Submitted: 17 January 2024
Accepted: 14 May 2024
Published online: 1 October, TAPS 2024, 9(4), 57-60
https://doi.org/10.29060/TAPS.2024-9-4/SC3234

Nicole Huiyi Ong¹, Boon Chong Kwok^2,3, Siti Munirah Aman⁴, Steven Michael Dans Macabasco⁵ & Wai Pong Wong²

¹Department of Physiotherapy, Singapore General Hospital, Singapore; ²Health and Social Sciences, Singapore Institute of Technology, Singapore; ³Rehabilitation, Clinical Pilates Family Physiotherapy, Singapore; ⁴Department of Rehabilitation, Outram Community Hospital, Singapore; ⁵Rehabilitation, NTUC Eldercare, Singapore

Abstract

Introduction: Clinical practice education is an important curriculum in developing physiotherapy students to professionals. This curriculum is largely dependent on clinical educators. Although traits of effective clinical educators had been studied in Western population, it was unclear if the Asian population would yield similar traits. Hence, we studied perspectives of students and academic educators to identify top five core traits of an effective clinical educator. The findings will then help guide policy development for clinical educator training and development.

Methods: A survey was circulated to physiotherapy students and academic educators through convenience sampling. We studied 16 traits – enthusiasm, availability, clarity, clinical competence / knowledge, feedback skills, organisational skills, professionalism, well prepared, scholarly activity, non-judgemental, respect students’ autonomy / independence, sincerity, listening skills, evidence-based practice, role model, and awareness of students’ learning needs.

Results: The top five traits identified by students and academic educators were similar in four traits – clinical competency / knowledge, clarity, feedback skills, and enthusiasm, and differed in the choice of “non-judgemental” by students and “awareness of students’ learning needs” by academic educators. Interestingly, when the top six traits were considered instead of five, students and academic educators identified the same traits but in different ranked orders.

Conclusion: The study found six common core traits of an effective clinical educator from the perspectives of students and academic educators. Continuing education development for clinical educators should focus on these six traits prior to other 10 sub-traits.

Keywords:           Training, Development, Education, Allied Health, Entrustable Professional Activities, Mentoring

I. INTRODUCTION

Clinical Practice Education (CPE) is a core component in undergraduate allied health studies, partnering clinicians with additional role as a Clinical Educator (CE) (Gibson et al., 2019). A study evaluating effective residency teaching for doctors identified 15 traits that a CE should possess, which are enthusiasm, competence-knowledge, clarity, availability, non-judgemental, independence, feedback skills, role model, professionalism, sincere, organised, well-prepared, evidence-based practice, scholarly activity and listening skills (Buchel & Edwards, 2005). A recent study found that being aware of the learning needs of students could be the 16^th trait a CE should possess (Francis et al., 2016). Considering recent shift towards the use of the Entrustable Professional Activity framework for work place competency review at student and professional levels (Kwok et al., 2023), it is important to consider which top five traits are considered core competence of a CE as defined by the pinnacle of entrustment at Level 5.

Perspectives of critical traits of an effective CE might differ between students, CEs and academic educators (AEs). Students in early years of undergraduate study and CEs identified similar top five traits of an ideal CE (Cross, 1995). In the study by Cross (1995), CEs should be approachable, possess good communication skills, be knowledgeable and demonstrate enthusiasm in teaching, including clinical competency (Cross, 1995). Competency of CEs was similarly desired among academic educators, alongside “being approachable” and “good communicator”, whereas two differences were noted as compared to CEs and students, which were “interested in learning process of the students” and “concerned about patient care” (Cross, 1995). It is possible that among the Asian population, competency of the CEs would be similarly desired. Recent studies might have considered different trait terms as compared to the classic study, for instance, “learning process” was likely subsumed under “learning needs” (Francis et al., 2016). It is unclear whether the Asian population will present with different trait ranking as compared to Western population.

Therefore, this study was undertaken to identify the top five essential traits of an effective CE. In view of notable differences between perspectives of students and AEs in past literature, this study explored similarities and differences of perspectives between students and AEs. In addition, we explored what gaps might exist in developing CEs. In this study, the AEs, all of whom used to be CEs, could provide useful and important inputs on the traits required of a CE. The findings would then provide directions for future policy development pertaining to clinical education and professional supervision.

II. METHODS

A. Study Design

A survey was conducted through convenience sampling. The study was conducted between March to December 2022. The study was approved by the Institutional Review Board of the Singapore Institute of Technology (SIT-IRB-2022031).

B. Participants

Students in the third year of undergraduate physiotherapy programme and AEs of the physiotherapy faculty (as of April 2022) were involved in the survey. Large variations in response rate exists in convenience sampling, so we projected at least 50% response rate for the students and also the AEs. Students who had withdrawn from the programme were excluded. Associate faculty educators were excluded because they were only involved in ad hoc teaching sessions. Informed consent was sought at the beginning of the survey and digitally recorded.

C. Procedures

The survey described the 16 traits that contribute to an effective CE, which provided participants with knowledge about each trait, which was externally validated by five physiotherapists from the public and private sectors with experience ranging from eight to 25 years. The demographic data included student identification numbers to ensure that each response was unique. Thereafter, the data was de-identified to ensure anonymity during data analysis. As the sample size for the AEs was small, no personal data was collected to ensure anonymity. A survey invitation including a standardised survey link was distributed via email to all eligible participants. Participants were then asked to rank the 16 traits from 1 to 16, with 1 being the most important trait and 16 being the least important. Survey items were not randomised. The online survey was hosted on the secured Qualtrics Survey System (Qualtrics XM, 333 W. River Park Drive, Provo, UT 84604 USA). Student participants were first notified via email, followed by four reminder notifications, two months apart, via the cohort group chat on WhatsApp. AEs were first notified via email, followed by two reminder notifications via WhatsApp three months apart.

D. Statistical Analysis

Data analyses were performed using IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA). Continuous variables are presented with means (standard deviations) and categorical variables with counts (percentages). Friedman test was used to analyse the mean rank of each trait. Then Kendall’s coefficient of concordance (Kendall’s W) was used to test the level of agreement among students for the mean ranks of the traits, as well as among AEs. The level of agreement was interpreted based on common recommendation and should yield statistical significance at p < 0.05.

III. RESULTS

A total of 81 students completed the survey (response rate of 46.6%) and a total of five AEs completed the survey (response rate of 41.7%). The average age, mean (standard deviation), of the students is 24.5 (4.1) years, and 52 of them are female (64.2%). The traits were ranked and presented in Table 1. Among the top five traits, there were four similar traits found between students and AEs, which were clinical competency / knowledge, clarity, feedback skills, and enthusiasm. The students ranked “non-judgemental” within the top five traits, whereas the AEs identified “awareness of students’ learning needs”. If the top six traits were considered, both students and AEs yielded similar traits. In the traits ranking, the students showed fair level of agreement, approximating closely to moderate agreement, Kendall’s W = 0.38, p < 0.001, while AEs showed moderate level of agreement, Kendall’s W = 0.51, p = 0.001.

Submitted: 19 December 2023
Accepted: 26 April 2024
Published online: 1 October, TAPS 2024, 9(4), 50-56
https://doi.org/10.29060/TAPS.2024-9-4/SC3194

Craig S. Webster¹, Jack Forsythe², Antonia Verstappen¹, Phillippa Poole³, Tim Wilkinson⁴ & Marcus A. Henning¹

¹Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand; ²Auckland District Health Board, Te Whatu Ora, Auckland, New Zealand; ³School of Medicine, University of Auckland, Auckland, New Zealand; ⁴Education Unit, University of Otago, Christchurch, New Zealand

Abstract

Introduction: A valid, longitudinal approach is critical for service planning in healthcare and to understand career choice in medical graduates.

Methods: We quantitatively analysed self-reported influences underlying career choice in a national cohort of medical graduates over the first five years of their careers. Participants rated career influences on importance across 26 items using a 5-point Likert scale (1=not at all, 5=a great deal).

Results: We included 659 New Zealand medical graduates (mean 25.4 years old, 376 F, 283 M) from the University of Auckland and the University of Otago, graduating in 2012 and 2013 (85% response rate). Responses were linked longitudinally over their post-graduate years 1, 3 and 5, and underwent principal component analyses. At graduation the factor rated as the most important in career choice had a mean (SD) item score of 3.9 (0.7) and comprised: Medical School Experiences; Specialty Experience; Mentors; and Self-Appraisal – consistent with graduates securing initial employment. Factors which explained the most variance in career choice over the five years after graduation indicated that the costs of medical school and further training were consistently rated as the least important in career choices, while flexibility in working hours were consistently rated as the most important. Factors remained relatively stable over time, showing variation in scores of only a median of 0.5 Likert points, indicating further opportunities for career choice research.

Conclusion: Our results regarding costs of medical training are reassuring, and suggest that greater flexibility in working hours may attract graduates to underserved specialties.

Keywords:           Medical Education, Career Choice, Career Influences, Cost, Debt, Measurement, Medical Graduates, National Longitudinal Study, Working Hours, Work Culture

I. INTRODUCTION

A common strategic aim of medical schools throughout the world is to supply the range of graduates who will best meet the healthcare needs of their communities (Gorman, 2018). However, fulfilling this aim is far from straight-forward, with perhaps the most critical difficulty involving understanding the influences that underlie career choice in medical graduates and how these vary over time.

The financial burden of completing medical school and further training has been one of the most widely studied influences underlying career choice, with suggestions that rising costs may encourage graduates to pursue specialties perceived to be more highly paid, often in cities, thus undersupplying primary healthcare and rural locations. However, in New Zealand medical graduates are otherwise free to choose their preferred career path and choices may be influenced by many things other than training costs and debt, including personal interest, employment conditions, specialty availability and lifestyle preferences (Webster et al., 2020; Webster et al., 2017).

Therefore, in the following, we analyse the self-reported influences underlying career choice in a national cohort of medical school graduates during the first five years of their careers using quantitative data drawn from the existing longitudinal Medical Schools Outcomes Database (MSOD).

II. METHODS

The MSOD project is a bi-national longitudinal questionnaire study that aims to improve healthcare delivery in Australia and New Zealand (Poole et al., 2019). At graduation and in postgraduate years (PGY), graduates are asked to specify their preferred area(s) of medicine, and complete a schedule of influencing items, indicating the degree to which each was important in their choice, using a 5-point Likert scale with anchors of 1 (not at all) to 5 (a great deal) – see Supplementary Table 1 for full question set.

A. Data Analysis

We conducted a series of principal component analyses (SPSS v27, IBM Corporation, New York) of the responses to the 26 influencing item questions at each time point to identify factors within responses, and describe them over time.

III. RESULTS

Data from a national cohort of 659 New Zealand medical school graduates who had graduated from the University of Auckland and the University of Otago in 2012 and 2013 were included. The response rate for completed questionnaires in the Exit cohort was 85% – representing a sampling margin of error of only 1% at the 95% level of confidence. The mean (SD) age of participants in the cohort was 25.4 (2.7) years, with a higher proportion of female graduates (376 F vs 283 M). Over the next five years, this Exit cohort self-reported on the same set of influences underlying career choice at PGY1, PGY3 and PGY5 – maintaining a response rate between 53% and 56%, and a sampling margin of error of 3%.

We used conventional settings during analysis, comprising varimax rotation and suppression of loadings below 0.3. The Kaiser-Meyer-Olkin measure of sampling adequacy across time points demonstrated a median (range) of 0.77 (0.75 to 0.82), indicating distinct and reliable factors at each time point. In addition, Bartlett’s test of sphericity was highly significant at each time point, (2338<c²<3498, p<0.0001), demonstrating correlation with little redundancy in items (Kaiser, 1974).

Submitted: 12 December 2023
Accepted: 25 March 2024
Published online: 1 October, TAPS 2024, 9(4), 40-49
https://doi.org/10.29060/TAPS.2024-9-4/SC3254

Vivien Lee¹, Jeffrey Jiang¹, Anna Szücs¹, V Vien Lee¹, Low Si Hui², Faith Teo¹, Jose M Valderas¹ & Victor Loh¹

¹Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; ²National University Polyclinics, Singapore

Abstract

Introduction: Globally, persons with disabilities (PWD) face structural and social barriers to inclusive healthcare. Medical schools, as crucibles of medical professional identity formation, have the responsibility to foster person-centredness toward all patients, including PWD, among her graduates. We co-designed with PWD a “Communications with Persons with Disabilities” workshop and evaluated its impact.

Methods: The workshop enlisted PWD as patient educators, occurred within the third-year undergraduate Family Medicine posting, and was designed to positively impact communications skills and attitudes toward PWD. Students (n=135) were surveyed pre- and post- workshop following a mixed-methods approach (demographic data, Attitude Towards Disabled Persons (ATDP)-O scale, feedback questions, and post-workshop free reflections). Descriptive analysis was used for demographic and feedback questions, and thematic analysis for reflections. Paired t-test was used to evaluate change in ATDP-O scores.

Results: There were 69 survey respondents (51.11%). Most students agreed that communications training with PWD could be strengthened in medical school, and that the workshop was relevant to their future medical career (n=68, 98.55%). Attitudes towards PWD significantly improved after the workshop (ATDP-O change: +9.29 points (12.7%), p <0.001). Student reflections included attitudes, such as the importance of seeing the person beyond the disability, and a call for action towards inclusivity and accessibility of care for PWD.

Conclusion: Students’ attitudes were positively affected by involving PWD in the curriculum. Further research is needed for assessing the impact of how a longitudinal PWD curriculum could affect medical trainees and improve social inclusiveness in healthcare practice.

Keywords:           Medical Education, Communication, Persons with Disabilities, Disability, Social Inclusiveness, Student Attitudes, Person Centred Care, Active Learning

I. INTRODUCTION

Globally, persons with disabilities (PWD) face structural and social barriers to inclusive healthcare. In Singapore, few are comfortable with direct personal interaction with PWD (National Council of Social Service Singapore, 2019).

With respect to medical education, different disability curriculum from didactic lectures to longitudinal patient experiences have been described (Ali et al., 2023). Overall evidence suggests that more frequent and positive contact with PWD increased positive attitudes (Ali et al., 2023; National Council of Social Service Singapore, 2019).

Medical schools, as crucibles of medical professional identity formation, have the responsibility to foster person-centredness toward all patients, including PWD, among her graduates. In July 2022, the National University of Singapore’s Division of Family Medicine developed with PWD, piloted and assessed a four-hour experiential workshop for third-year medical students called “Communication with PWD” in July 2022.

The four-hour workshop was prefaced by pre-event reading materials. A plenary started on site learning, followed by fishbowl discussions where student volunteers took turns to perform a clinical consultation with PWD who enacted scripted role-plays. There was a ratio of one tutor and PWD to a group of ten to fifteen students. Each student would encounter three broad categories of disability (vision, hearing, mobility) during the fishbowl sessions. Students interacted with PWD after each role play. Reflections and debrief by tutors would close the workshop.

This study aimed to evaluate the workshop’s impact on students’ attitudes towards PWD for: (Q1) differences in pre-workshop attitudes towards PWD between male and female medical students; (Q2) within-person changes in students’ overall attitudes towards PWD pre-post workshop; (Q3) associations between pre-workshop attitudes towards PWD and personal experience with PWD; and (Q4) exploration of how the workshop has affected students’ attitudes towards caring for PWDs.

II. METHODS

A. Study Design

This study had a mixed methods design including a pre- and post-intervention survey (quantitative), and reflections (qualitative). Students attending the 3^rd and 4^th Family Medicine Rotation (January to March 2023) of Academic Year 2022/23 were invited to participate in the study. The questionnaire was administered in person. Students completed the questionnaires independently. A waiver of consent was applied for reflections. 

B. Survey

The pre-workshop questionnaire comprised demographic information and the 20-item Attitude Towards Disabled Persons (ATDP)-O scale (Yuker et al., 1960). The questions were scored on six-point Likert scale from “I disagree very much” (-3) to “I agree very much” (+3). The post-workshop questionnaire comprised the ATDP-O scale and feedback questions.

We used the original ATDP-O form as it had been used in other studies on medical students (Arabi et al., 2021) and was deemed reliable (reliability coefficient .80) and valid by prior psychometric analyses (Yuker et al., 1960).  Performance in local context was assessed through cognitive testing with five randomly selected medical students who were classmates of study participants and excluded from the study sample.

C. Reflections

Student reflection sheets included a single open-ended statement: “Please pen a question or a reflection you’d like to share from the session today”.  Reflections were transcribed verbatim and de-identified before analysis. All reflections were used to limit selection bias.

D. Data Analysis

Numeric data was analysed by R software (version 4.31). Internal consistency of the scale in our study sample was measured with Cronbach’s alpha. We used two samples independent unpaired t-test to evaluate Q1 (differences in baseline ATDP-O scores between males and females), two samples paired t-test to evaluate Q2 (change in pre-post workshop ATDP-O scores), and two samples independent unpaired t-tests, Welch’s t-tests and Spearman’s correlation tests to evaluate Q3 (difference in baseline ATDP-O scores across different types/levels of contact with PWD). In the evaluation of Q3, two samples independent unpaired t-test was used when two groups have similar sample sizes or similar variances while Welch’s t-test was used when there’s unequal variances or disparate sample sizes between two groups. Spearman’s correlation was used to analyse associations with ordinal variables.

Student reflections were analysed thematically. Four researchers (VLE, VVL, AS, FT) reviewed the data and generated initial codes independently. Multiple discussions were conducted to explore different perspectives and increasingly develop codes. Based on codes generated, potential themes and subthemes were developed over several iterations. Final themes and subthemes were reviewed in relation to the entire dataset.

III. RESULTS

Of 135 students invited, 69 students consented to the study and completed both the pre- and post-workshop questionnaire. The results are summarised (Table 1a and 1b).

Cognitive testing confirmed that students had no difficulties understanding questions nor suggested any edits for clarification. The internal consistency of the scale was α = 0.72 (pre-workshop) and α = 0.78 (post-workshop).

(Q1) Female gender had a significantly higher baseline ATDP-O scores (p = 0.028).

(Q2) There was a significant improvement of 9.29 points (12.7%) in the ATDP-O score post workshop (p <0.001).

(Q3) Previous experience of training to care for PWD (p<0.001) and previous experience caring for PWD (p = 0.033) had significantly lower baseline ATDP-O scores.

 

Results	Number (%)	ATDP-O baseline score Mean (SD)			Statistics
Overall	N=69	72.71 (10.46)
By age (Mean = 21.59, SD = 0.96)					Pearson’s r(67) = – 0.02, p = .857
By gender
Female	37 (53.62%)	75.32 (8.61)			t(67)  = 2.30, p = .025*
Male	32 (46.38%)	69.69 (11.69)
By ethnicity
Chinese	56 (81.16%)	73.18 (10.20)			F(2, 66) = 1.64, p = .201
Indian	12 (17.39%)	69.33 (11.18)
Others	1 (1.45%)	87.00 (.)
Self-reported disability
No	66 (95.65%)	72.74 (10.59)			t(2) = 0.14, p = .900
Yes	3 (4.35%)	72.00 (8.89)
Self-reported training to care for PWD
No	67 (97.10%)	73.06 (10.42)			t(7) = 7.45, p < .001*
Yes	3 (4.35%)	61.00 (1.41)
Self-reported frequency of care for PWD (ranked variable ranging from never = 1 to often = 4)
Never	34 (49.28%)	75.7 (9.5)			Spearman’s rho(67) = – 0.26, p = .033*
Rarely	22 (31.88%)	69.8 (11.8)
Sometimes	12 (17.39%)	69.5 (9)
Often	1 (1.45%)	75 (.)
Self-reported knowledge of PWD who is important to them
No	53 (76.81%)	73.57 (10.95)			t(67) = 1.24, p = .219
Yes	16 (23.19%)	69.88 (8.34)
Self-rated likelihood of pursuing career in Family Medicine (ranked variable ranging from very unlikely = 1 to very likely = 5)
Very likely	9 (13.04%)	72.1 (10)			Spearman’s rho(67) = 0.03 , p = .803
Likely	18 (26.09%)	73.2 (11.5)
Undecided	37 (53.62%)	73.5 (10.3)
Unlikely	4 (5.80%)	63.5 (8.9)
Very unlikely	1 (1.45%)	78 (.)
Do you feel your education about persons with disabilities in medical school has been adequate so far?
Agree	1 (1.45%)		–		–
Neither disagree nor agree	19 (27.54%)		–		–
Disagree	42 (60.87%)		–		–
Strongly disagree	7 (10.14%)		–		–
Would you find it important to include education and training on persons with disabilities?
Strongly agree	23 (33.33%)			–	–
Agree	39 (56.52%)			–	–
Neither disagree nor agree	5 (7.25%)			–	–
Disagree	1 (1.45%)			–	–
Strongly disagree	1 (1.45%)			–	–
Do you feel that the education provided during the Communications with Persons with Disabilities workshop was relevant to your future career as doctors?
Strongly agree	45 (65.22%)			–	–
Agree	23 (33.33%)			–	–

Table 1a. Baseline ATDP-O scores and curriculum feedback

 

Results	ATDP-O score Mean (SD)	Pre-Post workshop comparison statistics
Descriptive statistics
Pre-workshop ATDP-O score	72.71 (10.46)	t(68)  = 8.69, p < .001*
Post-workshop ATDP-O score	82.00 (11.46)
Difference in ATDP-O scores
Overall sample	9.29 (8.88)	t(68)  = 8.69, p < .001
By age (Mean = 21.59, SD = 0.96)		Pearson’s r(67) = – 0.06, p = .643
By gender
Female	8.62 (9.33)	t(67) = – 0.67, p = .505
Male	10.06 (8.41)
By ethnicity
Chinese	9.02 (9.45)	F(2, 66) = 0.15, p = .859
Indian	10.33 (6.21)
Others	12.00 (.)
Self-reported disability
No	9.50 (8.06)	t(2) = 0.36, p = .752
Yes	4.67 (23.12)
Self-reported training to care for PWD
No	9.09 (8.92)	t(1) = – 2.17, p = .230
Yes	16.00 (4.24)
Self-reported frequency of care for PWD (ranked variable ranging from never = 1 to often = 4)
Never	8.8 (6.1)	Spearman’s rho(67) = 0.05, p = .678
Rarely	11.5 (9.1)
Sometimes	9.4 (10.8)
Often	-22 (.)
Self-reported knowledge of PWD who is important to them
No	10.72 (7.61)	t(67) = 2.52, p = .014*
Yes	4.56 (11.20)
Self-rated likelihood of pursuing career in Family Medicine (ranked variable ranging from very unlikely = 1 to very likely = 5)
Very likely	10.4 (9.2)	Spearman’s rho(67) = 0.07, p = .547
Likely	10.9 (7.8)
Undecided	7.9 (9.5)
Unlikely	11.5 (9.3)
Very unlikely	11 (.)

Table 1b. Difference in ATDP-O scores post workshop

Most students found the workshop a positive experience and reported feelings of thankfulness and inspiration towards patient educators. Four themes emerged from the students’ post-workshop reflections, of which we highlight those related to attitudes – Humanizing mindsets towards PWD (Theme 1) and Call for action towards inclusivity and accessibility (Theme 2). The other themes were Knowledge and Skills, as students included knowledge and communication skills they acquired during the workshop (Appendix 1 and 2).

A. Theme 1 – Humanising Mindset towards Persons with Disabilities

Students expressed attitudes of empathy, sensitivity, and humanising care through viewing PWD as individuals beyond their disabilities. A student reflected

“Being able to speak to members of these respective communities helped me to understand how empowered PWD can be… It is essential that [PWD] are treated as exactly that, [and] not characterised by their disabilities.”

On providing care for PWD, students noted the distinction between empathy and sympathy, and highlighted the importance of empathy instead of pity. As summed up by a student,

“Not to sympathise but to empathise. Not to see them and pity them”

B. Theme 2 – Call for Action towards Inclusivity and Accessibility

Concurrent with attitudes expressed in the reflections, students discussed the need to improve inclusivity and accessibility from an individual and societal perspective. One student wrote,

“As doctors, we need to try our best to alleviate their disease burden, and at the same time, make their journey to accessing healthcare more seamless with less barriers.”

Beyond self-improvement, students were aware of the need to shift their own perspectives of disability from a medical to a social model. Students also reflected the need for greater national efforts towards societal inclusivity for PWD. A student reflected,

“I think policymakers and organisations should periodically involve PWD to [better] take their needs into consideration as they have the right to integrate into our society just as much as everyone else.”

IV. DISCUSSION

Our study showed positive change in attitudes towards PWD among medical students after a workshop with improvement of 9.29 points in the ATDP-O score (Table 1b), reinforced by their post-workshop reflections. To our knowledge, this is the first study in Asia evaluating an educational intervention focusing on communications skills training with PWD. Based on student reflections, the communications workshop was effective in developing knowledge and communication skills, prompting the key attitudes of humanizing care, and a call for action towards societal inclusivity and accessibility towards PWD.

We intentionally had PWD co-designing the workshop and playing key roles as patient educators. Student reflections support these curriculum design decisions. Our work coheres with literature that a contact-based approach with PWD would be impactful: reducing anxiety and improving empathy levels, rather than more theoretical approaches to promote attitudes towards PWD (Arabi et al., 2021).

Our study corroborates the widely reported result that female gender positively influenced baseline attitudes towards PWD in medical students (Satchidanand et al., 2012). A possible explanation is females having a propensity to exhibit more empathetic feelings toward others. There is a greater change in attitudes in males than females after the workshop, but this change is not significant.

In contrast to prior research that consistently associated increased contact with PWD with more positive attitudes (Satchidanand et al., 2012), we found that having previous experience with PWD influenced baseline ATDP-O scores negatively (Table 1a). Moreover, there was a significantly smaller change in ATDP-O scores if they knew a PWD who is important to them (Table 1b). A possible explanation is “caregiver fatigue” due to unavailability of support to allow adequate care for PWD (Arabi et al., 2021). The type of previous experience may thus be key factors in shaping current attitudes towards PWDs.

This study has several limitations. We cannot determine if positive change in attitudes post-workshop would translate into changes in clinical practice in the future. The survey was not compulsory for students, potentially leading to selection bias. We tried to overcome the selection bias by including all student reflections.

V. CONCLUSION

There was significant improvement in students’ attitudes towards PWD post-workshop, as shown through the ADTP-O score and reflection analysis. Medical students benefit particularly from the fishbowl discussions which allows students to interact with persons with disability, growing our future generations of healthcare professionals who humanise care.

Notes on Contributors

Author VLE conceptualised the study, developed the methodology, conducted the investigation, did the formal analysis and visualization of data, wrote the original draft, reviewed and edited the manuscript. Author JJ conceptualized the study, developed the methodology and original draft, reviewed and edited the manuscript. Author AS developed the methodology, did the formal analysis of data, reviewed and edited the manuscript. Author VVL did the formal analysis of data, wrote the original draft, reviewed and edited the manuscript. Author LSH did the formal analysis and visualization of data. Author FT did the formal analysis, reviewed and edited the manuscript. Author JMV supervised the conceptualization and methodology of the study, reviewed and edited the manuscript. VLO supervised the conceptualization of the study, developed the methodology, reviewed and edited the manuscript. All authors have read and agreed to the published version of the manuscript.

Ethical Approval

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of the National University of Singapore on 11 November 2022 (NUS-IRB-2022-608).

Data Availability

Quantitative data repository can be freely accessed at: https://doi.org/10.6084/m9.figshare.24013134  

Qualitative data repository can be freely accessed at: https://doi.org/10.6084/m9.figshare.24051195  

Funding

There was no funding for this research study.

Declaration of Interest

Authors VLE, JJ and VLO are tutors in the “Communications with Persons with Disabilities” workshop. There are otherwise no other conflicts of interest.

References

Ali, A., Nguyen, J., Dennett, L., Goez, H., & Rashid, M. (2023). A scoping review for designing a disability curriculum and its impact for medical students. Canadian Medical Education Journal, 14(3), 75–86. https://doi.org/10.36834/cmej.74411

Arabi, H., Adarmouch, L., & Ahmed Eladip, G. (2021). The assessment of student doctors’ attitude towards disabled people after teaching them a module. Acta Bio-Medica: Atenei Parmensis, 92(2), e2021059. https://doi.org/10.23750/abm.v92i2.9547

National Council of Social Service Singapore. (2019). Public Attitudes Towards Persons with Disabilities 2019. https://www.ncss.gov.sg/docs/default-source/ncss-publications-doc/pdfdocument/public-attitudes-towards-persons-with-disabilities-2019-infographics.pdf

Satchidanand, N., Gunukula, S. K., Lam, W. Y., McGuigan, D., New, I., Symons, A. B., Withiam-Leitch, M., & Akl, E. A. (2012). Attitudes of healthcare students and professionals toward patients with physical disability: A systematic review. American Journal of Physical Medicine & Rehabilitation, 91(6), 533–545. https://doi.org/10.1097/PHM.0b013e3182555ea4 

Yuker, H. E., Block, J. R., & Campbell, W. J. (1960). A scale to measure attitudes toward disabled persons. In Human Resources Study Number 5. Human Resources Foundation.

*Vivien Lee
1E Kent Ridge Rd,
Singapore 119228
Email: vivienl@nus.edu.sg

Submitted: 3 July 2023
Accepted: 18 June 2024
Published online: 1 October, TAPS 2024, 9(4), 61-64
https://doi.org/10.29060/TAPS.2024-9-4/SC3071

Victoria Scudamore, Sze Yi Beh, Adam Foster & Michaela Goodson

School of Medicine, Newcastle University Medicine Malaysia, Malaysia

Abstract

Introduction: This study compares online and in-person delivery of a weekly clinical reasoning seminar for fourth-year medical students at a Malaysian medical school. During the easing of COVID-19 pandemic restrictions, the initial eight seminars took place online, followed by eleven in-person seminars. This study looks at student preference for online or in-person delivery and how these reasons differ due to gender.

Methods: An online questionnaire was sent to fourth-year medical students after returning to in-person seminars. The response rate was 60/128 (46.88%) and the data was analysed using SPSS software.

Results: 65% of students preferred in-person seminars and a larger proportion of female students (71.43%) preferred in-person sessions compared to male students (50.00%), although this was not statistically significant (p=0.11). A significantly larger proportion of female students preferred in-person seminars for the following reasons compared to male students: enjoyment (p=0.041), developing history-taking skills (55.56%) and for formulating differential diagnoses (p=0.046). Students were asked whether online or in-person seminars were most appropriate for eighteen reasons, they felt in-person seminars were most appropriate for 16/18 of these reasons.

Conclusions: More students preferred in-person clinical reasoning seminars and a higher proportion of these students were female. A significantly larger proportion of female students felt in-person seminars were better for; enjoyment and for developing history-taking skills and formulating differential diagnoses, compared to male students. The students preferred online seminars for home comforts and ease of travel, but they preferred in-person seminars for the other 16/18 reasons listed including all reasons linked to learning skills and interreacting with others.

Keywords:            Online Teaching, In-person Teaching, Gender, Clinical Reasoning, Medical Students

I. INTRODUCTION

Fourth-year medical students at Newcastle Medical School Malaysia attend weekly clinical reasoning seminars as part of their ‘Clinical Decision Making’ (CDM) module. Each week of CDM covers a different medical speciality and students attend a seminar where the group works through a presentation with patient cases and they discuss how to diagnose, investigate and manage the patient. The sessions are attended by eleven students and the groups remain the same throughout the year. In 2021-22 the initial eight seminars took place online using Zoom video conferencing software and as COVID-19 restrictions eased in Malaysia the final eleven sessions took place in-person.

The academic performance of students undertaking online and in-person clinical reasoning seminars has been researched and third-year medical student academic performance was comparable in both settings (Babenko et al., 2022). However, there is currently no research regarding medical student preference for online or in-person delivery of clinical reasoning seminars. Medical student preference for online or in-person delivery of all parts of the curriculum has been analysed and second-year medical students at a US medical school had a preference for online lectures and there was a correlation between these students and those who felt online lectures reduced stress (Altaf et al., 2022).

A cohort study analysed participation in a teaching programme for US graduate physicians and this showed female students asked and answered less questions during in-person sessions compared to online sessions (Cromer et al., 2022). The results of this study are contrasting with my observations whereby female students participated less in online seminars and their participation increased when seminars returned to an in-person setting. This could be due to differences in the research environments or due to the group of observed students being small with less statistical significance.

My first research question was to understand medical student preference and reason for preference of online or in-person delivery of clinical reasoning seminars. My second research question was to establish if student preference differed due to gender and why.

II. METHODS

The data was collected using survey methodology with a self-developed questionnaire made using Microsoft forms. The questionnaire was emailed to all fourth-year medical students after they had experienced both session deliveries. Students were provided with a consent form and informed the research project was optional and were asked to provide voluntary consent before participating. Participants were informed they could withdraw from the project at any time up until the data was anonymised during data collection.

The survey response rate was 60/128 (46.88%), the low participation numbers are likely due to the data collection being optional and undertaken in the students own time. This could lead to a nonresponse bias, as it is likely the more engaged students participated and students with less motivation who did not participate may have responded differently. The data was analysed using SPSS software. Chi-squared tests were used to cross-tabulate the results and to calculate p-values to indicate data with statistical significance.

III. RESULTS

Overall 65% of students preferred in-person seminars and 71.43% (30/42) of female students preferred in-person sessions compared to 50.00% (9/18) of male students (p=0.11). The students were asked if they felt online or in-person seminars were best for eighteen different reasons (see table 1). There were three statistically significant reasons female students preferred in-person sessions more than male students (p<0.05). These were Enjoyment (p=0.041), developing history-taking skills (p=0.011) and formulating differential diagnoses (p=0.046).

The students felt in-person sessions were most appropriate for 16/18 of the reasons listed in (table 1). The reasons with the highest proportion of students feeling in-person were the most appropriate were; interaction with friends (95.00%), interaction with the facilitator (91.67%), and developing clinical reasoning skills (91.67%). There were only two reasons students felt online sessions were most appropriate, these were home comforts (98.33%) and ease of travel (91.67%).

Original data can be accessed in Figshare at https://doi.org/10.6084/m9.figshare.23616627.v1 and https://doi.org/10.6084/m9.figshare.23616630.v1

Results are ranked from reasons with the highest proportion of students thinking in-person was most appropriate for that reason. P-values have been calculated to establish if there is statistical significance between the results for male and female students, significant results are highlighted in bold.

	All students	Female students	Male students	P-value
Interaction with friends	57/60 (95.00%)	39/42 (92.86%)	18/18 (100.00%)	0.245 (>0.05)
Interaction with the facilitator	55/60 (91.67%)	39/42 (92.86%)	16/18 (88.89%)	0.610 (>0.05)
Developing clinical reasoning skills	55/60 (91.67%)	39/42 (92.86%)	16/18 (88.89%)	0.610 (>0.05)
Learning from the facilitator	51/60 (85.00%)	35/42 (83.33%)	16/18 (88.89%)	0.581 (>0.05)
Flow	47/60 (78.33%)	33/42 (78.57%)	14/18 (77.78%)	0.945 (>0.05)
Developing history-taking skills	46/60 (76.67%)	36/42 (85.71%)	10/18 (55.56%)	0.011 (<0.05)
Developing knowledge	45/60 (75.00%)	33/42 (78.57%)	12/18 (66.67%)	0.329 (>0.05)
Ease of sharing opinions	45/60 (75.00%)	33/42 (78.57%)	12/18 (66.67%)	0.329 (>0.05)
Enjoyment	44/60 (73.33%)	34/42 (80.95%)	10/18 (55.56%)	0.041 (<0.05)
Learning from peers	41/60 (68.33%)	28/42 (66.67%)	13/18 (72.22%)	0.672 (>0.05)
Formulating differential diagnoses	41/60 (68.33%)	32/42 (76.19%)	9/18 (50.00%)	0.046 (<0.05)
Interpreting clinical data	40/60 (66.67%)	29/42 (69.05%)	11/18 (61.11%)	0.550 (>0.05)
Formulating management plans	39/60 (65.00%)	29/42 (69.05%)	10/18 (55.56%)	0.315 (>0.05)
Better for mental health	36/60 (60.00%)	26/42 (61.90%)	10/18 (55.56%)	0.645 (>0.05)
Developing communication skills	35/60 (58.33%)	22/42 (52.38%)	13/18 (72.22%)	0.153 (>0.05)
Interpreting investigations	35/60 (58.33%)	27/42 (64.29%)	8/18 (44.44%)	0.153 (>0.05)
Ease of travel	5/60 (8.33%)	5/42 (11.90%)	0/18 (0.00%)	0.126 (>0.05)
Home comforts	1/60 (1.67%)	1/42 (2.38%)	0/18 (0.00%)	0.509 (>0.05)
Table 1. The proportion of medical students who felt in-person sessions were the most appropriate for the listed reasons.

IV. DISCUSSION

Overall, more students in our cohort preferred in-person clinical reasoning seminars and a larger proportion of these students were female than male, however, the difference in preference based on gender did not show statistical significance. This could be due to a smaller cohort of male respondents (18/60) compared to female respondents (42/60). However, even in a study of 488 medical and dental students there was no significant difference in preference for online or in-person delivery when asked about all sessions in the curriculum (Al-Azzam et al., 2020). A larger sample size of medical students will need to be analysed to establish if gender significantly influences student preference for online or in-person delivery of clinical reasoning seminars.

Students felt in-person seminars were better for 16/18 of the listed reasons. This included all reasons pertaining to interaction with other students and staff and all reasons regarding learning a variety of skills. The only two reasons students felt online sessions were better were ease of travel and home comforts. Therefore, this data suggests the only reasons the medical students preferred online seminars were due to the convenience of the setting, and they felt the learning and interaction were superior in in-person seminars.

Of these eighteen reasons, three reasons showed a significant difference in response based on gender, with more female students preferring in-person seminars for the following reasons: enjoyment, development of history-taking skills and formulating differential diagnoses. History-taking and formulating differential diagnoses are more commonly undertaken by doctors within in-person environments. Therefore, female medical students may have a stronger preference for learning skills in the same setting they will be undertaken in when they are doctors.

This study helps to identify the components of clinical reasoning seminars male or female students prefer to undertake online or in-person. Future research could try to identify the reasons for these preferences and to establish if female students have a stronger preference for learning a skill in the same environment it would be undertaken in when they become a doctor.

This research will have most transferability to educators designing clinical reasoning modules to undergraduate students. It may also have some transferability to any undergraduate seminars and to postgraduate medical education. Also, understanding the environment each gender prefers to learn in and why, could help to designing future educational programmes. Especially if these programmes have previously shown differing participation or attainment based on gender.

V. CONCLUSION

In conclusion, students preferred in-person clinical reasoning seminars compared to online seminars and a higher percentage of female students preferred in-person compared to male students, although this was not statistically significant. Students had the strongest preference for in-person sessions due to interaction with friends and the facilitator and for developing clinical skills. Students had the strongest preference for online sessions due to home comforts and ease of travel. Female students preferred in-person seminars compared to male students for the following statistically significant reasons: enjoyment, developing history-taking skills and formulating differential diagnoses.

Notes on Contributors

Dr Victoria Scudamore was involved in data collection, data analysis and wrote this manuscript in full.

Dr Sze Yi Beh was involved in data collection and data analaysis.

Dr Adam Foster was involved in data collection and data analysis.

Dr Michaela Goodson supervised and advised on data collection and analysis.

Ethical Approval

Research and ethics approval was granted by the research committee at Newcastle University Medicine Malaysia on 08/02/2022 (Approval number: 18547/2022).

Data Availability

The data used in this paper is available in the Figshare repository through the following links with associated DOI’s https://doi.org/10.6084/m9.figshare.23616627.v1 and https://doi.org/10.6084/m9.figshare.23616630.v1. The data is shared on the Figshare repository under the CC0 licence (no rights reserved) as there is no copywritten information included.

Funding

No additional funding was used to undertake this project.

Declaration of Interest

There are no potential conflicts of interest to declare.

References

Al-Azzam, N., Elsalem, L., & Gombedza, F. (2020). A cross-sectional study to determine factors affecting dental and medical students’ preference for virtual learning during the COVID-19 outbreak. Heliyon, 6(12), 4. https://doi.org/10.1016/j.heliyon.2020.e05704

Altaf, R., Kling, M., Hough, A., Baig, J., Ball, A., Goldstein, J., Brunworth, J., Chau, C., Dybas, M., & Jacobs, R. J. (2022). The association between distance learning, stress level, and perceived quality of education in medical students after transitioning to a fully online platform. Cureus, 14(4), 3. https://doi.org/10.7759/cureus.24071

Babenko, O., Ding, M., & Lee, A. S. (2022). In-person or online? The effect of delivery mode on team-based learning of clinical reasoning in a family medicine clerkship. Medical Sciences, 10(3), 41. https://doi.org/10.3390/medsci10030041

Cromer, S. J., D’Silva, K. M., Phadke, N. A., Lord, E., Rigotti, N. A., & Baer, H. J. (2022). Gender differences in the amount and type of student participation during in-person and virtual classes in academic medicine learning environments. JAMA Network Open, 5(1), 1. https://doi.org/10.1001/jamanetworkopen.2021.43139

*Dr Victoria Scudamore
Newcastle University Medicine Malaysia
No. 1 Jalan Sarjana 1,
Kota Limu, EduCity@Iskandar,
Iskandar Puteri, Johor, Malaysia, 79200
Email: victoria.scudamore@nhs.net

Submitted: 8 August 2023
Accepted: 9 January 2024
Published online: 2 July, TAPS 2024, 9(3), 50-54
https://doi.org/10.29060/TAPS.2024-9-3/SC3107

Chuu Ling Chan¹, Russell Lee², Lih Ing Goh¹, Nathanael Hao Kai Chong¹, Li Neng Lee² & Jun-Hong Ch’ng¹

¹Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; ²Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore

Abstract

Introduction: We frequently associate microbes with infection, rarely expounding on their usefulness and importance to healthy development. For humanity to leverage these microbial “super powers”, learners from all backgrounds need to appreciate their utility and consider how microbes could help solve some of the most critical problems we face. However, learners are frequently uninterested or intimidated by microbiology. The card game “No Guts No Glory” was created to engage students by piquing curiosity and encouraging informal learning to change perceptions and advocate the value of microbes to good health.

Methods: Undergraduates from various faculties in the National University of Singapore were invited to play and give feedback on accessibility, engagement and self-reported learning gains.

Results: The game was well-received across disciplinary backgrounds with positive feedback (5-point scale) on game mechanics being fun (4.17±0.63), attractive artwork (3.83±1.00) and scientific snippets (3.79±1.04), positive re-playability (3.46±0.84), player engagement for those without foundational knowledge in microbiology (3.63±1.04), and usefulness of knowledge taught (3.54±1.10). Areas for improvement evidenced from feedback included unclear instructions (2.74±0.98), limited content taught (2.76±0.93), not generating interest to attend formal microbiome classes (2.88±1.17) and not prompting lifestyle changes (1.98±1.11).

Conclusion: This pilot study provided valuable insights from the target demographic, with concrete ideas on how to improve the educational potential of “No Guts No Glory”. Findings further lay the groundwork for the design of future instruments to objectively quantify learning gains from gameplay.

Keywords:           Game-based Learning, Microbiome, Microbiology, Card Game, No Guts No Glory

I. INTRODUCTION

Though responsible for infection and disease, microbes are also necessary for promoting and maintaining good health and are remarkably useful in many industries. Microbes are crucial and versatile tools which can be used to tackle some of the world’s most complex problems ranging from pandemics and climate change to sustainable foods and environmental remediation (Akinsemolu, 2018). Recognising the true potential of microbes could encourage their use in impactful problem-solving. However, students may perceive microbiology as a difficult subject and not associate microbes with anything positive.  To address this, we developed the card game “No Guts No Glory” that focuses on the positive aspects of microbes, particularly in the context of the gut microbiome which is closely tied to many aspects of our health and development (Lynch & Pedersen, 2016). We sought to engage learners from diverse disciplines by reducing the psychological barrier to learning microbiology, sparking curiosity and encouraging self-directed exploration.

Previous studies on card games, including one involving immunology (a related and equally complicated subject), have demonstrated the benefits of game-based learning (Barnes, 2022; Su et al., 2014): (a) games provide an attractive, innocuous entry point for individuals to explore complex subjects in a fun and enjoyable manner; (b) they remove barriers associated with traditional learning approaches, making it easier for learners to get started and actively participate; (c) additionally, game-based learning promotes active engagement; (d) through interactive gameplay, players become immersed in theoretical concepts which fosters deeper understanding of the subject and enhances retention.

In this study, we examined the impact of playing “No Guts No Glory” on participants’ interest in microbiology and garnered feedback for optimising game mechanics, instructions and artwork in preparation for future studies on the game’s impact on learning gains.

II. METHODS

Undergraduate students from various academic backgrounds were invited to participate in this pilot study on version 1 of the microbiome card game “No Guts No Glory”. Students were briefed on the details of the study and implied consent was given with their participation. Documentation of informed consent was waived as the collection of personal, sensitive information was kept to a minimum. A total of 41 participants were recruited – 29% from Medicine, 46% from Life Sciences, 20% from Psychology and 5% from other majors. Although not enforced, most participants played the game with others from the same discipline due to the way participants were recruited and how gameplay sessions were organised.

Participants first read through the game instructions and provided feedback on the instructions before playing two rounds of the game in groups of three or four. During the first round of gameplay, participants discussed and negotiated the rules among themselves based on what they had read, without input from the session facilitator. There was a break between the two rounds when the session facilitator highlighted deviations from the intended gameplay and answered questions about the game, before proceeding to the second round of gameplay. Participants then gave feedback via Qualtrics on their experience with the game. Throughout the two rounds of gameplay, the session facilitator also recorded observations of questions about instructions, disagreements about rules, deviations in gameplay and comments about game mechanisms, artwork, experiences and learning gains.

For quantitative feedback, participants rated the clarity and presentation of the instructions, the accessibility of the game, player engagement level and perceived learning gains, based on 5-point rating scales. Open-ended qualitative questions included: 1) suggestions to improve the instructions or the game, 2) elaboration on likely lifestyle/behavioural changes after playing and 3) key ideas they had learnt about the gut microbiome.

III. RESULTS

Quantitative feedback from participants after playing “No Guts No Glory” is summarised in Table 1 and qualitative feedback (individual comments and suggestions) is accessible at https://doi.org/10.6084/m9.figshare.23735211

Table 1. Participants’ quantitative feedback (5-point rating scales) on the microbiome card game “No Guts No Glory”

A. Instructions

Participants rated the ease of understanding and the presentation of the instructions near average (2.74±0.98 and 3.11±1.09 respectively). Qualitative feedback on the instructions revealed that many participants felt uncertain of game components, rules and mechanics (19 participants), that phrasing and overall wordiness of the instructions could be improved (14 participants), and that the instructions lacked emphasis on the goals of the game (3 participants). They suggested the need for more examples, visuals or even a demonstration video (10 participants) and reformatting the instructions (3 participants).

B. Game Accessibility and Player Engagement

Participants agreed that the length of one game was just right (3.02±0.42) and felt that the game was fun (4.17±0.63). They also had a good impression of the artwork (3.83±1.00) and scientific snippets included on the game cards (3.79±1.04), although 7 participants did not manage to read these snippets. Most participants responded positively regarding the replayability of the game, with a likelihood of playing the game if they owned it scoring 3.46±0.84, at an average frequency of 2.80±0.8. They perceived that players without any prior microbiome knowledge would be able to play and find the game engaging (3.63±1.04). Suggestions were given to enhance the game by changing the game mechanics to enrich learning (17 participants), improving the quality of game components (7 participants), including visual aids in the instructions (6 participants), and refining the artwork aesthetics (4 participants).

C. Experiences and Learning Gains

Gameplay helped participants to recognise the usefulness of microbiome knowledge (3.54±1.10), and to a lesser degree, connect topics (3.05±0.92) and raise curiosity (3.00±1.02). Participants who indicated more prior knowledge reported that the game was moderately effective in reinforcing existing content (3.19±1.05) while those with less prior knowledge indicated that the game was less effective in teaching content (2.76±0.93). In the qualitative feedback, suggestions for improving learning gains involved linking the scientific snippets found on the cards to gameplay (4 participants), and including a quiz component in the game mechanics (3 participants). Participants showed little interest in taking formal microbiome classes after gameplay (2.88±1.17), and only half (51.2%) indicated potential behavioural or lifestyle changes: 14 mentioned changes in their diet, two mentioned an increased curiosity in microbiome-related topics while one reflected on blindly chasing lifestyle/dietary trends.

D. Key Lessons Learnt by Students from Playing the Game

Drawing on open-ended feedback from participants, the top three ideas drawn from gameplay were the importance of the gut microbiome in health (8 out of 36 responses, 22%), how our microbiome is affected by multiple factors (19.4%), and the importance and definitions of pre/pro/syn-biotics (16.6%).

IV. DISCUSSION

Based on the feedback received, the game was enjoyable, with the inclusion of both attractive artwork and intriguing scientific snippets being crucial in generating interest. Participants acknowledged the value of the information presented in the game, which could inspire them to further explore specific areas of interest on their own. Participants also agreed that the game’s entry barrier was low enough, such that even individuals without a microbiology background could comprehend the gameplay and find it engaging. Positive replayability of the game could aid learning through increased exposure to information on the cards and instructions. Notably, the game’s effectiveness in reinforcing existing knowledge received higher ratings compared to its ability to teach new content in this study, aligning with similar findings published by others (Spandler, 2016; Su et al., 2014). While positive, these outcomes need to be viewed with caution as some of the students were likely to have been from classes taught by the researchers. Although feedback was anonymous and collected in the absence of their teachers, we acknowledge that this student-teacher/researcher relationship may have inadvertently introduced bias in this study.

This study also revealed four shortcomings of the game: 1) unclear instructions, 2) ineffectiveness at teaching new content, 3) generating little interest to enrol in microbiology classes and 4) low possibility of changing lifestyles. The latter three points allude to current game mechanics being ineffective in highlighting the relevance of microbiomes to students’ lives. To assess the concordance between the game’s intended learning objectives and students’ actual learning outcomes, self-reported key takeaways were examined. Although many of the mentioned themes corresponded to the learning objectives that were established during the game development phase, it was evident that certain learning objectives were insufficiently emphasised.

With valuable suggestions provided by participants to enhance learning impact, we anticipate that the revised game (version 2), which further integrates learning outcomes with game mechanics, will better showcase the importance and relevance of microbiomes. Furthermore, student insights from the current study have facilitated the development of assessment tools for quantifying learning gains in future studies through pre- and post-play testing methodologies. Also, since “No Guts No Glory” emphasises the beneficial impact of microbes on our health, future studies could compare the impact of this game to others which emphasise disease-causing pathogens and antimicrobial resistance, especially in how they shape perceptions about microbes.

V. CONCLUSION

In conclusion, our pilot study of “No Guts No Glory” highlighted its strengths in terms of accessibility and player engagement. However, it also brought to attention areas requiring improvement. These include simplifying the instructions to enhance clarity, ensuring that learning is effectively integrated with gameplay and better aligning game mechanics with the science.

Furthermore, we have identified key learning outcomes from unsupervised gameplay which will guide the development of assessment instruments in future studies, via pre- and post-play testing. Such testing will allow us to evaluate learning gains more effectively in subsequent studies involving both microbiology and non-microbiology undergraduates.

Notes on Contributors

Chuu Ling Chan was involved in conceptualisation, methodology, project administration and supervision, data analysis and writing (original draft and editing).

Russell Lee was involved in conceptualisation, methodology, project administration and supervision, data analysis and writing (editing).

Lih Ing Goh was involved in methodology, project administration and supervision, data analysis and writing (editing).

Nathanael Hao Kai Chong was involved in project administration and supervision.

Li Neng Lee was involved in conceptualisation, methodology and writing (editing).

Jun-Hong Ch’ng was involved in conceptualisation, methodology, data analysis and writing (editing).

Ethical Approval

This study was reviewed by the Learning and Analytics Committee on Ethics- Departmental Ethics Review Committee (LACE-DERC) from the National University of Singapore (NUS) Institute for Applied Learning Sciences and Educational Technology (ALSET) and Centre for Development of Teaching & Learning (CDTL), with an exemption from IRB review and the approval to conduct research at NUS (LACE Reference Code: L2021-12-01).

Data Availability

Qualitative study data can be accessed at https://doi.org/10.6084/m9.figshare.23735211.

Acknowledgement

We would like to acknowledge all the students who participated in this study.

Funding

This study is funded by the Teaching Enhancement Grant (TEG FY2023) from the Centre for Development of Teaching and Learning (CDTL), National University of Singapore (E-571-00-0001-01).

Declaration of Interest

The authors declare no conflicts of interest.

References

Akinsemolu, A. A. (2018). The role of microorganisms in achieving the sustainable development goals. Journal of Cleaner Production, 182, 139–155. https://doi.org/10.1016/j.jclepro.2018. 02.081 

Barnes, R. L. (2022). A protein purification card game develops subject knowledge and transferable skills. Journal of Biological Education, 56(4), 365–375. https://doi.org/10.1080/00219266.20 20.1799844

Lynch, S. V., & Pedersen, O. (2016). The human intestinal microbiome in health and disease. New England Journal of Medicine, 375(24), 2369–2379. https://doi.org/10.1056/NEJMra16 00266

Spandler, C. (2016). Mineral supertrumps: A new card game to assist learning of mineralogy. Journal of Geoscience Education, 64(2), 108–114. https://doi.org/10.5408/15-095.1

Su, T., Cheng, M.-T., & Lin, S.-H. (2014). Investigating the effectiveness of an educational card game for learning how human immunology is regulated. CBE Life Sciences Education, 13(3), 504–515. https://doi.org/10.1187/cbe.13-10-0197

*Jun-Hong Ch’ng
MD4, 5 Science Drive 2,
Singapore 117545
Email: micchn@nus.edu.sg

Submitted: 19 August 2023
Accepted: 21 December 2023
Published online: 2 July, TAPS 2024, 9(3), 41-49
https://doi.org/10.29060/TAPS.2024-9-3/SC3111

Rosy Swee Cheng Tay¹, Debby Regina Wegner², Li Siong Lim³, Joshua Ting⁴ & Shu Ting Ong⁵

¹University of Glasgow Singapore, Singapore; ²Singapore Institute of Technology, Singapore; ³Singapore Institute of Technology, Singapore; ⁴Alexandra Health, Singapore; ⁵Gleaneagles Hospital, Singapore

Abstract

Introduction: The Singapore Institute of Technology-University of Glasgow (SIT-UofG) Nursing Programme has traditionally taken a didactic teaching approach in the delivery of the Evidence-Based Practice (EBP) module.  A hybrid approach was introduced using Game-Based Learning (GBL) to encourage active learning through gameplay. 

Methods: A Randomised Controlled Trial (RCT) was undertaken encompassing a cohort of 100 Nursing students taking the EBP module in their first year at the Singapore Institute of Technology (SIT) in the 2021/22 academic year. The experimental group (n=27) worked through the online GBL intervention and the EBP module, while the control group (n=27) took the EBP module alone. The GBL included five Learning Quests and three case studies.

Results: High levels of satisfaction were reported by both the experimental group (n=22) and the control group (n=15) on the traditional content and delivery of the EBP module. High levels of engagement were reported by the experimental group on the GBL intervention; a one-sample statistics analysis confirming a significant level of engagement (p<0.001). A Mann-Whitney U Test, however, found no significant difference in the Continuous Assessment (CA) scores of the two groups (p=0.507 and 0.461). 

Conclusion: The introduction of GBL designed to deliver educational content directly associated with the learning outcomes increased the nursing student engagement in the EBP module. These findings and discoveries can be utilised to improve the GBL intervention to the EBP module to have a more positive impact the student CA scores and therefore on student learning.

Keywords:           Evidence-Based Teaching, Evidence-Based Practice (EBP), Nursing Education, Game-Based Learning (GBL), Teaching and Learning EBP, Nursing Students, Gamification

I. INTRODUCTION

The Singapore Institute of Technology-University of Glasgow (SIT-UofG) Nursing Programme has traditionally taken a didactic teaching approach in the delivery of the Evidence-Based Practice (EBP) module. Numerous undergraduate nursing programmes have taken a similar approach aimed at preparing students to be informed knowledge generators, rather than the more effective savvy consumers of research, or “evidence users” (Melnyk & Fineout-Overholt, 2019). These undergraduate nursing programmes continue to teach “traditional” nursing research courses that fail to address many of the skills, attitudes, and critical knowledge needed to foster EBP, doing little to promote the development of competencies critical for engaging in EBP in clinical contexts (Davidson & Candy, 2016).

EBP is mandated by the Singapore Nursing Board as a key entry to nursing practice competency (Singapore Nursing Board, n.d.) and yet new graduate nurses still lack the knowledge, skills, and attitudes that nurture EBP. In addition, the COVID-19 pandemic brought about unprecedented challenges when classes moved from face-to-face to online, with one of the side-effects being a marked deterioration in the active engagement of the students in their classes. Active engagement is seen as critically pertinent to the learning development of nursing students in preparing them to be future-ready graduates.

Gamification, or the application of game design elements like levels and badges to non-game activities, has been avidly adopted to support contextual teaching and learning, assignments, and assessments in efforts to strengthen student creativity and retention (Caponetto et.al., 2014). Although, as reported by Tavares (2022), results have been varied, Game-Based Learning (GBL) is being increasingly utilized in nursing education.  The aim of this short communication is to describe the development and evaluation of an innovative teaching strategy to evaluate student satisfaction, perception, level of engagement, and overall achievement of the learning outcomes via the gamification of the EBP module.

II. METHODS

A Randomised Controlled Trial (RCT) was undertaken using the 100 Nursing students taking the EBP module in their first year at the Singapore Institute of Technology (SIT) in Trimester 3 of the 2021/22 academic year. All the students were invited to participate in the study and complete the Informed Consent form. The participants were randomized into either the experimental/ intervention group (n=27) or the control group (n=27).

The control group attended the traditional EBP module made up of lectures, workshops, and seminars. The intervention group completed both the EBP module and the GBL intervention. The web-based, mobile-optimized GBL was composed of five levels or Learning Quests (LQs) and three case studies. The LQs followed six different EBP steps (Melnyk & Fineout-Overholt, 2019), with each LQ calling for increasing levels of knowledge and proficiency to cultivate a spirit of inquiry for the undergraduate nursing students. The intervention group was informed to access the GBL only after the key EBP concepts and teaching were delivered to both groups.

Two surveys were used to evaluate participant satisfaction, perception, level of engagement, and overall achievement of the learning outcomes. At the end of the trimester, a university-wide Module and Teaching Feedback survey (Appendix 1) was used to assess how satisfied both groups were with teaching and learning within the EBP module. The GBL Module Learning Outcomes Feedback survey was to get a sense of how the intervention group evaluated the effectiveness of the four main GBL outcomes (Appendix 2).

III. RESULTS

A total of 54 students out of the 100 (54%) taking the EBP module agreed to participate in this study. A total of 22 (81.5%) participants from the intervention group and 15 (55.6%) from the control group completed the surveys. There was a 44.4% attrition from the control group.

A. Grade Performance

There were two types of Continuous Assessment (CA) used – a group presentation worth 40% of the total grade, and an individual essay worth 60%. For the group presentation the mean score and standard deviation of the intervention group was 79.56 (3.70) and the control group was 78.70 (4.03). For the essay, the mean score and standard deviation of the intervention group was 69.6 (11.93) and for the control group was 67.81 (10.76). The Mann Whitney U Test found that there was no significance difference between the CA scores of the intervention and control groups (p = 0.507 and 0.461).

B. Level of Satisfaction

Overall, there was a high level of satisfaction for the EBP module for both groups (intervention: 95.5%; control: 93.3%) with no significant difference (p=0.658) found between the two groups.

C. Level of Perception

Both groups demonstrated similar positive perceptions about the EBP module. 5 themes emerged from the thematic analysis of the open-ended questions (Table 1)

D. Level of Engagement

The GBL was reported by the students to have deepened their learning of EBP. 4 themes emerged from a thematic analysis of the open-ended questions (Table 1).

Table 1. Themes and associated subthemes

Note. This table lists the themes and associated subthemes that were identified from the student responses to the open-ended questions under perception and engagement. Selected student comments are included.

IV. DISCUSSION

There were several key findings from the development of GBL for the EBP module. Although no significant difference was found on the CA grade performance between the groups, both groups expressed a high level of satisfaction upon completing the EBP module.

Despite facing challenges with the usual didactic approach of teaching and learning of EBP, participants expressed appreciation to the faculty for the close stepwise guidance and prompt feedback in facilitating synergistic class teamwork. The systematic flow helped create a positive perception of the module delivery. This well-structured learning scaffold also provided a solid foundation for writing their Honours Thesis.

Gamification using case studies provided good interactivity for applied learning to enhance student engagement and learning. With regards to the interface itself, the navigation of the case studies via the user interface was found to be challenging, so side-by-side scrolling can be considered to improve future user experience.  Standardizing teaching and instructional methods to manage student expectations can also be considered, as there was definite support for moving the EBP module towards game-based learning.

This development of GBL for the EBP module was an innovative hybrid approach to the teaching pedagogy of the educational and healthcare institutions in Singapore. The employment of both didactic and GBL teaching and learning served to enhance the learning experience of the students and helped clarify the future translation of EBP into their respective clinical practice. While the feedback from the intervention group indicated the GBL interface can be improved, the high levels of satisfaction and engagement experienced by this group demonstrated the incorporation of game mechanics in the design of a teaching-learning process can help engage learners in a more productive learning experience.

With no significant difference between the grades of the two groups, it could be argued that the nursing students are already being well guided and supported by Faculty in the teaching and learning of EBP and that the intervention was built upon a firm foundation. Leveraging upon authentic digital learning with a sound pedagogical approach, however, can help to further promote critical thinking, active engagement, and positive learning experiences for the nursing students. Future enhancement to the GBL intervention can consider levelling up the basis of gamifying learning for higher immersive learning experience.  As there was a high attrition from the control group of 44.4%, future studies can consider a larger sample size for better generalizability. As this study only employed the GBL after the key concepts and teaching of EBP was delivered, future studies can consider the teaching and learning pedagogy of GBL along with seminar sessions to evaluate its viability.

V. CONCLUSION

This research project was carried out at the Singapore Institute of Technology to assess the impact of a GBL intervention on teaching and learning in the EBP module for nursing students. Despite no significant differences in grades between the groups, the results show the intervention had a positive impact on the student engagement, satisfaction, and perception of the learning experience, offering an excellent option of combining traditional didactic teaching with the innovative approach of GBL to enhance the EBP teaching and learning of undergraduate nursing students and healthcare professionals in both educational and healthcare institutions.

Notes on Contributors

Assistant Professor Rosy Tay Swee Cheng spearheaded the development of this research project, conducted the survey and data analysis, contributed to the conception, drafted, and critically revised the manuscript.

Ms. Debby Regina Wegener is a Senior Librarian and assisted with the development of a part of this research project, and critically revised the manuscript.

Mr. Lim Li Siong is a Senior Educational Developer in CoLEAD and coordinated the development of the research project and contributed to the critical review of the manuscript.

Mr. Joshua Ting is a Staff Nurse, Alexandra Health and played a key role in the development, conducted the survey and data analysis of this research project, and assisted in the critical review of the manuscript.

Ms. Ong Shu Ting is a Staff Nurse, Gleneagles Hospital and played a key role in the development, conducted the survey and data analysis of this research project, and assisted in the critical review of the manuscript.

All authors gave their final approval and agreed to be accountable for all aspects of the work.

Ethical Approval

Ethical approval approved by Singapore Institute of Technology (SIT) Review Board (IRB Project No. 2021157).

Data Availability

As per institutional policy, research dataset is available on reasonable request to the corresponding author.

Acknowledgement

The authors would like to thank Adjunct Associate Professor Edward Poon, Singapore Institute of Technology (SIT) for his invaluable support to the research project and Tam Yew Chung, Centre for Learning Environment and Assessment Development (CoLEAD), SIT for his advice and invaluable support in navigating the funding process.  

Funding

Funding (WBS Code: P-ALI-A203-0008) was received from Applied Learning and Innovation Grant (ALIGN), CoLEAD, SIT for the development of this web-based EBP game-based learning.  

Declaration of Interest

The authors declare no conflict of interest.

References

Caponetto, I., Earp, J., & Ott, M. (2014). Gamification and education: A literature review. European Conference on Games Based Learning, 1, 50–57.  

Davidson, S. J., & Candy, L. (2016). Teaching EBP using game-based learning: Improving the student experience. Worldviews on Evidence-Based Nursing, 13(4), 285–293. https://doi.org/10.1111/wvn.12152

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4^th ed.). Wolters Kluwer.

Singapore Nursing Board. (n.d.). Guidelines and Standards. https://www.healthprofessionals.gov.sg/snb/guidelines-and-standards  

Tavares, N. (2022). The use and impact of game-based learning on the learning experience and knowledge retention of nursing undergraduate students: A systematic literature review. Nurse Education Today, 117, Article 105484. https://doi.org/10.1016/j.nedt.2022.105484 

*Rosy Tay Swee Cheng
University of Glasgow, Singapore,
10 Dover Drive, Singapore 138683
+65 6592 4521
Email: rosy.tay@glasgow.ac.uk

Submitted: 17 August 2023
Accepted: 21 December 2023
Published online: 2 April, TAPS 2024, 9(2), 87-91
https://doi.org/10.29060/TAPS.2024-9-2/SC3114

Isharyah Sunarno^1,2, Budu Mannyu^2,3, Suryani As’ad^2,4, Sri Asriyani^2,5, Irawan Yusuf ^2,6, Rina Masadah^2,7 & Agussalim Bukhari^2,4

¹Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Indonesia; ²Department of Medical Education, Faculty of Medicine, Hasanuddin University, Indonesia; ³Department of Ophthalmology, Faculty of Medicine, Hasanuddin University, Indonesia; ⁴Department of Clinical Nutrition, Faculty of Medicine, Hasanuddin University, Indonesia; ⁵Department of Radiology, Faculty of Medicine, Hasanuddin University, Indonesia; ⁶Department of Physiology, Faculty of Medicine, Hasanuddin University, Indonesia; ⁷Department of Pathological Anatomy, Faculty of Medicine, Hasanuddin University, Indonesia

Abstract

Introduction: The study aimed to ascertain how the faculty at the Faculty of Medicine, Hasanuddin University perceived their role as a tutor during a problem-based learning activity during the academic phase of medical education, based on the length of time they acted as a tutor.

Methods: This was prospective observational research with an explanatory sequential mixed-method design, which was performed at the Undergraduate Medical Study Program, Faculty of Medicine, Hasanuddin University, from January 2023 until May 2023. Research subjects were divided into two groups: a) the Novice group and b) the Expert group. Quantitative data were collected by giving a questionnaire containing six categories with 35 questions and distributed by Google form. An independent t-test was used to compare the faculty’s perception, with a p-value <.05 significant. Followed by Focus Group Discussion (FGD) for qualitative data, which then were analysed by thematic analysis. The last stage is integrating quantitative and qualitative data.

Results: There were statistically significant differences in seven issues between the two groups. Most of the tutors in both groups had favorable opinions, except for the expert group’s disagreement with the passive role of the tutor in the tutorial group. Eight positive and twelve negative perceptions were found in the FGD.

Conclusion: Most tutors positively perceived their role in PBL, with the expert group having more dependable opinions and well-reasoned suggestions.

Keywords:           Problem-Based Learning, Undergraduate Medical Education, Focus Group Discussion

I. INTRODUCTION

The transition from teacher-centered to student-centered learning occurs with the introduction of active learning based on the needs of the students. The majority of effective active learning activities in the classroom were created in small groups using the Problem-Based Learning (PBL) approach. PBL has no worse outcomes in terms of academic performance and is more effective than conventional methods at enhancing social and communication skills, problem-solving abilities, and self-learning abilities, and allows the students to collaborate while integrating science, theory, and practice (Trullàs et al., 2022; Wiggins et al., 2017). A tutor or a facilitator is a pertinent element for the success of tutorial activities in PBL, thus evaluating periodically their perception and understanding about PBL activities, will help determine the need for resource development at the faculty level. Based on the aforementioned background, the author is intrigued to understand how the faculty at the Undergraduate Faculty of Medicine at Hasanuddin University perceived their role as a tutor during a PBL activity based on the duration they acted as a tutor.

II. METHODS

Short-case PBL tutorial is the model being implemented in our institution. An explanatory sequential mixed-methods observational prospective design study was carried out from January 2023 to May 2023. Informed consent was obtained from all the participants (ethics approval recommendation number: 99/UN4.6.4.5.31/PP36/2022). The study was conducted in three stages (Figure 1):

A. Stage 1

Gathering quantitative data via a survey disseminated using Google form, after which the information was analysed using SPSS version 25. The Likert scale, which ranged from 1 (extremely disagree) to 5 (extremely agree), was used to evaluate the 35 items in the questionnaire that served as the study’s primary data collection tool (Table 1 which is openly available on Figshare). The validity and reliability test for the study’s questionnaire was carried out as the first step and the Pearson Correlation was used to examine the outcome; all questions were valid with Cronbach’s α .951. The next step was to collect data through convenience sampling. Inclusion criteria were lecturers who: have attended training to become PBL tutors, are actively involved in PBL activities, and are willing to participate in the research projects to completion. Exclusion criteria were lecturers who were not familiar with the Google form application. Subjects with other commitments that prevented them from finishing the research activities and with a conflict of interest in continuing the study were considered dropouts. The research participants were split into two groups: the novice group (participants who served as tutors for less than five years) and the expert group (participants who served as tutors for five years or more). The Slovin formula was used to determine the minimum sample size, and the result was 32 people for each group. Characteristics of the study subjects were presented descriptively. An independent t-test was used to compare the faculty’s perception of their role as a tutor during a problem-based learning activity, with a p-value <.05 significant.

B. Stage 2

Focus Group Discussions (FGD) were held to collect qualitative data. The participants in the FGD were divided into two groups using the identical criteria utilised for the quantitative group categorisation, and each group consisted of six subjects. Each participant received a set of open-ended questions to be discussed during the FGD. All events and discussions were recorded, and then all conversations were transcribed using the VERBATIM app. MAXQDA 2020 was then used to tag and categorise the data. Thematic analysis was used to assess qualitative data. We used an audit trail and triangulation during data collection and conducted a peer review during data analysis to ensure the validity of the qualitative data.

C. Stage 3

Integrating quantitative and qualitative data was performed by linking data, followed by integration at the interpretation and reporting level which was conducted by integration through a narrative with a weaving approach.

III. RESULTS

A. Characteristics of the Subjects

The subjects in the novice groups were all under 45 years old, but the expert group was predominately made up of older faculty members. Both groups were predominately female. At the time of the research, medical doctors dominated the novice group, but the expert group included people with a range of educational backgrounds. Characteristics of the study subjects are openly available in Table 2 on Figshare.

B. Quantitative Data

Seven question items from four categories significantly differed between the novice and expert groups as shown in Table 3 which is openly available on Figshare.

C. Qualitative Data

Thematic analysis from the FGD revealed that the expert group only has negative perceptions, whereas the novice group has both negative and positive perceptions. The data are openly available in Table 4 on Figshare.

D. Integration of Quantitative and Qualitative Data

Faculty staff has the same perception about almost all concepts about the role of a PBL tutor, except for seven concepts that were statistically significantly different (Figure 1): 

1) PBL as Pedagogical Method: Q5 (group tutorials help students share experiences) and Q9 (PBL is a great tool for student learning) were significantly different, with the majority of the novice group agreeing with it while the majority of the expert group were extremely agreeable. Nevertheless, while the novice had a positive perspective shown in the discussion, the expert expressly stated that “(PBL) increased the (student’s) ability to discuss but not the depth of knowledge.”

2) Supervising Problem Processing in Tutorial Groups: Q12 (I function as a resource person in the group) and Q13 (I participate in creating a positive work environment for the group) were significantly different, with most of the novice group agreeing to the concept while the majority of the expert group were extremely agreeable. The novice group stated in the FGD that “PBL is very effective for building students’ analytical skills because the students can interact with each other to express their opinions and find key problem-solving strategies.” Both groups had the same perception that some tutors attended the PBL activities “just as a formality.” Q17 (I am sensitive to the wishes of the students regarding their need for support) was also significantly different, with most participants in both groups agreeing that tutors are sensitive to the student’s need for support, but 5.71% of the novices extremely disagreed. In contrast, none of the experts in the expert group disagreed with the concept. From the FGD results, the expert group suggested that the “tutor should give feedback and guidance to the students”.

3) Potential Barriers to Student Learning in PBL: the majority of both groups agreed that the group size is just right from a tutorial point of view (Q24), but the novice group had a wide range of responses (from extremely disagree to extremely agree), while 77.14% of the expert group agreed. “Six to eight students in one PBL group” is an elaborate suggestion made by the expert group as a result of the FGD.

4) There was a statistically significant difference between the two groups regarding the role of the tutor, which is usually passive in the tutorial group (Q29), with the expert group’s consensus on the matter being unfavorable, whereas the novice group’s responses were evenly split between neutral and disagree. The FGD’s results revealed that the novice merely stated, “If the students had a misleading concept, the tutor could not be kept silent,” whereas the expert suggested, “The tutor should be the chairman of the group discussion,” and “Questions and keywords must be made by the tutor.”

Figure 1. Integration of Quantitative and Qualitative Data

IV. DISCUSSION

PBL can be regarded as a multidisciplinary method that allows the learners to resolve real-life problems and situations in every aspect, learn how to construct new information meaningfully, put away the understanding of ready-to-use knowledge, and acquire critical thinking skills. Problem processing or facilitation is a challenging task (Aydogmus & Mutlu, 2019). Since PBL can be used in specific topics and can break up the monotony of traditional didactic teaching, it has become a popular alternative teaching strategy for undergraduate medical students. It can also be used as a method of integrated teaching. Overall, it is a great tool for students learning (Gadicherla et al., 2022).

The group size is one of the possible obstacles to students’ learning in PBL. All students will not be able to participate in a team that is too big. A team that is too small could not have enough members to address the learning objectives or enough diverse opinions to guarantee a robust discussion. The tutor should be aware of how the participants play their roles, noting those who do not contribute to debates or who are silent. Therefore, they must pay close attention to what is happening in the group process to intervene and provide feedback, promoting the participants’ individual and group progress. The tutor can assist the student in identifying their requirements through motivated evaluations and simple feedback, fostering the growth of self-confidence, autonomy, and, ultimately, integration into group dynamics. PBL teams ideally consist of 6–10 students (Dent et al., 2017).

V. CONCLUSION

Aside from seven concepts, both groups mostly had positive perceptions about their role as tutors, with the expert group having more dependable opinions and well-reasoned suggestions.

Notes on Contributors

Isharyah Sunarno made the following contributions to the study: conceptualised, created the initial draft and study design, investigated and collected data, conducted formal analysis, looked for research references, performed critical revision of the article, reviewed and edited the article, and approved the study’s final published version.

The following are the contributions Budu Mannyu made to the study: provided insights into the methodology, suggested research references, served as a peer reviewer of the study’s findings, performed critical revision of the article, and gave his approval of the final draft to be published.

Suryani As’ad contributed the following to the study: she offered insights into the methodology, proposed research references, served as a peer reviewer of the study’s findings, revised the article critically, and approved the final draft of the manuscript to be published.

The study benefited from Sri Asriyani’s efforts, which included: suggestion for research references, peer review of the study’s findings, and performed critical revision of the article.

The following contributions were made to the study by Irawan Yusuf: peer reviewing of the result, supervising the research activities, and critical editing of the publication.

The following are the contributions Rina Masadah contributed to the study: provided ideas into the original draft, supervised the research activities, and edited the publication critically.

Agussalim Bukhari made the following contributions to the study: offered insights into the methodology, oversaw the research activities, critically revised the final version of the article.

Ethical Approval

The study was approved by the Research Ethical Committee Faculty of Medicine Hasanuddin University with recommendation number: 99/UN4.6.4.5.31/PP36/ 2022.

Data Availability

The authors confirm that the data supporting the findings of this study are available within the article and its Supplementary material for research instrument in https://doi.org/10.6084/m9.figshare.23646918

Acknowledgement

Authors would like to express our sincere gratitude to all the tutors who participated in this study. A special appreciation is given to Ichlas Nanang Affandi and A. Tenri Rustam from the Psychology Study Program, Faculty of Medicine, Hasanuddin University for their valuable support throughout the research process, including their role as the facilitator of the FGD. We also would like to thank Andriany Qanitha and the CRP team from Faculty of Medicine, Hasanuddin University for their support in developing the manuscript. We are also grateful to the Department of Medical Education, Faculty of Medicine, Hasanuddin University for providing us with the resources and support we needed to complete this study.

Funding

This research received no external funding.

Declaration of Interest

The authors declare no conflict of interest.

References

Aydogmus, M., & Mutlu, A. (2019). Problem-based learning studies: A content analysis. Turkish Studies-Educational Sciences, 14(4), 1615–1630. https://doi.org/10.29228/turkishstudies.23012

Dent, J. A., Harden, R. M., & Hunt, D. (2017). A practical guide for medical teachers (5th ed.). Elsevier.

Gadicherla, S., Kulkarni, A., Rao, C., & Rao, M. Y. (2022). Perception and acceptance of problem-based learning as a teaching-learning method among undergraduate medical students and faculty. Azerbaijan Medical Journal, 62(03), 975–982.

Trullàs, J. C., Blay, C., Sarri, E., & Pujol, R. (2022). Effectiveness of problem-based learning methodology in undergraduate medical education: A scoping review. BMC Medical Education, 22(1), 1–12. https://doi.org/10.1186/s12909-022-03154-8

Wiggins, B. L., Eddy, S. L., Wener-Fligner, L., Freisem, K., Grunspan, D. Z., Theobald, E. J., Timbrook, J., & Crowe, A. J. (2017). ASPECT: A survey to assess student perspective of engagement in an active-learning classroom. CBE Life Sciences Education, 16(2), 1–13. https://doi.org/10.1187/cbe.16-08-0244

*Isharyah Sunarno
Jl. Perintis Kemerdekaan Km. 11,
Faculty of Medicine, Hasanuddin University
+62411-585859
Email: isharyahsunarno@gmail.com

Submitted: 12 June 2023
Accepted: 24 October 2023
Published online: 2 April, TAPS 2024, 9(2), 81-86
https://doi.org/10.29060/TAPS.2024-9-2/SC3066

Lean Heong Foo¹, Nurul Haziqah Binte Suhaimi², Saudha Binte Sadimin², Marianne Meng Ann Ong¹

¹Department of Restorative Dentistry, National Dental Centre, Singapore; ²Dental Assisting, National Dental Centre, Singapore

Abstract

Introduction: An online survey was conducted on 16 National Institute of Technical Education Certificate (NITEC) Dental Surgery Assistant (DSA) trainees in National Dental Centre Singapore to find out their perceptions and understanding of mental well-being.

Methods: The 43-item survey included (i) Psychological General Well-being Index (PGWB) with 22 items based on 6 domains (anxiety, depression, positive well-being, self-control, general health, and vitality); (ii) 5 items on mental health knowledge; (iii) 4 items on lifestyle; and (iv) 12 items on perceptions of mental well-being and working in the dental clinic. Responses were collated for descriptive analysis and Cronbach’s alpha analysis was done for internal consistency for Likert scale items.

Results: The average PGWB score was 61.5 (range 18-89). Fourteen trainees (75%) indicated they were feeling depressed and 31.2% of trainees felt under stress in the past month. The majority (81.3%) of trainees recognised the role of exercise in maintaining mental health and 75% of trainees were able to differentiate between sadness and depression. However, 56.3% and 87.5% of the trainees incorrectly answered that mental and psychological disorders are not preventable conditions and mental disorders are caused by a wrong way of thinking respectively. The Cronbach’s alpha on PGWB (a = 0.87) and trainees’ perception of working in the clinic (a = 0.76) revealed good internal consistency.

Conclusion: The PGWB scores and survey analysis indicate there is a knowledge gap about mental health and the need to improve mental well-being in this cohort of NITEC DSA trainees.

Keywords:            Mental Well-being, Dental Surgery Assistant Trainee, Psychological General Well-being Index

I. INTRODUCTION

In National Dental Centre Singapore (NDCS), Dental Surgery Assistant (DSA) trainees are required to complete a 1-year National Institute of Technical Education Certificate (NITEC) DSA programme to be qualified as a DSA. Similar to the training of dental students, DSA trainees undergo a significant transition from learning in a classroom setting (4 weeks pre-clinical didactic and observation) to a high-stress dental clinic work environment (clinical) when they start on-the-job training 1 month after commencing their programme. During this transition period, they need to multi-task and adapt to new clinical responsibilities related to infection control, patient management, and assisting clinicians. It has been reported that 80% of 299 Israeli DSAs suffered from a high level of burnout where the most stressful work-related factors were low income, high workload, and work hazards (Uziel et al., 2019). A survey was thus conducted to gain insights into the perceptions of mental well-being and working in the dental clinic among NDCS’s NITEC DSA trainees. This was a needs analysis survey done in June 2022 for a mental wellness module that aimed to provide support to DSA trainees enrolled in the 1-year NITEC DSA programme.

II. METHODS

An online anonymous survey with written consent was disseminated via Form.SG to the 2022 cohort of DSA trainees to complete three months after starting their 1-year programme.  The 43-item survey included (i) Psychological General Well-being Index (PGWB) with 22 items based on 6 domains (anxiety, depressed mood, positive well-being, self-control, general health and vitality) (Dupuy, 1984); (ii) 5 items on knowledge about mental health; (iii) 4 items on lifestyle; and (iv) 2 items on perception of mental well-being (adapted from Puspitasari et al., 2020) and 10 items on working in a dental clinic (crafted based on NDCS context). DSA trainees rated their level of agreement based on a 6-point Likert scale for PGWB (5 -most favourable response to 0 – unfavourable response) and a 5-point Likert scale for the perception of mental health and working in a dental clinic (5 – strongly agree to 1 – strongly disagree). The PGWB score ranges from 0 to 110, effectively representing an individual’s comprehensive subjective well-being. Additionally, the six dimensions of the PGWB index provide valuable insights into the subjective well-being associated with each specific dimension. The survey responses were collated for descriptive analysis and Cronbach’s alpha analysis was done for internal consistency for Likert scale items.

III. RESULTS

The entire cohort of sixteen DSA trainees {all female; age 17-50, mean 28.19 (23.39-32.99)} completed the online survey (100% response rate). The data of this study are openly available in the Figshare repository at http://doi.org/10.6084/m9.figshare.23501136.

Only 25% of trainees (4/16) had more than 1 year of prior working experience in a dental clinic. Their collated responses based on their second-month experience of the 1-year programme are as follows:

A. Psychological General Well-being Index (PGWB)

The average PGWB score for this cohort was 61.5 (range 18-89, 95% CI 52.80 – 70.20), indicating lower than average general well-being in this cohort {normal range 68-83 (Dupuy, 1984)}. No significant correlation was found between age and dental clinic experience on PGWB (r=-0.03; -0.06). The Cronbach’s alpha in PGWB (a = 0.93) indicated good internal reliability with a good individual domain analysis of 0.85 for all the domains (Appendix A: Table 1, Figures 2 and 3).

1) General health: The trainees achieved a mean score of 8.94 (Range 0-15) in general health. The majority (68.75%, 11/16) of trainees agreed they felt healthy enough to function.

2) Positive well-being: The trainees experienced a lower than moderate level of positive emotion and life satisfaction with a mean score of 9.94 (Range 0-20). Only 5 out of 16 trainees (31.25%) were happy with their personal life most of the time.

3) Self-control: The trainees possessed a moderate to higher level of self-control in regulating their behavior and emotions (mean 56, Range 0-15). However, about half of the cohort (56.25%, 9/16) admitted they felt a lack of control over their action in the past month.

4) Vitality: The trainees exhibited a moderate level of energy and vitality (mean 10.31, Range 0-20). However, 7 trainees (43.75%) admitted they felt worn out and exhausted most of the time in the past month.

5) Depressed mood: The trainees, on average, experienced a relatively moderate level of depressive symptoms in the past month (mean:88, Range 0-15). Fourteen trainees (75%) admitted they were feeling depressed and 31.2% of trainees (5/16) had felt under stress in the past month.

6) Anxiety: The trainees exhibited a moderate level of anxiety (mean 12.88, Range 0-25). Majority (81.25%, 13/16) of trainees admitted they felt high-strung quite a good bit of time in the past month.

B. Knowledge about Mental Health

Majority of DSA trainees (81.3%, 13/16) recognised the role of exercise in maintaining mental health and 75% (12/16) of trainees were able to differentiate between sadness and depression. However, 56.3% (9/16) of the trainees incorrectly answered that mental and psychological disorders are not preventable conditions, and a majority (87.5%, 14/16) incorrectly answered that mental disorders are caused by a wrong way of thinking (Appendix B).

C. Lifestyle

Half of the cohort exercised at least once a week. Only 50% of the cohort had self-care activities for themselves. Majority of the trainees (15/16) did not meditate and 50% of the trainees sought help from their friends and family when necessary (Appendix B).

D. Perception of Mental Well-being and Working in a Dental Clinic

Majority of the trainees also gave a neutral response (75%, 12/16) to the statement related to stress from working in the dental clinic. Majority agreed that mental health is important for their general health (87.5%, 14/16). Only half of the cohort indicated they were comfortable to work in the dental clinic (56.3%, 9/16) (Figure 1). About ¾ of the cohort believed they could complete the training programme and were confident to perform the on-the-job training (75%, 12/16). Majority (81.3%, 13/16) were willing to seek help if they encountered problems working in the dental clinic (Figure 1). The Cronbach’s alpha of trainees’ perceptions of working in the clinic (a = 0.76) revealed good internal consistency.

Figure 1. Perceptions of DSA trainees of mental well-being and working in the dental clinic in the second month of their 1-year programme

IV. DISCUSSION

Mental well-being is associated with one’s ability to cope with normal stresses of life and work productivity. This is particularly important in health professionals, including DSAs, to ensure the quality of patient care and professional satisfaction. To our knowledge, this is the first local survey to investigate DSA trainees’ perceptions of mental well-being and working in the dental clinic. The PGWB analysis revealed this cohort of DSA trainees had a lower-than-normal score that was even lower than a group of 320 Japanese dental students (61.5 versus 68.63) (Sugiura et al., 2005). Additionally, the trainees also demonstrated moderate levels of depression and anxiety, with a detailed analysis indicating a significant number experiencing stress.  This observation highlighted the transition from pre-clinical to clinical training phase can be challenging and stressful with increased workload and responsibility, as evident among DSAs who demonstrated a moderate level of professional burnout (Uziel et al., 2019). A similar trend was observed in this transition phase for dental students, where stress was associated with increased responsibility and demands associated with caring for real patients (de Souza Ferreira et al., 2023). Despite the difference in curriculum and a larger student cohort, the Japanese dental students (Sugiura et al., 2005) appeared to cope with their training better as their PGWB revealed they were more relaxed (Anxiety 16.43 versus 12.88) and cheerful (Depression 11.24 versus 9.88) compared with our DSA trainees. This finding reflects the need for providing mental well-being support for our DSA trainees in their programme.

The misconceptions about mental health and infrequent self-care practices among trainees suggest a lack of awareness of mental wellness.  Implementing a mental wellness module focusing on positive psychology, coping techniques like breathing exercises and meditation, and resource awareness can help address these issues. The Trainees’ willingness to seek help and recognise exercise’s role in mental health shows openness to support and intervention. Our pilot data is constrained by a small sample size and the absence of a control group for comparison, making it insufficient for general population inferences. The limitation of PGWBI includes only 6 dimensions and the potential of bias due to self-reported data.  Future recommendations involve re-evaluating the impact of the mental wellness module at the end of the 1-year program, inclusion of qualitative data, and establishing a supportive work environment with accessible mental health resources and mentorship to enhance the well-being and job satisfaction of DSAs.

V. CONCLUSION

In conclusion, the survey findings from this small cohort of DSA trainees underscore the importance of addressing mental health and well-being in this group of learners. The high prevalence of depressive symptoms and reported stress among the trainees highlights the need for targeted interventions and support systems to promote mental well-being. Hence, a mental wellness module will be introduced to this cohort of DSA trainees and this survey will be repeated 3 months after the module completion to assess any changes in this cohort’s perception of mental well-being and working in the dental clinic. 

Notes on Contributors

FLH reviewed the literature, contributed to the study conception, data acquisition, and data analysis, drafted, and critically revised the manuscript.

NHS contributed to the data acquisition, data analysis, and critically revised the manuscript.

SS contributed to the data acquisition, data analysis, and critically revised the manuscript.

MO contributed to the study conception, data acquisition and critically revised the manuscript. All authors gave their final approval and agreed to be accountable for all aspects of the work.

Ethical Approval

This study was exempted from the formal Centralised Institutional Review Broad review by SingHealth Institutional Review Board (CIRB Ref: 2022/2122).

Data Availability 

The data that support the findings of this study are openly available in the Figshare repository http://doi.org/10.6084/m9.figshare.23501136.

Acknowledgement

We would like to thank Ms Liu Yanting for her help in data preparation and collection.

Funding

There was no funding involved in the preparation of the manuscript.

Declaration of Interest

The authors declare no conflict of interest.

References

de Souza Ferreira, F., Barros, I., da Costa Neves, T., Pazos, J. M., & Garcia, P. P. N. S. (2023). Stress amongst dental students in the transition from preclinical training to clinical training: A qualitative study. European Journal of Dental Education. 27(3), 568-574.

Dupuy, H. J. (1984). The Psychological General Well-Being (PGWB) index. In: Wenger NK, Mattson ME, Furberg CF, & Elinson J (Eds). Assessment of quality of life in clinical trials of cardiovascular therapies. 170-183. Le Jacq.

Puspitasari, I. M., Garnisa, I. T., Sinuraya, R. K., & Witriani, W. (2020). Perceptions, knowledge, and attitude toward mental health disorders and their treatment among students in an Indonesian university. Psychology Research and Behaviour Management, 27(13), 845-854. 

Sugiura, G., Shinada, K., & Kawaguchi, Y. (2005). Psychological well-being and perceptions of stress amongst Japanese dental students. European Journal of Dental Education. 9(1),17-25. 

Uziel, N., Meyerson, J., Birenzweig, Y., & Eli, I. (2019). Professional burnout and work stress among Israeli dental assistants. Psychology, Health & Medicine, 24(1), 59-67.

*Foo Lean Heong
National Dental Centre Singapore
5, Second Hospital Avenue
168938 Singapore
Email: foo.lean.heong@singhealth.com.sg

Submitted: 20 April 2023
Accepted: 23 August 2023
Published online: 2 January, TAPS 2024, 9(1), 54-57
https://doi.org/10.29060/TAPS.2024-9-1/SC3048

Atul Kumar¹, Amol Gawande¹, Meghana Bhilare², Vishal Wadajkar², Indrajit Ghoshal³ & Shirish Raibagkar⁴

¹Dr.D.Y. Patil B-School, Pune, India; ²Dr.D.Y. Patil Institute of Management and Research, Pune, India; ³Faculty of Computer Science and Engineering, Poornima University, Jaipur, India; ⁴Savitribai Phule Pune University, Pune, India

Abstract

Introduction: The purpose of this study is to carry out a comparative analysis of the job satisfaction of nurses working in India based on the different types of the hospital they are working with. The study tests the null hypothesis that the job satisfaction of nurses from India across different types of hospitals is the same.

Methods: Four hundred nurses divided into 100 each for four popular types of hospitals – (1) Educational; (2) Government; (3) Charitable Trust; and (4) Private, from all over India were surveyed. Two ANOVA tests were performed. The first one was performed, taking overall job satisfaction as the dependent variable. The second ANOVA was performed by taking the monetary and compensation factors, work environment and management support, and job-related factors as the dependent variables.

Results: The overall mean of job satisfaction was -0.73 (SD 0.60). Overall, 65 percent of the variability of the dependent variable, job satisfaction, is explained by the type of hospital and is statistically significant (p<0.0001).

Conclusion: Monetary and compensation factors, work environment and management support, and job-related factors impact nurses’ job satisfaction. These factors vary with the type of hospital, and hence it can be concluded that due to variation in these factors depending on the type of hospital, the job satisfaction of nurses varies. Implications of our study are for the educational, government, and charitable trust hospitals to improve their work culture, management, and work environment so that nurses will have higher job satisfaction.

Keywords:           Nurses, Job Satisfaction, India, Hospitals, Government, Private, Charitable Trust, Educational 

Type	Total		Monetary		Work Env.		Job related
	Mean	SD	Mean	SD	Mean	SD	Mean	SD
Educational	-0.22	0.86	-0.21	0.87	-0.27	0.89	-0.19	0.90
Govt.	-1.55	0.40	-1.53	0.39	-1.60	0.47	-1.54	0.44
Trust	-1.57	0.46	-1.51	0.47	-1.65	0.50	-1.53	0.50
Private	0.42	0.68	0.39	0.74	0.39	0.68	0.48	0.71
Total	-0.73	0.60	-0.71	1.05	-0.78	1.09	-0.70	1.09

Table 1. Descriptive statistics of the sample

The overall job satisfaction mean scores of the hospitals were -0.22 (0.86) for educational hospitals, -1.55 (0.40) for Government hospitals, -1.57 (0.46) for Trust hospitals, and 0.42 (0.68) for private hospitals. For all the 400 respondents taken together, the mean job satisfaction score was -0.73 (SD 0.60).

In the case of educational hospitals, all three factors of job satisfaction were negative – monetary and compensation factors (M= -0.21, SD 0.87), work environment and management support (M= -0.27, SD 0.89), and Job-related factors (M= -0.19, SD 0.90). The same was the case with government hospitals which reported negative job satisfaction for all three factors – monetary and compensation factors (M= -1.53, SD 0.39), work environment and management support (M= -1.60, SD 0.47), and Job-related factors (M= -1.54, SD 0.44).

Further, charitable trust hospitals too reported negative job satisfaction for all three factors – monetary and compensation factors (M= -1.51, SD 0.47), work environment and management support (M= -1.65, SD 0.50), and job-related factors (M= -1.53, SD 0.50). However, private hospitals were the only type of hospitals that reported positive job satisfaction for all three factors – monetary and compensation factors (M= 0.39, SD 0.74), Work environment and management support (M= 0.39, SD 0.68), and job-related factors (M= 0.48, SD 0.71).

B. Testing of the Hypotheses

Two ANOVA tests were performed. The first one was performed, taking overall job satisfaction as the dependent variable (R² 0.65, p<0.0001). The second ANOVA was performed by taking the monetary and compensation factors (R² 0.62, p<0.0001), work environment and management support (R² 0.64, p<0.0001), and job-related factors (R² 0.64, p<0.0001) as the dependent variables.

IV. DISCUSSION

The overall job satisfaction score of the entire sample size of 400 respondents is -0.73 (SD 0.60), which is close to -1, indicating somewhat dissatisfied. Thus, on an overall basis, Indian nurses have reported job dissatisfaction. An important reason for this is the mismatch between the guidelines of the Nursing Council about the working conditions and the actual working conditions at the various hospitals. The analysis shows that for all the three factors, namely, the Monetary and compensation factors, the work environment and management support factors, and job-related factors the scores are range-bound. This indicates a close relationship between these three factors.

However, when we look at the analysis by the type of hospitals, major variations are seen. Three out of the four types: educational hospitals, government hospitals, and charitable trust hospitals, show negative job satisfaction, whereas only one type, the private owned hospitals, show positive job satisfaction. This is because private hospitals offer a much better and more professional work culture leading to higher job satisfaction among the nurses (Srimulyani & Hermanto, 2022). Interestingly, there is not much difference between the job satisfaction scores of government hospitals and charitable trust hospitals. The standard deviations associated with these two high negative scores are also similar. Scores of government hospitals and charitable trust hospitals can be taken as lying between somewhat dissatisfied and strongly dissatisfied ratings, pointing out a big gap between the prescribed norms of working conditions and the actual working conditions. The score of -0.22 indicates relatively much lesser job dissatisfaction in the case of educational hospitals (as compared to government and charitable trusts). It indicates that the control over educational hospitals is better as compared to the other two types of hospitals. The positive score of 0.42 in the case of private hospitals lies between neutral and somewhat satisfactory pointing a positive and professional work culture.

An important observation that emerges from the analysis is that for each of the four types of hospitals, there is little variation in the three factors of job satisfaction or dissatisfaction. This is because the three factors are closely related to each other.

V. CONCLUSION

Indian nurses, on an overall basis, are somewhat dissatisfied with their jobs. However, when we look into different types of hospitals, it is concluded that nurses working in private hospitals are moderately satisfied, those working in educational hospitals are moderately dissatisfied, and those working in government and charitable trust hospitals are highly dissatisfied. monetary and compensation factors, work environment and management support, and job-related factors impact nurses’ job satisfaction. These factors vary with the type of hospital, and hence it can be concluded that due to variation in these factors depending on the type of hospital, the job satisfaction of nurses varies. This impact is strong on an overall basis, as well as for the three factors (monetary and compensation Factors, work environment and management support, and job-related factors) separately. Interestingly there is a strong correlation among the three factors that we have used for measuring the job satisfaction of nurses. We conclude that positive and relatively higher job satisfaction among nurses working in private hospitals (Srimulyani & Hermanto, 2022) can be attributed to professional working culture, better monetary and compensation factors, better co-worker relationships, and other factors.

Notes on Contributors

Dr. Atul Kumar contributed to the conceptualization of the entire study. Dr. Amol Gawande contributed in designing methods for the study. Dr. Meghana Bhilare contributed to data collection. Dr. Vishal Wadajkar contributed to data analysis. Dr. lndrajit Ghoshal contributed in deducing findings and writing the discussion. Dr. S S Raibagkar contributed in writing the full paper including the conclusion. All the authors have read and approved the final manuscript.

Ethical Approval

The study got ethics committee approval number DYP202301, from the Institutional Review Boards of Dr.D Y Patil (Deemed to be) University, Pune, India, and Dr.Ajeenkya D Y Patil University, Pune, India.

Data Availability

All 400 responses were collated in a data set that has been deposited in a repository and can be accessed at https://www.openicpsr.org/openicpsr/project/190042/version/V1/view

Funding

No external funding was used for the study.

Declaration of Interest

We declare that there is no conflict of interest or competing interest of any sort with any individual or organization.

References

Bhilare, M. (2023). Data set Nurses Job Satisfaction (ICPSR 190042; Version V1) [Data set]. ICPSR. https://www.openicpsr.org/openicpsr/project/190042/version/V1/view

Business Standard. (2021, September 2). India in need of 4.3 mn more nurses by 2024 to meet who norms: Nurse org. Retrieved March 29, 2023, from https://www.business-standard.com/article/ current-affairs/india-in-need-of-4-3-mn-more-nurses-by-2024-to-meet-who-norms-nurse-org-121090201448_1.html

Chang, E., Cohen, J., Koethe, B., Smith, K., & Bir, A. (2017). Measuring job satisfaction among healthcare staff in the United States: a confirmatory factor analysis of the Satisfaction of Employees in Health Care (SEHC) survey. International Journal for Quality in Health Care, 29(2), 262-268. https://doi.org/10.1093/intqhc/mzx012

Rahnavard, F., Sadati, A. K., Hemmati, S., Ebrahimzade, N., Sarikhani, Y., Heydari, S. T., & Lankarani, K. B. (2018). The impact of environmental and demographic factors on nursing job satisfaction. Electronic Physician, 10(4), 6712. https://doi.org/10.19082%2F6712

Srimulyani, V. A., & Hermanto, Y. B. (2022). Organizational culture as a mediator of credible leadership influence on work engagement: empirical studies in private hospitals in East Java, Indonesia. Humanities and Social Sciences Communications, 9(1), Article 274. https://doi.org/10.1057/s41599-022-01289-z

*Shirish S Raibagkar
Savitribai Phule Pune University,
Ganeshkhind, Pune, India
Email: ssrssr696@gmail.com

Submitted: 5 March 2023
Accepted: 2 August 2023
Published online: 2 January, TAPS 2024, 9(1), 49-53
https://doi.org/10.29060/TAPS.2024-9-1/SC3016

Thamudi D Sundarapperuma^1, Eranthi Weeratunga¹, Prabhavi Wijesiriwardhana², Eranga Silva², Shanika Karunanayaka³, & Kithmini Yasarathne³

¹Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka; ²Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka; ³Department of Pharmacy, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka

Abstract

Introduction: Several nations around the world had to close schools, colleges, universities, and other educational institutions as they were badly affected by the spread of COVID-19. The purpose of this study was to measure the effectiveness of online vs physical teaching during the COVID-19 pandemic, at the Faculty of Allied Health Sciences (FAHS), University of Ruhuna (UoR) Sri Lanka.

Method: A cross-sectional study was conducted among 200 undergraduates. The data were collected through displayed/approved results sheets of the students of selected batches in the Department of Nursing, Department of Pharmacy, and Medical Laboratory Science (MLS). Paired sample T-test was used to compare the results of undergraduates.

Results: The examination results of 47-54 undergraduates in nursing, 28 in pharmacy, and 22 in MLS were analysed. Significant differences in Psychiatry in Nursing and Nursing Clinical Attachment were identified in the Department of Nursing (p=0.001). In the Department of Pharmacy, only Pharmaceutical Chemistry I (p=0.012) reported a significant difference. The undergraduates of MLS who underwent online theory sessions had scored more in Microbiology and Immunology (p=0.022) and Basic Genetics and Molecular Biology (p=0.000) whereas in Research Methodology and Epidemiology, the undergraduates who participated in physical lectures had scored more marks (p=0.001).

Conclusion: Practical/interactive session-based course units and clinical appointments had a higher impact on the mode of teaching than many theoretical course units. The results might serve as a primer for the creation of an action plan to support the academics and clinical/practical components of undergraduates.

Keywords:           Undergraduates, Online Teaching, Physical Teaching, Examination Results, COVID-19

I. INTRODUCTION

The provisional closure of educational institutions during the coronavirus disease-19 (COVID-19) pandemic has unexpectedly transformed the Sri Lankan education landscape in favour of distance learning or online learning. As a result of this, drastic changes in digital platforms and applications i.e., digital learning management systems became common among universities (Ariyananda et al., 2022). These universities used existing modular object-oriented dynamic learning environment-based learning management systems (Moodle) and the Lanka Education and Research Network (LEARN) was connected to university web servers and used for online education to mitigate the effects of disrupted learning (Hayashi et al., 2020).

Online teaching was a novel experience for university lecturers and undergraduates, and it was a huge challenge for both parties. In the beginning, both parties had to face several issues due to the unfamiliarity of these novel methods, the unavailability of basic facilities, and insufficient network coverage in Sri Lanka. Though it would be an effective alternative to conduct Zoom lectures again as physical lectures once the university reopened, we were unable to conduct lectures due to limited time during the semester. Therefore, the need emerged to identify a more effective mode to deliver lectures to undergraduates. This study aims to address the effectiveness of online vs. physical teaching during the COVID-19 pandemic, by analysing the examination results at the Faculty of Allied Health Sciences (FAHS), University of Ruhuna (UoR).

II. METHODS

A cross-sectional study was conducted to measure the effectiveness of online teaching vs. traditional/physical teaching and its impact on the performance of undergraduates. The data were collected through displayed/approved results sheets of the students of selected batches in the Department of Nursing, Pharmacy, MLS, FAHS, UoR. Nursing, though considered as a separate discipline from other para-medical disciplines in other countries, is considered under the Faculties of Allied Health Science in Sri Lanka.  The examination results of two batches of undergraduates in a similar semester but who had learned in a different mode (in this group one batch has completely learned online while another batch has learned physically) were purposefully selected from each department. All lectures done via Zoom were recorded and distributed among students. Both groups underwent the same types of examination, mainly multiple-choice questions (MCQs) and short structured questions (SEQ) for theoretical knowledge. Practical and clinical skills were assessed using practical-based examination and patient-based clinical examination respectively. These examinations had been conducted in 2021 and 2022 and results were released in 2022. The analysis of results was conducted in January and February 2023.

Data from approximately 208 proper undergraduates (who sat for the first time) were analysed. The population was composed of nursing (n=108), pharmacy (n=56), and MLS (n=44) students. However, the results of repeat undergraduates were excluded. Six subjects were considered under the Department of Nursing. The number of candidates for the subjects was not equal. To analyse the effectiveness, a comparative analysis of the results of the end-semester examinations was performed by three departments separately. Mainly, in the Department of Nursing and Pharmacy the end semester examination results (two examinations/academic year) were evaluated while in the Department of MLS, the final term results were evaluated (three examinations /academic year).

Statistical Package for Social Science (SPSS) 26 software was used to analyse data. The mean and standard deviation (SD) values of the results sheets were analysed using descriptive statistics. After considering the distribution of the data set, paired sample T-test was used to compare the means of two batches. All results were regarded as statically significant at p < 0.05.

Ethical approval was obtained to analyse the published data from the Ethics Review Committee, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka (Ref. no. 200.01.2023). Consent was obtained from all relevant authorities before taking results from the notice board.

III. RESULTS

Two batches were selected in the nursing department and each batch consisted of 54 undergraduates.  An equal number of candidates had not participated in every subject and therefore results were analysed based on students’ attendance for the different subjects.  Under the nursing department, there were six subjects for students. Four subjects out of these six subjects consisted only of theory components. One subject had both theory and clinical components and the other subject had only clinical-based examination.

All the subjects had only a theory component in the selected semester in the pharmacy department. Under the department of MLS, all subjects consisted of theory and practical components.