|Year : 2022 | Volume
| Issue : 2 | Page : 102-108
Participation of 1st -Year Medical Undergraduate Students in an Anatomy Exhibition as “Near-Peer” Teachers – An Innovative Method to Implement Components of the Competency-based Curriculum in India
Priyanka Daniel, John Bino Stephen, Priyanka Clementina Stephen, Suganthy Rabi
|Date of Submission||27-Apr-2021|
|Date of Acceptance||03-May-2022|
|Date of Web Publication||30-Jun-2022|
Source of Support: None, Conflict of Interest: None
Introduction: To develop a medical professional multidimensionally, experiences must be built in the medical undergraduate curriculum using existing programs and resources. Utilizing the involvement of 1st-year medical students in an anatomy exhibition as “near-peer” teachers, we aimed to develop an interest in teaching among them and to sensitize them to the surrounding community and the need for the development of communication skills. Material and Methods: One hundred 1st-year medical students were involved in teaching anatomy to school students from the community during an anatomy exhibition. The students were divided into 10 groups and they demonstrated the displayed specimens for 4 days on a rotation basis. Feedback was collected to evaluate students' responses to the program. Results: The feedback from the students (n = 88) revealed that students enjoyed the experience (97.7%) and found the experience useful for their appreciation of anatomy (87.4%). About 53.4% of students were able to communicate effectively, although 61.4% had language difficulties. Students appreciated the opportunity to interact with school students (90.9%), the need for educational outreach (94.3%) and also recommended their future involvement in teaching programs (94.3%). In making the learning experience enjoyable to the students, the factors that played a key role were their ability to communicate easily (P = 0.019) and their ability to appreciate the need for community outreach (P = 0.005). Discussion and Conclusion: Developing the interest of 1st-year medical students in teaching and sensitizing them to the need for improved communication skills and societal consciousness can be achieved by enabling them to act as “near-peer” teachers in school teaching programs.
Keywords: Communication skills, competency-based curriculum, medical education, near-peer teaching, social consciousness
|How to cite this article:|
Daniel P, Stephen JB, Stephen PC, Rabi S. Participation of 1st -Year Medical Undergraduate Students in an Anatomy Exhibition as “Near-Peer” Teachers – An Innovative Method to Implement Components of the Competency-based Curriculum in India. J Anat Soc India 2022;71:102-8
|How to cite this URL:|
Daniel P, Stephen JB, Stephen PC, Rabi S. Participation of 1st -Year Medical Undergraduate Students in an Anatomy Exhibition as “Near-Peer” Teachers – An Innovative Method to Implement Components of the Competency-based Curriculum in India. J Anat Soc India [serial online] 2022 [cited 2022 Nov 30];71:102-8. Available from: https://www.jasi.org.in/text.asp?2022/71/2/102/349466
| Introduction|| |
The medical curriculum globally has been gradually and steadily shifting toward competency-based medical education. Medical students are no longer required to become a competent clinician only, but they are required to embrace and exercise softer skills such as communication, professionalism, lifelong learning, and leadership as well. To train an individual in these various attributes, multiple experiences must be built in the medical undergraduate curriculum, enabling the students to acquire the requisite skills. These experiences can be designed in the form of curricular and extracurricular activities to broaden the scope of learning in a limited period. With the advent of competency-based education, there is a greater need for identifying avenues to enrich our medical training.
One such activity planned for 1st-year medical undergraduate students at our institution was their involvement in a walk-through anatomy exhibition, conducted in the department of anatomy for higher secondary biology school students. This exhibition, which is approved by the institution, is periodically held to help the school students of the surrounding region, to understand three-dimensional human anatomy, and to create an interest in the subject. The main mode of teaching is through soft-tissue prosections, plastinates, models, charts, figures, and other audio–visual aids. [Figure 1] In this first-of-a-kind effort, the 1st-year medical undergraduate students were involved in a 4-day anatomy exhibition to describe simple anatomical specimens to school students. This was done to provide them a “near-peer” teaching experience to develop an interest in teaching among them, to create awareness of the surrounding community, and also to sensitize them for the need to develop communication skills in medicine.
|Figure 1: “CORPORA-2018, a walk-through anatomy exhibition, conducted by the Department of Anatomy for higher secondary” biology school students|
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| Material and Methods|| |
After obtaining permission from the Institutional Review Board (IRB Min. No. 12490, dated December 18, 2019) and informed consent, 100 1st-year medical students were involved in teaching anatomy to school students during “CORPORA 2018,” an anatomy exhibition, conducted by the department of anatomy over 4 days which was attended by over 5000 school students. One day before starting the study, the knowledge of basic human anatomy was tested by a multiple-choice quiz (MCQ) test to make sure that the students were aware of simple school-level anatomy. On the days of the exhibition, the MBBS students were randomly divided into 10 groups and assigned various regions of the human anatomy been displayed for the exhibition. They were required to demonstrate the displayed specimens to the visiting school students. The activity was conducted during their regular anatomy class timings of two and a half hours daily, for 4 days on a rotation basis [Figure 2]. Students were provided faculty facilitators to help them if they had any doubts or queries. After the exhibition, an anonymous feedback designed on a 5-point Likert scale as well as having descriptive feedback questions was collected to evaluate students' responses to the program [Figure 3]. Data were summarized using frequency along with percentage, and the association between the variables was measured by constructing crosstabs and Kendall's Tau-b correlation coefficient. The P = 0.05 was set as the level of significance, and IBM SPSS Statistics for Windows, version 21.0 (IBM Corp., Armonk, NY., USA).
|Figure 2: 1st-year medical students demonstrating anatomy specimens to high-school students during the anatomy exhibition|
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| Results|| |
Feedback was obtained from a total of 88 (n) students. Out of a feedback from 88 (n) students, a total of 76 students indicated their age on the feedback, which was a mean age of 18.34 years (±0.946), and 77 students indicated their sex on the feedback, where the male students were 31 in comparison to 46 female students. The 1st-year medical students (n = 86) scored an overall mean of 82.71% (±13.23) in the basic anatomy MCQ test before the start of the study, indicating their ability to be able to demonstrate specimens to school students.
The feedback collected from the students (n = 88) revealed that 97.7% of the students enjoyed the experience of teaching school students and 87.4% felt that this experience was useful for their appreciation of anatomy. About 53.4% of the students were able to effectively communicate with the visitors, although 61.4% had language difficulties and felt that they needed to work toward developing language and communication skills. Being involved in teaching was a new experience for many students (77.3%) and 70.1% of the students expressed that they would love to be involved in future teaching programs as well. Most of the students appreciated the opportunity to interact with school students and teachers from the community (90.9%) and felt that there was a need for outreach in education (94.3%). The majority of the students (94.3%) recommended the future involvement of medical students for anatomy exhibitions [Figure 4].
|Figure 4: Graph representing student feedback obtained on a 5-point Likert scale|
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On Likert scale, scores were given for various responses as follows: strongly agree – 1, agree – 2, disagree – 3, and strongly disagree – 4 (neutral was given a value of 0). The score of the student responses to all questions was between 1 and 2, indicating the agreeability of the students with the questions posed, such as enjoyability of the experience, communication abilities, usefulness of the session for their own learning, and opportunity for community interaction. Question number 6 explored the usefulness of the time spent on the exercise and students gave a mean score of 2.39 ± 1.573, indicating that there was a greater proportion of students disagreeing with the concept of wastage of time due to the exercise. Surprisingly, question number 9 asked the students about the fact that if they faced difficulty due to language issues and response score of 1.78 ± 1.208 indicated that a large proportion of the 1st-year medical students have language issues which should be taken care of early in the medical training to improve their learning during clinical years [Table 1].
|Table 1: Feedback response mean scores indicating the mean agreeability of the students for the questions given|
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Cross tabulation and statistical analysis done using Kendall's Tau-b correlation coefficient between various responses on the feedback questions revealed some important aspects [Table 2]. In making the learning experience enjoyable to the students, the factors that played a key role were their ability to communicate easily (P = 0.019) and their ability to appreciate the need for community outreach (P = 0.005). The factor that made the students communicate effectively was their appreciation for the need for outreach in education (P = 0.016), although communication for some was greatly hampered by language barriers (P = 0.051). There was a positive correlation found between the students who understood the usefulness of the session for the appreciation of human anatomy also their willingness to be a part of such endeavors in future (P = 0.027).
|Table 2: Correlation and statistical significance between the individual feedback questions|
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Comments from the students were varied where many appreciated the experience, whereas some had concerns regarding not knowing the local language and the magnitude of the anatomical work at display for school students [Table 3].
| Discussion|| |
Doctors today are custodians of health, wellness, and well-being of society and are required to embrace a multidimensional approach to their practice of medicine. The medical profession requires a doctor to not only be responsible toward the treatment of his patients but also Excel in other essential roles to serve as the physicians of first contact for the community while being globally relevant. The essential roles of an Indian Medical Graduate (IMG), listed by the National Medical Commission of India, are clinician, professional, leader, communicator, and lifelong learner. Each role has required competencies laid down under it, which the graduate needs to achieve to become a competent IMG.
Teaching “how to teach” has hardly ever been taught to medical undergraduate students. Medical students form future residents and faculty members of medical institutions with responsibilities including teaching and training of juniors. Teaching is also an essential aspect of physician–patient interaction and medical students tend to develop as effective communicators if exposed to training in teaching skills. In addition to these factors, it is also believed that medical students with a better understanding of teaching and learning principles become better learners.
A study done at the University of Vermont College of Medicine on the perceptions of undergraduate medical students (n = 83) on themselves and residents as teachers showed that medical students are interested both in learning teaching skills and teaching during medical school and during residency. Sixty-seven percent of students felt that residents played a significant role as teachers. Students appreciated the need for teaching training and many students wanted to teach during medical school (80%) and residency (93%). In our study, most of our students were exposed to a teaching opportunity for the first time in their life (77.3%) but did appreciate the usefulness of teaching and expressed their interest in being involved in teaching programs in future (70.1%).
There have been studies suggesting that when students teach, they develop a deeper and more persistent understanding of the material. Furthermore, there is enough evidence to say that when teaching is used as a mode of learning, the retention of content is better. A study done by Peets et al. concluded that the involvement of medical students in teaching small group sessions improves their knowledge acquisition and retention. In our study too, most of the students (87.4%) felt that there was an improvement in their understanding of the subject as a result of the teaching experience.
In a survey done by Andrew Jay et al. evaluating the effects of student-as-teachers (SAT) program at Mayo Medical School using a web-based survey sent to all teaching assistants in the anatomy-based SAT program over 5 years (2007–2011), indicated that participants in the anatomy-based SAT program achieved core competencies of a medical educator and felt prepared for the teaching demands of residency. In a study done by Haber et al., 4th-year students were trained in the form of a 4 h session called “teaching to teach” in preparation for teaching during their internship. The course evaluations indicated that students highly supported the program (overall ratings 2000–2005: mean = 4.4 [scale 1–5], n = 224). Zijdenbos et al. in 2011 did a 1-week basic teacher training program as a part of a course called block supervised training in attitude research and teaching for the final year of internship, which was scored on a 5-point Likert scale and the mean score was found to be more than 3.0 which lead to the conclusion that the training provided raised interest among teachers and students. On comparing this to our study, the major difference is that we have initiated a near-peer teaching approach for our students at a much earlier stage in their medical career, in preparation for future teaching experiences. Although, we recognize that this program was of a short duration, this would establish a foundation for all future endeavors to enable more teaching opportunities for our students.
Community outreach has been an important aspect of medical education and needs to be initiated as early as possible. The importance of providing anatomical teaching to high school students has been reported in the literature. This exhibition which is conducted once in every alternate year caters to the needs of the biology students in our area which benefits not only our students but it also helps in kindling the interest of biology students toward human anatomy by live demonstration of both wet specimens and plastinates. Keeping the exhibition locally relevant, we have been able to maintain a great relationship with the surrounding community and have an immense community support in maintaining our department resources. The idea of medical students being involved in teaching was to expose them to the surrounding community in a nonthreatening way, where they can communicate and interact freely. There is much emphasis on the need for social consciousness among medical students and to develop into better doctors for the future, they need to be aware of their surrounding community and their culture. There have been no such similar reports in the literature as this was a unique initiative by our department. In our study, the students appreciated the fact that they got an opportunity to interact with students and teachers from the local community (90.9%) and also realized a need for outreach in the field of education as well. There was a statistically significant positive correlation (P = 0.005) between students who enjoyed the experience and those who were able to appreciate the need for community outreach. We also hope that through this experience, we can cultivate an idea of sharing of knowledge among our students.
Over the past decade, communication skills have been extensively incorporated in the medical curriculum globally and now form an important component of medical education. However, sensitization to the need for developing communication skills is not addressed in the medical curriculum and we need to realize that it may not occur automatically to students that there is a need for growth in this area unless challenged with targeted experiences and environments. For a 1st-year medical student, it is important to be aware of this need to work on developing this skill in his future years. In a study done by Moral et al. using 120 1st-year and 110 final-year students using a Communication Skill Attitude Scale, it was shown the 4th-year students were less enthusiastic about communication skills training than 1st year, indicating the importance of inculcating communication skills training at an earlier stage like in 1st year. In a study done by Joekes et al. to investigate whether the introduction of professional development teaching in the first 2 years of a medical course improved students' observed communication skills with simulated patients (n = 82). Thirty-five students were given traditional preclinical curriculum and 47 students were given training in a curriculum with communication skills integrated into a “professional development” vertical module. Videoed consultations were rated using the Evans interview rating scale by communication skills tutor. Results showed that students who received training scored higher ratings when compared to students who received traditional curriculum. In a study done by Taveira-Gomes et al., 255 undergraduate medical students, at the Faculty of Medicine, University of Porto, completed a 1.5 h per week course over 4 months on basic communication skills. The students' final evaluation consisted of an interview with a simulated patient assessed by a teacher using a standardized framework. After 3 years, while attending internship, 68 students from the same group completed a reevaluation interview following the same procedure, which showed that medical students maintained a communication skill mean level similar to that of the original posttraining evaluation, but significant differences in specific communication abilities were detected in this group of students.
In the studies cited above, it showed that inculcating communication skills in the early years of MBBS significantly improved the communication skills of MBBS students and helped them in becoming better communicators and also helped in their attitude toward patients. In our study, students realized the need for good communication skills as a large proportion of our 1st-year medical students (61.4%) had language issues and had difficulty in communication, language barriers significantly hampering their communication abilities (P = 0.051). This language issue, which has been listed as some of the negative comments in the data, is since most of our students are from different parts of the country and have different mother tongues. The local language is not known to many, who are required to learn the language in the coming years to be able to talk to the local patients in their clinical years. Highlighting that almost two-thirds of our students face this issue, there is a need for organized language teaching to help these students, which has now been included in their foundation course as a mandatory session. There was a significant positive correlation (P = 0.019) between the students who enjoyed the experience of teaching the school students and their ability to communicate easily with them, indicating that good communication skills help the students benefit from such experiences. We believe that it is important to create a sensitization toward the need for honing of communication skills among the students early in their training, to maximize on the communication training opportunities that they might receive in their future years, and to improve their learning during clinical years.
| Conclusion|| |
Training a medical professional is challenging and requires multiple avenues for developing these traits. A review analysis of 10 interventional studies showed that medical students had positive responses and attitudes toward new teaching methods and that new teaching strategies in medical education could positively impact learning.
Developing the interest of 1st-year medical students in teaching, sensitizing them to the need for improved communication skills, and improving social consciousness among them can be achieved by enabling them to act as “near-peer” teachers in high-school teaching programs.
In training future doctors, the added demands of the profession have to be kept in mind and avenues for growth must be provided as early as the 1st year of medical training. There is also an urgent need for innovations in medical education and the development of multiple learning opportunities in light of the new competency-based curriculum rollout in India. We believe that educational innovations can be contextual, and there should be emphasis on using the already established structure of our systems and available resources in designing such innovations rather than mimicking the ideas of a different setup elsewhere in the world.
The authors would like to thank the MBBS batch of 2018 students for their active participation in the study, the teaching and nonteaching faculty of the department of anatomy for their help in conducting the exhibition and the study, Mrs. Mahasampath Gowri for help in statistical analysis and the Institutional Review Board, Christian Medical College, Vellore, India, for ethical clearance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Supe A. Graduate Medical Education Regulations 2019: Competency-driven contextual curriculum. Natl Med J India 2019;32:257-61.
] [Full text]
Shah N, Desai C, Jorwekar G, Badyal D, Singh T. Competency-based medical education: An overview and application in pharmacology. Indian J Pharmacol 2016;48:S5-9.
Koshi R, Indirani K. Clinical anatomy for high school students. Clin Anat 2006;19:82-3.
Raina SK, Kumar R, Kumar D, Chauhan R, Raina S, Chander V, et al.
Game change in Indian Health Care System through reforms in medical education curriculum focusing on primary care – Recommendations of a joint working group. J Family Med Prim Care 2018;7:489-94.
] [Full text]
Dandavino M, Snell L, Wiseman J. Why medical students should learn how to teach. Med Teach 2007;29:558-65.
Bing-You RG, Sproul MS. Medical students' perceptions of themselves and residents as teachers. Med Teach 1992;14:133-8.
Fiorella L, Mayer RE. The relative benefits of learning by teaching and teaching expectancy. Contemp Educ Psychol 2013;38:281-8.
Peets AD, Coderre S, Wright B, Jenkins D, Burak K, Leskosky S, et al.
Involvement in teaching improves learning in medical students: A randomized cross-over study. BMC Med Educ 2009;9:55.
Andrew Jay E, Starkman SJ, Pawlina W, Lachman N. Developing medical students as teachers: An anatomy-based student-as-teacher program with emphasis on core teaching competencies. Anat Sci Educ 2013;6:385-92.
Haber RJ, Bardach NS, Vedanthan R, Gillum LA, Haber LA, Dhaliwal GS. Preparing fourth-year medical students to teach during internship. J Gen Intern Med 2006;21:518-20.
Zijdenbos I, Fick T, ten Cate O. How we offer all medical students training in basic teaching skills. Med Teach 2011;33:24-6.
Moral RR, García de Leonardo C, Caballero Martínez F, Monge Martín D. Medical students' attitudes toward communication skills learning: Comparison between two groups with and without training. Adv Med Educ Pract 2019;10:55-61.
Joekes K, Noble LM, Kubacki AM, Potts HW, Lloyd M. Does the inclusion of 'professional development' teaching improve medical students' communication skills? BMC Med Educ 2011;11:41.
Taveira-Gomes I, Mota-Cardoso R, Figueiredo-Braga M. Communication skills in medical students – An exploratory study before and after clerkships. Porto Biomed J 2016;1:173-80.
Ahmady S, Khajeali N, Sharifi F, Mirmoghtadaei Z. Educational intervention to improve preclinical academic performance: A systematic review. J Educ Health Promot 2019;8:83.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]