk 66 (17.1%) 156 (40.6%) 102 (26.5%) 61 (15.8%) Use of white board & marker 44 (11.4%) 96 (24.9%) 154 (40.0%) 91 (23.6%) Use of transparency projector 56 (14.5%) 147 (38.2%) 124 (32.2%) 58 (15.1%) Use of PowerPoint projector 27 (7.0%) 72 (18.7%) 153 (39.7%) 133 (34.5%) Dictating lecture notes 158 (41.0%) 98 (25.5%) 91 (23.6%) 38 (9.9%)



Table 4 illustrates students’ perception about teaching 150 students in a class. Although students had mixed opinion about teaching a large number of students in a class, larger fraction of students artic-ulated that handling such a large class is difficult and students mainly of back rows have to suffer. Therefore, the class should be broken into two sections.

Table 4: Medical students’ opinion about difficulties in teaching large class size (n=385) Particulars Yes (%) No (%) Handling of class is difficult 232 (60.3%) 153 (39.7%) Class becomes non interactive 197 (51.2%) 188 (48.8%) Students of back rows have to suffer

229 (59.5%) 156 (40.5%)

Class should be broken into two sections

230 (59.7%) 155 (40.3%)

Students’ perception about conducting fortnightly written test and seminar

About 60% of the students were in favor of conducting both fort-nightly written tests as well as seminars as they help in self-assess-ment of the students and increase their confidence level. On the con-trary, about 40% of the students opined to have either fortnightly written tests or fortnightly seminars but not the both.

Students’ perception about poor performance in fortnightly written test

Although an array of views emerged out about the poor perfor-mance of the students in fortnightly written tests, the crucial factors were dealing with many subjects at a time (53.5%), lack of serious-ness in study (28.1%), lack of regular study habit (17.4%), ineffective teaching (7.0%) and vast syllabus (4.2%).

The association of gender, origin of the students and their parents’ occupation with students’ perception about improving academic performance, teaching-learning methods, teaching large class size and fortnightly tests and seminars respectively were calculated. However, statistically significant associations were found only in the cases depicted in Table 5.

Discussion The objective of this study was to explore medical students’ percep-tion about teaching-learning activities and to suggest improvements in academic performance at medical schools. In Nepal, medical edu-cation is a highly attractive profession and the quality of teaching-

learning activities is one of the most important factors for quality medical education [11]. Nearly two third (64%) of the students were male which indicates either males are more directed or parents pro-mote their sons more compared to daughters towards medical edu-cation.

At the time of enrolment in first year of MBBS, the minimum age of the students in general was 18 years or more and about three fourths of students were from first two years of the course. This may be the reason for large fraction of the students representing the age group 20-21 years. Although students studying at Nobel Medical College were from various part of the nation including the neighboring country India, about 61% of the students were from three zones of Nepal such as Bagmati, Koshi and Janakpur. Koshi is the zone in which Nobel Medical College is situated; Janakpur is a nearby histor-ical zone; Bagmati zone represents the capital city.

In terms of improving the academic performance, students’ prefer-ences were towards experimental methods of learning rather than theoretical. This may be due to the reason that interactive discus-sions encourage greater participation, improve the grasping ability and self-confidence [8, 11, 12]. On the contrary, the trivial curiosity of the students towards any type of tests or examinations such as surprise test (15.3%), fortnightly test (37.1%) or monthly test (14.8%) indicates that students harbored a fear of examinations, in general. Examinations are considered as one of the important stress factors among the students [13]. However, a study conducted by Larsen et al found that tests or examinations promote better retention of in-formation among the students [14].

While inquiring the students’ opinion about the effectiveness of five teaching-learning methods such as PowerPoint projectors, black-board-chalk, whiteboard-marker, overhead (transparency) projectors and dictation, PowerPoint projectors (multimedia projectors) were found the most effective. This may be due to the reason that multi-media incorporate elements such as text, images and even audio-video which makes it easier for the teacher to represent the things as well as it is more receptive to the students [15]. On the other hand, dictating lecture notes mainly in large class size was the least effec-tive method of teaching-learning as lecturing lacks two way commu-nication and may be considered boring leading to less students’ par-ticipation. But, lecturing (the most common form of teaching) can be made effective if the teacher or presenter is able enough to pre-sent the information in the form of text and diagrams or photos in addition to capturing the attention of students and improving their participation [16].

*Association (2-tailed) was significant at α level of 0.05; P-value was calculated by Pearson’s chi-square test

Table 5: Association of gender, origin and parents’ occupation with students’ perception about improving academic performance and teaching-learning activities (n=385) Characteristics Students’ Perception χ2 df P value Gender Improving academic performance Fortnightly class tests 13.562 1 <0.001*

Teaching methods Use of Transparency projector 11.240 3 0.010* Use of PowerPoint projector 11.641 3 0.009*

Poor performance Many subjects at a time 4.688 1 0.030* Students’ Origin Conducting fortnightly tests Both fortnightly class tests and seminars 33.226 16 0.007*

Fortnightly written tests 34.820 16 0.004* Parents’ Occupation Poor Performance Lack of a serious attitude 18.726 8 0.016*



In general, medical schools of Nepal have a large number of students per class, which is negatively linked with students’ performance. Stu-dents were mostly of the opinion that class size should be reduced, as larger classes are difficult to handle, non-interactive and poorly communicative. This reflects students’ temptations for more partici-patory or problem-solving classes which are more effective than tra-ditional, didactic lectures [17]. Reducing class size can be another suitable option but if class size is reduced, financial and technical burdens on management authority may hike up and may not be practically feasible.

There can be various approaches to assess the students and their academic performance. Although the practice of fortnightly tests (FNT) is one of the popular concepts in developed nations for as-sessing the students, Nobel Medical College has recently introduced this concept in the form of fortnightly written test and seminar. When students were asked about the relevance of fortnightly tests, there were mixed opinions about conducting fortnightly written tests and seminar. A major fraction (60%) of the students was in favor of both with the justification that fortnightly written tests and semi-nars help in self-assessment of the students and increase the confi-dence level. Similarly, about 40% of the students expressed positive views about either fortnightly written tests or fortnightly seminars, but not the both. Although students’ participation and performance was good in fortnightly seminars, their performance in fortnightly written tests was poor.

Although the findings of our study were interesting, there were cer-tain limitations. The study was conducted in a single medical college of Nepal and thus the findings cannot be generalized. Therefore, it is recommended to conduct such studies at different medical schools of Nepal and other countries and make comparisons. It is further rec-ommended that the medical colleges of Nepal and the concerned authorities should comply with and adopt the study findings in their institutions for better quality medical education.

Conclusion The students’ preferences for better retention of material and aca-demic performance were towards modern method of teaching-learning such as PowerPoint slides, combined with Problem Based Learning and discussions mainly in small groups.

Authors’ Contribution: Mukhtar Ansari: designed, carried out and edited the study. Attique ur Rahman Mufti and Salman Khan: designed and edited the study. Acknowledgements: The authors would like to thank Prof. Dr. J.N. Bhagawati, Principal of Nobel Medical College, Biratnagar, Nepal for facilitating this study. We are also grateful to the students for their active participation. We also would like to express our gratitude to Dr. S. P. Patel, biostatistician, National Medical College, Birgunj, Nepal for his valuable suggestions and cooperation in statistical analysis of the data. Competing interests: The authors declare that no competing interests exist. Received: 29 November 2013 Accepted: 10 January 2014 Published Online: 10 January 2014

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