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| ORIGINAL ARTICLE |
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| Ahead of print publication |
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Effectiveness of multiple-choice questions (MCQS) discussion as a learning enhancer in conventional lecture class of undergraduate medical students
Geethu G Nair1, M Feroze2
1 Department of Pathology, Government Medical College, Kozhikode, Kerala, India
2 Department of Pathology, M. E. S. Medical College, Perinthalmanna, Kerala, India Institution to which study is associated with: Department of Pathology, Government Medical College, Kozhikode, Kerala, India
| Date of Submission | 08-Mar-2022 |
| Date of Decision | 20-Mar-2022 |
| Date of Acceptance | 21-Mar-2022 |
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Correspondence Address:
Geethu G Nair,
Assistant Professor, Department of Pathology, Government Medical College, Kozhikode, Kerala – 673 008
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/mjdrdypu.mjdrdypu_192_22
Context: Multiple Choice Questions (MCQs) are one of the commonly used assessment tools in the field of medical education. A few initiatives have been made to use MCQ tests during classes as a mode of test-enhanced learning. However, there is a lack of enough scientific information regarding the use of MCQs as a learning enhancer. Aims: The present study has been undertaken to analyze the effectiveness of MCQ discussion as a learning tool. Methodology: The study was conducted in a Government Medical College in Kerala among Phase 2 MBBS students. They were divided into study and control groups of 61 students each. Online lecture classes were conducted for both groups on six topics of Pathology. For the study group, an additional MCQ discussion was done towards the end of the lecture class. Post-test was conducted on day 1 and after 2 weeks. A questionnaire was given to assess the attitude of students. Scores obtained in the post-tests were used to test the significance. Results: There was a significant difference in the mean score obtained between control and study groups in the post-test conducted on the same day suggesting that the MCQ discussion conducted at the end of the lecture class has added benefit (P value = 0.04). There was no significant improvement in academic performance when an assessment was made after 2 weeks (P value = 0.59). More than 80% of students showed a positive perception of this method. Conclusion: MCQ supplementation towards the end of the didactic lecture class is an effective teaching-learning method. Students also express a very positive attitude towards it. MCQs can be considered not only as an assessment tool but as a learning enhancer also.
Keywords: Learning enhancer, lecture, MCQs
How to cite this URL:
Nair GG, Feroze M. Effectiveness of multiple-choice questions (MCQS) discussion as a learning enhancer in conventional lecture class of undergraduate medical students. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2023 Mar 20]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=346446 |
| Introduction | |  |
The CBME curriculum for MBBS students introduced by National Medical Commission in 2019 and implemented in Universities across India has brought in many fundamental changes in the teaching-learning methods. One of them is to reduce the number of lectures classes to one-third of the total learning sessions and replace it with Small Group Discussions. This is considering the passive nature and poor learning outcome of lecture classes. However, didactic lectures still remain an important teaching-learning method for knowledge transfer in many Medical Colleges in India. As medical education has now become more learner-centric than teacher-centric, many methods are tried to make lecture classes more participatory and effective. Question-answer sessions, pause procedures, giving assignments, conducting tests are some of them. There is a strong consensus from many studies that repeated testing after conventional lecture classes enhance learning and help in the retention of study material, a phenomenon called the testing effect.[1],[2],[3] Tests, though generally used to grade the academic performance of a student, can be a learning event too. Taking a test is almost always a more potent learning device than the additional study of the target material.[4] The amount of class time sacrificed for taking a quiz is small compared to the gain in retention of material.[5] Testing when combined with feedback has an additive effect on retention by reinforcing the concept.[6] Different types of tests including simple MCQ exams help in test enhanced learning.
Multiple-choice questions are the all-time favorite assessment tool in the field of education. Many medical schools and universities worldwide use MCQs as an integral part of their assessment systems. MCQs are considered to be a method of providing rapid feedback to students as well as a way of reducing faculty time in marking. The other benefits of taking MCQ exams are that they are highly motivating for students, facilitate the development of self-esteem, and help faculty to identify an area of learning difficulty.[7] Moreover, it is the preferred method for a large group of students in resource-limited settings.[7]
MCQs are also beneficial as a method of test-enhanced learning for medical undergraduates.[1],[2],[4],[8] Administering MCQs at the end of the lecture class helps students to recollect and reflect on the topic discussed.[9] In a recent study, it was shown that students who had an opportunity to answer voluntary multiple-choice questions on each topic, performed better in the written examination at the end of the semester.[10] But it may not be possible to conduct MCQ tests after every lecture class, especially in a large group. This study is an attempt to look at the use of MCQs as a learning aid instead of an assessment tool. Only very few studies have been conducted in this area to date. So, the present study has been undertaken to analyze the effectiveness of MCQ discussion during lecture class as a learning tool.
Study objectives and research hypotheses
This study seeks to explore the effectiveness of MCQ discussion as a learning enhancer for Phase 2 MBBS students in Pathology.
Primary Objective: To determine whether the supplementation of MCQ discussion to lecture classes result in better performance of Phase 2 MBBS students in Pathology as compared to lecture classes alone
Secondary Objective: To understand the perceptions of students towards lectures combined with MCQ discussion
Null Hypothesis: There is no difference in the scores in the achievement tests of undergraduate medical students in Pathology when they are taught either by lecture alone or lecture combined with MCQ discussion.
Alternate Hypothesis: There is a significant difference in the scores in the achievement tests of undergraduate medical students in Pathology when they are taught by lecture alone or lecture combined with MCQ discussion.
| Methodology | | |
This was a quasi-experimental study that was conducted between January 2021 and September 2021. The study targeted Phase 2 MBBS students attending Pathology classes in a Govt. Medical College in north Kerala. The entire batch was divided into study and control groups of 125 students each, based on roll numbers.
Inclusion Criteria: Only those who gave informed consent were included in the study.
Exclusion Criteria: Those who could not attend all the lecture classes, post-test, and questionnaire sessions after enrollment were excluded from the study. In each group, out of 125 students, only 61 who attended all sessions were considered for further analysis.
After getting ethical clearance, students were explained the procedure of the study in detail. They were assured that assessments conducted during the study would not be considered in their internal assessment marks in any way. A total of six cycles of interventions were conducted covering 6 different topics in Pathology. The teaching module was designed after consultation with faculty members in Dept of Pathology. The same topic was covered by the same faculty for both groups. As students were not available on campus due to the Covid Pandemic situation, lecture classes of 1-hour duration were taken online for each group separately, through Microsoft Teams using PowerPoint presentation. The study group was also provided with a set of five MCQs at the end of the lecture class prepared from the portions discussed during that session. Students were given 5 minutes to prepare, after which they were given chance to say the answer. Following this, a cumulative interpretation of each question was given by the teacher as immediate feedback. For the control group, only a lecture was conducted.
Data gathering Tools: After each module, two assessments were conducted using Google forms – one on the same day and the second after 2 weeks. Eight questions were given as post-test comprising of one-word questions, true or false questions, reason assertion type of questions, and single response MCQs. Students were given only 6 minutes to submit their assessment to avoid discussion. The questions in the post-test were different from those discussed in class. The mean of test scores was taken for final analysis. A peer validated questionnaire was also administered to the study group at the end of the study to explore their perceptions of the new teaching method. A 5-point Likert scale (strongly agree, agree, neutral, disagree, and strongly disagree) was used for this questionnaire.
Analysis: The marks obtained in the tests were used to test the hypothesis by unpaired t test using SPSS Software. Likert scale scores were expressed in percentage.
Ethical issues: All the MCQs provided to the study group were also discussed with the control group after the assessment was over so that the control group will not be deprived of the benefit.
| Observations and Results | | |
A total of 250 students were enrolled in the study after obtaining informed consent. They were divided into study and control groups of 125 students each. Since the classes and assessments were conducted online, many of the students could not attend all the sessions. Only 61 students from each group participated in all the activities. Hence, the rest of the students were excluded from further analysis. The topics selected were necrosis, apoptosis, embolism, amyloidosis, leukemia, and intracellular accumulations.
Results of the assessment conducted on the same day are shown in [Table 1]. The significance of the hypothesis was tested with the help of an unpaired t test. Out of the six topics, MCQ discussion was found to be effective in two topics (apoptosis and amyloidosis) with a P < 0.05. For the rest of the topics, there was no significant difference between the study and control groups. A similar analysis was done for assessment tests conducted after 2 weeks, results of which are shown in [Table 2]. None of the topics showed a significant P value of <0.05.
The mean score of the marks obtained in all the 6 tests was calculated for both day 1 and 2-week assessments as shown in [Table 3]. There is a significant difference in the mean score obtained between study and control groups in the post-test conducted on the same day itself considering all topics together (P value = 0.037). This suggests that the MCQ discussion conducted at end of the lecture class is better than lecture classes alone for the understanding of the topics. However, the P value was 0.59 when the mean scores of both groups are compared in the 2-week assessment. This signifies that this method is probably not helpful in retention of the academic matters.
Along with post-tests, students were also given a questionnaire to know their perceptions of the MCQ-based discussion. The eight points analyzed were whether 1. The method is effective overall, 2. The method is helpful in performing in the exam, 3. Useful in retaining concepts in memory, 4. Makes it easier to understand the concepts, 5. Makes the student interested to read textbooks, 6. Enhances critical thinking ability, 7. Makes learning interesting and 8. Makes learning easy
This was rated by the Likert scale, the results of which are shown in [Figure 1]. A total of 81.8% agreed that MCQ discussion makes it easier to understand the concepts in Pathology and 90.1% said that it helps to retain the concepts in memory. A total of 83.5% opined that it makes learning easy. For 81.8%, this method was effective overall. Along with this, students were also asked about the advantages and disadvantages of this learning method. Students' opinions are shown in [Figure 2] and [Figure 3]. For nearly 30% of students, the greatest advantage of MCQ discussion was that it helps to memorize the concepts. While 52.5% of students opined that there were no disadvantages, 16.4% commented that MCQ discussion is not useful to answer descriptive questions included in the summative exams. A total of 4.9% opined that this method does not help them to recollect later.
| Discussion | | |
It takes a lot of effort and time from the side of a medical teacher to make a lecture interesting and memorable. Many studies have described different ways by which a faculty can attract the attention of students. Having question and answer sessions, giving small quiz/tests, pause procedures are some of them. In this study, an attempt is made to make students more attentive and participatory in the classes by giving them a few MCQs followed by a discussion. Thus, a deliberate effort is made to change the usual role of MCQs as an assessment tool to a learning enhancer. It can make the lecture classes more interesting in addition to retaining the test-enhanced learning effect.
Analyses of the data of our study show that the MCQ discussion towards the end of the lecture classes helps to achieve better results in the immediate assessments. There is a significant difference in the mean score obtained between the study and control groups in the post-test conducted on the same day. However, there was no significant difference in the mean score obtained in the post-test conducted after two weeks. One of the reasons for this could be the contamination of the control group, as the students of both groups would have discussed the MCQs during the interval of two weeks.
The analysis of the questionnaire also showed a positive student preference. A total of 81.8% of students agreed that MCQ discussion makes it easier to understand the concepts in Pathology and 83.5% opined that it makes learning easy. Interestingly, more than 90% of students said that it helps to retain the concepts in memory even when we did not find a significant difference in the mean score of marks obtained between study and control groups in the post-test conducted after two weeks. This underscores the contamination effect of the control group following a possible discussion of the MCQs with the study group during the interval of two weeks. The method was effective overall for 81.8% of students. Detailed analysis of the options of the MCQs and step-wise elimination of wrong answers may be the reason behind their opinion. For this, the faculty has to carefully frame higher-order MCQs. A study on MCQ-based discussion at the end of lecture class conducted by Kamel et al.[11] in a medical school in Saudi Arabia, showed a 70% excellent response by the students towards their satisfaction and preference for this practice. The same study also suggests that MCQs play a pivotal role as a tool for revision and motivation. The reasonable number of MCQs for discussion was seven according to their student's opinion.
Studies conducted by Madhu Bhatt suggested that MCQs should not be considered as an assessment tool alone. In one of her studies conducted for 1st-year MBBS students, in the subject of Physiology at AFMC Pune, students showed improved scores in their formative written assessment when the lectures are assisted with the use of MCQs.[12] The score in short answer questions was also higher in MCQ-assisted topics over other topics in the above study. This is contrary to the opinion of about 16% of students in our study that MCQ-assisted discussions are not useful to answer descriptive questions. In another study, 25% of students opined that the best part of such a teaching method was that it helps them to understand the topics.[13] In those studies, MCQs were given one day before the scheduled lecture class followed by discussion in a class hour giving more time for students to analyze and answer. In our study, the MCQs were introduced only towards the end of the class.
| Strengths and Limitations of the Study | | |
This teaching-learning method does not have any economical or time constraints since the discussion of MCQs takes place during the regular class hour itself. It made the students more attentive as they were anticipating MCQs towards the end of the class. It also contributed to inducing active learning. One of the limitations of this study was the unexpected pandemic situation that led to all the lecture classes and MCQ discussions being conducted online and the consequent reduction in the number of active participants. The assessments also had to be conducted online in an unsupervised manner. In our study, the second post-test was conducted after a time gap of 2 weeks which may have led to the contamination of the control group, as the students of both groups would have discussed the MCQs. Most of the topics selected were small as they had to be completed in 1 hour and the number of MCQs was limited to five only. The selection of an entire organ system in Pathology, requiring a series of lectures, followed by a discussion of more numbers of MCQs, would have resulted in a better assessment of retention of study material.
| Conclusion | | |
MCQ supplementation towards the end of the didactic lecture class is an effective teaching-learning method. Students also express a very positive attitude towards it. MCQs can be considered not only as an assessment tool but as a learning enhancer also. More studies involving larger topics with a greater number of MCQs may give more information.
Acknowledgements
Dr Biju George (Assistant Professor, Dept of Community Medicine, Government Medical College, Kozhikode, Kerala).
NMC Nodal Centre for Faculty Development, GMC, Kottayam.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]
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