INTRODUCTION
Small-group teaching–learning activities are beneficial to students as they experience the freedom to interact with their teachers in a safe and nonthreatening environment.[1] As described by Bloom's taxonomy, it is a standard to ensure higher critical thinking and learning levels.[2] Small-group teaching–learning activity is very effective in the delivery of a kinesthetic subject like anatomy. Effective small-group teaching requires adequate teacher and student participation.[3] The author's department highly regarded the small-group teaching–learning activities and significantly invested in its development.
When the pandemic struck unawares, we had to adapt and reframe our small-group teaching methodology rapidly. With inputs from the team, we quickly adapted to a virtual environment and continued the valued small-group learning (SGL). Anatomy is a volatile subject for 1st-year MBBS students. In a regular small-group setting, education supplemented by visual and kinesthetic inputs is the norm. With a translational intent to the virtual environment, content had to be created and made available to the students rapidly. Face-to-face teaching relied heavily on nonverbal feedback from students, which was stripped away in a virtual SGL (VrSGL) setting. Faculty had to unlearn their usual methods of face-to-face teaching and learn the art of handling virtual instruction.
The difficulty faced challenged the members of the faculty to develop new skills required for VrSGL. Maintaining focus on the students made the challenges seem less daunting. Faculty training, student orientation to the online platform, and content creation were the significant developments that ran simultaneously. We aimed to study the effects of the online platform and the content created on students' perception in the delivery of VrSGL. We also aimed to record the experience of the faculty in the delivery of VrSGL.
MATERIALS AND METHODS
We utilized Microsoft Teams to deliver the VrSGL in a setting with 10–12 members each. Each group of VrSGL comprised up to ten 1st-year MBBS students, one trainee, and one faculty. The group met every working day according to the teaching schedule over 6 weeks. The faculty underwent training on various aspects: (a) functionality of Microsoft Teams, (b) photographing specimens, and (c) video editing. Different faculty members took a problem-based approach in training their colleagues based on their interests and skillsets. We introduced the students to Microsoft Teams through participating in VrSGL sessions, viewing the content created, and submitting assignments.
The arduous task of developing relevant content was delegated to the faculty members and achieved by team effort. Equipment was purchased and made available to the faculty for creating videos. All members recorded videos, but video editing was taken up by a few who had the required skillsets. We prioritized content privacy and verified that suitable safeguards were in place. The videos created were assessed for relevance, accuracy, and quality before making them available to the students on Microsoft Teams. On the VrSGL sessions, we contacted our students regularly, and the topic of the day was addressed in length, just as it would have been in a face-to-face session. The content prepared was made available to the students for their reference both during and outside class hours.
VrSGL tutors evaluated scheduled work regularly, and weekly virtual viva voce sessions encouraged students to learn the material presented that week. To minimize the prejudice of being examined by the same VrSGL instructor each time, we swapped students across all faculty members for their virtual viva voce sessions. We conducted periodic virtual self-assessments online in the form of (a) spotters, (b) short note writing, and (c) solving case scenarios. These assessment activities were given appropriate weightage and considered toward formative assessments. Summative assessments were also conducted online, with students keeping their recordings on, due to a lack of a provision to detect malpractice on Microsoft Teams. The summative assessment was partly a picture-based identification (spotters on Moodle Pty Ltd, West Perth WA, Australia) and partly written work (which they had to submit in a photo or PDF format within a stipulated time frame). The answer key was prepared and circulated among the faculty for a standardized online evaluation of the students' answers.
Questions pertaining to the online teaching in virtual small groups, assessments conducted, the online platform used, and the overall perception of the topics covered were included in the questionnaire. A section of the questionnaire catered to the quality of teaching videos, dissection demonstration videos, and online spotters. The questionnaire was validated by the faculty with multiple revisions for appropriateness and necessity before circulation among the students. The online form consisted of an initial segment that required the students to consent before proceeding with the questionnaire. The detailed questionnaire could be availed at request.
The institutional review board provided ethical clearance of this knowledge, attitude, and practice study (IRB Min. No. 12974, approved in June 2020), and students and teachers offered web-based consent after the VrSGL sessions. The responses were taken as percentages for individual items on the questionnaire, and correlation analysis was performed. Data were presented in frequency and percentage for categorical variables wherever required. As the variables are on Likert scale, we used Spearman's correlation to present the relation between continuous variables. For all analyses, the significance was kept at 5% level. All the analyses were performed using STATA IC/16.0 (StataCorp, 4905 Lakeway Drive, College Station, Texas 77845, USA) after eliminating identifiers.
RESULTS
Ninety-seven of the 99 1st-year MBBS students consented to take part in this study and gave their feedback. The participants were 46 male and 51 female students, ranging from 17 to 23 years, with a mean ± standard deviation age of 19.1 ± 1.0 years.
Even though 57.7% of participants reported problems accessing the Internet, most of the students (92.7%) liked using Microsoft Teams as the digital interface for VrSGL. There was a significant negative correlation between these two variables [Table 1]. In learning anatomy, many students regarded the frequency of VrSGL sessions as optimal (85.5%) and valuable (87.6%). Both these variables had a substantial positive connection [Table 1].
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Table 1: Correlation between the percentage of students who liked using Microsoft teams for virtual small-group learning with other variables using Spearman's rank correlation coefficient
Most of the students responded positively about the quality (97.9%) of the demonstration videos. They noted the length of videos as optimal (88.6%), clear and concise (94.8%) in content, appropriately oriented (83.5%), and enjoyable (80.4%) for learning. The different aspects of demonstration videos positively correlated with the students' enjoyment and learning process during VrSGL sessions [Table 2].
Table 2: Correlation between percentage of students endorsing different aspects of demonstration and proportion who enjoyed the virtual small-group learning sessions using Spearman's rank correlation coefficient
Many students agreed that the assignments positively impacted their learning process (72.1%) and clarified their concepts (72.1%). Assignments and learning were positively correlated [Table 3].
Table 3: Correlation between percentage of students that felt assignments impacted their learning with those that enjoyed the virtual small-group learning sessions using Spearman's rank correlation coefficient
Students reported that the periodic online viva voce sessions had the largest influence on learning, followed by digital spotters, clinical cases, and short answer writing, among the various assessment modalities [Chart 1].
About half of the students found the transition from regular SGL to VrSGL easy. Most of the students felt that VrSGL helped them learn anatomy well (72.3%), enabled their learning at their own pace (89.6%), and improved their self-learning ability (84.5%) and their accountability (71.1%). A fraction of students (57.7%) felt that learning clinical concepts through VrSGL was comparable to regular SGL. A significant drawback of VrSGL was the lack of handling (90.7%) of cadaveric specimens. The effectiveness of VrSGL sessions based on different teaching–learning modalities was evident in the analysis. This analysis demonstrated a significant positive correlation with the quality of the demonstration videos, assignments given, and assessments conducted [Table 4].
Table 4: Correlation between the percentage of students who enjoyed virtual small-group learning sessions based on teaching-learning and assessment modalities employed using Spearman's rank correlation coefficient
DISCUSSION
Pandemics have disrupted the lives of humanity throughout history; COVID-19 was no exception in this regard.[4] The disruptions became palpable in the field of medical education too. Exploration for alternatives became the need of the hour.[5] The most feasible option was to rely mainly on established medical education methods proven for teaching practical skills. Peyton's four-step approach was tweaked and applied to a virtual small-group setting.[6] We propose a step-by-step approach for VrSGL that includes (a) demonstration (using videos to demonstrate appropriate structures), (b) discussion (in a VrSGL setting to ensure comprehension), (c) assignments (to consolidate comprehension), and (d) assessments (to certify comprehension).
Microsoft Teams was used as the digital interface to tackle the disruption of regular small-group teaching. A choice of the digital interface was vital since it would facilitate engagement with the students[7] for VrSGL. In this study, most of the students liked the digital interface. It positively reflects the successful orientation to Microsoft Teams during the revision of topics before the initiation of the VrSGL sessions.[5] The results of this study suggest that a digital interface significantly facilitated learning in a virtual environment. The negative correlation seen with the connectivity issues faced by the students is self-explanatory. Those who missed handling the specimens did not (a) enjoy the sessions or the videos, (b) like the video quality, (c) comprehend clinical concepts, and (d) report a difficult transition from the regular to online mode.
The importance of dissection-based learning of anatomy has been time-tested, but with the COVID-related disruption, a switch to a virtual model was imperative.[8] We used existing resources on YouTube in an attempt to substitute a dissection-based approach. The content created for a virtual setting plays a significant role in promoting learning in the students.[9] Photography and videography are different fields of art in themselves. Medical education does not specialize in these fields of art, but the COVID-19 emergency pushed the creative instincts of the medical fraternity to their limits. Our faculty embraced the challenge and adopted a combination of these fields to enhance our teaching–learning experiences and tide over the emergency. A hiatus in the literature exists regarding video quality for teaching anatomy. Although virtual courses are on the rise, the effect of video quality on small-group learning remains unexplored.[7] Studies have evaluated the role of videos in the setting of a lecture[10] or for teaching embryology.[11] Still, their role in the VrSGL environment remains unexplored. Responses to our questions on video quality direct us to its significance in the future of medical education. They highlight the importance of good quality, clear and concise content, and optimal length (<10 min) of videos in driving learning. This study highlights the role played by video quality in facilitating learning.
In the regular small-group setting, only a fractional input from the teacher, compounded with a good amount of learning from peer interactions, aids learning. We tried to overcome this challenge by introducing activities such as polling and circle time with limited success. Online polling was conducted on individual groups to keep track of the participants' attention. Circle time refers to the participants taking turns to answer questions to ensure participation from all. We have, previously, published the psychological elements of emergency remote learning.[12]
We ensured the alignment of VrSGL with the updated medical curriculum in transitioning from a regular SGL to VrSGL. The updated curriculum “Competency-Based Medical Education” (CBME) comprised horizontal integration, vertical integration, and clinical relevance.[13]
Students were motivated to put in their best effort by scheduling periodic assignments. This fits well with the adult learning principles of problem-based learning.[14] Regular assignments had a deadline for submission and contributed toward formative assessments in the CBME.[13] The students in this study have noted the positive effect of assignments on their learning as described by Taslibeyaz et al.[9] Similarly, it is well known that assessments drive learning;[15] the positive correlation between assessments and learning is a testament to this. We utilized different forms of assessments, and each one played its role in facilitating learning among students. Since we conducted assessments periodically, the students had limited portions to prepare and could do a good job. All these students went on to clear their 1st-year university examinations and have progressed in their course.
CONCLUSION
The most impactful factors brought out in this study are the quality of content delivered, the assignments given, and the assessments conducted to motivate learning in a virtual small-group setting. Although learning is multifaceted, some of these facets stand out by the results of this study. Further studies could look to quantify the effects of these factors on learning outcomes of students.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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