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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 17  |  Issue : 2  |  Page : 62-66

Online course in geriatrics for final-year medical students


1 Department of Community Medicine, Government Medical College, Eranakulam, Kerala, India
2 Independent Qualitative Consultant, Currently with Vellore Christian Medical College Foundation, USA and formerly with Institute for Public Health, Bangalore, Karnataka, India
3 Department of Geriatric Medicine, Yenepoya Medical College, Derlakatte, Karnataka, India
4 Department of Medicine, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India

Date of Submission20-Jun-2021
Date of Acceptance29-Jul-2021
Date of Web Publication22-Oct-2021

Correspondence Address:
Dr. Alka Ganesh
Department of Medicine, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiag.jiag_17_21

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  Abstract 


Background: The new competency-based MBBS undergraduate curriculum articulates 24 competencies in geriatrics. Acknowledging the dearth of faculty in the country, a group of geriatricians developed and conducted an online modular course for final-year medical students. Methods: This 6-week online course included 13 modules and the study materials were developed through a two-stage vetting process. The course was advertised to potential students through social media and was delivered over Google classroom platform. Students' learning was assessed by multiple-choice questions (MCQs), and the course was evaluated with comparison of pretest and posttest, feedbacks from students with both structured and open-ended questionnaires. Results: Out of 200 eligible students from 38 medical colleges who applied, 142 students joined the course. Out of 142 students joined, 98 (69%) completed the course with 80% attendance; 91 (64.1%) secured scores above 50%; and 46 (32.4%) secured scores above 80% in MCQ test. Posttest scores were significantly higher than pretest scores (P < 0.001) with medium Cohen's effect size. Median scores of feedbacks on 20-point Likert scale for all modules were 15 or 16. Content analysis of qualitative feedback showed appreciation for the structure and content of the course, praise for the expertise and commitment of the faculty in delivering it effectively, scope for further improvement, and positive change in attitude toward discipline of geriatrics. Conclusions: This endeavor shows that short online course will be helpful for motivated medical students to expand their knowledge in geriatrics.

Keywords: Competency-based medical education, geriatrics education in India, geriatrics in undergraduate medical curriculum, online medical education


How to cite this article:
Bhatt AN, Ganesh G, Adhikari P, Ganesh A. Online course in geriatrics for final-year medical students. J Indian Acad Geriatr 2021;17:62-6

How to cite this URL:
Bhatt AN, Ganesh G, Adhikari P, Ganesh A. Online course in geriatrics for final-year medical students. J Indian Acad Geriatr [serial online] 2021 [cited 2021 Nov 27];17:62-6. Available from: http://www.jiag.com/text.asp?2021/17/2/62/329018




  Introduction Top


Geriatrics has not been formally taught to medical students in India. The new competency-based MBBS curriculum has put in place 22 competencies under the section IM24 of the discipline of internal medicine.[1] Out of 554 medical colleges in India,[2] only six institutions have recognized postgraduate geriatric departments.[3] This highlights dearth of trained faculty to teach the required competencies.

To fill this gap, Group for Education and Research in Geriatrics, an association of senior clinician's practicing geriatrics, decided to test the feasibility of delivering these competencies through an online course to final-year medical students. We took advantage of the fact that the medical colleges were closed due to the COVID 19 lockdown provisions, starting March 24, 2020, which prevented students from attending physical classes. They would therefore have time to engage in an online teaching course. We report here the curriculum development, faculty, curriculum contents, and evaluation, of the course.


  Methods Top


Curriculum development

A list of 13 modules was drawn up based on the common clinical areas of health problems experienced by the elderly and these were aligned with all the 22 competencies articulated in section IM24 of competency-based undergraduate curriculum prescribed by the Medical Council of India.[1] The list of modules and topics is shown in [Table 1].
Table 1: Modules and mapping of IM24 competencies

Click here to view


The course was designed and supervised by professors of geriatrics and the content was developed along with lead faculty of each module. These were scrutinized by designated faculty in a two-stage process: In the first stage, the suitability of learning material for undergraduates was assessed and in the second, the adequacy and clarity of audiovisual aids were evaluated.

Faculty recruitment

The faculty was recruited by information circulated by word of mouth, in the national geriatric associations (Geriatric Society of India and Indian Academy of Geriatrics). The faculty comprised of the following: 18 university faculty (11 professors and 7 asst/assoc. professors) and 6 senior clinicians.

Student recruitment

The brochure of the course was circulated to various national and subnational associations and groups of medical students through social media platforms, WhatsApp, and Facebook.

Method of instruction

The online modules were delivered through home tutoring account of Google classroom platform. Participation was free. Each module consisted of one or more recorded faculty lectures. These were supplemented with links to selected videos or text materials which were freely available over the internet. Each day's teaching/learning material was designed to occupy 30–45 min of the students' time at their convenience. Google Classroom platform has facility for students to post query and comments to faculty. This facility enabled the students to interact with faculty though the sessions were not live. The queries posted by the students were answered by respective faculty who were hosting the module. The modules were posted according to a scheduled timetable, but students were at liberty to complete the modules at their own pace.

Method of student assessment

Each module was completed in 3 days, at the end of which students were required to answer 5 single-response multiple-choice questions (MCQs) based on the materials they had studied. Completion of these MCQs was also taken as a marker of student performance and attendance.

Method of course evaluation

This was done by three methods:

  1. Pretest and posttest analysis
  2. Quantitative student feedback on each module by 5-point Likert scale with 4 questions: (a) fulfillment of course objectives, (b) time required, (c) clarity of materials, and (d) quality of materials
  3. Qualitative evaluation at the completion of the course, by invitation to answer three open-ended questions: (a) what did you like about the course and why? (b) what did you not like and what are your suggestions for improvements? (c) how would this course help you in future career and what is the gist of your learning?


Statistical analysis

Kolmogorov–Smirnov test was to done to assess normality of distribution of the scores. Pretest and posttest scores were compared by Wilcoxon signed-rank test as the normality assumption was not met. Cohen's effect size for paired samples was calculated. The total score on the Likert scale was analyzed and summarized as median and range and depicted as box and whiskers plot. The MCQ test scores for each student were analyzed as pass/fail according to an arbitrary 50% mark. Analysis was done in EZR software, developed by Jichi Medical University Saitama Medical Centre, Saitama, Japan.[4]


  Results Top


Student enrolment

The total number of applications received was 209 from 38 medical colleges, mainly from south India, of whom 9 were rejected due to incomplete applications, or not being in the final year class.

Of the 200 students accepted, only 166 completed the pretest and were enrolled, but only 142 joined Google classroom. Of those 142 who attended, 98 students (69%) completed the course with 80% attendance. There were only three students from an institution with MCI recognized Department of Geriatrics.

Student performance in multiple-choice question tests

Analysis of the single response MCQs revealed that 70% were recall type and 30% were case based, requiring application of knowledge. Among the 142 students who attended the course, 91 (64.1%) students scored above 50% marks and 46 (32.4%) students scored above 80% marks.

Course evaluation

  1. Pretest and posttest evaluation: Posttest scores were significantly higher than pretest scores with P < 0.001 for Wilcoxon signed-rank test. Median of the score was 11 and 8 and ranged from 4–14 to 2–14 for posttest and pretest, respectively. Cohen's effect size for paired samples was 0.42 which falls into medium effect size category.[5]


    1. Structured feedback: The distribution of Likert scale scores for each module for structured feedback questionnaire by students is depicted as box and whiskers plot in [Figure 1]
    2. Qualitative feedback: Out of 98 students who completed the course, 39 (39.8%) students gave answers to an open-ended questionnaire. Themes that emerged in the content analysis was interpreted as follows:
Figure 1: Module-wise summary of structured feedback scores given by students

Click here to view


Students praised the course structure and content which included the topics covered, level of information provided, “module approach” to learning, and length of the course. They found inclusion of additional materials (videos, articles, and presentations) helped to integrate content across disciplines with an emphasis on holistic patient-centered care. Students absorbed more information through case presentation discussions which aided their critical thinking. The “high caliber of the teachers,” their “enthusiasm and encouragement” of discussion, and “empathy for the elderly” made the learning experience enjoyable.

“I liked the highly structured way of the course. Lectures, videos, articles, tests were incorporated in an efficient way.”

Students suggested improvement in the audio and video quality of lectures, standardized duration of lecture and offline availability of lectures, inclusion of “live” discussions, and more case-based discussions.

“Make every module equal in length so that it can be structured and planned equally.”

Overall, students felt sensitized toward the problems of the elderly and gained both specific and practical knowledge on drug prescriptions and protocols for the elderly as well as an holistic understanding of caring for the elderly. Students appreciated the initiative taken by the faculty to initiate a course on geriatrics which are largely omitted in undergraduate medical training that most believed will be beneficial for their careers.

“Geriatrics is a small chapter in our textbooks. This comprehensive knowledge will help us in our clinical practice and also in our exams.”


  Discussion Top


This study describes the implementation and outcome of an online modular course, which included all the 22 competencies prescribed by the new MBBS curriculum.[1] This was done in a short time frame during the COVID-19 lockdown-induced disruption of regular college education courses. Since the project was a pilot, the course announcement was made through social media and reached 38 medical colleges mainly in the southern states. The process of scrutiny of the modules ensured that there was uniformity of style and that the content and presentation of the materials were suitable for undergraduate students

The low completion rate of 69% may be attributed to the course content not being interesting enough, insufficient interaction with teachers and peers, or a lack of recognition of student accomplishment.[6] In addition, lack of motivation may be ascribed to the fact that the scores attained did not contribute to university mandated internal assessment marks.

Student performance was good with two-third of students achieving a passing grade and one-third scoring above 80%. It is difficult to assess student performance in online courses, because the learning material is accessible for reference. This obstacle can be overcome if the questions are set in “Open-book examination” mode.[7] In this project, only 30% of questions satisfy the requirements of open-book tests. Therefore, the results cannot be taken as a marker of what the students learned.

Posttest scores were significantly higher than pretest scores. Cohen's effect size of 0.42 places the learning benefits in the medium range.[5] Although this is a pointer to the efficacy of the course, it indicates room for improvement in content and structure of the course, such as the inclusion of more assignments for knowledge application.

Quantitative students' feedback by Likert scale questionnaire shows high acceptance with a median score of 15 out of a possible maximum of 20. The reasons can be found in the qualitative feedback responses.

Qualitative students' feedback

Forty percent of students responded to the qualitative questionnaire. The responses indicated that the students felt, in addition to imparting knowledge of geriatric problems and their management, the course also fostered empathy and sensitized them to the unique problems of the elderly. They felt that this would empower them to become better health professionals.

The course's success in improving knowledge and attitudes to the elderly patient can be extended to include skill development, by combining it with face-to-face physical clinical exposure. Such combinations of teaching methods have been termed “blended curriculum.”[8] Although blended curricula are common in postgraduate fellowships and courses, there are few examples in undergraduate medical curricula, mainly restricted to preclinical disciplines[8],[9],[10],[11] and rare in clinical disciplines.[12]


  Conclusions Top


This pilot online modular course in geriatrics, for final-year medical students, was effective in improving knowledge and attitudes in the discipline of geriatrics. The course was rated highly by students. Course completion rate and assessment of students' knowledge require improvement.

Ethical considerations

This online geriatric course for undergraduate medical students was conceived to take advantage of the COVID-19 pandemic during which in-person learning was suspended. The course was intended to fill this learning gap rather than to provide material for scientific publication. However, due to the pre and postknowledge tests that we administered as part of the course, the faculty determined that there was sufficient new knowledge in the field of online learning for undergraduate medical students to merit a scientific publication. Students did not pay for the course. The faculty conducting the course and its various modules were not remunerated for their teaching time. All student feedback comments were anonymized and confidential and students did not receive any financial remuneration for their feedback. All faculties have been acknowledged for their efforts. Retrospectively, we informed all students that their anonymized feedback will be used for this publication and no objections have been raised.

Acknowledgment

Submitted in First Page file with covering letter.

  1. The authors would like to place on record the professional inputs by the following faculty who gave their time freely and unconditionally in preparation of their modules and interaction with students.


    1. Professors: P. S. Shankar, S. Sharma, C.V Raghuveer, A. Ambali, K.K. Ubrangala, V. Vasdev, V. Aggarwal, P. Pereira, S. Roopa, U. Kulkarni, B. Govind
    2. Asst. Professors: S. P. Manjaly, S. Avarbeel, Tejeswani C.J., H. Naaz, P. Behal, S.V. Desai
    3. Consultants: O. P. Sharma, K.R. Das, S. Paul, S. Shankaran, S. P. Tamane


  2. We acknowledge the service of Dr. N. C. Philip, for recruiting medical students through social media
  3. We acknowledge Google for education services which enabled us to provide this online course.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Competency based undergraduate curriculum for the Indian medical graduate. Medical Council of India, 2018. Available from: https://www.nmc.org.in/wp-content/uploads/2020/01/UG-Curriculum-Vol-II.pdf. [Last accessed on 2020 Dec 09].  Back to cited text no. 1
    
2.
List of Colleges Teaching MBBS. National Medical Commission. Available at https://www.nmc.org.in/information-desk/for-students-to-study-in-india/list-of-college-teaching-mbbs. [Last accessed on 2020 Dec 09].  Back to cited text no. 2
    
3.
Search Colleges and Courses. National Medical Council. Available from: https://www.nmc.org.in/information-desk/college-and-course-search. [Last accessed on 2020 Dec 09].  Back to cited text no. 3
    
4.
Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 2013;48:452-8.  Back to cited text no. 4
    
5.
Patil I. Test and Effect Size Details. Foundation; 2020 December 08. [Last updated on 2020 Dec 03]. Available from: https://cran.r-project.org/web/packages/statsExpressions/vignettes/stats_details.html. [Last accessed on 2021 Jan 05].  Back to cited text no. 5
    
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Khalil H, Ebner M. MOOCs completion rates and possible methods to improve retention-A literature review. In: World Conference on Educational Multimedia, Hypermedia and Telecommunications. Interaction Design Foundation: Virginia; 2014. p. 1305-13.  Back to cited text no. 6
    
7.
Centre for Teaching and Learning, University of New Castle. Guide for Academics – Open Book Exams. Available from: https://www.newcastle.edu.au/__data/assets/pdf_file/0006/268980/Open-Book-Exams.pdf. [Last accessed on 2020 Dec 09].  Back to cited text no. 7
    
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Morton CE, Saleh SN, Smith SF, Hemani A, Ameen A, Bennie TD, et al. Blended learning: how can we optimise undergraduate student engagement? BMC Med Educ 2016;16:195.  Back to cited text no. 8
    
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Chandran DS, Muthukrishnan SP, Barman SM, Peltonen LM, Ghosh S, Sharma R, et al. IUPS physiology education workshop series in India: Organizational mechanics, outcomes, and lessons. Adv Physiol Educ 2020;44:709-21.  Back to cited text no. 9
    
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Rosenbaum PE, Mikalsen O, Lygre H, Solheim E, Schjøtt J. A blended learning course design in clinical pharmacology for post-graduate dental students. Open Dent J 2012;6:182-7.  Back to cited text no. 10
    
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Venkatesh S, Rao YK, Nagaraja H, Woolley T, Alele FO, Malau-Aduli BS. Factors Influencing Medical Students' Experiences and Satisfaction with Blended Integrated E-Learning. Med Princ Pract 2020;29:396-402.  Back to cited text no. 11
    
12.
Makhdoom N, Khoshhal KI, Algaidi S, Heissam K, Zolaly MA. 'Blended learning' as an effective teaching and learning strategy in clinical medicine: A comparative cross-sectional university-based study. J Taibah Univ Med Sci 2013;8:12-7.  Back to cited text no. 12
    


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