Problem Based Integrated Teaching of Bronchial Asthma to Second MBBS Students

International Multispecialty Journal of Health (IMJH) [Vol-1, Issue-7, Sept.- 2015]
Page | 28
Problem Based Integrated Teaching of Bronchial Asthma to
Second MBBS Students
Dr. Lokendra Sharma1
, Dr. Kopal Sharma2
, Dr. Monica Jain3
, Dr. Ramesh Kumar
Mishra4
, Dr. B.S. Sharma5
, Dr. Sanjay Singhal6
and Dr. Shivankan Kakar7
1
Associate Professor, Department of Pharmacology, SMS Medical College, Jaipur (Rajasthan) India
2
Senior Demonstrator, Department of Pharmacology, MG Medical College, Jaipur (Rajasthan) India India
3
Professor, Department of Pharmacology, SMS Medical College, Jaipur (Rajasthan) India
4
Associate Professor, Department of Microbiology, SMS Medical College, Jaipur (Rajasthan) India
5
Professor, Department of Pediatrics Medicine, SMS Medical College, Jaipur (Rajasthan) India
6
Assistant Professor, Department of Physiology, SMS Medical College, Jaipur (Rajasthan) India
7
Senior Demonstrator, Department of Pharmacology, SMS Medical College, Jaipur (Rajasthan) India
Abstract— Medical Council of India has laid down the norms and guidelines for integrated teaching to
enhance the students approach for learning in a comprehensive manner. A comparative interventional
study was carried out on II MBBS students of SMS medical College, Jaipur to compare the effect of
traditional teaching and integrated teaching method. After taking pre-test students were divided into
two groups, one group underwent traditional teaching and other group is given integrated teaching on
Bronchial Asthma. Post-test was taken after finishing the topic. Mean change in score improved in both
the group were compared by unpaiered “t’ Test. Perception of students and faculty about new method
was also found out. It was found in this study that mean change of score of students from pre-test to
post-test in the study group was significantly higher (p<0.001) than in control group (3.43±1.88 v/s
0.65±1.81). More than 90 % students liked and retained the subject better with the new teaching
methodology only 9.3% felt it more time consuming. Majority of faculty had liked this method.
Key words: Medical Council of India (MCI), Integrated teaching, Bronchial Asthma
I. INTRODUCTION
Integrated teaching is a means and process by which the student’s potential to approach a subject
logically, scientifically and in an objective manner is cultivated. Several recommendations were made to
incorporate multi – disciplinary integrated teaching module as an essential ingredient of medical school
curriculum. The learning process, applications and clinical skills are designed in such a manner to lead
the medical students in the desired direction to effect quality medical education and patient care1
.
The Medical Council of India has laid down norms and stipulations for integrated teaching,
evolving the medical curriculum in a manner that enhances the student’s approach to learning in a
comprehensive way2
.
In the field of medical education several innovations and new trends have come up and have
been accepted globally that include Integrated teaching, problem based learning, self directed learning
and community orientation.3
In a vast number of settings, integrated teaching is being employed in
bridging the gap between academic knowledge and its practical application.4
Medical education basically aims to produce medical personnel having sound clinical
competences and community orientation with proficient communication skills. All these are
fundamental to counter the formidable health problems.5
With the existing medical practices, there is a general dissatisfaction. The present day medical
curricula are labeled as the basis of this dissatisfaction.6
These are discipline based, teacher centered,

Page | 29
examination oriented, where in learners are presented with a series of discipline or building blocks in
isolation. Such modules are under criticism for placing too much emphasis on memorization of facts and
figures and for overloading the students with excessive details.7
As a result, students are unable to
correlate the basis of clinical problems or cases, as they are unable to correlate in context of a clinical
problem. This could affect quality of diagnosis and treatment of a patient.
To improve the quality of students and to have effective diagnosis and better treatment of the
patients, integrated learning is the need of hour. In recent years throughout the world such Curricula
have been used by faculties to teach the students.8
Medical educationists realized that there was need for integrating basic and clinical medical
sciences.9
Medical teaching of yester-years was initiated in the pre- and para- clinical sciences with
structured boundaries in various disciplines and the students and faculty used to strictly adhere to the
ambits and purview of the varied disciplines. It was observed that such fragmentation in medical
education did not serve the very spirit of medical pedagogy. Subsequently, the concept of integrated
medical teaching evolved breaking the frontiers of structured teaching, sensitizing the students to the
multi – discipli nary and multi – axes approach to clinical dilemmas. This interdisciplinary approach
has gained acceptance world – wide and has opened new horizons for active interactive medical
education.10
It is also said that students learn best when they are engaged by different materials of learning
presented in variety of ways and formats11
. So, this present study of integrated teaching was designed
for undergraduate medical students with following objectives:-
1. To assess and compare the effect of traditional teaching with Integrated TL modular teaching in
II MBBS students.
2. To find out the feedback of students and faculty teachers about this Integrated TL modular
teaching
II. METHODOLOGY
After taking approval from Institutional Ethics committee, SMS Medical College, Jaipur, this study was
conducted on second MBBS (Fifth semester) students. Students, who has given written inform consent
were assessed with a pre-designed pre-test questionnaire and then randomly divided in two groups, one
group were taught diabetes in traditional manner (Control group) whereas another group of students
(Study Group) were taught Bronchial Asthma with this new integrated TL.
Integrated teaching was implemented by the active involvement of the departments of
Physiology, Pathology and Respiratory Medicine. The faculty of all the departments was sensitized to
this method and feedback forms from them were taken in order to find out their response. Students of
“study group’ were taught the through this integrated TL method.
After finishing the teaching from both the methods to both the groups, they were again assessed
with a pre-designed post-test questionnaire. Students absent on the day of post-test were excluded from
the study.
Significance of effect of traditional teaching and integrated TL method teaching were assessed
with the difference of scores of pre and post-test students paired ‘t’ test. Significance of difference in
effect of traditional teaching and integrated TL method teaching were assessed with students unpaired
Student ‘t’ test.
Student’s and faculty’s perception of the new approach was also inquire d. It was followed by
clinical examination of asthmatic patient and students were taught the significance of clinic-pathological
association.
Data thus collected were analyzed and classified on MS Excel 2007. Significance of difference in mean
score change from pre to post test scores in the group were inferred by paired Student ‘t’ Test whereas
in both the group was inferred by unpaired ‘t’ Test with the help of statistical software Primer version 6.
For significance p value <0.05 was considered significant.

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III. RESULTS
Out of total 150 students of II MBBS students 106 students were present on the day of selection of
subjects for the study. Out of these 106 students everyone has given written informed consent for the
study so they have given pre-test and then randomly divided into two groups i.e. 53 for study group
(integrated TL teaching) and 53 for control group (traditional teaching). But at the time of post-test 3
from study group and 2 from control group were absent. So, finally 50 of study group and 51 students of
control group students were included for assessment of effect of teaching.
It was observed through pre-test that although mean scores of control group was slightly higher
than study group (43±12.5 v/s 39±11.5) but there is no significant difference i n mean scores of control
and study group (p>0.05). (Table 1)
It was also observed in this study that although post-test mean scores of control group was
slightly higher than pre-test scores (43±12.5 v/s 48±14) but there is no significant difference in mean
scores of pre-test and post-test in control group (p>0.05). (Table 1)
It was also depicted from this study that post-test mean scores of study group was significantly
higher (p<0.001) than pre-test scores (39±11.5 v/s 67±15). (Table 1)
When change in mean scores from pre-test to post-test in both the group it was revealed that
mean change of score of students in study group was significantly higher (p<0.001) than in control
group (5±1.5 v/s 28±1). (Table 1)
Table No. 1
Analysis of Pre-test and Post Scores of Control Group and Study Group
S. No. Groups Mean Scores SD of Scores
Test of Significance
P value LS
1 Control Group (n=51) 43 12.5 Unpaired ‘t’ Test=1.657 at 99 DF
P Value= 0.098 NS2 Study Group (n=50) 39 11.5
Pre-test and Post-test Scores of Control Group (n=51)
1 Pre-test Scores 43 12.5 Paired ‘t’ Test =1.903 at 49 DF
P Value= 0.060 NS2 Post-test Scores 48 14
Pre-test and Post-test Scores of Study Group (n=43)
1 Pre-test Scores 39 11.5 Paired ‘t’ Test =10.475 at 98 DF
P Value<0.001 HS2 Post-test Scores 67 15
MeanChangeof Scores fromPre-test toPost-test of Control GroupandStudyGroup
1 Control Group(n=51) 5 1.5 Unpaired ‘t’ Test =90.483 at 99 DF
P Value<0.001 HS2 Study Group (n=50) 28 1
Regarding student’s feedback it was observed that out of 50 students of study group, 46 (92% )
students were liking the new teaching methodology & felt that they had a better understood clinico
pathological association. Only 4 (8%) felt that a lot of time was spent on teaching of a single topic. 38
(76%) students appreciated the fact that they could relate to the clinical aspects and wanted this
approach to be extended to other topics as well. (Fig.1)
Regarding faculty’s feedback it was observed that from the faculty of physiology, pathology and
medicine 97%, 100%, and 86% respectively were liking this new method and 59%, 62% and 51%
respectively were in favor of applying this method in MBBS curriculum at least for certain selected
topics. (Fig.2)

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Figure 1 Figure 2
Regarding faculty’s feedback it was observed that from the faculty of physiology, pathology and
medicine 97%, 100%, and 86% respectively were liking this new method and 59%, 62% and 51%
respectively were in favor of applying this method in MBBS curriculum at least for certain selected
topics. (Fig.2)
IV. DISCUSSION
In the view of new guideline of regulatory body in medical education every country and medical college
must educate the student regarding physical, mental health and social and spiritual well being.
The ideal basic objective of medical education in every country and institution is to educate the
students in such a way that they should be capable enough to use their teaching in a effective manner.
Educational program has a better chance of being effective if its purpose has been clearly expressed.
One can give an analogy of functioning of human body, where no system functions in isolation but
operates in an organized and interdependent manner to achieve optimum level of functioning.1
Medical
teachers should present the vast amount of information to the students in a planned, organized and
integrated manner1
.
The need for integration is also felt by the students. Students find the preclinical subjects not so
interested, one of the main reason for which is its theoretical and fragmented nature12
. In this the same
subject is taught by each preclinical department at different times, without any awareness of what is
taught by other departments. This disjointed approach to the topic leads to unnecessary repetition, loss
of valuable time and also creates confusion in the student’s mind. 12
This study has revealed that those students who were taught by this new integrated TL method
were performed significantly better than students of traditional teaching.
Regarding student’s feedback it was observed in this present study that majority (92% ) of
students were liking the new teaching methodology & felt that they had a better clinico-pathological
association only 8% felt that a lot of time was spent on teaching of a single topic.
Regarding faculty’s feedback it was observed that all most all faculty members of physiology,
pathology and pediatric medicine (97%, 100% and 86% respectively) were liking this new method and
more than half of faculty member liking this new method (59%, 62% and 51% respectively) were in
favor of applying this method in MBBS curriculum at least for certain selected topics.
Smith SR3
also reported new trends in field of medical education that have been accepted
globally that include integrated teaching, problem based learning, self directed learning and community
orientation.
Paul, V.K. etall5
reported that medical education basically aims to produce medical personnel
having sound clinical competences and community orientation with proficient communication skills.
All these are very essential to solve formidable health problems.

Page | 32
Tennyson, R.D. et all10
also observed that nowadays this teaching is disciplined based, teacher
centered, examination oriented, where in learners are presented with a series of discipline or building
blocks in isolation. Such modules are under criticism for placing too much emphasis on memorization
of facts and figures and for overloading the students with excessive details. 7
Ruth, N et al suggested that the feedback helps the faculty identify the strength and
weakness of their teaching methods.13
Even Sehgal, R et al also observed that feedback from students
regarding teaching is very important to improve the quality of teaching and is the best method available
to bridge the communication gap between students and teachers14
.
V. CONCLUSION
The new integrated TL method of integrated teaching was found to be more effective than the traditional
ones. This integrated TL method was well accepted by faculty as well as students. Students showed
better clinic-pathological understanding. Both students and faculty had a positive attitude toward this
innovation in education. To improve the quality of students and to have effective diagnosis and better
treatment of the patients, integrated learning is the need of hour.
ACKNOWLEDGEMENTS
Authors acknowledge the contribution of Dr. U S Agarwal, Dean for providing the necessary guidance
for the study. Authors also want to thank Dr. Gopal Jhalani and Dr. Kusum Gaur who did the scientific
writing for this article.
CONFLICT OF INTEREST
None declared till now.
REFERENCES
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2. Arun V. Jamkar, Vishwnath L Yemul and Gurpreet Singh : Integrated teaching program with
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3. Smith, S. R. (2005) . Toward an Integrated Medical curriculum. Med Health R I, 88(8): 258-61
4. Huber, M. T., P. Hutchings (2004). Integrative Learning: Mapping the Terrain. The Academy in
Transition. Washington, DC.: Association of American Colleges and Universities
5. Paul, V. K. (1993) Innovative programmes of Medical Education: Case studies. Indian J Pediatr,
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6. World Health Organization. (1981) Global strategy for health for all by year 2000. Health for all
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8. Irby, D., L. Wilkerson (2003). Educational innovations in academic medicine and environmental
trends. J Gen Intern Med, 18; 370-6
9. Dr. Bipin S. Jain, MD (Hom) : Integrated Medical Education: A Must for Homeopathic Colleges
and Homeopaths in the Making. http://www.hpathy.com/ezine/2009july.asp
10. Tennyson, R.D. (1998) An instructional strategy planning model to improve learning and cognition.
Computer in Human Behavior 4: 13-22.
11. Ashok Rattan et al.( 1994): Curriculum Development for Integrated Teaching of Infectious Diseases
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12. S Joglekar, PS Bhuiyan, S Kishore (1994 ): Integrated teaching--our experience. JPGM (Journal of
post graduate medicine.) Vol . 40 Issue 4; 231-2 ISSN : 0975-9492 22
13. Ruth, N. (2000) Communicating student evaluation of teaching results. Rating interpretation guides
(RIG’s). Assessment And Evaluation In Higher Education, 25: 121-34
14. Sehgal, R., V. Dhir, A. Sawhney (1998) Teaching technologies in gross anatomy. J Anat Soc India,
48: 36

Problem Based Integrated Teaching of Bronchial Asthma to Second MBBS Students

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