Interactive teaching in medical education: Experiences and barriers

Experiences from abroad

Studies around the world have shown that interactive teaching is a reform in medical education toward effective learning. A quasi-experimental study by Ali et al. was conducted among university students in Jordan to assess the usefulness of interactive teaching in promoting awareness about reproductive health. Since health education at teaching institutes is a cost-effective and ideal method of developing healthy lifestyles, researchers assessed the effectiveness of interactive teaching method to educate youth about reproductive health in conservative societies like Jordan. The faculty delivering interactive lectures for promoting reproductive health was trained about the teaching methods such as brainstorming, group discussion, debate, educational games, and reflections on real life stories. Interactive teaching sessions were given to students as 60-min session/day, for 4 weeks. This study revealed a significant improvement in students’ knowledge and attitudes, when post-test scores were compared with pre test scores. Authors suggested that reproductive health should be integrated into university’s curriculum and should be taught with interactive learning approach.^[4] This study implies that interactive teaching method is a better way of facilitating higher level of thinking and extending the learning to affective domain as well. The affective domain is one of the vital areas of the learning outcomes of medical students, other than cognitive and psychomotor domains. Studies in education have demonstrated that students who are actively involved in the teaching-learning session learn more than the students who are just passive recipients of knowledge. Interactive lecturing encourages the evaluation of the subject content, application to other types of situations and evaluation of the material presented. It can facilitate problem-solving, decision-making, and communication skills. This is particularly important in medical education where the application of knowledge is as important as the retention and recall of facts.^[5] Apart from interaction between teacher and students, when there is interaction within a group of students to define their own learning objectives, it is called problem-based learning (PBL). In PBL, students use “triggers” from the presented problem case or scenario and construct their learning objectives. Afterward, students independently do self-directed study and gather as a group to discuss and refine their acquired knowledge.^[6] PBL is an active way of learning but its implementation in developing countries has some hurdles because large number of students have to be managed with minimum resources. Alaaqib et al. evaluated and compared the effectiveness of lectures based on problems (LBP) and traditional lectures (TLs) in physiology teaching in a medical college in Sudan. Equal number of lectures was given as LBP and as TL in the course. Post-test assessment of students was taken through quiz sessions and scores were used to compare the effectiveness of the two types of lectures. A structured questionnaire was used to assess students’ perceptions and satisfaction about LBP. The results revealed that students had significantly better retention during LBP and more active role than TL (P < 0.01). About 64% of students found LBP more interesting and believed that it improved their understanding of physiology concepts. The post-test scores of students in quiz sessions of LBP were significantly better than that of TL (P < 0.01).^[7]

In today’s world, technology is a powerful tool for educators to make their teaching more creative, interactive, and more engaging. Flipped classroom (FC) is a teaching approach in which direct instruction moves from the group learning space to the individual learning space, and the classroom is transformed into a dynamic, interactive learning environment where the teacher guides the students as they apply concepts and engage creatively in the subject matter.^[8] Traditional teaching method and FC approaches were compared by Limniou et al., under the perspectives of Higher Order Thinking Skills (HOTS) development among ^1st year psychology students in Liverpool, United Kingdom. In this study, it was revealed that there was a significant difference in students’ views about the teachers’ contribution to teaching learning approach, students’ HOTS development, and choice of learning material. This study concluded the importance of the relationship between choice of learning material and the teacher’s contribution to the FC session and their attitudes toward technology.^[9] A randomized controlled trial by de Jong was conducted to assess the effectiveness of interactive seminars or small group tutorials among undergraduate medical students in Leiden Medical School, the Netherlands. Educational effectiveness was measured by comparing the students’ results on the end-of-block test. Students’ perceptions and satisfaction data were collected by means of questionnaires. The study revealed that retention of knowledge through active participation was the most frequently cited reason for preferring small group tutorials, a dislike of compulsory course components was mentioned more frequently by students preferring interactive seminars. Small group tutorials led to greater satisfaction.^[10] Another research done by McLaughlin et al. used the FC as a course redesign to foster learning and engagement in a health professions school. Researchers offloaded all lectures to self-paced online videos and used the class time to engage students in active learning exercises. This study revealed that after participation in FC, class attendance as well as students’ learning improved. The authors concluded that this approach warrants careful consideration as educators aim to enhance learning, improve outcomes, and fully equip students to address present day healthcare needs.^[11] A study by Missildine et al. aimed to determine the effects of innovative learning activities on academic success and the satisfaction among nursing students. A quasi-experimental design was used to compare three teaching learning methods: TL only (LO), lecture and lecture capture back-up, and FC approach of lecture capture with innovative classroom activities (LCI). The study revealed that examination scores were higher for the FC LCI group (Mean = 81.89 ± SD 5.02) than for both the LLC group (Mean = 80.70 ± SD 4.25), P = 0.003, and the LO group (Mean = 79.79 ± SD = 4.51), P < 0.001. However, it was found that students were less satisfied with the FC method than with either of the other methods (P < 0.001). Authors concluded that combining new teaching approaches with interactive classroom activities can result in improved learning but not necessarily improved the students’ satisfaction.^[12]

Experiences from India

The Medical Council of India recommended new curriculum for undergraduate medical education emphasizing on competencies, in a move toward competency based medical education. It deals with the application of current educational methodologies to bring about medical educational reforms and prioritizes learner centric methods of instruction. In a resource limited country like India, to bring about reforms in medical education is a difficult process. It has implications for staffing and learning resources and demands a different approach to workload and assessment. Findings of the educational research done in India reinforce the need to implement learner centric and interactive teaching methods in medical curriculum. Begum et al. conducted an interventional study to compare the effectiveness of interactive teaching learning (ITL) and traditional teaching learning methods among undergraduate medical students in Andhra Pradesh. This study also assessed the perception of students and faculty toward it. Results showed that there was an increase in performance of students in the intervention group with significantly better scores than the students in traditional teaching group. Students and faculty found interactive teaching better than traditional methods.^[13] In another study from Maharashtra, Buch et al. used a number of interactive teaching methods such as brain storming, group discussions, question answer sessions, multiple choice questions (MCQs), confusion technique, and summaries. among 150 medical students. A pre validated questionnaire was used to assess the perceptions of students about new methods, using the Likert scale. Most (>70%) of the students liked the sessions. Majority (75%) of the students found MCQs (76% completely agreed) to be the most popular ITL method, followed by brainstorming (64% completely agreed) and confusion technique (53% completely agreed). Most of the students believed that interactive teaching helped in improving attention span, communication skills, better retention of the topic and suggested that such teaching method should be regularly used during lectures.^[14] Roopa et al. did an evaluation of the type of lectures dental students prefer in a college in Tamil Nadu. The students were exposed to both regular and interactive lectures. Out of the total 12 lectures, alternate lectures were interactive. Students’ feedback was obtained at the end of the 12-lecture series. About 92% students found interactive lectures to be more useful. Interactive lectures were found to be more useful than regular lectures by 92% of the students. Majority of the students either agreed or strongly agreed that they were more attentive and motivated during interactive lecture. Students also found interactive teaching to be non-monotonous and well-defined learning method. Out of the different techniques, most liked one was use of video clippings (58.1%).^[15] A prospective longitudinal study was conducted in Maharashtra by Datta et al., among 192 students to compare the conventional versus interactive teaching with a series of twenty lectures. An independent observer was used to keep record of the number of interactions in each class. After analyzing the results, it was found that pre-test scores from both the groups were similar and post-test scores improved in both groups. However, there was a significant difference in the post-test scores between two groups (P < 0.05). The post-test score of interactive lectures was better than conventional post-test score by 9.24% (95% Confidence Interval: 8.2–10.3%) (P < 0.01). Furthermore, the retention test score after interactive sessions was better than conventional retention test score (P < 0.001) by 15– 18.2% (95% Confidence Interval: 15.0–16.64%) (P < 0.01). There were 51 participative events in the interactive group as compared to 25 in the conventional group.^[16]

Kumar et al. conducted a cross-sectional study among VII^th semester medical students to study the effectiveness of tutorials as an interactive method of teaching undergraduate students in Pondicherry. Students were divided into six groups and tutorial session was conducted by trained faculty. Feedback from students was taken through a predesigned pretested questionnaire using Likert scale. Most of students (63.4%) revealed that they understood the topic better in tutorial session. About 69% of students felt time management was better in a tutorial as compared to lecture.^[17]

Another study done by Cheema and Arora among 150 medical students of a medical college in Jalandhar, Punjab to evaluate the effectiveness of interactive lectures as teaching method in Obstetrics and Gynaecology, demonstrated that interactive methods stimulate self-directed learning among students.^[18]

A study done in the state of Meghalaya, Panda et al. compared three types of interactive teaching methods: Flipped class room; MCQ based interactive teaching; and Confusion technique Kirkpatrick level 1 evaluation. This academic study was conducted for a period of 1 year with medical students. Twelve topics were selected to be included in the study. Out of the total 12 topics, four topics were taught in FC technique, another four were taught with MCQs in the class and remaining four topics were taught using confusion technique. Feedback was obtained from students with the post-test questionnaire using Likert chart. The study revealed that students preferred FC technique of teaching followed by MCQ technique and confusion technique.^[19]

In Karnataka, Angadi et al. did an interventional study with 98 students, divided into two batches of flipped class and conventional small group teaching. FC involves providing study resource material to students, outside the class so that class time is used for instructional activities. This study was done to assess the effectiveness of FC activity as an interactive teaching-learning method. For the flipped class, an online Google group was created. Brief introduction and pre-recorded videos related to the assigned topic were posted in the Google group, followed by discussion in the form of problem-solving exercises. Study showed that there was a significant difference between the post-test scores of each session and also the mean scores of summative tests between two groups (P < 0.001). About 82% of the study participants strongly agreed that FC session was more engaging and interesting in comparison to TL. Majority (76%) strongly agreed that more such classes (FC) should be conducted in the future.^[20]