Medical Students’ Perception and Attitude towards Embryology Course in Khartoum State Universities, Sudan -2023

doi:10.21203/rs.3.rs-4277486/v1

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Medical Students’ Perception and Attitude towards Embryology Course in Khartoum State Universities, Sudan -2023

https://doi.org/10.21203/rs.3.rs-4277486/v1

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Background:

Embryology teaching is challenging; it is important to determine how students think about it to develop the best teaching strategies. This study was conducted to assess Sudanese medical students’ perception towards embryology course.

Materials and methods:

A descriptive cross-sectional survey conducted in medical schools at Khartoum state, Sudan. The study included all the medical students who have completed the embryology course within their faculty curricula. Data was collected using a pretested structured questionnaire. The collected data were cleaned using Microsoft excel 2016 and analyzed using SPSS V28, the results are presented in terms of tables and figures.

Results:

The study included 385 participants with a mean age of 22.3 ± 2 years, females were 273 (71%), and they were from public governmental universities 264 (68.6%). Medical students perceived that integrating embryology and gross anatomy courses in the first and second years are better than teaching each discipline alone 225(58.5%), and they preferred problem-based learning 244(63.4%), and virtual reality for teaching embryology 307(79.7%). Only 22 (5.7%) of them reported that they would pursue embryology as a career due to absence of role model 248 (64.4%), followed by lack of future specialization 238 (61.8%), lack of promotion chances 194 (49.6%), difficulty of the subject 171 (44.4%), and the slow financial growth 110 (28.6%).

Conclusion:

The study found that medical students preferred problem based learning and use of technology to enhance the learning experience. While they showed positive attitude towards embryology course, only few considered it as a future career.

Anatomy has been a pillar of medical education, regardless of nation, race, or medical school system. By studying gross anatomy, medical students gain a "first impression" of the human body's structure, which is the foundation for understanding pathologic and clinical problems (1).

Although the importance of anatomy instruction for both undergraduate and graduate students remain uncontested, there is currently a lively debate regarding the methods of anatomy instruction and teaching approaches (2).

Human anatomy is divided into various branches to make the process of learning and understanding easy and effective. It includes gross anatomy, living anatomy, embryology, histology, surface anatomy, and clinical anatomy (3).

Embryology is a branch of developmental biology concerned with the study of life before birth (4). This is the study of the origin and development of the human from oocyte fertilization to the end of the eighth week of pregnancy, and by extension, any stage of prenatal development (5).

It is frequently included in medical school curricula as part of the basic sciences taught in the first and second years of undergraduate education, and it is frequently included in the anatomy course. Embryology is an essential component of undergraduate education because it enables students to better manage and comprehend clinical cases (6).

In addition to understanding the developmental origins of the diverse anatomy of the human body, knowledge of embryology is essential for a number of medical specialties, including pediatrics, general surgery, craniofacial surgery, obstetrics, and gynecology, due to its coverage of a number of clinical subjects, such as the basis of gametogenesis and fertilization, cleft palate, congenital anomalies, and the effect of intrauterine events, such as congenital infection, on the development of the fetus (7).

One of the most important steps in learning such a basic subject is selecting an appropriate teaching method that can encourage active learning, improve motivation in classrooms, and accordingly promote the learning process. Generally, lectures are the most common method of academic education. In spite of the profuse information conveyed to a large audience in a short time, this method does not seem to be appropriate for teaching a variety of educational contents (8).

Embryology has traditionally been taught in a manner similar to that of gross anatomy, relying primarily on textbooks and lectures, along with two-dimensional images, models, and, in some cases, preserved human embryos. Due to modifications to the medical curriculum, the amount of time students has access to learning resources has decreased. The majority of embryology courses are taught as part of a combined curriculum, and there appears to be a trend toward less lab work during course delivery (9).

Education in embryology has profited immensely from growing virtual reality technologies in recent years. Technology gives the three-dimensional (3D) orientation of the structure concerned and therefore would be able to help students better understand the subject, especially embryology, which students usually find difficult to understand. In recent years, teaching has been revolutionized with the adoption of new teaching methods—learning methods with PowerPoint lectures, etc.—but demonstrating videos and animations along with traditional lectures is not a frequently used method. The videos and animations give them an exact idea of how organ development actually happens, helping them to have a better concept when they begin their clinical postings (10).

The perceptions of medical students are essential to the design of an anatomy curriculum that satisfies the requirements for safe medical practice in the context of constantly evolving diagnostic and therapeutic modalities. Students are almost never involved in the creation or revision of curricula. In order to modify the curriculum in a way that facilitates the learning process, it is crucial to obtain the students' input and determine the most effective method of instruction (11).

Taking into consideration the importance of student’s feedback about their own curriculum. This study aims to evaluate the medical Students’ perception and attitude towards embryology course.

Study design/setting:

This was a descriptive cross-sectional institutional based study, conducted in different faculties of medicine in Khartoum state, Sudan including both governmental and private medical schools. The study took place in the period from March 2023 to December 2023.

The study population

All medical students at medical faculties in Khartoum state, who has completed the embryology course are included. All medical students who agreed participate were included and we excluded those who hasn’t yet completed the embryology course, and those who refuses to participate.

Sample size and Sample technique:

The sample size was determined by using a formula:

(n = (Z_α/2)² p (1-p)/ d²) for estimating a single population proportion.

Considering a 95% Confidence Interval (CI) (Z_α/2 =1.96), 5% margin of error (d), and the sample proportion (p) of 50%, generated a minimum sample size of 385 for the study. Sampling technique was convenient non-probability sampling method.

Data collection tools and instrument:

Data was collected using a pretested, structured, self-administered questionnaire. The questionnaire was obtained from related literature. It includes socio-demographic variables, students’ attitudes toward embryology courses, students’ interests and career choices, and students’ perceptions of the integration of embryology and teratology courses. All viewpoints were rated using a positive Likert scale, with responses ranging from “strongly disagree” to “strongly agree”. Following data collection, the data was reviewed for errors and completeness to ensure data quality.

Data management and Analysis:

Data was cleaned and entered into Microsoft excel 2016 data sheet and was analyzed using SPSS version 28 software. Categorical data was represented in the form of frequencies and proportions. Microsoft Excel and word were used to obtain various types of graphs such as bar diagram. Data was represented after analysis in form of tables, figures and narrative illustration.

Ethical considerations:

Ethical approval

from the research board committee at National University – Sudan (NUSU) was obtained. A signed consent from the administration was distributed for each university involved in the Study, after being approved from NUSU Ethical approval committee. An informed consent was obtained from each participant after explaining the purpose of the study.

Demographic characteristics

The study included 385 medical students from different universities in Khartoum state, Sudan. The mean age of study participants was 22.3 ± 2 years, majority of them were females 273 (71%), and they were from public governmental universities 264 (68.6%) (Table 1).

Perception of embryology teaching

Medical students perceived that integrating embryology and gross anatomy courses in the first and second years are better than teaching each discipline alone 225(58.5%), and they preferred problem-based learning that combine embryology and gross anatomy 244(63.4%), they also thick that, virtual reality is more effective than images in the book for teaching embryology 307(79.7%), while half of them thought that It is more successful to teach embryology using adopted embryos 194(50.4%), and they preferred limiting embryology lab material in the first year to what needs to be compared with typical teratologic disorders 219 (56.9%) (Table 2).

Positive attitude towards embryology course

Regarding medical students’ attitude towards embryology course, they showed positive attitude towards embryology in some areas as they disagreed that embryology requires little understanding 204(53%), and they agreed that embryology terminologies provide the foundation of medicine 211(54.8%), and they perceived embryology as a vital tool in medical practice 228(59.2%). Medical students also disagreed that embryology has no significance in contemporary medicine 212(55.1%), or is waste of time in the basic medical years 273(71%). They also think that every doctor must have a sound understanding of embryology 228(74.8%), and they disagreed that the principles of medicine are not founded on embryological knowledge 170(44.2%), and that medical students should concentrate on clinical practice rather than learning embryology 139(36.1%) (Table 3).

Negative attitude towards embryology course

However, nearly half of them, were uncertain whether embryology is most clinically relevant for all basic sciences or not 171(44.4%). On the other hand some negative thoughts about embryology teaching were existent; almost half of medical students think that embryology needs to be modernized to be considered useful in medicine 191(49.6%), they also agreed that embryology is important only in some medical fields 169(44%), found it possible that a reasonable diagnosis could be reached without embryology 137(35.6). medical students also think that, existence of medicine is not possible without sound knowledge of embryology. 208(54%), most medical diseases do not require a great understanding of embryology 168(43.6%), and satisfactory medical practice requires only limited knowledge of embryology 163(42.3%) (Table 3).

Embryology as a future career

Nearly half of medical students were interested in embryology course 186 (48.3%) (Fig. 1), however, only 22 (5.7%) of them reported that they would pursue embryology as a career (Fig. 2), and only 51 (13.2%) would recommend it for juniors as a career (Fig. 3).

The most common reason reported by medical students for not joining the embryology field was absence of role model 248 (64.4%), followed by lack of future specialization 238 (61.8%), lack of promotion chances 194 (49.6%), difficulty of the subject 171 (44.4%), and the slow financial growth 110 (28.6%) (Fig. 4).

Over half of them think that embryology teaching encourages students to join the field 214 (56%) (Fig. 5), and majority of them think that integrated curriculum will increase the interest of medical students in the embryology course 322 (84%) (Fig. 6).

Table (1)

Demographic Characteristics of medical students under study.

	Mean ± SD
Age	22.3 ± 2
Gender	Frequency	Percentage
Male	112	29%
Female	273	71%
University	Frequency	Percentage
Governmental	264	68.6%
Private	121	31.4%

Table (2)

Medical students’ perception toward teaching methodology of Embryology.

Improving Methods	SD + D	Neutral	SA + A
Integrating embryology and gross anatomy courses in the first and second years are better than teaching each discipline alone.	71(18.5%)	89(23%)	225(58.5%)
I prefer problem-based learning that combine embryology and gross anatomy.	59(15.3%)	82(21.3%)	244(63.4%)
Virtual reality is more effective than images in the book for teaching embryology.	15(3.9%)	63(16.4%)	307(79.7%)
It is more successful to teach embryology using adopted embryos	113(29.4%)	78(20.3%)	194(50.4%)
It is preferable to limit embryology lab material in the first year to what needs to be compared with typical teratologic disorders.	45(14%)	112(29.1%)	219(56.9%)

Table (3)

Medical students’ attitude towards Embryology course

Variables	SD + D	Neutral	SA + A
Embryology requires little understanding.	204(53%)	88(22.9%)	93(24.2%)
Embryology terminologies provide the foundation of medicine.	59(15.3%)	115(29.9%)	211(54.8%)
Embryology is a vital tool in medical practice.	49(12.7%)	108(28.1%)	228(59.2%)
Embryology is important only in some medical fields.	131 (34%)	85(22%)	169(44%)
Embryology has no significance in contemporary medicine.	212(55.1%)	80(20.8%)	93(24.2%)
Embryology is waste of time in the basic medical years.	273(71%)	25(6.5%)	87(22.5%)
Embryology needs to be modernized to be considered useful in Medicine.	84(21.8%)	110(28.6%)	191(49.6%)
Every doctor must have a sound understanding of embryology.	43(11.2%)	54(14%)	228(74.8%)
It is impossible to do a reasonable diagnosis without embryology.	137(35.6)	137(35.6%)	111(28.8%)
Existence of medicine is not possible without sound knowledge of embryology.	50(13%)	127(33%)	208(54%)
The principles of medicine are not founded on embryological knowledge.	170(44.2%)	102(26.5%)	113(29.4)
Most medical diseases do not require a great understanding of embryology.	121(31.4%)	96(24.9%)	168(43.6%)
Embryology is most clinically relevant for all basic sciences.	88(22.9%)	171(44.4%)	126(32.7%)
For satisfactory medical practice only limited knowledge of embryology is required.	111(28.8%)	111(28.8%)	163(42.3%)
Medical students should concentrate on clinical practice rather than learning embryology.	139(36.1%)	128(33.2%)	118(30.6%)

Figure (1)

Interest in embryology among medical students

Figure (2)

Embryology as career choice among medical student.

Figure (3)

Encouraging juniors to pursue Embryology as career among medical students.

Figure (4)

Reasons for not joining the embryology field

Figure (5)

Opinion on whether teaching embryology would encourage students to join the field

Figure (6)

Opinion on embryology curriculum integration

Teaching embryology aims to increase students’ understanding and long-term retention. The main goal of this course is to instruct students on identifying and understanding the typical and atypical progressions during the embryonic and fetal stages of human development. Students must complete this initial requirement in order to gain knowledge about aberrant organ anatomy and function in later years of study or during clinical training. Moreover, their capacity to incorporate knowledge acquired in fundamental and clinical medical courses will rely on their ability to accurately and analytically recognize and manage diverse conditions in their forthcoming medical profession. To achieve this goal, this study assessed the students' perceptions of embryology courses among Sudanese medical students.

Compared to Sume et al.'s (2022) study in Ethiopia (14), which included 246 students, our study included 385 undergraduate students who successfully completed the embryology course. A larger sample size allows for a more comprehensive understanding of the perceptions of Sudanese medical students towards embryology courses. Additionally, including a diverse range of students from different backgrounds and academic abilities would provide a more representative perspective on the effectiveness and relevance of the course in preparing future doctors.

Students expressed a preference for the integration of embryology and gross anatomy courses, problem-based learning, and the use of technology to enhance their learning experience. Osman et al. (2014) found that the integrated curriculum in embryology was more satisfactory for students (17). Momeni et al. (2014) on the other hand found that problem-based learning (PBL) improves students' concentration, comprehension, and level of learning, supporting the notion PBL has a greater focus on the student (12). In addition, Chaudhary et al. (2018) discovered that most students demonstrated that integrating 3D movies and animations with conventional lectures aided in resolving uncertainty and misconceptions related to the subject matter while also enhancing the topic's level of engagement (10).

The majority of students in this study had a favorable attitude towards embryology and recognized that it as an essential instrument in the field of medicine. This is similar to recent studies conducted by Sume et al. (2022) in Ethiopia (14), Waseem et al. (2021) in Pakistan (13), and Zaletel et al. (2016) in Serbia (18). All of these studies found that medical students recognizes and value the significance of embryology. However, we found that the students perceives the current embryology teaching methods to be conventional and in need of modernization, they also expressed the belief that a significant understanding of embryology is not necessary for most medical conditions, indicating a limited comprehension of the clinical significance of embryology.

Although approximately half of the study participants expressed an interest in embryology, only a small minority had aspirations to pursue it as a future career. This can be attributed to various factors, such as the absence of a role model, limited opportunities for specialization and advancement, the challenging nature of the field, and the slow financial progression. These findings are unsurprising, given the numerous obstacles that deter students from pursuing a career in embryology. It is therefore expected that only a small number of students would be interested in this field. This finding aligns with the results published by Sume et al. (2022) in Ethiopia (14).

The findings of this study have important implications for curriculum development in medical education. By understanding students' preferences and areas for improvement in embryology courses, educators can design curricula that better meet the needs and expectations of students. However, the study was not free of limitations. One limitation of this study is that it relied on the self-reported perceptions of the students, which may be subject to bias or inaccuracies.

The study provides valuable insights into the perceptions of Sudanese medical students towards embryology courses. Sudanese medical students showed positive attitude towards embryology, however, few of them considered it as a future career option, due to the absence of a role model, limited opportunities for specialization and advancement, the challenging nature of the field, and the slow financial progression. The findings of the study highlights the importance of integrating different teaching methods and technologies to enhance the learning experience.

Recommendations

Our recommendations for incorporating problem-based learning and technology into the embryology curriculum align well with current educational trends and student preferences. Problem-based learning encourages active engagement and critical thinking, while technology can enhance visualization and understanding of complex concepts.

Highlighting the practical relevance of embryology through research on its clinical applications is crucial for motivating students and fostering a deeper appreciation for the subject. Investigating how embryology knowledge directly impacts medical practice can help bridge the gap between theory and application.

Longitudinal studies tracking students' retention of embryology knowledge and its impact on their academic and clinical performance provide valuable insights into the effectiveness of the curriculum. Continuous evaluation allows educators to refine teaching methods and content to better meet the needs of future medical professionals.

By emphasizing the clinical relevance and conducting further research on embryology's applications, educators can enhance student engagement and prepare them more effectively for medical practice.

Consent for Publication:

Not Applicable

Availability of Data and Materials:

The dataset used and analyzed during the current study available from the corresponding author on reasonable request.

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No competing interests reported.

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Medical Students’ Perception and Attitude towards Embryology Course in Khartoum State Universities, Sudan -2023

Status:

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Abstract

Background:

Materials and methods:

Results:

Conclusion:

Figures

Introduction

Research Methods

Study design/setting:

The study population

Sample size and Sample technique:

Data collection tools and instrument:

Data management and Analysis:

Ethical considerations:

Results

Demographic characteristics

Perception of embryology teaching

Positive attitude towards embryology course

Negative attitude towards embryology course

Embryology as a future career

Discussion

Conclusion

Recommendations

Declarations

References

Additional Declarations

Status:

Version 1