Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

An Audit of Medical Students’ Performance in 2nd MBBS Physiology Examination in a Medical School in Nigeria: A 7-Year Review

Tochukwu C. Okeke*, Bond U.S. Anyaehie, Emmanuel O. Ugwu, Polycarp U. Agu, Ifeoma Orizu, Charles Adiri, Joe Ezugwuorie, Euzebus C. Ezugwu, Uchenna I. Nwagha

Department of physiology, College of Medicine University of Nigeria, Enugu Campus, Enugu, Nigeria

Abstract: There is need for periodic evaluation of medical students’ performance in professional medical examinations. This helps to identify possible gaps in teaching and may offer solutions that could redress such situations. This study is an audit of medical students’ performance in 2nd MBBS professional examinations in physiology at the University of Nigeria Medical School over a 7 year period (2004 – 2010). Data were collected from the Department of Physiology of the university. A total of 2152 students sat for the professional examination over the study period, and 1485 students passed the examination at first attempt giving an overall pass rate of 69%. The pass rate from 2008 when medical doctors (clinicians) with fellowships were employed as lecturers (tutors) to teach physiology was significantly higher than the pass rate before this reform (2004 – 2007) when mainly non-clinicians taught physiology [(76.5%), (n =1646) vs 63.4% (n=1364); P<0.0001]. The ongoing reforms in physiology department that brought about the employment of clinicians as lecturers to teach medical physiology is good and should be reviewed with time. These reforms should further be expanded to include provision of adequate modern infrastructure and teaching aids in order to keep pace with increasing enrolment into medical school.

Keywords: audit, physiology students’ performance, Nigerian medical school

Received February 17, 2013; Revised March 14, 2013; Accepted April 07, 2013

Citation: Tochukwu C. Okeke, Bond U.S. Anyaehie, Emmanuel O. Ugwu, Polycarp U. Agu, Ifeoma Orizu, Charles Adiri, Joe Ezugwuorie, Euzebus C. Ezugwu, Uchenna I. Nwagha, An Audit of Medical Students’ Performance in 2nd MBBS Physiology Examination in a Medical School in Nigeria: A 7-Year Review. American Journal of Clinical Medicine Research, 1 (2). 28-31. January 2013. doi:10.12691/ajcmr-1-2-2

1. Introduction

The admission of medical students in Nigeria into a 6- year MBBS program is through the Joint Admission and Matriculation Board (JAMB). The first 12 months in medical school is spent on preliminary basic sciences. The next 18 months is the preclinical program which includes basic medical courses: human anatomy, medical biochemistry and human physiology. The basic medical courses run concurrently. The remaining 42 months are clinical training in the teaching hospital.

At the college of medicine, university of Nigeria, Enugu campus (UNEC), teaching activities in physiology consist of formal practical sessions, lectures and tutorial classes. Physiology students attend 6 to 7 hours/week of lectures and practical training sessions made up of lectures (3 hours), tutorial (1 hour), and laboratory practical session (2 – 3 hours).

Physiology classes close by 3.00PM while students study privately in the evenings. Didactic lectures are the predominant teaching method for students in the basic medical courses [1]. Teaching activities are led by the departmental academic staff and the students are the passive recipients. Tutorial classes [2] are also conducted by the departmental academic staff. Tutorial is an interactive session where students express their opinions, ask questions and enhance their communication skills during tutorials. Physiology teaching is conducted in English language in all cases.

The Department of physiology at College of Medicine, UNEC, Enugu has been implementing a series of reforms in both teaching assessment strategies and recruitment of academic staff since its inception in 1970. Starting in 2008, academic staff in the department of physiology were recruited based on MBBS degree with additional qualifications (M.Sc, PhD, Fellowship of post graduate medical college or fellowship of West African College of Surgeons or Physicians) Thus the recently recruited physiologists are mainly clinicians with thorough training in system physiology and pathophysiology. These reforms/modification in physiology teaching and learning in this medical school are part of the process to improve the quality of teaching and assessment methods. The emphasis of these reforms, are directed toward establishing a solid foundation for the clinical sessions through team work, self directed learning, communication skills and cooperation among students [3,4]. It was intended to develop critical thinking skills, foster independent information gathering and learning and promote student retention of information [5]. This is expected to ultimately result in intellectual frameworks and a platform for question generation and deeper understanding.

In physiology teaching in the preclinical program, knowledge is usually what is assessed [6], but it is mandatory that a student scores 50% in order to proceed to the clinical session. Students are assessed on essay questions, short answer questions, multiple choice questions (MCQ), practical questions and viva or oral examination. The questions are formulated to test the student knowledge and prepare them for clinical sessions.

This study aims to audit the current situation of physiology learning at the college of medicine UNEC, Enugu, Nigeria and to determine appropriate interventions that may improve physiology learning in Nigerian medical schools.

2. Methods

This was a retrospective study of medical students’ performance in 2nd MBBS examinations at the College of Medicine, UNEC, Enugu, Nigeria over a 7-year period (2004-2010). Data were retrieved from records in the department of physiology.

Ethical review and clearance was obtained from the College of Medicine, University of Nigeria Enugu Campus. The study protocol was approved by the College Review Board. Department protocol included informed written consent prior to data collection. Confidentiality was maintained as there was no disclosure of the names of the students from where the data were retrieved.

The College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria was established in 1970 as the only Medical School then in South East Nigeria. This college was modeled on the British system and awards the MBBS after 6 years of study or 5 years for direct entry admission for those with higher school certificate (HSC) or First degree or Interuniversity and intrauniversity transfers from related academic programs. Admission into the college of medicine is mainly through a Unified National University Matriculation Examination [UME]. Annual admission into this medical school varies between 250 and 370 students. Examination grades are modeled on the British System whereby ≥ 70% is a distinction grade, 50 – 69% is a passing grade and < 50% is a failing grade.

There is an intensive preclinical program of basic medical sciences lasting 18 months prior to a final physiology examination. Students were assessed via long essays, short answer questions, multiple choice questions (MCQ), practicals and oral examinations. The students were given 6 questions (five essay and one short answer question) to attempt 5 questions and had 30 minutes to answer each question. The MCQ consisted of 100 questions with a 2 hour time limit. The MCQ paper was divided into two sections. The main section consisted of questions with one correct answer out of five options. The other section included questions with one or more correct answers out of the five options. The continous assessments contributed 30% of the total 2nd MBBS examination, while the final examination at the end of 18months training contributed 70% of the total 2nd MBBS examinations.

The data were entered and analyzed by descriptive and inferential statistics using statistical software for social sciences (SPSS) version 15 (SPSS Inc. Chicago IL). Data was presented descriptively as proportions and percentages. The chi-square test (x²) was used to determine the association between the students’ performance before and after clinicians was used as lecturers (tutors). Furthermore, binary logistic regression was equally used to determine the association between students’ performance before and after clinicians was used as lecturers (tutors). The level of significance was set at p < 0.05.

3. Results

There has been an increase in student population admitted into the medical school since 2004 as shown in Table 1. Academic staff initially included seven instructors (two with PhD, five with M.Sc) in 2007 but was increased to fourteen in 2008. The increase in student admission was not matched with a corresponding increase in academic staff or existing lecture halls. In 2008, the College of Medicine employed clinicians with MBBS and additional clinical qualifications to augment the pre-existing M.Sc or PhD academic staff in Physiology department. There was an improvement in 2nd MBBS physiology passes since 2008 with percentage pass rate of over 70% since 2008.

Specifically, the overall pass rate in the 2nd MBBS physiology examinations over the 7-year period of this study was 69.0%. The pass rate from 2008 – 2010 when clinicians were additionally employed as lecturers was 76.5%, whereas the pass rate from 2004 – 2007 was 63.4%. This difference was statistically significant (P<0.0001) see Table 2.

The obvious problems on ground were poor infrastructure, funding gaps, increasing class sizes without provision for expansion in the existing lecture halls. The learning environment was completely unfriendly backed with a lot of shortcomings. There was evidence of declining interest in didactic lectures and practical sessions with an increased preference for interactive and interesting sessions in form of peer tutored discussion classes. All lectures were delivered as scheduled with inherent limitations such as administrative barriers, limited funds, funding gaps, poor infrastructure and unfriendly learning environments. The students are eager to pass and continue with the clinical sessions. The students had no hands in evaluation of their teachers or academic curriculum.

The factors that may have contributed to an increase of pass rate in physiology examination are peer-assisted learning, more student-centered learning techniques, collaborative team work, active participation of both teachers and students, and a decrease in total number of students admitted from 2008-2010.

4. Discussion

Physiology is the basis of medicine. Thus, a good understanding of basic physiology enhances clinical training. The principles of physiology teaching are relatively constant but instructional methods vary from centre to centre [7].

Physiology education worldwide is currently undergoing innovative evidence based changes to teaching and learning environments. These changes favour student-centered learning [8]. These changes are rudimentary in most medical schools in Nigeria. Student assessments are largely by examinations with its limitations since the examinations are set and graded by the same teachers [1]. External examiners play limited role in assessing the students as they only participate in the final assessment of 2nd MBBS examinations.

In the past, the department of physiology had limited funds and administrative barriers with limited number of tutors. However, in 2008, we added seven additional academic staff members with MBBS and additional clinical qualifications. This appears to have resulted in a higher pass rate in our physiology examinations. With this introduction of clinicians as academic staff in 2008, the pass rate increased from roughly 60% to 70% and above. The obvious reasons for this increase in pass rate is still not very clear because there was no change in the content of the physiology course, no change in the presentation of material, the scientific rigor has not changed, the student assessment has not changed, the examination pattern and student assessment have not changed and there were no changes in the educational infrastructure. However, what have changed were introduction of peer-assisted learning, more student-centered learning techniques [9,10], and a decrease in total number of students admitted from 2008-2010 and an increase in the number of faculty from 2008.

Thus, it may be of help for students in their clinical sessions to have tutors with primary degrees in medicine and surgery to teach physiology in order to lay more emphasis on applied physiology in the preclinical studies. These clinicians are usually well versed in physiology because as medical students they were taught physiology of all the human systems. This assertion was supported in this study by the significant increase in medical students pass rate in 2nd MBBS physiology examination following the employment of clinicians to teach physiology.

We suggest that the current reform in medical physiology education should include peer-assisted learning, collaborative team work, active participation [10,11], improvement in learning environment, reduction in students admission, students involvement in evaluation of their teachers or academic curriculum [1,4,12,13]. These are factors that may be considered for an excellent academic performance in physiology learning in Nigerian medical schools.

The limitation of this study, was the restriction of this study to college of medicine, Enugu campus. Furthermore, the retrospective nature of the study allowed for finding associations but did not allow for definitive conclusions on cause and effect. However, this is a stepping stone towards further research on physiology evaluation among medical students in Nigeria.

Table 1. (Yearly Distribution of Performance of Medical Students’ in 2nd MBBS Examination)

Table 2. Performance of medical students’ in 2nd MBBS Physiology Examination before and after recent employment of Doctors (fellows) as Lecturers in the Department

Disclosures

No conflicts of interest, financial or otherwise, are declared by the authors.

References

[1]   | Anyaehie USB, Nwobodo E, Oze G, Nwagha U.I, Orizu I, Okeke T, Anyanwu GE. Medical Student’s evaluation of physiology learning environments in two Nigerian medical schools. Adv physiol Educ 2011; 35: 146-148.
[2]   | Hurley KF, Mckay DW, Scott TM, James BM. The supplemental instruction project: peer-devised and delivered tutorials. Med Teach 2003; 25: 404-407.
[3]   | Kibble J, Hansen PA, Nelson L. Use of modified SOAP notes and peer-led small-group discussion in a medical physiology course: addressing the hidden curriculum. Adv Physiol Educ 2006; 30: 230-236.
[4]   | Wood DF. Problem based learning. Br Med J 2003; 326: 328-330.
[5]   | Lockspeiser TM, O’Sullivan P, Jeherani A, Muler J. Understanding the experience of being taught by peers: the value of social and cognitive congruence. Adv Health Sci Educ 2008; 13: 361-372.
[6]   | Pepple DJ, Young LE, Carroll RG. A comparison of student performance in multiple-choice and long essay questions in the MBBS stage I physiology examination at the University of the West Indies (Mona Campus). Adv Physiol Educ 2010; 34: 86-89.
[7]   | McMilliam B. Powerlab in physiology teaching. International workshop: Modern Approaches to Teaching and Learning physiology. San Jose, Costa Rica. 2000, Nov. 16-18th.
[8]   | Silverthorne DU. Incorporating active learning in practical experiments for students. International workshop: modern approaches to teaching and learning physiology. San Jose, Costa Rica: 2000, Nov. 16-18th.
[9]   | Cortright RN, Collins HL, DiCarlo SE. Peer instruction enhanced meaningful learning: ability to solve problems. Adv Physiol Educ 2005; 29: 107-111.
[10]   | Donner RS, Bickley H. Problem-based learning: an assessment of its feasibility and cost. Human Pathol 1990; 21: 881-885.
[11]   | Joyner MJ, Charkoudian N, Curry TB, Eisenach JH, Wehrwein EA. What we talk about when we talk with medical students. Adv Physiol Educ 2011; 35: 16-21.
[12]   | Kibble JD, A Peer-led supplemental tutorial project for medical physiology: implementation in a large class. Adv Physiol Educ 2009; 33: 111-114.
[13]   | Kommalage M, Imbulgoda N. Introduction of student-led physiology tutorial classes to a traditional curriculum, Adv Physiol Educ 2010; 34: 65-69.