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Year : 2019 | Volume : 7 | Issue : 3 | Page : 70 - 72  


Original Articles
Knowledge of Primary Health Care in India: Pre and post test analysis of sixth semester students of Dr. Shankarrao Chavan Government Medical College, Nanded

Dr. Venkatramana K Sonkar

Associate Professor, Department of Community Medicine, Malla Reddy Institute of Medical Sciences , Suraram X Road, Quthbullapur(M), Medchal (D), Telangana State – 500055

Email: sonkar123@gmail.com                                                                              

                                                                                                                       

Abstract:

Background: As one of the essential part of curriculum of Community Medicine subject understanding of primary healthcare by medical student will be seen as key for effective teaching of the subject. Lectures are the most economical of teaching-learning methods.  It is essential to evaluate whether the learning objectives have been accomplished. In the present study pre and post lecture MCQs (Multiple choice questions) are introduced for sixth semester medical students in Community Medicine lectures and to assess the effect on gaining and retention of knowledge acquired at the end of the lecture.

Objective: To assess the knowledge of primary health care in India and to know the impact of outcome of Class room teaching by pre test and post test questionnaire.

Methods: A prospective study was conducted at Dr. Shankarrao Chavan Government Medical College, Nanded. A total of 23 students from sixth semester medical students were enrolled in this study. Ten single best responses multiple choice questions from primary health care topic were used to assess knowledge gained by students before and after class room teaching on primary health care lecture series by pre test and post test analysis method.

Results: A total of the 20 students out of 23 sixth semester students completed both pre and post test questionnaire. The average pre test score was 4.2±0.894 and post test score was 9.5±0.945. Fischers exact test was applied to analyze the improvement in scores between pretest and posttest which was significant at 𝑃 < 0.05. The paired 𝑡-test was applied to know improvement in mean scores between pretest and post test which was significant at 𝑃 < 0.001.

Conclusion: There is significant increase in knowledge of student after class room teaching. Class room teaching is effective for way assessing gain in knowledge.

Key words:  Pre test, Post test, Medical education, lecture

INTRODUCTION:

The broad goal of the teaching of undergraduate students in Community Medicine is to prepare them to function as community and first level physicians in accordance with the institutional goals and one of the objectives of teaching Community Medicine is students should know about primary health care.1

The backbone of public health services in India is Primary Health Care because it caters the basic comprehensive health services through its eight essential components covering all principles of primary health care. Every medical student needs to know its working, administration and principles of primary health care. As one of the essential part of curriculum of community medicine subject understanding of primary healthcare by medical student will be seen as key for effective teaching of the subject.

Lecturing or large group teaching is one of the oldest forms of teaching. Whatever their reputation, lectures are an efficient means of transferring knowledge and concepts to large groups. They can be used to stimulate interest, explain concepts, provide core knowledge, and direct student learning.2

Lectures are the most economical of teaching-learning methods as they can cover varied topics and can address large student population. The teacher can incorporate difficult topics, different perspectives on the same topic, research updates and practical experiences to convey the message. 3

Hence this study was done with Objectives to assess the knowledge of primary health care in India and to know the impact of outcome of Class room teaching by pre test and post test questionnaire.

METHODS:

The prospective study was carried out at Dr. Shankarrao Chavan Government Medical College, Nanded, which has intake capacity of 50 students per year. There were twenty three students present in sixth semester. These sixth semester MBBS undergraduate students attending community medicine theory classes were included as study subject. Study period was from 8th December 2014 to 20th December 2014. Informed consent was obtained from all the students before start of study. Assessment of students done by 10 single best responses multiple choice questions based on topic of primary health care in India. Students were asked to answer all questions independently on starting of lecture series on primary health care in India and once again at the completion of series. The students were categorized into 4 grades based on the marks they obtained: Grade I: 90% marks and above, Grade II: 75%–89%, Grade III: 50%–74%, and Grade IV: <50% marks obtained. An overall assessment was done by comparing the scores obtained during pretest and posttest to know the improvement in the knowledge of primary health care in India. The results were tabulated and analyzed using Microsoft office excel. Descriptive statistics, namely, mean and standard deviation was applied to describe the data distribution. Qualitative data with respect to different grades of scoring was presented using frequency and percentages.

Fischers exact test was applied to test any association between the various scoring grades between pretest and posttest. Paired 𝑡-test was applied to assess any significant differences in mean scores between pretest and post test.

RESULTS:

A total of the 20 students out of 23 sixth semester students completed both pre and post test questionnaire, 3 could not complete either pre or post test questionnaire so excluded from analysis.

Table 1: Descriptive statistics for pre test and post test score

 

N

Minimum

Maximum

Mean

Std. Deviation

Pre test

20

3

5

4.2

0.894

Post test

20

7

10

9.5

0.945

 Table 2: Distribution of scoring grades between pre test and post test

Grade

Pre test N (%)

Post test N (%)

  1. ≥91%

0

14 (70%)

  1. 71% to 90%

0

4 (20%)

  • 31% to 70%

16 (80%)

2 (10%)

 

4 (20%)

0

Total

20 (100%)

20 (100%)

 Table 3: pre test and post test grade cross tabulation

Pre  test grades

Post test grades

Total

 

 

≥91%

71% to 90%

31% to 70%

%

 

  1. I) ≥ 91%

0

0

0

0

0

0

II)71% to 90%

0

0

0

0

0

0

III)31% to 70%

16

14

2

0

0

16

  1. IV) ≤ 30%

4

0

2

2

0

4

Total

20

14

4

2

0

20

 

The average pre test score was 4.2±0.894 and post test score was 9.5±0.945 with minimum score of 3 and maximum of 10.

In pre test 16 students were in grade III and 4 were in grade IV while in post test 14 were in grade I and 4 were in grade II and only 2 were in grade III and none was in grade IV.

Those who were in grade IV in pre test 2 of them secured in grade II and 2 in grade III, while those who were in grade III in pre test 14 of them secured in grade I and 2 in grade II.

Fischers exact test was applied to analyze the improvement in scores between pretest and posttest which was significant at 𝑃 < 0.05. The paired 𝑡-test was applied to know improvement in mean scores between pretest and post test which was significant at 𝑃 < 0.001.

DISCUSSION:

Didactic lecture plays an important role as a teaching tool in medical colleges. It is a passive method of learning. Though many institutes have replaced it with problem based and case based learning didactic lectures still remains as the main methodology of teaching. Teaching method involving lecture classes has its advantages and disadvantages.4

Quality medical care depends upon the development of knowledgeable, skilled, and competent medical personnel. Any assessment whether formative or summative has intense effect on learning and is an important variable in directing the learners in a meticulous way. Single correct response type MCQ is an efficient tool for evaluation.5

Pre-test and post-test in a new chapter will tell a student where he or she stands. Comparing both the marks also hints the teachers about the grasping and retaining power of students. From this we can easily identify the top performer of a class and also slow learners. Accordingly we can plan further corrections in teaching methodology.6

Present study was done with objective of to assess the knowledge of primary health care in India and to know the impact of outcome of Class room teaching by pre test and post test questionnaire.

This study has revealed that previous knowledge of primary health care in India was very poor in students as revealed by pre-test scores, none of them had scores in grade I or grade II ; but after post-test it was evident that most of them except two moved to either grade I or grade II with minimum of score being seven. The average pre test score was 4.2±0.894 and post test score was 9.5±0.945 with minimum score of 3 and maximum of 10. By taking pre-test before starting of lecture, from the findings in this study we can assume that their interest, curiosity and points to be remembered have definitely risen. Similar findings were observed by M Viswanathan3, Jayachandran AL4, Lakshmikandhan A6, Shivaraju PT7. This shows that class room teaching or didactic method of teaching and learning are good for short term gain of knowledge.

Another finding in this study revealed that those the scores of student whose performance in pre test questionnaire was good have actually bettered their performance in post test questionnaire, this shows that the students having baseline knowledge are likely to score more in post test, Janaki Mandla et al8 also found similar correlation in her study.

There are certain limitations in this study such as few study participants, long term gain of knowledge has not been studied and study has used multiple choice questionnaires as exclusive method of assessment, as we know that for overall assessment of students there is need of short term as well as long term gain in knowledge. We have to use different types of assessment methods like short answer questions and essay type questions for overall assessment which was lacking in this study. I hope taking cue from this study, researchers in future will take care of these limitations in their study. 

CONCLUSION:

Knowledge about primary health care in students after class room teaching has increased significantly as well as from this study it is concluded that didactic method teaching-learning is important method in medical education. From this study it is also concluded that pre and post test assessment of students in class room teaching is effective for way assessing gain in knowledge.

REFERENCES:

  1. Medical Council of India Regulations on Graduate Medical Education, 1997. Available from: https://www.mciindia.org/CMS/rules-regulations/graduate-medical-education-regulations-1997 Accessed on: 12-12-2014
  2. Cantillon P. ABC of learning and teaching in medicine: Teaching large groups. Br Med J 2003; 326: 437-440.
  3. Viswanathan M, Viswanathan KV. Effectiveness of didactic lecture in imparting knowledge in medical education. Int J Med Sci Educ. July-September 2017;4(3):247-251.
  4. Jayachandran AL, Balaji J. Introduction of pre and post lecture multiple choice questions for second year undergraduate medical students in microbiology: a technique to assess knowledge acquired from the lecture. Int J Res Med Sci 2016;4:575-8.
  5. Gajjar S, Sharma R, Kumar P, Rana M. Item and test analysis to identify quality multiple choice questions (MCQS) from an assessment of medical students of Ahmadabad, Gujarat. Indian J Community Med 2014;39:17-20
  6. Lakshmikandhan A, Ramraj B, Ravinder JR. Does Pre-Test Accelerate Learning Pattern In Undergraduate Medical Students? A Prospective Study in a Tertiary Care Teaching Hospital in Tamilnadu. Int J Pharmacol and Clin Sci. 2016;5(4):109-12.
  7. Shivaraju PT, Manu G, Vinaya M, Savkar MK. Evaluating the effectiveness of pre- and post-test model of learning in a medical school. Natl J Physiol Pharm Pharmacol 2017;7(9):947-951.
  8. Mandla J, Shaik H, Pidigundla D, Katepogu V. Evaluation of lectures by pre & post-test MCQS. J Edu Technol Health Sci May-August, 2016;3(2):65-67




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