Perception of problem based learning versus conventional teaching methods by clinical medical students in Nigeria

Open Access Research Perception of problem based learning versus conventional teaching methods by clinical medical students in Nigeria Helen Chioma Okoye1, Ijeoma Angela Meka2,&, Angela Ogechukwu Ugwu3, Isah Adagiri Yahaya4, Ochuko Otokunefor5, Olugbenga Olalekan Ojo6, Emmanuel Onyebuchi Ugwu 7 1 Department of Haematology and Immunology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria, 2Department of Chemical Pathology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria, 3Department of Haematology and Immunology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria, 4Department of Chemical Pathology and Immunology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria, 5Department of Chemical Pathology, College of Medicine, University of Port Harcourt, Rivers State, Nigeria, 6Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria, 7Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria & Corresponding author: Ijeoma Angela Meka, Department of Chemical Pathology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria Key words: Problem based learning, conventional teaching, medical students, pathology, Nigeria Received: 17/05/2019 - Accepted: 19/07/2019 - Published: 20/08/2019 Abstract Introduction: Problem-based learning (PBL) method which was introduced about 50 years ago in Canada is beginning to gain acceptance over conventional teaching method (CTM) worldwide in medical education but still remains unpopular in Nigeria. This study aims to determine the perception of clinical medical students to the use of both learning methods in pathology courses. Methods: a cross-sectional quantitative survey was conducted in four Nigerian universities drawn from four regions of the country. Data were collected using pretested semi-structured self- administered questionnaires. Results: the study included 310 respondents, 182(58.7%) males and 128(41.3%) females. Of all the participants, 257(82.9%) had heard of PBL prior to the study and 260(83.9%) thought it suitable for teaching and learning Pathology. Majority of participants, 221(71.3%) preferred a combination of both PBL and CTM while 238(76.8%) thought PBL suitable for all medical students. Some identified factors capable of enhancing adaptation of PBL into medical curriculum include conducive quiet spaces for learning and availability of computers with internet facilities for students' use. Conclusion: participants demonstrated high level of awareness of PBL and thought it suitable for all medical students. Availability of computers and up-to-date libraries with internet and audio-visual facilities could enhance adaptation of PBL into medical curriculum in Nigeria. Pan African Medical Journal. 2019;33:311. doi:10.11604/pamj.2019.33.311.19169 This article is available online at: http://www.panafrican-med-journal.com/content/article/33/311/full/ © Helen Chioma Okoye et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, p rovided the original work is properly cited. Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com) Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net) Page number not for citation purposes 1 Introduction of Port Harcourt, UNIPORT (South); and Bayero University, BUK, Kano (North); between March and October, 2018. The study population was recruited using total population sampling of all final year medical Pedagogy entails knowledge impaction on a learner through a well- students of the four institutions. Informed consent was obtained from defined learning process which lately is becoming complex due to participants after the study aim was explained to them. Data were evolution of ideas and societal changes [1]. This learning process then collected using self-administered semi-structured questionnaires. involves a strategy of deliberately delivering a lesson in a professional The questionnaire was designed by the researchers, and pretested manner in a bid to assist the learner to acquire skills and make using ten students who eventually were not part of the study. The perceptual changes [1,2]. The two major teaching methods are the major questions in the questionnaire included, whether respondents problem-based learning (PBL) and the conventional teaching methods had heard of PBL, if respondents think PBL is suitable for teaching and (CTM). The PBL is a student-centered learning method first introduced learning in Pathology, who PBL is best suited for, and factors that can in Canada half a decade ago and involving critical thinking in order to enhance adaptation of PBL into the medical curriculum. Final year solve problems aimed at empowering students to take more medical students who had not rotated through all arms of clinical responsibility for their learning while increasing their motivation and medicine at the time of the study were excluded. Ethical clearance for sense of accomplishment [3,4]. On the other hand, CTM otherwise the study was obtained from University of Nigeria College of Medicine known as the traditional method of learning, is a much older learning Research Ethics Committee. Data obtained from the questionnaires method which in itself is teacher-centered where information which is were transferred to the statistical package for social sciences (SPSS) not easily accessible is shared or delivered by the teacher in a quick version 20.0 program, Chicago Illinois. Statistics was both descriptive manner, the students passively memorize facts often times and are and inferential. Continuous variables were presented as mean (SD), not actively involved [5]. This teaching method appears to be of number and percentages while categorical variables were presented immense benefit to students who learn best by listening [5]. According only as counts (number) and percentages. Chi square (Χ 2) was used to Awotua-Efebo, the essence of teaching is to assist students to gain, to compare categorical data. All tests were two-tailed with p < 0.05 retain and utilize knowledge, develop the ability to criticize, synthesize taken as statistically significant. and analyse issues while developing patterns and perspectives [1,6]. In order to achieve this purpose, one must consider the subject to be taught, the environment and the needs of individual students. The PBL is not yet popular as the official method of learning in Nigerian Results medical schools and to achieve better quality in medical schools, there has to be some tailoring of the curriculum to meet the exigencies of Out of 418 questionnaires distributed to final year medical students in the students [7]. The curriculum in Nigerian medicals schools stems 4 different institutions, a total of 310 participated in the survey with a from basic (e.g. anatomy) to clinical (e.g. paediatrics) science courses response rate of 74.2%. The participating institutions (and the through a mixture of both basic and clinical sciences (pathology). A number of respondents) were UNILAG (104, 33.5%), BUK (94, few studies have been carried out to evaluate the teaching method in 30.3%), UNN (67, 21.6%) and UNIPORT (45, 14.5%). The some clinical courses but rarely in pathology which is the only specialty participants consisted of 100(58.5%) males and 71(41.5%) females with both basic and clinical aspects. This study aims to evaluate the with a mean age of 22.4±3.6 yrs. These students were dichotomized perspectives of final year medical students towards methods of into 3 different age groups: 20-25 years being the youngest followed teaching or learning pathology. by 26-30 years and then those >30 years of age representing the oldest age group. Majority of respondents were within the 20-25 age group (222, 71.6%) followed by the 26-30 age group (80, 25.8%). Methods Only 8(2.6%) of the students were more than 30 years at the time of the study. Two hundred and fifty seven (82.9%) participants had heard of PBL prior to the study. After a brief overview of what PBL is This was a descriptive cross-sectional study carried out among final all about, 260(83.9%) of the respondents thought it was suitable for year medical students in four Nigerian medical schools (each from one teaching and learning pathology. Comparison of the different learning of the 4 regions of the country) in the following universities: University methods revealed that majority (221, 71.3%) preferred a combination of Nigeria, UNN (East); University of Lagos, UNILAG (West); University Page number not for citation purposes 2 of both PBL and CTM, 63(20.3%) preferred using PBL alone, while male counterparts [9]. An explanation to this finding is not clear but 26(8.4%) students found CTM preferable. Table 1 shows the may be as a result of the different perceptions of these courses by the participants' preferences according to the individual pathology different genders and the extent of their preparedness in lower levels courses. of education. The mean age was found to be slightly lower than an earlier report by Bakare [10] which gave a mean age of 25 years. Concerning the opinion of the respondents on whom PBL was best While universities in Sokoto and Kano were used in that study, only suited for, it was found that 238 (76.8%) thought it suitable for all Kano was used in the present study and this may account for the medical students. Majority (298, 96.1%) affirmed that PBL was not higher mean age. Over four-fifth of the respondents had heard of PBL just for extremely gifted students or only for students who voluntarily as a learning method. This high awareness rate in PBL may stem from opted for PBL (266, 85.8%). Conducive quiet spaces for learning, the fact that clinical medical training uses a lot of case studies. availability of computers with internet facilities for students' use, well Students are also made to undergo some levels of medical clerkship equipped and user-friendly laboratories and up-to-date libraries with under the supervision of trainers. This is quite similar to what is audio-visual facilities were the factors identified by the students which entailed in PBL. Majority of the students thought it suitable for could enhance adaptation of PBL into medical curriculum. learning/teaching Pathology in medical schools. Pathology is a diverse Development of stronger problem solving skills (66.1%), higher discipline encompassing several subspecialties and may be defined as retention ability and development of better attitude towards learning the study of the mechanisms underlying the disease processes [11]. (53.9%) were the listed benefits of PBL while over half (165, 53%) of While students are known to do better in basic sciences if they were the respondents believed that development of team spirit was not a taught using the CTM, those who learn using the PBL method do benefit. Students not being sure of the extent of what to learn better in clinical sciences [12-15]. It is not surprising that respondents (59.7%) and demands for longer teaching time (49.7%) were the preferred a combination of both PBL and CTM in learning Pathology major disadvantages perceived by respondents to be associated with because Pathology is a discipline which encompasses both basic and PBL, whereas over four-fifth (82.6%) of them were of the opinion that clinical science aspects. Since CTM involves passing information from higher cost of learning was not a problem. As shown in Table 2, the the teacher to the learner in a faster manner, [1] one would expect it proportion of respondents who preferred PBL as a method for teaching to be the preferred learning method in Pathology given the large was higher among those in the age group 20-25 years (54.8%), while curriculum expected to be taught in a short time, but for education to only one respondent above age of 30 years preferred PBL. In the age be successful, the learner is expected to gain, retain and utilize the group 20-25 years, 53.8% preferred CTM as a method of teaching, knowledge [2,5,6]. PBL concept is centered around students being while 3.9% of those above age 30 years preferred CTM. The able to learn independently outside of class time thereby freeing up differences observed among age groups and institutions were time for critical analysis and group discussion and it is associated with statistically significant (P<0.001) while that observed among gender higher retention rates [1,2]. were not statistically significant (P=0.386). Details are as shown in Table 2. Even though Han pointed out in a study that PBL approach is particularly appropriate for well-gifted students because it is effective in inducing their motivations, [16] it should not be restricted to such students because it is a teaching method that leads to development Discussion of deep critical thinking in the students while stimulating the development of problem solving skills and knowledge retention [1,2]. Four Nigerian Universities, each from one of the major regions of the This is reflected in the opinion of majority of the study participants country: BUK from the North, UNILAG from the West, UNN from the who indicated that PBL is suited for all medical students and not just East and UNIPORT from the South were involved in the present study. for extremely gifted ones. Adaptation of PBL may be challenging giving This makes the study population a good representation of the nation. the nature of the learning method; students are divided into smaller There was a slight male preponderance in the study. This is in keeping groups, given a problem to solve and each expected to assume an with previous researches revealing that there were more male active role [1]. They take charge of their learning by determining the enrollees than females in Nigerian universities [8,9] and more pace and extent, hence they would require a conducive space as well specifically, fewer females were enrolled for science courses than their as access to information source to be effective [17]. As expected, the Page number not for citation purposes 3 study participants listed conducive quiet spaces for learning, Conclusion availability of computers with internet facilities, well equipped and user-friendly laboratories and up-to-date libraries with audio-visual Most respondents were aware of PBL and thought it suitable for facilities as factors that could enhance adaptation of PBL into medical learning Pathology because it could lead to developing stronger curriculum. Through effective implementation of PBL, students are problem solving skills, higher retention ability and better attitude expected to develop a stronger problem solving skills, higher retention towards learning. Availability of computers and up-to-date libraries ability and better attitude towards learning, these were rightly listed with internet and audio-visual facilities could enhance adaptation of by the participants as benefits of PBL. Inasmuch as PBL is student PBL adaptation into medical curriculum. Problem of not knowing the centered, the tutor plays a pivotal role in facilitating the learning extent of learning and demand for longer learning time may be some process by directing and guiding the students [18]. Despite the disadvantages. numerous benefits, PBL is not without disadvantages [17]. When not properly applied or guided, students may face problems of not being What is known about this topic sure of the extent of what to learn with consequent demands for • Problem-based learning is a newer teaching method longer learning time. These problems as noted by the respondents are compared to conventional teaching method; in keeping with those documented by Woods and Vemon [17,19]. However, contrary to one of Wood's statements, majority of the • Problem-based learning is gradually gaining acceptance respondents opined that higher cost of learning was not a problem. over conventional teaching method worldwide in medical education; It has been noted that while male students tend to preside over and • Problem-based learning is still unpopular in Nigeria. direct discussions more than females who in turn are inclined to What this study adds listening more, the females appear more sensitive to interpersonal • Majority of the participants indicated that problem-based dynamics [20]. Since PBL involves a lot of discussion and interaction, learning was suitable for teaching and learning Pathology it is natural that males may tend to prefer PBL over CTM. Even though and equally suitable for all medical students, not just for there was no significant association, the present study supports the extremely gifted students; supposition that gender may impact on students' preference for either • Majority of participants however preferred a combination of PBL or CTM. It is noteworthy however that Sahu et al. found no gender both problem-based learning and conventional teaching difference in students' attitude to learning [21]. Despite the report method in teaching and learning; from a previous study that age had no impact on PBL, [21] it is • More respondents in the age group 20-25 years preferred reasonable to argue that older individuals may benefit more from PBL problem-based learning over conventional teaching method when compared to the younger ones because they are able to apply as a teaching and learning method. their life experiences in discussions. The present study showed that respondents in the younger age group were more likely to embrace PBL than the CTM. This may not be unconnected to the fact that Competing interests majority of the respondents are in the youngest age group, and this could have influenced the proportion that preferred PBL. The authors declare no competing interests. Strengths and weaknesses of study: being a cross-sectional study, causality of findings could not be determined. Participants' source of information on PBL was not determined in this study, and Authors’ contributions could be addressed by further studies on this subject. Despite this, the present study is very relevant as it contributes and provides much IAM and HCO conceived the study and drafted the protocol. IAY, OO needed data concerning PBL in Nigerian medical schools. Another and OOO handled data collection. AOU and EOU handled data entry. major strength of the present study is the multi-center design, IAY and IAM handled data analysis and interpretation. HCO, AOU and drawing representatives from the four major geographical regions of OOO drafted the manuscript. OO and IAM revised and edited the Nigeria. Page number not for citation purposes 4 manuscript. All authors read and approved the final draft of the 7. Srinivasan Malathi, Li S-TT, Meyers FJ, Pratt DD, Collins JB, manuscript for publication. Braddock C et al. Teaching as a competency: competencies for medical educators. Acad Med. 2011; 86(10):1211-1220. PubMed | Google Scholar Acknowledgments 8. Trading economics. Nigeria: ratio of male to female tertiary enrolment. Accessed on February 13, 2019. We thank the final year medical students of University of Nigeria Nsukka, University of Port Harcourt, University of Lagos, and Bayero 9. Agu NN, Omenyi AS. Gender Enrolment Status in Higher University Kano who participated in the study. 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PubMed | Google Scholar Table 1: methods preferred by respondents for pathology courses (N=310) Pathology Courses PBL CTM COMBINATION N % N % N % Chemical pathology 73 23.5 46 14.8 191 61.7 Haematology 69 22.3 40 12.9 201 64.8 Microbiology 51 16.5 65 21.0 194 62.5 Morbid Anatomy 55 17.7 42 13.5 213 68.8 Table 2: relationship of age, sex, and institutions to teaching methods preferred by the respondents (N=310) Variables Methods of teaching preferred X2 P PBL CTM Combination N % N % N % Age (Years) 20-25 34 54.8 14 53.8 174 78.4 19.062 <.001 26-30 27 43.5 11 42.3 42 18.9 >30 1 1.7 1 3.9 6 2.7 Total 62 100 26 100 222 100 Sex Male 39 61.9 12 46.2 131 59.3 1.904 0.386 Female 24 38.1 14 53.8 90 40.7 Total 63 100 26 100 221 100 Institution UNN 10 15.9 6 23.1 51 23.1 44.089 <0.001 UNILAG 19 30.2 9 34.6 76 34.4 BUK 11 17.4 3 11.5 80 36.2 UNIPORT 23 36.5 8 30.8 14 6.3 Total 63 100 26 100 221 100 Page number not for citation purposes 6