CC BY-NC-ND 4.0 · National Journal of Clinical Anatomy 2019; 08(02): 066-070
DOI: 10.1055/s-0039-1692301
Original Article
Society of Clinical Anatomists

Introduction of Group Discussion as a Teaching—Learning Method in Dissection Hall for the First MBBS Students

Mehul Tandel
1  Department of Anatomy, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
,
Daxa Kanjiya
1  Department of Anatomy, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
,
Neeraj Vedi
1  Department of Anatomy, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
,
Deepak Sharma
2  Department of Community Medicine, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
,
Sumati,
Praveen Singh
1  Department of Anatomy, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India
› Author Affiliations
Further Information

Address for correspondence

Asst. Prof. Mehul Ratilal Tandel, MD Anatomy
Pramukhswami Medical College
Karamsad, Anand 388325, Gujarat
India   

Publication History

Publication Date:
26 June 2019 (eFirst)

 

Abstract

Background Human cadaveric dissection is considered as a core teaching tool and plays a major role in active learning process of students. However, students’ active participation and self-directed learning in dissection hall has declined over the period of time. Group discussion in dissection hall allows students to participate actively, engage in cooperative interaction, communicate effectively, and utilize self-directed learning. Therefore, group discussion has been introduced and assessed as a teaching-learning method in dissection with the aim of improving participation, learning, and communication skill of students in dissection hall.

Methods This study was conducted on 100 students of Pramukhswami Medical College, Karamsad, Anand, Gujarat, India, during the 2018–2019 academic year. Students were divided in 10 groups for dissection. Group discussion was introduced as a teaching-learning method and assessed during dissection. Data were collected through anonymous feedback and then statistically analyzed.

Result There was significant increase in active participation of most students during dissection: 79% students rated this method as good or excellent; 51 to 74% students agreed that this method helped them in better understanding of subject, improving dissection skills and communication; and 68% students agreed that working in group is better as compared with traditional method of dissection. The Cronbach's alpha of feedback questionnaire was 0.816.

Conclusion Students perceived that the group discussion during dissection not only helped in creating active participation and better understanding of subject but also helped improve learning, communication, and dissection skills.


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Introduction

The teaching of anatomy has been one of the cornerstones of medical education for centuries. Knowledge of anatomy not only helps a physician in examining a patient and determining diagnosis but also helps in development of specialization in medicine.[1] [2] [3] Traditionally, anatomy has been learnt using didactic lectures, cadaveric dissections, demonstrations, case-based learning, problem-based learning, peer-assisted learning and computer assisted learning.[4] [5] [6]

Human cadaveric dissection is still considered as most useful teaching tool by both anatomists and students to meet the learning outcomes.[7] In a survey of 112 professional anatomists across the United Kingdom, 69% preferred the use of human cadaveric dissection over other teaching methods.[8] The cadaveric dissection helps students understand three dimensional relationships of structures in the human body, improve practical skills and encourage active involvement of students, small group learning, and promoting professionalism.[9] [10] [11]

Smell of cadaveric preservative leading to nausea, conjunctival irritation and other psychological effects such as anxiety, stress, emotional trauma, and depression have been specified by various researchers[12] [13] [14] due to association of medical students with cadaver in the early stages. Due to these inhibiting reasons, some students avoid dissection.[15] Moreover, in the initial months, many students actively participate in dissection because there is a lot of curiosity about it, but over the course of time, they start avoiding dissection and spend more time in prosection or cadaver-unrelated activities such as reading, studying models, and listening to talks.[16]

In recent years, many researchers in medical education promoted competency-based curriculum that also emphasizes small group teaching with group discussion.[17] [18] [19] Group discussion has an important role in all-round education of students and is an integral part of problem-based learning, case-based learning, and team projects.[20] [21] Group discussion can also be useful for developing the skills of listening, presenting ideas, and working as part of a team.[20] [22] Small dissection groups also provide opportunity for students for effective communication and reciprocal peer teaching and utilize both “self-directed and directed self-learning.”[23] [24] [25]

Thus, in this study, group discussion was introduced as a teaching-learning method in dissection hall. The main objectives of this study were to introduce this method to promote active participation, improve learning and communication skill, and to develop self-directed learning in dissection hall.


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Methods

This interventional study was conducted on 100 students of 2018–2019 batch of Pramukhswami Medical College, Karamsad, Anand, Gujarat, India. The purpose of this study was clearly explained to all students. All students (n = 100) participated voluntarily in this study. The approval of this study was taken from institutional ethics committee.

Students were divided into 10 groups, and each group of 10 students was provided a cadaver for dissection. The time duration for dissection was about 10 hours in a week. During the dissection of lower limb, 1-month time was given for dissection with traditional method. After the completion of dissection of lower limb, students’ feedback was taken about traditional method of dissection. After that, the group discussion was introduced as a teaching-learning method during dissection of upper limb for 1 month, so that students can compare method of group discussion with traditional method. The following general rules for group discussion were introduced amongst all groups:

  1. The students were asked to prepare for the dissection sessions by pre-reading the relevant sections in the prescribed textbook as well as using other resources.

  2. This is followed by dissection of respective region.

  3. Academic staff appointed a leader for each group in an individual session for 1 week.

  4. The leader allocated roles to the rest of the group members. The roles and duties of each student are summarized in [Table 1]. This methodology for group discussion was adopted from “A Strategy towards Professionalism in the Dissecting Room.”[26]

  5. After completion of session of 1 week, roles and duties of each student were changed in next week. Academic staff members circulated through the dissection hall and directly observed the students during the session.

Table 1

Roles and main duties

Role

Duties

Leader

Allocates roles to other members, ensures members understand and fulfill duties, and ensures completion of dissection and observation of structures by all members.

Dissector

Dissects the respective parts, follows dissection guide, and also gives opportunity for others to observe structures.

Reader

Read and explain dissection guide, elucidates structures in atlas or textbooks, and seeks additional resources as needed.

Summarizer

Summarizes the dissection at regular intervals and correlates structures observed to the clinical aspects relevant to the session.

Note taker

Documents important observations, anatomical variations, and record any other issue observed on cadaver.

After completion of second region (upper limb), again anonymous feedback of all students was taken by using preformed set of questions. A 5-point Likert scale was used ranging from strongly agree to strongly disagree in a feedback questionnaire ([Table 2]) and from excellent to poor for overall rating of method ([Table 3]). The data (students’ opinions) collected through feedback questionnaire were statistically analyzed using IBM SPSS statistics software (version 23 US). Mean and coefficient of variance were calculated for 5-point Likert scale questionnaire.

Table 2

Responses of the students (n = 100) regarding traditional method before introduction of group discussion in dissection

No.

Questions

“Yes” responses (%)

“No” responses (%)

1

Did you prepare the respective topics before starting the dissection?

12

88

2

Did you dissect or actively participate in dissection regularly?

46

54

3

Did you complete dissection task within the time limit?

78

22

4

Did you observe the structures during and after completion of the dissection during all sessions?

94

6

5

Did you learn the respective topics individually or by discussing with your dissecting partner?

76

24

6

Did you learn the respective topics by discussing with all group members of your table?

22

78

7

Did you express yourself and communicate with each other to learn respective topics during dissection?

33

67

Table 3

Responses of the students (n = 100) regarding process of group discussion during dissection

No.

Questions

“Yes” responses (%)

“No” responses (%)

1

Have you prepared the respective topics before starting the dissection?

36

64

2

Was your group effective in allocating roles to all members for dissection?

68

32

3

Did you understand and fulfill your duties (role allocated by leader) in dissection hall?

90

10

4

Did you complete dissection task within the time limit?

80

20

5

Did you observe the structures during and after completion of the dissection?

96

4

6

Did you document any anatomical variations observed or noted any clinical issues observed during dissection?

71

29

7

Is working in group better compared to other methods of teaching-learning?

81

19

8

Should we continue this method for dissection for next region?

85

15


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Result

[Table 4] shows that about 80 to 96% students followed the process of group discussion during dissection. Before starting the dissection, 36% students prepared the topics. Some groups (32% students) felt that leader could not allocate roles to all members effectively.

Table 4

Students rating for different aspects of group discussion as teaching-learning method in dissection (n = 100)

No.

Different aspects of group discussion

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

1

This method is better than traditional method to improve learning during dissection

15

52

27

6

0

2

Helped in improving understanding of the topics during dissection

18

51

25

4

2

3

Helped to improve dissection skills

26

48

24

0

2

4

Helped in increasing communication

17

44

31

8

0

5

Method was helpful to express yourself

15

39

36

7

3

6

Method was conducted in systemic manner

7

49

36

6

2

7

Is working in group better compared to traditional methods of dissection?

18

50

27

4

1

8

Enjoyed the dissection by using this method

16

46

30

3

5

As shown in [Table 2], 51 to 74% students either agreed or strongly agreed with different aspects of group discussion during dissection and 24 to 39% were neutral. As shown in [Table 3], 79% students liked overall effects of this teaching-learning method in dissection.

Coefficient of variation was almost same for Q.1, 2, 3, 4, 6, and 7 between 20 and 23%. It was maximum for Q.5 (26.29%) ([Table 6]). The Cronbach's alpha of feedback questionnaire ([Table 2]) was 0.816.

Table 5

Students overall rating for group discussion as teaching-learning method in dissection (n = 100)

Poor

Fair

Average

Good

Excellent

0

2

19

66

13

Table 6

Likert scale analysis of feedback questionnaire of [Table 2]

Question

Mean

Standard deviation

Benchmark (80% of the highest value)*

Z-score

Area beyond the curve

Percentages

Coefficient of variation (CV) (%)

Options 1 and 2 (strongly agree and agree) in Likert scale (%)

Note: 1, strongly disagree; 2, disagree; 3, neutral; 4, agree; 5, strongly agree.

Q.1

3.76

0.78

4

–0.307692

0.1443

14.43

20.74468

67

Q.2

3.79

0.856

4

–0.245327

0.0948

9.48

22.58575

69

Q.3

3.96

0.828

4

–0.048309

0.016

1.6

20.90909

74

Q.4

3.7

0.847

4

–0.354191

0.1368

13.68

22.89189

61

Q.5

3.56

0.936

4

–0.470085

0.1808

18.08

26.29213

54

Q.6

3.53

0.797

4

–0.589711

0.219

21.9

22.5779

56

Q.7

3.8

0.817

4

–0.244798

0.0948

9.48

21.5

68

Q.8

3.65

0.957

4

–0.365726

0.1406

14.06

26.21918

62


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Discussion

Anatomy is a major pillar of the medical education system without which clinical fields remain incomplete and incompetent to come up to final diagnosis of the patient's ailment.[27] Broadly in India, minimum modifications have been done in MBBS curriculum as far as teaching-learning approach is concerned. There has been little significant change in content as well as in teaching style.[28]

In the traditional way, anatomy is learned by both active and passive learning methods. Cadaveric dissection is an effective active learning method used, not only in traditional but also in modern anatomy curricula.[29] Dissection not only encourages active participation of students but also provides an opportunity for small group discussion.[30]

Group discussion is a process whereby two or more people express themselves, clarify and pool their knowledge, solve problems, and reflect.[25] [31] Various studies emphasize on the small group discussion as teaching-learning method to improve students’ academic performance and high-quality results.[32] [33] The ideal place to introduce group discussion as teaching-learning method in anatomy is dissection hall. Thus, in this study to increase interest in dissection and to improve understanding of subject through dissection, the group discussion method was introduced in dissection hall in modified form; that is, the discussion was going on along with dissection process.

During dissection with traditional method, it was found that only few students from each table were dissecting regularly and other students were not actively participating in dissection ([Table 1]). Winkelmann et al found similar problem during dissection courses in one medical school in Germany. They observed that on an average, students devoted 33% of the course time to active dissection, 27% to prosection, and 31% to cadaver-unrelated activities, and average active dissection time declined slowly over the course of the semester. In complementary fashion, amounts of course time for prosection and cadaver-unrelated activities both slowly increased over the course of the semester.[16] Sharma and Gupta and Khan et al also observed in their study that the dissection sessions were avoided by students for multiple reasons.[34] [35] Additionally, Sharma et al in their study “On Attitude towards Anatomy Dissection” found that some (29%) students did not get enough chances for dissection.[36] In this study, this problem was possibly overcome to much extent after introduction of group discussion method in dissection hall because each student was assigned specific role with duties and these roles, and duties were changed in each session in rotation. Most (80–96%) students understood various steps of this method, followed it, and fulfilled their duties (role allocated by leader) in dissection hall. Most students regularly participated actively in dissection by using this method irrespective of various reasons for avoidance of dissection mentioned in various literatures.[7] [8] [9] Therefore, each student got enough chance to participate actively in dissection by using this method.

During dissection, students’ learning is dependent not only on performance of a full dissection but also on outstanding instruction, engaged inquiry and interaction with peers.[37] In this study during traditional method of dissection, most students were learning respective topics either individually or by discussing with their dissecting partner ([Table 1]; Q.5: 76%). There was less interaction among their peers in each group ([Table 1]; Q.6: 22%). Group discussion method helped students to increase communication with each other ([Table 6]; Q.4: 17% strongly agreed and 44% agreed), express themselves during dissection ([Table 6]; Q.5: 15% strongly agreed and 39% agreed), and also to improve dissection skills (74%). Students also agreed that working in group is better as compared with traditional method of dissection (68%), and they enjoyed dissection by using this method (62%). The Cronbach's alpha of feedback questionnaire of [Table 2] was 0.816, indicating good internal consistency and reliability of the questionnaires in the scale. Coefficient of variation was almost same for Q.1, 2, 3, 4, 6, and 7 between 20 and 23%. In the Likert scale, agree and strongly agree options were chosen by 54 to 74% students for different questions. This study shows that according to students’ responses for most of the questions, coefficient of variation was only 20 to 23% and also the Likert scale options for agree and strongly agree was above 60%; that is, it is more for better options and suggests that students had a common consensus for liked options as is illustrated by a lesser coefficient of variation. Heyns in their strategy toward professionalism in the dissecting room mentioned similar findings that were reflected positively by students.[26]

In this study, only 36% students prepared respective topics before dissection, and in some groups, leader was not able to allocate roles effectively during dissection (32%). Similar problems of small group discussion were mentioned by Jaques in his article “Teaching Small Groups.”[20]


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Limitations

The current method was applied during dissection of only one region of human anatomy, which was not sufficient for assessment of effectiveness of this method. Due to limited availability of faculties for direct observation of the process, it was not possible to monitor role of each student.


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Conclusion

Group discussion in dissection hall is a very useful method in creating active participation, communication, improving understanding of subject, and attitude of students. However, to make this method more effective, prior preparation and positive participation of all students are required. This study provides a good starting point for discussion and further research.


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Conflict of Interest

None.


Address for correspondence

Asst. Prof. Mehul Ratilal Tandel, MD Anatomy
Pramukhswami Medical College
Karamsad, Anand 388325, Gujarat
India