Enrolment
figure 2.
A total of 82 medical students were invited to participate in the study, with 40 assigned to the traditional method of instructions and 42 to the FC. In the traditional method of instructions group, 3 students declined the invitation to participate. In the FC group, 5 students declined the invitation, 1 student did not register for the semester, 4 students did not complete the training, and 2 students forgot their unique identification number and these were all excluded. The remaining 67 were included for the final analysis, 37 in the traditional teaching methods arm and 30 in the intervention group as seen in figure 2.
Table 1: Baseline characteristics of the study participants
Variable
|
All
(N =67)
|
Standard practice (n=37)
|
Intervention (n=30)
|
P-Value
|
Age, mean, years
|
67
|
28.4±5.9
|
27.4±5.1
|
0.238
|
Age Group
|
|
20-24 years
|
23
|
11
|
12
|
0.636
|
25 -30 years
|
23
|
13
|
10
|
|
> 30years
|
21
|
13
|
8
|
|
Class
|
|
MBChB 3
|
33
|
19
|
14
|
0.703
|
MBChB 5
|
34
|
18
|
16
|
|
Mode of entry
|
|
Direct
|
39
|
20
|
19
|
0.444
|
Diploma/Mature aged
|
28
|
17
|
11
|
|
The mean age of the students was similar 28.4 and 27.4 for traditional method of instructions and intervention groups respectively. A total of 33 MBChB 3 were included in the analysis, 19 (57.6%) in the traditional method of instructions and 14(42.4%) for intervention group. Of the 34 MBChB 5 included in the final analysis, 28(52.9%) were in the traditional method of instructions group and 16(47.1%) in the intervention group (table 1). Of the 67 participants, 39(58.2%) were admitted through direct entry while 41.8% were through diploma/mature entry scheme. The direct entrants had 20(51.3%) in the traditional method of instructions group and 19(48.7%) in the intervention group, meanwhile for those under diploma/mature age entry, 17(60.7%) were in the traditional teaching methods and 11(39.3%) in the intervention (table 1).
Table 2: Paired sampled t-test comparing pre test scores among the standard practice and intervention groups.
Variable
|
Observation (N)
|
Standard practice (n=37), mean±SD%
|
Intervention (n=30), %
|
P-Value
|
All
|
67
|
53.4±12.9
|
58.8±11.6
|
0.039*
|
MBChB 3
|
33
|
47.1± 9.5
|
54.6±13.7
|
0.035*
|
MBChB 5
|
34
|
60.0±12.9
|
62.5±8.4
|
0.257
|
Diploma entry
|
28
|
53.2±14.8
|
61.8±11.0
|
0.056
|
Direct Entry
|
39
|
53.5±11.5
|
57.1±11.9
|
0.171
|
Age20-24 years
|
23
|
53.6±10.5
|
53.7±13.0
|
0.491
|
Age25-30years
|
23
|
49.614.9
|
59.0±9.1
|
0.047*
|
Age >30 years
|
21
|
56.9±12.5
|
66.3±9.1
|
0.042*
|
*Statistically significant
The mean pre-test scores were significantly higher among participants in the intervention group (58.83±% versus 53.38±%, p= 0.039). The mean pre-test for MBChB 3 was 47.1 and 54.6 for the traditional teaching methods and intervention group respectively. Similarly, MBChB 5 scored 60 and 62.5 on average and this are not statistically different. Direct entrants had similar scores among the standard practice and intervention group; 53.4 vs 57.1 (table 2).
The mean post-test and pre-test score were 78.5±9.2 and 53.4±12.9 for traditional teaching methods group(A) and 81.6±7.2 and 58.8±11.6 for intervention group(B) respectively, and this was statistically significantly different p <0.001 (figure 3).
Table 3: Comparison of post-test scores among the traditional method of instructions and intervention groups
Variable
|
Observation (N)
|
Standard practice (n=37)
|
Intervention (n=30)
|
P-Value
|
All
|
67
|
78.5± 9.1
|
81.6± 7.2
|
0.0693
|
MBChB 3
|
33
|
76.3± 9.8
|
83.8±6.9
|
0.011*
|
MBChB 5
|
34
|
80.8±8.1
|
79.7±7.2
|
0.667
|
Diploma entry
|
28
|
82.6±8.3
|
83.6±7.8
|
0.378
|
Direct Entry
|
39
|
75.0±8.6
|
80.4±6.8
|
0.018*
|
Age20-24 years
|
23
|
71.4±6.6
|
82.3±5.5
|
0.002*
|
Age25-30years
|
23
|
79.6±9.0
|
79.5±8.3
|
0.517
|
Age >30 years
|
21
|
83.5±8.3
|
83.1±9.2
|
0.534
|
scored <50% pre-test
|
14
|
75.0± 7.1
|
85.0±5.0
|
0.021*
|
Scored 50 to <75% in pre-tests
|
44
|
78.9±9.9
|
81.0 ±8.2
|
0.2143
|
scored 75% or more in pre-tests
|
9
|
86.35±6.3
|
82.0 ±2.7
|
0.8941
|
|
|
|
|
|
*Statistically significant
The students who had the intervention had a higher average post test scores compared to the traditional method of instructions although, this was not a statistically significant difference, p 0.069. The post-test scores were higher for the intervention compared to the traditional method of instructions among those who failed pre-tests (85.0±5.0 Vs 75.0± 7.1, p=0.021), in MBChB 3 class (83.8±6.9 Vs 76.3± 9.8, p=0.011), direct entrant schemes(80.4±6.8 Vs 75.0±8.6 p=0.018) and aged younger than 25 years(82.3±5.5 Vs 71.4±6.6 p=0.002) as seen in table 3 above. Although the mean post test scores among mature/diploma entrants and those whose pre-tests scores are between 50-70% was higher among the intervention, it is not statistically significant p=0.2143 and 0.378 respectively. However, among those who scored more than 75% in the pre-tests, they performed better with the traditional teaching methods p=0.8941. There were similar mean post test scores among those in year 5 class, aged 25-30 years and aged above 30years old (table 3).
Table4: Comparison of mean PPIUD skills procedure score among the traditional method of instructions and intervention groups.
Variable
|
All
(N)
|
traditional teaching methods (n=37) mean ± SD
|
Intervention (n=30)
mean ± SD
|
P-Value
|
All
|
|
79.2±5.9
|
78.5±5.3
|
0.634
|
MBChB 3
|
33
|
83.0±11.2
|
78.1±7.9
|
0.989
|
MBChB 5
|
34
|
78.8±6.8
|
75.3±8.0
|
0.146
|
Diploma entry
|
28
|
81.0± 8.0
|
81.3±6.8
|
0.467
|
Direct Entry
|
39
|
77.7±10.6
|
76.9±6.3
|
0.601
|
Age20-24 years
|
23
|
76.8±10.3
|
77.9±5.2
|
0.368
|
Age25-30years
|
23
|
77.2±10.5
|
78.8±7.3
|
0.659
|
Age >30 years
|
21
|
81.1±7.9
|
81.1±8.0
|
0.5624
|
scored <50% pre-test
|
14
|
83.2± 5.7
|
77.2±6.4
|
0.928
|
Scored 50 to <75% in pre-tests
|
44
|
78.5±10.1
|
79.1±7.1
|
0.404
|
scored 75% or more in pre-tests
|
9
|
76.7±11.9
|
72.3±5.9
|
0.242
|
Overall, the mean procedure scores for intervention and traditional teaching methods were similar. For participants in year 5 and those who scored more than 75% in pre-test had better score in the intervention compared to the traditional method of instructions group although these were not statistically significantly, p=0.146and 0.243 respectively. The interrater agreement between assessor 1 and 2 was poor (4.48%) for the expected 5.10%, p=0.059(table 4).