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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 4  |  Page : 276-280

Rationale use of microbiological diagnostic techniques: A module for undergraduate medical students


Department of Microbiology, Christian Medical College and Hospital, Ludhiana, Punjab, India

Date of Web Publication14-Nov-2018

Correspondence Address:
Aroma Oberoi
Department of Microbiology, Christian Medical College and Hospital, Ludhiana - 141 008, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_61_18

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  Abstract 


Introduction: As we all know that 2nd-year professional students are just the beginner to learn the clinical skills. By teaching rational use of various laboratory techniques, one can shortlist the investigations to be ordered, thereby making it cost effective for the patients. This also encourages rapid and precise investigations, decreasing hospital stay and cost and lesser number of nosocomial infections. Aims and Objectives: The aims of this study were as follows: (1) to develop a module for an interactive disease-based teaching session to impart practical knowledge to undergraduate medical students of the microbiological diagnostic techniques, (2) to evaluate the outcome of this intervention on students for better perception and understanding of clinical microbiology, and (3) to encourage implementation of this knowledge imparted to students later on for rapid and precise investigations, diagnosis, and cost-effective hospital stay in a clinical scenario. Materials and Methods: The study was conducted in the Microbiology Department of Christian Medical College and Hospital, Ludhiana. Forty-five 2nd-year professional students participated in the study. Topics were taught in the theory classes as usual followed by preproject assessment by multiple-choice questions (MCQs). The same topics were taught in the practical classes with special emphasis to diagnostic tests (which test when required). Students were again evaluated by the same set of MCQs as given for preproject assessment. Marks obtained by both teaching methods were analyzed statistically. Results: By postproject analysis MCQ test, it was seen that 22.2% of students scored marks in the range 80%–90% (preproject marks 4.44%). Majority of the students (66.6%) scored between 70% and 80% postproject while the students performing in this range preproject were 6.66% only. The postproject performance in the range 60%–70% and 60%/below 60% was seen among 6.66% and 4.44%, respectively. Paired t-test was used for comparison and was statistically significant (P < 0.05). Conclusion: Results of the current study appear to support continued use of the interactive disease-based session. While prospective research is needed to best assess the utility of the session, the current study does provide support for session benefits. This project is still going on in the department and students are taught clinical microbiology at the end of the syllabus.

Keywords: Medical students, disease, microbiological diagnostic techniques


How to cite this article:
Oberoi A. Rationale use of microbiological diagnostic techniques: A module for undergraduate medical students. CHRISMED J Health Res 2018;5:276-80

How to cite this URL:
Oberoi A. Rationale use of microbiological diagnostic techniques: A module for undergraduate medical students. CHRISMED J Health Res [serial online] 2018 [cited 2018 Dec 11];5:276-80. Available from: http://www.cjhr.org/text.asp?2018/5/4/276/245447




  Introduction Top


Today is the era of infectious and communicable diseases. With change in technology and diagnostic techniques, pattern of various infectious diseases has also changed. The incidence of infections in humans has either increased during the last two decades or threaten to increase in the near future and has been defined by the WHO as Emerging infectious diseases.[1] This term includes newly appearing infectious diseases or those diseases which were previously easily controlled by antimicrobials but have now developed resistance to these drugs. Surprisingly, “new” agents of infectious diseases continue to be recognized, for example, HIV, Helicobacter pylori, Clostridium difficile, and Cryptosporidium parvum.[1]

Reemerging infectious diseases are those that have reappeared after significant decline in their incidence. Appearance of plague in an explosive form in India in 1994 after a period of quiescence of almost 27 years, cholera in 1995, and dengue hemorrhagic fever in 1996 are important examples of reemerging infectious diseases.[1] In this fight for survival and supremacy, microorganism has developed and devised various methods to inactivate the action of antimicrobial agents or to circumvent immune response induced by the vaccine.

The problem of drug resistance has assumed alarming proportions in various pathogens, especially the causative agents of tuberculosis and the bacteria responsible for hospital-acquired (nosocomial) infections such as Pseudomonas aeruginosa, Klebsiella, and methicillin-resistant Staphylococcus aureus.[2]

The only way to combat the spread of these infectious diseases is to recognize them early and take appropriate control measures rapidly. Therefore, this study was undertaken to provide practical knowledge to the students regarding infectious communicable and emerging infectious diseases prevalent in the country.

As we all know that 2nd-year professional students are just the beginner to learn the clinical skills. Only theoretical mugging of the subject is not enough for correlating the topic as this is short lasting. If they have clinical knowledge of the subject, they can remember it better and use it later on as and when required. The interactive disease-based session was designed to show students the value of basic science information in clinical applications, to provide a review of course material, and to familiarize the students with differential diagnosis. Given that the majority of questions are disease based, it was believed that such a session would also better prepare students to answer the types of questions they would encounter in a clinical scenario. By teaching rational use of various laboratory techniques, one can shortlist the investigations to be ordered, thereby making it cost effective for the patients. This also encourages rapid and precise investigations, decreasing hospital stay and cost and lesser number of nosocomial infections.

The proposed intervention will help us to train the medical students and young doctors with better practical knowledge of the microbiological diagnostic techniques. It will encourage the policy to diagnose and manage the clinical problems associated with infections on a much broader front. Better understanding of the subject avoids theoretical mugging of the subject leading to nice correlation and implementation later on. It also results in quick and rapid diagnosis and cost-effective hospital stay. Thus, this study was conducted to determine if there is improvement in rational use of microbiological diagnostic technique among medical students with a new interaction-based study module.

Aims and objectives

The aims of this study were as follows:

  1. To develop a module for an interactive disease-based teaching session to impart practical knowledge to undergraduate medical students of the microbiological diagnostic techniques
  2. To evaluate the outcome of this intervention on students for better perception and understanding of clinical microbiology
  3. To encourage implementation of this knowledge imparted to students later on for rapid and precise investigations, diagnosis, and cost-effective hospital stay in a clinical scenario.



  Materials and Methods Top


The study was conducted in the Microbiology Department of Christian Medical College And Hospital, Ludhiana, after seeking permission from the head of department, dean, and research and ethical committee. The entire batch of forty-five 2nd-year professional students posted for classes in the microbiology department participated in the interactive disease-based teaching session. The concept of study was shared with other faculty members of microbiology and medicine department. Initially, six syndromes were chosen, but because of shortage of time, only two could be done. Enteric fever and tuberculosis were selected as these are quite common in this part of country. A study-specific module was prepared after obtaining the participant's consent covering etiological, epidemiological, pathological, investigational, diagnostic, clinical, and therapeutic aspects of the two syndromes selected with major focus on diagnostic aspects like which investigation needs to be ordered when and on being able to effectively manage the clinical problems associated with infections [Table 1]. Multiple-choice questionnaires for the interactive disease-based teaching session were prepared for improving clinical knowledge of the syndrome and validated after discussion with other faculty members.
Table 1: Summary of study-specific module

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Topics were first taught in the theory classes as usual followed by preproject assessment by multiple-choice questions (MCQs). The same topics were taught in the interactive disease-based teaching session with special emphasis to diagnostic tests (which test when required). After the interactive disease-based teaching session, students were again evaluated by the same set of MCQs as given for preproject assessment. Marks obtained by both teaching methods were compared and analyzed statistically.

The whole programmer was running parallel to the conventional teaching programmer. The internal assessment protocol already in use was modified to provide certain additional information. The students and faculty were requested to provide feedback regarding this intervention.

For survey of student perceptions, a 10-item retrospective survey was developed [Table 2] for the current study to assess the student perceptions regarding the interactive microbiological session. Responses to scale items were made on a 4-point Likert-type scale ranging from strongly disagree(1) to strongly agree (4). No neutral response category was included although participants were able to choose “not applicable” as a possible response option.
Table 2: Survey of student perceptions (retrospective) on the session (using a Likert-type scale ranging from strongly disagree[1] to strongly agree[4])

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  Results Top


Preproject analysis was done by marks obtained by students in the MCQ tests conducted after the usual theory class. In postproject analysis, all the students were analyzed after the interactive disease-based teaching session by the same procedure as used for preproject analysis. The range of marks obtained in preproject analysis and postproject analysis is shown in [Table 3] and [Table 4], respectively.
Table 3: Preproject analysis

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Table 4: Postproject analysis

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Based on the survey of student perceptions (retrospective), in general, the students responded quite favorably to the ability of interactive disease-based sessions to facilitate the transfer of knowledge to clinical settings [Table 5].
Table 5: Retrospective analysis of student perceptions (Likert-type scale scoring)

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Feedback from students

  • Students found this as a better method of teaching and learning
  • Helpful for integrated learning
  • Better understanding of the subject
  • They had better training to diagnose the common infections
  • They insisted that all the clinical syndromes should be taught like this
  • This project should be continued in future also along with conventional teaching
  • Helpful in self-learning too.


Feedback from other faculty

  • Majority of the faculty members found this new method good, a better way of training doctors, but according to some, it is a wastage of time nothing useful to students
  • Involvement of all faculty members in preparing MCQs showed team-based approach
  • Students performed better in the university examinations
  • This motivated the ability of self-learning among the students
  • This should be an ongoing project and should supplement traditional teaching.


By postproject analysis MCQ test, it was seen that 22.2% of students scored marks in the range 80%–90% (preproject marks 4.44%). Majority of the students (66.6%) scored between 70% and 80% postproject while the students performing in this range preproject was 6.66% only. The postproject performance in the range 60%–70% and 60%/below 60% was seen among 6.66% and 4.44%, respectively [Figure 1]. Paired t-test was used for comparing pre- and postproject performance. The difference was statistically significant (P< 0.05).
Figure 1: Comparison of the pre- and postproject mark percentage scored by the students

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  Discussion Top


This study was carried out to determine if there is improvement in the rational use of microbiological diagnostic technique among medical students with the introduction of a new interactive disease-based teaching session module. The purpose of choosing and designing such a module was to show students the value of such disease-based information in clinical applications. Special emphasis was laid upon teaching the students to be able to choose and shortlist the precise investigations in future when in a clinical situation, thereby making it cost effective for the patients. The proposed intervention helped us to train the 2nd-year professional medical students with better practical knowledge of the microbiological diagnostic techniques. The students showed quite a favorable response and the study results suggest that their response was encouraging.

Only a small percentage of students (4.44%) secured 50% or below with the application of this novel module of teaching, hence showing the apparent difference in the performance of the students with regard to rational use of microbiological diagnostic techniques. Improvement after the project, students performed better in the send-ups and also in the university examinations. They were able to correlate the basic microbiology with the clinical syndromes very well.

In a study, attendance of the students was an important factor that predicted academic performance of medical undergraduate students of microbiology class. Other factors which were predictor of academic performances were sex, place of residence, and previous academic performance.[3] In a similar study, a case-based interactive session tutorial was conducted for microbiology students. Both students' performance and student perception data supported continued use of the tutorials. They concluded that case-based tutorials improve student performance on disease-based examination questions.[4]

Chamberlain et al., (2012) utilized small-group case presentation exercises to increase course relevance for medical students taking medical microbiology and infectious disease. Students found that the case presentation improved their critical thinking and presentation skills and helped to prepare them as future physicians.[5]

Results of the current study are consistent with the positive results demonstrated by other studies that examined disease-based medical teaching. For example, interactive disease-based teaching improved learning outcomes and increased student satisfaction in a dermatology program.[6] The authors were able to show significant differences between students taking the disease-based approach versus the standard lecture course. In another study, an electronic, interactive, disease-based cytopathology component was found to be useful in 2nd-year medical student teaching.[7]

Future work is needed that further examines the potential and limitations for using the interactive, disease-based sessions as an alternative to routine lectures.


  Conclusions Top


Results of the current study appear to support continued use of the interactive disease-based session. The interactive disease-based session appears to improve student performance on disease-based examination questions. In addition, students perceived the session as helpful in preparing for examination questions and reviewing the course material. A better knowledge of microbiological diagnosis techniques can, later on, be applied by the students to make a quick and rapid decision in various clinical situations. While prospective research is needed to best assess the utility of the session, the current study does provide support for session benefits. This project is still going on in the department and students are taught clinical microbiology at the end of the syllabus.

Acknowledgment

I am grateful to CMC and H administration for providing me with research facilities, Foundation for Advancement of International Medical Education and Research (FAIMER) Faculty, especially Dr. Tejinder Singh, CMCL (Regional Center for FAIMER), for the extensive support in organizing this study. I also thank 2nd-year medical students for their participation and the microbiology department.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Park K. Emerging and Re-emerging infectious diseases. In: Parks Textbook of Preventive and Social Medicine. 22nd ed. India: Banarsidas Bhanot; 2013. p. 355-9.  Back to cited text no. 1
    
2.
Dasgupta S, Das S, Chawan NS, Hazra A. Nosocomial infections in the Intensive Care Unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian J Crit Care Med 2015;19:14-20.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Roy SS, Chadalawada J. Predictors of academic performance of medical undergraduate students of microbiology class in Kolkata. Int J Med Public Health 2014;4:392-5.  Back to cited text no. 3
  [Full text]  
4.
Blewett EL, Kisamore JL. Evaluation of an interactive, case-based review session in teaching medical microbiology. BMC Med Educ 2009;9:56.  Back to cited text no. 4
    
5.
Chamberlain NR, Stuart MK, Singh VK, Sargentini NJ. Utilization of case presentations in medical microbiology to enhance relevance of basic science for medical students. Med Educ Online 2012;17:15943.  Back to cited text no. 5
    
6.
Ochsendorf FR, Boehncke WH, Sommerlad M, Kaufmann R. Interactive large-group teaching in a dermatology course. Med Teach 2006;28:697-701.  Back to cited text no. 6
    
7.
Steinberg DM, Chan TY, Freedman JA, Grimm LA, Ling L, Lehmann HP, et al. Teaching cytopathology to second-year medical students. An interactive, case-based approach. Acta Cytol 2002;46:481-9.  Back to cited text no. 7
    


    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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