Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : FC09 - FC13 Full Version

Impact and Perception of Virtual Team-based Learning in Comparison to Online Lectures in Pharmacology- A Randomised Crossover Interventional Study


Published: December 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/58726.17372
M Lakshmi Prabha, A Geetha Rani, Y Nisha Maheswari, J Ezhil Ramya

1. Assistant Professor, Department of Pharmacology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India. 2. Associate Professor, Department of Pharmacology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India. 3. Assistant Professor, Department of Pharmacology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India. 4. Professor and Head, Department of Pharmacology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India.

Correspondence Address :
J Ezhil Ramya,
Professor and Head, Department of Pharmacology, Tirunelveli Medical College, High Ground, Tirunelveli-627011, Tamil Nadu, India.
E-mail: ezhilramya_j@tvmc.ac.in

Abstract

Introduction: Competency-based Medical Education (CBME) emphasises small group teaching; henceforth, more innovative educational strategies are needed to stimulate student learning. Team-based Learning (TBL) is structured small-group teaching featuring student preparation out of class to acquire critical concepts. In the current study, TBL was carried out on a virtual platform using commonly available web applications.

Aim: To evaluate the impact and perception of virtual TBL compared to online lectures in Pharmacology.

Materials and Methods: The randomised crossover study was conducted from September 2021 to January 2022, in the Pharmacology department of Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India. The students were assigned into two groups in the ratio of 1:1 by simple random sampling. Students in group A attended TBL sessions, whereas group B attended lectures on the same topic via Google classroom for the first session. A crossover of groups was done for the second session. At the end of both sessions, a questionnaire with Multiple Choice Questions (MCQs) to assess knowledge recall and Short Answer Questions (SAQs) to assess critical analysis was sent to both groups in Google forms, and responses were collected and evaluated. A validated 33 item TBL Student Assessment Instrument (TBL-SAI) was used to determine the student perceptions. An unpaired t-test was used to compare the scores of both groups to assess performance. Mann-Whitney U test was used to compare the student accountability, preference, and satisfaction scales of TBL-SAI.

Results: Out of 130 students, 125 were taken up for analysis as five failed to attend the sessions or complete the questionnaire. TBL group scored significantly better than the lecture group in MCQs {(15.8±2.2 vs 12±2.6) and (12.7±3.5 vs 6.4±2.2)} and SAQs {(5.4±2.1 vs 2.3±1.4) and (6.1±2.0 vs 3.3±1.9)} in sessions 1 and 2, respectively. TBL-SAI subscale and total scores were higher than neutral scores in both groups, indicating a positive attitude toward virtual TBL.

Conclusion: Implementation of virtual TBL in synchronous setting in Pharmacology course established proof of high student accountability and satisfaction. Students preferred online TBL to online lectures. Virtual TBL sessions were more effective than online lectures.

Keywords

Critical analysis, Google classroom, Innovation, Knowledge recall, Small group teaching

Pharmacology is one of the basic sciences in medical education, which teaches all aspects of drugs and their uses. The ultimate goal of pharmacology is to make the undergraduate competent to apply the foundational knowledge acquired in classes for critical thinking and active decision-making. This can be achieved by dynamic learner-centered pedagogical approaches rather than passively transferring information with didactic lectures. A substantial transformation in Indian Medical Education ensued in 2019 with the National Medical Commission (NMC) launch and the implementation of CBME. Medical education in India for a long time was teacher-centric and time-oriented. The introduction of CBME has pivoted it to be learner-centric and outcome-oriented (1). It downplays time-based training and offers greater flexibility until learners accomplish the desired competencies (2).

Teaching-learning activities are improved in design and function to attain the predefined outcomes in CBME, underscoring the role of the learner (3). The new curriculum concentrates more on small group teaching-learning methods superseding the traditional didactic lectures. Innovative teaching-learning approaches incorporating transformations of formal passive instructor-paced classes into active learner-paced courses are encouraged and embraced. The new CBME curriculum emphasises lifelong learning, where the learner is in the driver’s seat and is responsible for the learning process (4). The TBL, an active pedagogical approach developed by Larry Michelson (2004), is an instructor-led but student-centred flipped classroom model that promotes individual and group accountability (5),(6). In typical in-class TBL, the learners acquire the basic knowledge through preclass preparation and then work individually and in teams to build upon this initial knowledge through readiness assurance tests. Finally, TBL prepares the learners to solve problems using collaborative learning and decision-making, improving content acquisition and critical thinking (7),(8). This application of the abstract to concrete situations naturally highlights essential contextual factors and analysis challenges. Students accomplish the desired learning experience and academic performance when they collectively engage in planned discourse in teams. Traditional in-class TBL effectively allows students to apply their foundational knowledge through collaboration and assessment (9) and is more effective than formal lecture-based learning (8).

Coronavirus Disease 2019 (COVID-19) has pushed medical schools to conduct exclusive online and virtual teaching at unprecedented and unseen levels, creating a new need for effective pedagogical teaching methods for online learning. Classes can entirely be delivered on a digital platform with modern technology and advancements. The changeover from face-face classes to a virtual basis is challenging in various aspects, and it should not compromise the learning process. Learners regarded TBL as engaging and enhancing critical thinking and problem-solving togain profound insight into the subject in face-face sessions (10),(11). However, more analyses are required to uncover the students’ perceptions of TBL in a virtual environment. Hence, the present study examined the effectiveness of virtual TBL and students’ perceptions of virtual TBL compared to online lectures.

Material and Methods

The randomised crossover interventional study was conducted at the Department of Pharmacology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India, from September 2021 to January 2022. The two teaching-learning formats (TBL versus Lectures) were studied using a randomised control trial design in the virtual mode in a synchronous setting using web-based video conferencing applications. The study was commenced after due permission from the Institutional Ethics Committee (TIREC-1818/Pharma/2020), and after obtaining informed consent from all the study participants.

Out of 250 second-year MBBS students from the academic year 2021-22, 130 students were assigned to groups A and B, in the ratio of 1:1, by a simple random sampling technique using a computer-generated sequence. Faculty members of the department of Pharmacology trained in TBL sessions constituted the team of facilitators.

Interventions: The topic chosen for the initial session was the pharmacology of 5-hydroxytryptamine agonists and antagonists. The pre-class learning materials, to accomplish the learning objectives of the initial session, were sent to both group A and B via Google Classroom before the initial session.

• Group A: Students attended TBL sessions.
• Group B: Students attended lectures on the same topic via Google classroom.

Study Procedure

Virtual TBL execution: The link for the TBL session was sent to the individual mail IDs of the participants. The session was initiated with the individual Readiness Assessment Test (iRAT), consisting of 10 MCQs to assess the basic understanding of each student for 10 minutes. To each virtual team breakout room, 10-11 students were allocated to discuss the questions and arrive at answers, and this discussion lasted for 30 minutes. Then they were instructed to answer the ten minutes- team RAT (tRAT) after arriving at a consensus. One facilitator was assigned to each break-out room to monitor the session. The facilitator provided an introduction, orientation on the initiation of the session, and feedback after tRAT. The readiness assessments with feedback and scores were administered through the KAHOOT quiz link. After addressing the queries and clarifications, an application exercise based on a clinical case scenario of the given topic with a set of five questions was given to each subgroup for discussion with a 30 minutes timer. Each team presented its answers to the application exercise and received feedback and clarifications from the facilitator.

Virtual lecture execution: Live online lecture-based classes for group B students were conducted via a separate link provided to the students in Google classroom. The learning objectives were specified at the beginning of the lectures, and the learners were engaged in virtual class by MCQs displayed on polls in Google meet.

Crossover of the groups was done for the second session; students from group B attended TBL sessions, and group A attended lectures. The topic for the second session was the pharmacology of thyroid hormones and their inhibitors. The best team and team members were acknowledged for promoting student participation and motivation in the sessions.

Outcome measures: At the end of both sessions, a questionnaire comprising 20 seconds MCQs, each carrying a score of 1 to assess knowledge recall (maximum score was 20), and five SAQs in the form of clinical case scenarios each carrying a score of 2 (maximum score was 10) to evaluatecritical analysis was sent to both groups in Google forms. A time limit of 20 minutes was given to complete the questionnaire, and responses were collected and evaluated.

A validated 33 item TBL-SAI (12) was used to record students’ responses on a 5 point Likert scale to determine the students’ perceptions. Permission from Heidi Mennenga was obtained to use TBL-SAI in the present study. The instrument had questions to assess accountability, preference for TBL, and satisfaction. Among the 33 items, ten negatively worded items (Q4, 11, 13, 14, 16, 18, 21, 22, 28 and 30) in the scale were reverse-scored. Cronbach-alpha coefficient value of TBL-SAI was 0.8 for the 33 item TBL SAI questionnaire, 0.8, 0.78 and 0.8, respectively, for the instrument’s accountability, preference, and satisfaction subscales reflecting the internal consistency.

Statistical Analysis

Data collected were analysed by Statistical Package for Social Sciences (SPSS) software version 23.0. The mean and standard deviation of scores for each team were calculated. Descriptive statistics were used to explore the scores of the TBL-SAI instrument. An unpaired t-test was used to compare the scores of both groups to assess the effectiveness of virtual TBL. Mann-Whitney U-test was used to compare the accountability, preference, and satisfaction scores for TBL.

Results

Out of 125 students, 62 (49.6%) were males, and 63 (50.4%) were females (32 male and female students in group A and 30 male and 31 female students in group B). In session 1, the assessment scores of group A (TBL) (21.2±3.6) were significantly higher than group B (Lectures) (14.3±3.3), as shown in (Table/Fig 1). When the groups were crossed over for interventions, group B (18.8±4.7) scored significantly better than group A (9.7±3.5), as shown in (Table/Fig 2). The scores were higher in MCQs and SAQs for virtual TBL than in e-lectures, as evident from (Table/Fig 1),(Table/Fig 2).

Descriptive analysis of the TBL-SAI instrument and respective subscales (accountability, preference for lecture or TBL, and student Satisfaction) are documented in (Table/Fig 3). The total scores of the 33-item TBL-SAI varied from 33-165. The neutral scores are as follows: accountability, 24; preference for lecture or TBL, 48; student satisfaction, 27; and total score, 99. A positive attitude towards TBL is presumed when the scores are above the neutral scores. Median scores of accountability, preference, and satisfaction subscales were 31, 59, 37 and 30, 54, 36 for groups A and B, respectively.

Results as certained the positive attitude towards virtual TBL on the TBL-SAI in both groups (A&B). Mann-Whitney U test showed significant differences between group A and B in their accountability, preference, and satisfaction scales of virtual TBL (Table/Fig 3).

In the accountability subscale (Table/Fig 4), 91.2% (114/125) felt that preparation before TBL is needed, and 68.8% (86/125) spend time on preparation; 92% (115/125) felt the need for their contribution to their teams’ learning, 76.8% (96/125) affirmed that they contributed to team members’ learning and 54.4% (68/125) felt accountable for their team’s learning. Only 7.2% (9/125) felt that their contribution is not important for TBL.

In the preference subscale (Table/Fig 5), 55.2% (69/125) agreed that they think about non related things during lectures, whereas, only 4% (5/125) agreed that they talk about non related things in TBL. A 58.4% (73/125) felt easily distracted during lectures, whereas, only 8% (10/125) felt distracted in TBL. The majority of the participants (107/125, 85.6%) affirmed easy remembrance and recall with TBL. An 84.8% (106/125) agreed that they remembered the material better after the application exercises in TBL.

In the satisfaction subscale (Table/Fig 6), 83.2% (104/125) enjoyed TBL activities, 73.6 (92/125) thought TBL activities to be fun, 85.6% (107/125) thought TBL was an effective approach to learning, (86.4) 108/125 had a good experience with TBL. About 72% (90/125) of participants thought TBL helped in improving their grades.

Discussion

Digital literacy has become obligatory in medical education. Virtual courses supersede face-to-face lectures in this world of technology, necessitating strategies to accomplish active pedagogical techniques in a digital platform to improve teaching-learning in medical education. Although the effectiveness of TBL is well-established in face-face settings, there is a need to explore the possibilities and perceptions of students on virtual TBL implementation.

The present study results suggested that online TBL can be effective in a synchronous setting for teaching Pharmacology. The overall performance of virtual TBL groups is better than virtual lecture groups. The present study results agree with a meta-analysis by Liu SN and Beaujean AA in which TBL groups displayed better academic outcomes statistically than other teaching-learning methods (13).

Online TBL groups scored significantly better than online lecture groups in MCQs, indicating that TBL can positively influence recall, similar to a study by Emke AR et al., (14). Also, this is very much in agreement with a meta-analysis of 17 studies documenting the positive effects of TBL on content-knowledge outcomes (12). Online TBL groups outperformed lecture groups in the case of critical analysis and applying the concepts in the present study. TBL enhances essential aptitudes of thinking in learners compared to other instructional strategies, as evident in literature, irrespective of the mode ofdelivery (15),(16). The present results indicate satisfactory and superior performance in the online TBL structure over online lectures; however, whether this learning method is sustainable and accomplishes the learning objectives similar to in-person TBL modules needs to be evaluated.

Active and collaborative learning can enhance critical analysis. As students are allowed to participate in virtual TBL actively, the level of student engagement is more. This can lead to better performance (17). Better performance of virtual TBL groups than lecture groups may be attributed to active learning, availability of precourse materials, formative assessment with constructive feedback sessions, and collaborative learning, imbuing a sense of self-responsibility in education.

The students obtained statistically higher overall scores in TBL-SAI than the neutral values suggested by Mennenga HA, (12) and across all the three sub-domains of the scale. This positive perspective towards virtual TBL in the current study might be due to their first venture of the learners to perform as teams in synchronous online settings. The real-time discussions with web conferencing tools may add an edge to this positive attitude.

On evaluating the subscales, the learners showed high accountability, preference, and satisfaction with virtual TBL in online settings. Though many researchers have shown an approvingly positive perspective of learners toward TBL (18),(19),(20), conflicting outcomes such as low accountability, poor preference, and satisfaction have also been documented (21). The positive attitude, high student engagement, and level of satisfaction in the present study might be due to the following reasons. The first and foremost reason might be due to the formal training of faculty members in the present study before executing virtual TBL sessions to familiarise the faculty with the essentials for conducting the TBL and motivate them to use the digital resources and technology to the fullest potential as the level of training of facilitator have an impact on the experience of the students (22).

Another reason may be the synchronous virtual TBL sessions in small groups simulating real-time face-to-face experience. A study done by Cross CE et al., Cross demonstrated increased student engagement in online synchronous TBL sessions (23). Also, social presence with effective communication increases with virtual TBL. This sense of social presence enhances active and collaborative learning (24),(25).

Limitation(s)

The present study results of virtual TBL are restricted to a few modules of the Pharmacology course and lack a more comprehensive appraisal of virtual TBL on a large scale. The feasibility of implementing virtual synchronous TBL classes on a broader scale encompassing an entire course period and enormous disciplinary scope is needed to check the validity.

Conclusion

Implementation of virtual TBL in synchronous setting in Pharmacology course established proof for high student accountability and satisfaction. Students preferred online TBL to online lectures. Virtual TBL sessions were more effective than online lectures. Team-based learning in a synchronous online setting is productive and engaging for the learners. Further research exploring the possibilities and challenges of implementing and incorporating regular virtual TBL in Pharmacology courses and its impact on students’ performance is needed to concede its entire prospect.

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DOI and Others

DOI: 10.7860/JCDR/2022/58726.17372

Date of Submission: Jul 04, 2022
Date of Peer Review: Sep 02, 2022
Date of Acceptance: Oct 19, 2022
Date of Publishing: Dec 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 06, 2022
• Manual Googling: Oct 10, 2022
• iThenticate Software: Oct 18, 2022 (3%)

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