Learning helminthiasis in an integrated manner through story writing and sharing by medical students

INTRODUCTION

Quality of classroom engagement is a very important factor that influences students learning at any age.^[1,2] To engage medical students in the large classroom, though challenging, is required to improve learning and develop thinking and analytical skills with better retention of knowledge and skills. The collaborative teaching–learning activities also help in developing team as well as communication skills with improved confidence and motivation for learning by the students.^[3] With the introduction of competency-based medical education (CBME) which focuses on integrated small-group teaching, teachers in medical colleges are facing new challenges that have led them to innovate ways to keep students engaged and eager to learn.^[4]

The burden of parasitic infections, though reduced due to government initiatives, is still significant in the Indian community and we need to equip the medical graduates with a sound knowledge and understanding of knowledge about common parasitic infection.^[5] The study of morphology, life cycle, pathogenesis, clinical manifestations, laboratory diagnosis, and treatment of parasites has been found quite confusing by the medical students and they find it quite boring as well as monotonous to study the same kind of concepts for each parasite. Students are taught helminths and anthelminthic drugs in microbiology and pharmacology, respectively. Students tend to get confused with many similar areas under which they are expected to learn parasites. Teachers need to explore interesting ways of teaching that could bring out the creativity of students along with learning in an integrated manner.

Keeping in mind these points, the faculty of microbiology and pharmacology engaged students in the second phase of medical studies in a tertiary care teaching hospital located in the rural part of Gujarat, in an integrated manner to teach helminthiasis.

Through this article, we share the experience of learning through this activity by students as well as facilitators.

The study was planned with the primary objectives to engage students in an interesting, innovative, and collaborative manner using jigsaw as student-centric learning followed by creative writing through story writing in a large group classroom setting. This was finally meant to help students retain the basic content and integrate the subjects of microbiology and pharmacology. The findings of the innovative experience are shared through this article.

MATERIAL AND METHODS

This is an educational intervention study conducted in 2023 as a part of student-centric activity. A combination of autobiography and jigsaw was used to engage 2^nd MBBS students in large groups (n = 153) and teach two competencies, one each from microbiology and pharmacology (MI 3.1 and PH 1.47) as per the CBME curriculum.

The flow of activity is depicted in Figure 1a and b. Students were randomly divided into small groups of eight and assigned the task of reading one of the parasites in pairs (45 min), reassembling in groups of four (one member each from pairs), and teaching each other the parasite learned (45–60 min). Facilitators used the cafeteria approach to guide the student groups and clear their doubts.

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Figure 1:

(a) Flow diagram of the study methodology using Autobiography and Jigsaw techniques. (b) Group formation and task assignment based on Jigsaw technique

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Finally, students were asked to sit and write the autobiography of the assigned parasite individually, to demonstrate their learning about the parasite using their imagination and creativity in the form of an autobiography of an intestinal nematode. All the written autobiographies were collected and assessed by using an assessment framework [Tables 1 and 2] made by the faculty coordinating the session and reviewed before use. Facilitators from microbiology and pharmacology were explained about the framework and were involved in the assessment of autobiography. Each facilitator was provided with 10–12 copies of the autobiographies written by students. They were instructed to read the autobiography and underline the subject-specific knowledge components in the autobiography and use the table of expected (model) answers to see the depth and correctness of the content written by the students. The scale used for rating the subject content was 0–3 based on the correctness and completeness of information given about each learning point as per the standard textbook. Simultaneously, the facilitators were also asked to read the storyline and rate it from 0 to 3 (boring to very interesting) based on the storyline, the imagination with emotions incorporated, and the interest it created while reading the autobiography. A student could score in the range of 0–30 in knowledge and 0–3 in storyline. The knowledge scores were grouped into three categories as poor (<10), average (10–20), and good (>20). An anonymous feedback form with eight statements was used to assess students’ perceptions of the new method as an enjoyable, interesting, engaging tool that enhanced creativity and communication skills on a five-point Likert’s scale (least agree to most agree). Descriptive and Chi-square statistics (<0.05 as significant) were used for data analysis. Cramer’s V value was calculated to study the association between the storyline and knowledge scores.

RESULTS

Out of 153, 146 students in the age range of 20–22 years attended the innovative teaching-learning method. The ratio of male (n = 68) and female (n = 78) students was 0.85:1 (46% and 54%). The score of students on the knowledge component using the framework is given in Figure 2. Scores were <20/30 for most of the students, with only 33% scoring >20 marks in knowledge components. The performance of female students was found better compared to male students with 14 (87%) boys in the <10 marks and 31 (65%) girls in the >20 marks category [Table 3]. Figure 2 depicts that the majority of students wrote down interesting stories, which also reflected their gain in knowledge. Here, we observed that female students wrote more interesting stories and also had better knowledge scores compared to male students. The statistical analysis of the rating of storyline and sex of students is seen in Table 4 and it shows that females were more creative and imaginative and wrote more interesting stories when compared to males (P = 0.0003). Table 5 depicts the comparison of the rating of storyline and scores on knowledge components between male and female students. Moderate-to-strong association is seen in the storyline rating and knowledge score using Cramer’s V value. Table 6 shows the feedback responses received from 56 (38.35%) students, including 24 males and 32 females. Overall, there was a positive response in most of the areas asked about the perceptions of an innovative teaching-learning method. More than 90% of female students agreed that they enjoyed this innovative learning activity, which stimulated their interest in the topic, helped them in learning through their creativity, and are in favor of using this kind of innovative method frequently in other topics. Contrarily, 75% of male students agreed to the same.

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Figure 2:

Comparison of storyline and knowledge gained by students (n=146).

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DISCUSSION

The main objective of this innovative teaching-learning methodology was to engage students interestingly and help them learn better with clarity of subject knowledge about helminthic infections in the community. With the advent of technology, a large number of classroom activities use technology to create interest and engage students while teaching. Although they are appreciated by the students, the use of activities that involve student’s creative thinking and sharing their creativity with their peers is always experienced as refreshing by the students.^[6] India’s medical education system has changed over time to the rest of the world. We do need some new approaches to teaching information and skills because of the evolving requirements of society, improvements in education, and technological revolutions.^[7]

Medical students during their 2^nd year are studying four subjects including microbiology and pharmacology. These two subjects are essential basic subjects of the medical curriculum in which students find it challenging to memorize them.^[8,9] Memorizing microbes and drugs that affect them is quite challenging for students.^[10] Because of these realities, educators must use innovative teaching strategies to make the teaching–learning process appealing, intriguing, creative, engaging, and conceptual so that students will be sufficiently motivated to study previously difficult subjects. For that, one of the approaches can be exposing students to active learning strategies and innovative pedagogical tools in teaching.^[11] When taught concurrently in separate topics, alignment refers to the elements of the same organ system or illness. Subject-based demarcation is lost when separate components of a single topic that is identical, overlapping, or redundant are mixed and taught in different topics over different phases.^[12] Integrating microbiology and pharmacology competencies creates a collaborative learning environment, empowering students to take ownership of their learning and develop teamwork skills. This approach encourages students to work together to synthesize information and enhance their understanding of parasitic concepts.

The Jigsaw method is a well-established collaborative learning technique that fosters student engagement and reinforces understanding of complex concepts. This method has been used since the 7^th century and is shown to be efficient in high school. A few recent studies have proved its role in medicine.^[13]

Autobiographies are fundamentally significant stories therefore, information conveyed through storytelling is more easily absorbed and retained.^[14] For helminths, requiring medical students to write autobiographies can be a powerful method to assist students in understanding the intricacies of helminthic diseases and getting them ready for diagnosis, treatment, and prevention. Based on statistical data, 84% of students reported an enhancement in their understanding of pharmacology, with 80% expressing their fascination with the instructional content. Furthermore, the utilization of autobiographical techniques as a research methodology tool has been instrumental in illuminating nurses’ experiences and emphasizing the importance of continuous learning.^[15]

The innovative and creative methods used in the activity were well-received by most students and were perceived as effective in enhancing learning and engagement. This is probably because, through autobiography, students can get a feel of parasites’ life experiences, which can encourage them to visualize and engage in learning with deeper understanding. Simultaneously, the learning was also supported by sharing and presenting their findings to their peers through jigsaw which is again expected to deepen their learning.

Over and above the usefulness of jigsaw and writing stories to support learning, the study findings revealed very interesting pattern where learning is associated with both gender and creativity. More number of female students could write very interesting storyline and have more imagination with creativity. This is also seen in the performance of students in the knowledge score as 21 (26.92%) females had above-average score and very interesting storyline in comparison to only 8 (11.76%) male students. Study done by Emma Peterson et al. (2017)^[16] stated that males and females have different perceptions in terms of elements that get their attention. Stories that put people on a desirable means seem to resonate more strongly with women. This indicates that women like to remember information presented in stories as a journey with subtle clues along the way leading up to the big idea at the conclusion. Contrarily, males appeared to be more likely to comprehend information that is succinctly and precisely conveyed since they seem to be more interested in figuring out the story’s goal than in seeing the wider picture. Due to this factor, we can say that stories written by females are liked by people.

This was a subjective scoring of the storyline. Among the residents who were assigned to evaluate the write-ups, majority of them were females so it can also be a factor that female writers and female assessors have similar thought processes to write the same thing with similar storyline which is why there is a possibility that they have given a higher score to the stories written by females.

CONCLUSION

It was an integration of two student-centric teaching learning concepts that are story writing in the form of “autobiography of a worm” and collaborative teaching using the small group method of the jigsaw. Such innovative interventions must be studied further to know their effect on improving knowledge retention and comprehension through effective story writing as well as storytelling methods. Feedback from students to evaluate the effectiveness of the autobiography with a cross-over approach and identify areas for improvement revealed their strong positive perceptions. This study and its findings highlight the importance of exploring stories either sharing or asking students to write as a technique to enhance knowledge comprehension and retention in students.