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

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
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Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
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."



Dr Kalyani R
Professor and Head
Department of Pathology
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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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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"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 : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : AC01 - AC05 Full Version

Role of Handmade Models in Teaching Early Stages of Human Embryology: A Quasi-experimental Study from South Kerala, India


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/59391.17377
Vandana Latha Raveendran, Reba Babu Alex, Umesan Kannanvilakom Govinda Pillai, Aswathy Maria Oommen

1. Associate Professor, Department of Anatomy, Government Medical College, Kollam, Kerala, India. 2. Assistant Professor, Department of Anatomy, Government Medical College, Thiruvananthapuram, Kerala, India. 3. Associate Professor, Department of Anatomy, Government Medical College, Thiruvananthapuram, Kerala, India. 4. Assistant Professor, Department of Anatomy, Government Medical College, Thiruvananthapuram, Kerala, India.

Correspondence Address :
Vandana Latha Raveendran,
Associate Professor, Department of Anatomy, Government Medical College, Kollam, Kerala, India.
E-mail: drvandanalr@gmail.com

Abstract

Introduction: Physical models are being used in embryology lectures along with PowerPoint presentations to improve the spatial orientation of students. But the demonstration of the sequence of changes is not possible with commercial models due to nonavailability and high expenses. The latest audio-visual aids including three-dimensional projections like simulation-based screens, or virtual reality enhance the visual-spatial ability of the students but are very costly and not affordable for all institutions.

Aim: To compare the effectiveness of hand-made physical models with the PowerPoint presentation mode of teaching in understanding the 3D concept of embryology, among first-year MBBS students and to assess the students’ perception of this model-based teaching.

Materials and Methods: The study was conducted using a quasi-experimental study design, on 218 phase 1 medical students of Government Medical College, Thiruvananthapuram, Kerala, India, from February 2020 to August 2020. The students were divided into two equal groups. Group B was taught the topic “Second week of embryonic life” with a PowerPoint lecture session (n=109) and the Group A had in addition a demonstration with the handmade models (n=109). Pretest and post-test were conducted with an internally validated questionnaire. Feedback on the student’s acceptance of teaching/ learning with models were also collected. The improvement of the test scores was analysed using paired t-tests in both the test and control groups.

Results: Statistically significant improvement in knowledge score was obtained while comparing the post-test scores of the intervention group (mean score was 4.83±2) with that of the non intervention group (mean score was 3.99±2.06) (student’s t-test, p-value <0.05). It was observed, 99.1% of students were satisfied with this model-assisted teaching, especially with the series of models demonstrating the sequence of events. A 93.1% of students said that they needed such model-assisted lectures in other subjects also.

Conclusion: Series of models pertaining to a particular event is beneficial and effective for learning complex concepts of embryology. Also, it’s a long-lasting, innovative mode of teaching which can be done cost-effectively.

Keywords

Anatomy, Cost-effectiveness, Education, Embryology Models

The study of human embryology deals with a highly complex process that transforms a single cell into a fetus in nine lunar months. This involves the amazing integration of a multitude of developmental phenomena. In universities in India, embryology as a subject is taught during the first academic year of the undergraduate MBBS curriculum. Understanding the detailed developmental process forms a strong anatomical basis for comprehending the gross structure and related anomalies (1). So, it is highly desirable that medical students have sound theoretical knowledge with spatial orientation, regarding different stages of development during intrauterine life.

Attending didactic lectures and referring to standard textbooks of embryology is still the mainstay of learning embryology for a good percentage of medical students (2). While books and Anatomy atlases provide a two-dimensional orientation of the basic concepts, generally they fail to impart the expected level of understanding (3). Didactic lectures aided by PowerPoint presentations and charts may serve to impart spatial orientation. Students, on the whole, may find it a challenge to imbibe the concepts delivered during routine lectures with projections of videos. Although the student passively imbibes the information, such lectures may fail to trigger their deeper learning process and improve the learning results (4).

Three-dimensional anatomy models, which the students can hold and manipulate can improve their kinesthetic learning. These physical models will stimulate the students to correlate the three-dimensional orientation of developing structures, thereby reinforcing the concept of that particular stage of development in a way more appreciable. Physical hand-painted embryological models are well appreciated by students and it can not be replaced by digital 3D atlases (2).

Models that are currently being used are made of synthetic fiber, resin or plaster of Paris. Each has its advantages and disadvantages. Every institution’s purchase model depends on its economic potential. In government institutions like ours where only limited funds are available, procuring an expensive model limits the purchasing power to a minimum. Cost-effective models that the faculty and students can make with locally available material are a good alternative to overcome these limitations (5). More models (individual or series) can be made at low cost, thereby allowing the students to learn in small groups or individually. The present study was conducted with such hand-made, cost-effective sequential models as educational tool.

The aim of the present study was to compare the effectiveness of hand-made physical models alongside a PowerPoint presentation in understanding the 3D concept of embryology among phase 1 MBBS students and to assess the student’s perception towards using physical models in embryology teaching.

Material and Methods

A quasi-experimental study with pretest and post-test was conducted in the Department of Anatomy, Government Medical college, Thiruvananthapuram, Kerala, India, from February 2020 to August 2020. Approval for the study was obtained from the Institutional Ethics Committee. (HEC.No.01/50/2020/MCT dated 07/02/2020.) Informed consent was obtained from the students after explaining the study procedure.

Inclusion and Exclusion criteria: All phase 1 MBBS students, 2019 batch were included in the study and students who were not willing to study were excluded from the study.

Out of 250 phase 1 MBBS students, 218 students participated in the study. There was no dropout postintervention in any group. The sampling frame used was the attendance roll of the students. Alternate students were enrolled in the group.

Group A: Intervention group

Group B: Non interventional group.

Study Procedure

The authors decided to conduct the study during a general embryology lecture class. The changes in the embryo in the first week of intrauterine life are relatively easy to understand. Since the 3D conformational changes started happening mainly from the 8th to the 14th day, the second week was selected as the lecture topic. Further weeks were not included due to time constraints. Models of the developing embryo in the second week were made in the department of Anatomy with reference to the diagrams in the embryology textbook (6).

Six coconut shells of appropriate size were cleaned and their outer surfaces were scraped smooth with a knife. A layer of clay was then applied over the outer surface and smoothened. To denote the sequential growth of the embryo, a series of changes were designed in each shell. Cells were made with thermocol balls and fun clay, and the embryonic disc with dried paper pulp mixed with gum and polished with clay. The models were created to impart an accurate spatial orientation regarding the layout of the germ layers, blastocoele, and extra embryonic coelom. The prepared models are shown in (Table/Fig 1),(Table/Fig 2),(Table/Fig 3).

A set of 10 embryology questions were prepared, which were internally validated by two senior Anatomy professors in the department. The questions were based on the changes in the embryo and blastocyst during the second week of development. The same set of questions was used for the pretest and post-test. Knowledge score was assessed giving a score of 1 for the correct response and 0 for the wrong response. Total scores ranged from 0 to 10.

Method of Collection of Data

The study was conducted during the routine embryology theory class. A pretest of five minutes duration was done for group B before the lecture class. Then group B (non interventional group) was given the one-hour didactic lecture class, with 3D pictures in PowerPoint presentation and diagrams drawn on the board. After one hour, a post-test was conducted for group B.

Then Group A (interventional group) had the pretest for five minutes. After that, they had the same lecture experience for one hour as Group B, added with models pertaining to the second week of development. The six small handy models were presented and explained to the students. They were allowed to handle them to get a better three-dimensional orientation. After one hour, a post-test was conducted for group A.

Both lectures were handled by the same lecturer to avoid bias. After the post-test, the models were demonstrated to group B students also for the sake of completion of delivery of academic material.

After the sessions, separate time (10 minutes) was allotted for collecting feedback from the 218 students about the simulation we used, by a questionnaire that included 10 closed-ended questions. The responses were recorded on 5-point Likert scale. A structured questionnaire similar to that by Chaudhary P et al., was adopted for collecting the responses about the current intervention (7). For the present study, a few modifications were made to the questions making them suitable for assessing the student’s attitudes toward model-assisted learning. The reliability of the questionnaire showed Cronbach’s Alpha value of 0.615. The questionnaire also included one open-ended question asking for their independent observations and suggestions.

Statistical Analysis

The data collected were analysed statistically using Statistical Package for Social Sciences (SPSS) software, version 22.0. The scores of preintervention and postintervention tests were described as mean and standard deviation. The improvement of the test scores was analysed using paired t-test in both the test and control groups. Postinterventional scores of both groups were compared. Feedback score was described in percentage. Comments and suggestions were noted.

Results

In the present study, the mean age of the students in years was 19.07±0.69 and 19.1±0.71 for the intervention and non intervention groups respectively. The number of males and females in the intervention group were 52 and 57 in a ratio 1: 1.1 and the same in the non intervention group was 49 and 60 in a ratio 1:1.2. The pretest scores of both groups were comparable. Post-test scores showed a statistically significant difference between groups (student t-test, p<0.05) (Table/Fig 4). There was a significant improvement in knowledge scores in the intervention group compared to the non intervention group (student t-test, p-value<0.003) (Table/Fig 5).

It was observed that 99.1% of students mentioned this method as satisfactory and appreciated the benefit of using a series of models in making the concepts clear. While 85.8% of students felt it as more interactive, 96.8% got a better understanding of the topic and found it useful to solve confusion related to the topic. The duration given for handling models was not adequate for 68.1% of students (Table/Fig 6).

Students’ responses to the open-ended question asking for any observation regarding the use of models included the following remarks.

1. PowerPoint is rather confusing because the cross sections at different levels are difficult to grasp at first look.
2. Got a better 3D picture of embryonic development.
3. Models were impressive and they made it easy to remember the ‘week of twos’.
4. Easy to understand
5. Cavities well understood
6. Spatial understanding of germ layers is better.
7. Much better than the videos and diagrams for understanding the changes.
8. Able to visualise the second week’s changes more perfectly.
9. No need to memorise the events.
10. Handmade models are better than synthetic models because that itself generates interest among students.

Discussion

Theory hours are preferred for teaching embryology over practical hours, due to limited hours for embryology in the curriculum and large class size. For beginners, visualisation of the three-dimensional concept of the developing embryo with its related developmental processes within a short time becomes a tedious and time-consuming experience. (8).

Newer technologies that include simulation methods, Virtual Reality (VR), simulation-based screens or 3D printed models may not be available or used universally (5). Expensive 3D embryology learning modules prompt many institutions to stay away from these resources (2),(5). There are studies available incorporating non digital, physical models which report the significant role of physical models in teaching anatomy in spite of the increasing availability of 3D web-based and computer-based models (3),(9),(10),(11). The models available in the department museums will be usually a single model representing a particular stage or week, which will not be suitable to deliver or understand the sequence of changes happening in the embryo. The material by which they are made is also heavy most of the time and not suitable for frequent, rough handling by the students and faculties. In such situations, cheaper handmade models can to a great extent be substitutes for the costly digital embryology platforms (5). The incorporation of low-cost effective models is not a newer concept. Teaching with these models can be done synchronously with dissection or small group discussions.

Handmade models may be of two broad categories; either prepared and performed by competent faculty themselves or prepared under guidance by the students as part of their academic program (12),(13). But the creation of models requires the expression of psychomotor skill and imparts both implicit and explicit knowledge and provides three-dimensional information about the topic concerned (14). Some students respond negatively to learning by making models, as they are not skilled in handcraft or the time consumed for this process is apparently more than the time spent by them for effective learning of the same topic without relying on models (15). So, authors concentrated on teaching with instructor-designed low-cost models.

Ribaupierre S et al., noticed the influence of models in gaining spatial awareness (8). Authors method of teaching with hand-made models provides more room for the generation of 3D concepts of embryological events which are otherwise difficult to attain. This can be simultaneously used for induction of learning embryology as well as for the later reassessment of the knowledge they gained, which in turn provides an index of the efficiency of the proposed teaching exercise. Visual, auditory, and tactile sensations that the students achieve by using models will stimulate a lot of neuronal circuits within the brain that will augment the consolidation of long-term memory (16).

The initial weeks of embryogenesis, especially the second week which is called the “week of twos” demonstrates a series of sequential and partially overlapping developmental events. This week entails the transformation of morula to germ disc and the evolvement of two cavities (amniotic cavity and yolk sac), two germ layers (ectoderm and endoderm), two divisions of trophoblast and two divisions of extra-embryonic mesoderm (somatopleuric and splanchnopleuric) (17). To bridge the lacuna existing in didactic lectures and to simplify the learning of this complex mechanism of development, the current model-based teaching strategy was introduced.

In the present study, a statistically significant improvement was noted in the knowledge score of the intervention group. A positive influence of spatial visualization and spatial relation abilities of students on their performance was observed (18). A remarkably good percentage of students were satisfied by the demonstration using models (99.1%). This was in accordance with the studies done by Oh CS et al., (15). Also, a series of models showing the event-by-event progress in the developmental process was well accepted by the students, with a score of 99.1%. So, it was apparent that the introduction of models to the teaching process serves the purpose of delivering the concepts clearly.

In our study, the lecture was covered in one hour for both interventional and non interventional groups for the purpose of comparison. Thomas Huk in his study stated that students with a high spatial ability would benefit from 3D models (19). The low spatial ability students became cognitively overloaded by these models and appeared stressed. They observed a more prolonged use of 3D models by low spatial ability students than by students with high spatial ability. Around 10% of students in our study group opined that it would have been better if more time was allowed to handle the models. This may be due to the difference in the level of spatial ability of the participants (20).

Students appreciated the need for such models in other anatomy topics also. This type of interactive session allows discussions, reducing the monotony of passive learning and increasing their interest in the subject (21). Studies have shown that such sequential learning styles through different modalities of teaching like demonstrations and diagrams are preferred by students (22). To know the efficacy of the intervention on the target group and to assess its effect on immediate retention, the proposed assessment was done just after the completion of the session. The long-term assessment was not done as it was assumed that the results would be influenced and altered depending on the possibility of acquiring additional information from various sources like textbooks or educational videos.

One of the advantages of this study is the possibility of the students getting triggered to make similar models on their own singly or in small groups as the materials used are readily available to them. Another advantage of these handmade models is that it can be considered for use in Objective Structured Clinical Examination (OSCE) stations for conducting formative or summative assessments (5). The commercially available models are generally not so handy and are expensive, that the examiner may hesitate to pass it to the student, whereas our models can be handled easily and frequently.

Limitation(s)

The difference in the level of response may become more apparent and demonstrable if the sessions were carried out with a greater number of models-in-sequences taking more time for demonstration and handling by the students. Time constraints for such detailed demonstrations with models representing the whole embryonic period as well as the fact that periodic assessment of the students to test the contrast between the short-term and long-term retention was not done.

Conclusion

Whether technically advanced or technology-assisted, the ultimate goal of teaching is to enhance learning. The introduction of low-cost handy models motivated the students and gave them a better understanding of the three-dimensional structure and related developmental processes of embryos in the earlier weeks of intrauterine life. This method changed their attitude toward learning embryology.

Acknowledgement

Authors would like to thank the first MBBS students of 2019 batch in Government Medical College, Thiruvananthapuram, who participated and provided feedback in this interventional study. The authors gratefully acknowledge Dr. Priti Chaudhary and Dr. K Arora, Dr. SK Dhir for permitting us to use the feedback questionnaire. Authors are extremely thankful to our senior scientific officer Dr. Chandramohan Nair and other faculty in the Department of Anatomy for their guidance and support.

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DOI and Others

DOI: 10.7860/JCDR/2023/59391.17377

Date of Submission: Jul 30, 2022
Date of Peer Review: Sep 05, 2022
Date of Acceptance: Nov 04, 2022
Date of Publishing: Jan 01, 2023

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. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 09, 2022
• Manual Googling: Oct 25, 2022
• iThenticate Software: Nov 03, 2022 (5%)

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