Effect of group dynamics on performance of first year medical students

Introduction: Cadaveric dissection forms integral part of learning anatomy. Few students are actively involved in dissection and remaining are passive observers. Present study was conducted to compare students’ perception about cadaveric dissection practices following group dynamics [allotting a dissectiontask related to each student] And effect of following group dynamics during cadaveric dissection on student’s performance. Materials and Methods: Perception and performance in theory and practical assessments were compared between control group [not following group dynamics] and study group [following group dynamics]. Results: Study group perceived following group dynamics has positive effect on learning and skill acquisition. Difference in performance was not significant in first theory assessment between study and control group, study group performed significantly better in both practical and second theory assessment. Conclusion: Group dynamics used during dissections help students perform better by understanding complex task by peer learning and feedback and also helps them to develop leadership, time management and communication skills. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by/4.0/)


Introduction
Cadaver dissection is integral part of anatomy curriculum for studying gross structure of human body. Anatomy knowledge is required for Medical practitioners, surgeons, anatomy teachers, and researchers to be a competent professional. For clinically oriented teaching prosections are used in some part. 1 Still collective data indicate that cadaver dissection in the undergraduate curriculum has continued in many institutions across the world. [2][3][4] Depending upon availability of cadavers, 8 to 20 students are dissecting on one cadaver. practically maximum 3 students can dissect on each side of cadaver.

1.
To compare students' perception of cadaveric dissection practices between following group dynamics and not following group dynamics. 2. To know if following group dynamics during cadaveric dissection practices helps students to understand and perform better.

Materials and Methods
Institutional ethical committee clearance was obtained. written informed consent taken from participants.

Inclusion criteria
Students willing to participate in study

Data collection
Two tables were following traditional method during dissection time wherein 4 -6 students were dissecting and others observing. Remaining students were not allotted any particular role and were self-studying.
For other two tables out of 10 students each was given a role /responsibility to read and explain with clear instructions about what is expected from them for initial 2 weeks.
Once the students were aware of roles distribution, it was decided by team leader from table.
On each table of 10 students doing any regional dissection 1 leader was appointed to coordinate / moderate discussion -and maintain daily log 2 dissectors -were allotted to do the dissection 1 student read the surface projections/landmarks and dictated steps from dissection guide 2 students would read and explain osteology related to the dissection 2 students read and explained muscles in the region 2 read and explained vessels /nerves related in the region Students were doing all roles in rotation so in week schedule each will play each role once sequence of topic and time needed to complete was flexible according to students need. Initial 10 min was for distributing roles and hand over of previous session roles. Each one will do the allotted study for 30-40 min followed by discussion and demonstration of dissected parts simultaneously for 30 min. A faculty was moderating activities and discussions as well addressing any doubts.

Statistical methods
The perception of students was obtained by using a questionnaire on Likert scale from strongly disagree to strongly agree.

Descriptive statistics
Parametric test -two tailed unpaired 't' test was applied to compare the knowledge scores of students. Non parametric test-rank based, Mann -Whitney u test was applied. Control group average score in first formative assessment was 41% & 54% in theory and practical respectively while the score in second formative assessment was 36% and 44% in theory and practical respectively. The performance of control group showed fall in theory and practical as well by 5 and 10 % respectively. [Graph 2, Graph 4] Study group average score in first formative assessment was 46% & 60% in theory and practical respectively while the score in second formative assessment was 44 % and 64 % in theory and practical respectively. The performance of control group showed improvement in practical by 4% but remained consistent in theory. [Graph 3, Graph 4] Compared to control group, study group performed better in all formative assessments and could perform consistently even with more syllabus for second formative assessment. The difference in performance is statistically significant in first practical and second formative assessments. [ Table 1] Students of study group performed better in first formative assessment of theory was not statistically significant as compared to control group. Performance of study group was significantly better in practical suggested that group dynamics in dissection lab help to improve the skills related to practical. Study group performed significantly better in second formative assessment both in theory and practical. Due to group dynamics students are actively involved in learning all aspects of anatomy [ surface landmarks, osteology, myology, vessels and nerves  and dissection correlating relations of structures]. Improved performance in theory and practical of second formative assessment suggests distributing task, feedback and peer leaning helps in long term learning, recall and performance. Good group dynamics help learning, retention and reinforce skills relevant to group and individual [5][6][7] Informal feedback from students suggested applying group norms and following dynamics regularly helped them to make complex tasks easy, manage time. They could discuss, explain give and receive feedback on performance of /from peers. They felt responsible & accountable for allotted task. Non-English-speaking students reported it was helpful to develop communication skills which helped in improving performance in viva-voce. Efforts were made to meet learning objectives as daily progress and expected target was monitored by table teacher.

Limitations
We cannot attribute the better performance of study group only to group study, student self-study and involvement cannot be ruled out. We could not study performance of control group following group dynamics because of time constrains and students were to appear for university examinations. We commented about improvement in time management, leadership qualities and communication skills which are self-reported by students or observed by table incharge. We could not give exact numerical for improvement of soft skills.

Conclusions
Positive group dynamics help learning, retention and reinforce skills relevant to group and individual. Sensitising students and using group dynamics in daily practices will help students to step towards the IMG standard of MCI 8 by being able to communicate, lead, learn from peers, handle the groups and to perform better. We suggest to make students aware of group dynamics and use in daily practices as dissection hall, labs, clinical settings, even in administration to be an effective performing group.

Source of Funding
None.

Conflicts of Interest
None.