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ORIGINAL ARTICLE
Year : 2020  |  Volume : 61  |  Issue : 6  |  Page : 297-302  

Perspectives of final year students and newly qualified doctors of the teaching of preclinical courses at the college of health sciences, Obafemi Awolowo University, Ile-Ife, Nigeria


1 Department of Medical Biochemistry, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
2 Department of Oral and Maxillofacial Surgery and Oral Pathology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
3 Department of Otolaryngology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria

Date of Submission17-Feb-2020
Date of Decision27-Jul-2020
Date of Acceptance20-Oct-2020
Date of Web Publication19-Dec-2020

Correspondence Address:
Dr. Beatrice Oluyomi Emma-Okon
Department of Medical Biochemistry, College of Health Sciences, Obafemi Awolowo University, Ile-Ife
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nmj.NMJ_33_20

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   Abstract 

Background: It is established that there is a strong relationship between perception and outcome of learners' satisfaction, achievement, and success and that a positive learning environment well received by learners is necessary for positive learning outcomes. This study is a first step in providing an answer to the question “how do learners perceive preclinical medical education in Ife” with the aim of obtaining information which can serve as basis for the review of teaching methods and improvement of learning environment. Methodology: A questionnaire adopted from two validated questionnaires (Dundee Ready Education Environment Measure questionnaire from Dundee and another from a study carried out in Bangladesh) was administered to 187 respondents comprising 106 final year students and 81 newly qualified doctors to obtain the information about their perception of teaching and learning of the three major preclinical participants. Items were rated using the 5-point Likert scale, and each item was scored 4-0. Data were analyzed using the descriptive and inferential statistics. Values were expressed as the mean of scores. Results: The mean gross scores for the 19 items rated for anatomy, biochemistry, and physiology were 28.92, 35.76, and 45.06 (out of 76), respectively. Physiology had the highest score in all the subdomains examined, with 62% of the respondents rating their overall quality of learning experience in the subject “very good.” Scores for perception of learning environment were generally low (7.54 ± 0.43, 10.44 ± 0.42, and 12.51 ± 0.47, out of a total of 28 for anatomy, biochemistry, and physiology, respectively). Conclusion: The opinion of learners in this study emphasizes the need for the improvement of teaching methods and learning environment.

Keywords: Anatomy, biochemistry, learning experience, perception, physiology


How to cite this article:
Emma-Okon BO, Ogundipe OK, Eziyi JA. Perspectives of final year students and newly qualified doctors of the teaching of preclinical courses at the college of health sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. Niger Med J 2020;61:297-302

How to cite this URL:
Emma-Okon BO, Ogundipe OK, Eziyi JA. Perspectives of final year students and newly qualified doctors of the teaching of preclinical courses at the college of health sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. Niger Med J [serial online] 2020 [cited 2021 Oct 18];61:297-302. Available from: https://www.nigeriamedj.com/text.asp?2020/61/6/297/304015


   Introduction Top


The course of studies leading to award of M.B.Ch.B/B.Ch.D degree in the Obafemi Awolowo University College of Health Sciences is a 6-year programme. In the 1st year, the students take courses in the basic sciences such as chemistry, physics, and zoology among others, while anatomy, biochemistry, and physiology are the three major preclinical participants taken in the 2nd and 3rd years as is the practice in most other Colleges of Medicine.[1] These participants are expected to prepare the students for clinical years during which they are exposed to the clinical content of the curriculum. The preclinical anatomy, biochemistry, and physiology courses have been taught since inception (47 years ago) using mostly the traditional method of pedagogy while more learner-centred and problem-based methods are only employed where possible and practicable in light of existing facilities.

It is important that regular evaluation of learners' perception of teaching is conducted from time to time as this may provide information which can be used as basis for the review of teaching methods and improvement of the learning environment. It is well-established that there is a strong relationship between perception and outcome of learners' satisfaction, achievement and success and that a positive learning environment well received by the learners is necessary for positive learning outcomes.[2],[3],[4] This study is, therefore, a first step in providing an answer to the question, “How do learners perceive pre-clinical medical education in Ife?”

The Dundee Ready Education Environment Measure (DREEM) questionnaire has long been in use as a valid measure of educational environment since it was developed.[5] While some of the questions asked in this questionnaire were taken directly from the DREEM questionnaire, some others were modified to suit our Nigerian context while the remaining was taken from a similar study carried out in Bangladesh.[6]

To the best of our knowledge, there has not been any previous attempt in our college to study students' perception of the way the preclinical subjects are being taught and how the learning environment impacts on the students. This study aims to explore learners' and newly qualified doctors' perspectives on teaching of these participants.


   Methodology Top


A cross-sectional study involving 187 respondents was employed. A self-administered questionnaire (comprising of direct and modified questions from the DREEM questionnaire and questions obtained from the study by Atokolara and Atapattu, 2014[6]) was first administered to 30 final year students. The data were analyzed to ensure that it was well-understood and could serve to achieve the objectives of the study. Some of the statements were further modified for clarity, and the questionnaire was then administered to 106 final year medical and dental students, 70 medical inductees, and 11 medical interns between April and June 2019. The questionnaire was administered to final year students during their group block lectures for surgery, community health, and medicine while the inductees were given the questionnaires during the leadership workshop organized for them in their induction week. Informed consent was obtained from all participants.

Data were collected on the following domains: Students' perception of learning (8items), perception of atmosphere of learning (7 items), academic self-perception (2 items), and perception of teaching (2 items). All items were rated using the 5-point Likert scale, ranging from strongly disagree to strongly agree and each item was scored 4-0 with 4 = strongly agree, 3 = agree, 2 = not sure, 1 = disagree, and 0 = strongly disagree. Negative items were scored in a reverse manner.

Respondents were also asked to do an overall rating of the quality of learning experience for each of the preclinical participants on a 4-point scale from very good to poor.

Data were analyzed with IBM Statistical Package for the Social Sciences software (IBM SPSS Statistics for Windows version 20.0. Armonk, NY: IBM Corp.), Chicago using descriptive and inferential statistics. Maximum score for each domain was as follows: Students' perception of learning = 32, perception of atmosphere of learning = 28, academic self-perception = 8, and perception of teaching = 8. Total score: 76. Values were expressed as the mean of scores, and t-test was used to determine statistically significant differences (P < 0.05) for male versus female respondents and final year students versus inductees/interns across the three preclinical participants.

Permission to publish the findings from the study was sought and obtained from the Ethics Committee of the College of Health Sciences, Obafemi Awolowo University.


   Results Top


The demographic characteristics of 187 respondents comprising 137 males and 50 females (ratio 2.7:1) are shown in [Table 1]. Their age range was 22–39 years (mean age = 25.2 ± 2.6 years). Most (73.3%) of the respondents were <25 years.
Table 1: Demographic characteristics of respondents

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Scores for individual items and domains are shown in [Table 2] as follows:
Table 2: Mean scores for items in each domain across preclinical subjects

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Perception of learning (total score: 32)

Overall, physiology has a higher perception of learning by the respondents with a total score of 22.79; this is distantly followed by biochemistry (16.95) and anatomy (14.1). The respondents agreed that the pre-clinical participants were interesting to learn and that teaching of the participants encouraged them to search for additional knowledge and information. However, they did not agree that the level of instruction received in the anatomy was adequate, appropriate, or well-focused compared to biochemistry and physiology. Respondents also opined that they are not free to ask questions in anatomy and biochemistry classes and that teacher-student interaction during lectures was inadequate.

Perception of atmosphere of learning (total score: 28)

Atmosphere of learning was generally perceived to be poor. Mean scores for the various items were below 2.0 except that the respondents perceive that the teaching atmosphere for physiology is motivating (2.5). However, the rating of newly qualified doctors was slightly better than those of final year students. A significantly higher number of female students also had more positive perception that there is good support system for students in physiology (males 1.77 vs. females 2.14 [P = 0.02]).

Perception of teaching (total score: 8)

Final year students and newly qualified doctors agree that teachers are knowledgeable across anatomy, biochemistry, and physiology. Physiology teachers are perceived to have good communication skills (3.1), whereas the scores for anatomy and biochemistry were rather low (1.7 and 2.2, respectively).

Academic self-perception (total score: 8)

Most of the respondents do not wish to pursue postgraduate studies in any of the preclinical subjects, with more females in this category, especially for anatomy (males 1.16 vs. females 0.74 [P = 0.02]). Most respondents admitted that they studied just to pass the courses, except physiology (2.0, 2.3, 1.4).

[Table 3] shows statistically significant differences between final-year students and newly qualified doctors across the preclinical participants. Newly qualified doctors had a more positive perception of all domains studied than the final year students except academic self-perception. The same trend is observed for biochemistry, while the reverse is the case for physiology.
Table 3: Statistically significant differences between clinical 3 students and inductees/interns across preclinical subjects

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The individual mean domain scores are shown in [Figure 1]. For overall rating of quality of learning experience, the proportion of respondents who rated their experience as “very good” for anatomy, biochemistry, and physiology were 15.5%, 17.5%, and 62%, respectively, whereas 27.8%, 5.4%, and 2.2% rated their experience as “poor” for the subjects, as shown in [Figure 2].
Figure 1: Mean domain scores across subjects

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Figure 2: Overall rating of quality of learning experience

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   Discussion and Conclusion Top


Obafemi Awolowo University (OAU) College of Health Sciences has produced hundreds of doctors, nurses, and physiotherapists since inception 47 years ago. This study reveals the general perception of final year students and newly qualified doctors toward the three major preclinical subjects (anatomy, biochemistry, and physiology) which are taught in the second and third years of the M.B.Ch.B program of the College.

The opinion of learners in this study has revealed the need for improvement of teaching methods and learning environment. The general trend observed in all the four domains studied is that physiology has the highest score, followed by biochemistry and then anatomy. Although mean scores were generally low for perception of atmosphere of learning, physiology still obtained higher scores than the other two subjects. In addition, students had very positive perception of the teaching of physiology and wish to pursue the subject at postgraduate levels. Physiology also had the highest overall rating of quality of learning experience. These findings are in agreement with a previous study by Ebomoyi and Agoreyo in which students identified physiology as the subject with which they were most satisfied with the quality of teaching and most confident of passing.[7] In another study carried out in Bangladesh, physiology was selected as the most retained and clinically relevant subject.[6] Furthermore, our academic records reveal that more students usually pass physiology than the other two subjects. However, there is always room for improvement as reported by a study which found that interactive lectures, case-based lectures, and structured interactive sessions are very useful tools in teaching and learning of physiology.[8]

In general, respondents in this study had poor perception of anatomy. They perceived that the level of instruction received was not appropriate for clinical training but rather excessive. This observation is also not peculiar to this study. In previous similar studies, students identified anatomy as one of the courses with overloaded content,[9],[10] and the most difficult to understand.[7] They opined that the anatomy curriculum should only cover the general concepts to provide a working knowledge of the subject. However, in a study carried out to investigate the opinions of newly qualified doctors in a UK medical school, close to half of the respondents believe that they received insufficient anatomy teaching, with a substantial proportion calling for the integration of anatomy teaching throughout the medical school.[11] Turney in his article “Anatomy in a modern medical curriculum” expressed the need to introduce newer teaching modalities and modern technology which will encourage interest and retention of anatomical knowledge and its clinical relevance. The author also believes that detailed knowledge should be integrated into specialist training where it becomes clinically relevant, allowing specialists to practice safely and accurately.[12],[13]

Biochemistry has also not been in the good books of medical students as far as perception of its teaching and learning are concerned. Although this study reports fairly good perception of learning and teaching, the perception of atmosphere of learning and academic self-perception was poor. Only few respondents agreed that they wish to pursue the subject at postgraduate level, and many perceived that the course content was excessive. Previous studies reported that most students perceived that they do not retain most of the information received in this subject during their preclinical years[7],[8] and are not likely to make it their specialty choice.[6] The fact remains that biochemistry is the common language of the life sciences, and a working knowledge of the subject is necessary to understand health and disease at the molecular levels.[14] Many people have advocated problem-based learning[15] as the way out, but the practical truth is that basic information still has to be passed across before it can be related to clinical settings. In doing this, however, there is a need to simplify the language of expression and review course content to remove unnecessary details.[16] A departure from the traditional way of teaching is necessary, with the introduction of innovative learner-centered methods of teaching such as student presentations, assignments, and virtual teaching aids.[17] This, however, will require reduction of class sizes and hence more hands on the teaching job.

Means scores for atmosphere of learning were generally low in this study [Table 2] and [Figure 1], with respondents having poor perceptions of teaching facilities, support systems, class size, and laboratory space. This calls for urgent intervention on the part of stakeholders. Over time, these facilities have become dilapidated and grossly inadequate to meet up with the growing student population.

In this study, newly qualified doctors seem to have more positive perception than the final year students in all the domains investigated, especially for anatomy and biochemistry [Table 3]. This could be because they have the benefit of being more knowledgeable about what is required in the clinical practice, and this may have influenced their responses. This finding may also be a pointer to the fact that the learning environment is slowly depreciating, especially in a situation where increase in student intake is not matched with improvement of facilities.

In general, the integrated curriculum being proposed by the National Universities Commission (NUC) will be of help as students will be able to harmonize the teaching and learning of the three subjects and directly understand their relevance to medicine. This will require cooperation and coordination on the part of the various departments and underscores the need to set up a medical education unit in the college which will coordinate and bring together the activities of the various units.

The study concludes that there is an urgent need to improve learning environment, revise teaching methods, and embrace interdisciplinary integration in OAU Medical School. This is expected to improve, not just the perception of learners but the overall quality of training and ultimately, global output of the college. The need to improve teaching facilities such as classroom and laboratory space cannot be overemphasized, as the response of learners indicate that these facilities are inadequate. The new integrated medical curriculum being proposed by NUC is a welcome development as it is expected to promote better understanding of the preclinical subjects and further demonstrate their relevance to clinical training and practice. The present study also underscores the need to have a medical unit in the college to oversee and harmonize the activities of the various departments. Areas of future studies will include investigation of how students of physiotherapy and nursing science perceive teaching of anatomy, biochemistry and physiology, investigation of doctors' perception of the relevance of their overall learning experience to professional practice, and a comparison of learners' perception across medical schools in Nigeria.

Acknowledgement

Authors gratefully acknowledge the support and contributions of the 2018/2019 set of OAUTHC Interns and Inductees as well as the 2019 graduating set of Obafemi Awolowo University Medical Students to this study.

Financial support and sponsorship

Authors' personal funds.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

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Roff S, Mcaleer S, Ifere OS, Bhattacharya S. Development and validation of the Dundee Ready Education Environment Measure (DREEM). Med Teach 1997;19:295-99.  Back to cited text no. 5
    
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Atokolara KR, Atapattu P. Preclinical basic sciences teaching curriculum of a medical school in a developing country Are we doing if right? J Bangladesh Soc Physiol 2014;9:98-104.  Back to cited text no. 6
    
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Ebomoyi MI, Agoreyo FD. Preclinical Students' perception of their courses and preclinical specialty choice. J Med and Biomedical Res 2007;6:47-58.  Back to cited text no. 7
    
8.
Rehan R, Ahmed K, Khan H, Rehman R. A way forward for teaching and learning of Physiology: Students' perception of the effectiveness of teaching methodologies. Pak J Med Sci 2016;32:1468-73.  Back to cited text no. 8
    
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Fitzgerald JE, White MJ, Tang SW, Maxwell-Armstrong CA, James DK. Are we teaching sufficient anatomy at medical school? The opinions of newly qualified doctors. Clin Anat 2008;21:718-24.  Back to cited text no. 11
    
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Turney BW. Anatomy in a modern medical curriculum. Ann R Coll Surg Engl 2007;89:104-7.  Back to cited text no. 12
    
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Motaz A, Abdelrahman N. Perception and significance of Basic Sciences for Clinical Studies. Int J Hum Anat 2018;1:26-32  Back to cited text no. 13
    
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Murray RK, Bender DA, Botham KM, Kennelly PJ, Rodwell VW, Weil PA. Harper's Illustrated Biochemistry. Ch. 1., 29th ed.. USA: The McGraw-Hills Companies; 2012. p. 2.  Back to cited text no. 14
    
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Alamoudi A, Hassanien M, Al Shawwa L. Introducing TBL in Clinical Biochemistry: Perceptions of Students and Faculty. MedEdPublish 2018:7:26.  Back to cited text no. 15
    
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Dennick R. How much biochemistry should a good doctor know? An Educationist's perspective. Biochem Educ 1996;24:85-8  Back to cited text no. 16
    
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de Fátima Wardenski R, de Espíndola MB, Struchiner M, Giannella TR. Blended learning in biochemistry education: Analysis of medical students' perceptions. Biochem Mol Biol Educ 2012;40:222-8.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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