Learning medical biochemistry by combination of traditional & modern teaching methods: students perceptions

Introduction: Biochemistry is the key subjects for a clinical diagnosis because that’s depends on laboratory analysis of body fluids. Detailed information of clinical biochemistry is essential for proper diagnosis of clinical and its effective management . Very little is known about the students’ perceptions towards improving the teaching of biochemistry. Materials and Methods : Data was analysed from feedback forms of a questionnaire study from the first year students of a medical college in India. The self administered questionnaire which were related to liking the subject of biochemistry, rating of the different topics and the effectiveness of teaching methods. Results: Regarding coordinated approach with multiple teaching tools like Didactic lecture (DL), Group Based Learning (GBL),Video Based Learning( VBL ) ,Case Based Learning (CBL) most students felt that it was useful toward understand biochemistry better (79%),learn biochemistry better (83%),find out importance of biochemistry in future medicine (84%),prepare for university examination (81%). Practical exercises, lectures, exams, and other methods have been found by majority of the students to be the excellent or very good methods, for effectively teaching biochemistry. Conclusions: Through the study, depending on the topic to be covered the combination of the teaching methods is beneficial to improve the understanding and retaining of the subjects better as perceived by the students. © 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
Biochemistry is the language of biology.
Learning biochemistry is crucial to comprehend the basic functions of the body. 1 Biochemistry is the key subjects for a clinical diagnosis because that depends on the laboratory analysis of body fluids. Detailed information of clinical biochemistry is essential for proper diagnosis of clinical and its effective management. 2 Biochemistry subject is a part of first-year MBBS curriculum in India. Current scenario for teaching method for learning biochemistry is traditional lectures, tutorial and practical.
The traditional teaching method gives full play of the teacher's leading role and enables the student to obtain more knowledge .(3) But the traditional teaching methods makes the students lose the learning initiative and creativity. 3 Modern teaching method like case based learning, videobased learning, seminars, demonstrations play a pivotal role for overall understanding of medical biochemistry subject and application in clinical medicine. 4 The combination learning is learning through the flexible combination of two or more learning components. Combination allows teachers and students to work together. The result of combination learning is a flexible, self-directed learning environment where the teacher acts as facilitator and mentor, and the student is at a center of and entirely accountable for their own progress and performance.
Combination learning may vary like technology based, based on in person, human interaction, project based, quiz based.
Pick and choose one or more of the following "Pieces" to use and /or combined to create a https://doi.org/10.18231/j.ijcbr.2020.005 2394-6369/© 2020 Innovative Publication, All rights reserved. 25 learning experience that's meaningful to you and results in something interesting, playful and unique.
Research and exploration to figure out useful and effective teaching and learning methods are one of the most important necessities of the education system.

Materials and Method
This study was carried out in the biochemistry department, GMERS medical college, Valsad, Gujarat, India. A total 150 students of the first MBBS course were included. It was a quasi-experimental study. Informed oral consent was taken from the participants and institutional ethical committee approval was obtained.

Combination of teaching methods
After completion of dietetic lecture (DL) on a particular topic, a group based learning (GBL) was conducted on the same topic for better understanding and deep learning. This gives a platform to students for interact with teachers and openly ask the queries. This was followed by a practical on the same topic eg. Lipid chemistry and metabolism followed by quantitative estimation of serum total cholesterol. This was followed by case based learning (CBL) on the same topic. Eg. myocardial infar ction after lipid metabolism.
Here tutors guided a batch of 10-15 students. In this small group facilitator give case history, patients reports, photos to the students. This was followed by discussion of case based question answer with reasoning of the case. Clarifications and explanations were given regarding Biochemical basis of the disorder, Biochemical basis of clinical features, Biochemical basis of abnormal lab tests, Other clinical features, lab tests in support of the diagnosis, Complications and treatment in short wherever required. At the end of each topic, a unit test was conducted with one liner questions, justification, case and short notes. This was followed by paper solving and how to write answer in paper. Formative assessment was conducted simultaneously with feedback to students. Student's perception was collected regarding the effectiveness and usefulness of multiple teaching tools by a self administered questionnaire.

Statistical analysis
The data was compiled in Microsoft excel, presented as tables and analyzed in terms of proportion and represented in percentages.
Toward the end of the session, feedback was taken from the students using a self administered questionnaire.

Results
Majority (87%) of students felt that the basic information given in DLs was appropriate. They also opined the there was only 51% clarify doubts easily with peers and teacher. Most of the participating students suggested that VBL was informative (73%) understand complex steps in a simple way (79%) VBL helped them to retain (66%) & recall (66%) content and increase concentration when there included in DLs (73%).
The response of student for CBL was that 77% students express that CBL was stimulate thinking, analysis and reasoning capability. It also helped them to match the level of prior knowledge (73%), place themselves as a future doctor (77%), increase interest in the subject (90%), help them to interpret patients reports & diagnose the patients diseases (83%), benefits to solve patients problem (77%) and CBL session showed clinical applicability in medicine(83%).
Interestingly, students enjoy GBL; participating students suggested that they learn useful addition information (77%), plan their study(85%), actively participate in their discussion (79%) clarify doubts easily with peers & teachers (78%) solving problems in a group is an effective way to practice what they have learned and helped them to know how to answer in exam(81%).
Regarding co ordinated approach with multiple teaching tools like DLS, GBL, VBL, CBL most students felt that it was useful toward understand biochemistry better (79%),learn biochemistry better (83%) , find out importance of biochemistry in future medicine (84%) , prepare for university examination (81%).

Discussion
The Medical Council of India (superseded by the Board of Governors) released three volumes of the curricular framework for the proposed Competency-based Undergraduate Medical Education few months ago. 5 Rapid changes of modern world have caused the Higher Education System to face a great variety of challenges. Effective teaching and learning methods are one of the most important necessities of educational systems. Attention to this task in higher education is considered as a major one, so in their instruction, educators must pay attention to learners and learning approach; along with these two factors, the educators should move forward to attain new teaching approaches. 6 Long and short question and answer, one liner questions, case, justification A teaching method is the system of operations and activities of the teacher and students, which help them to gain knowledge, understand the topic, analyze, synthesize and evaluate skill and establish habits and develop attitude. 7 The present study was undertaken to evaluate different teaching methods in biochemistry including DLs with PPT, VBL, GBL, CBL, practical and unit test. The present study revealed that the majority of the students feel that according to the topic different combination of the teaching methods is essential for lecture delivery, as far as inheritant prons and cons of each method students preferred combination of teaching methods.
Here we elicited the student's opinion about a single method of teaching is on more attractive and informative, in DLs students opinion that basic information gives appropriate but difficult to clarify doubts easily with peers and teachers they also fail to retain subject, this limitation of DLs covered by GBL and VBL that in GBL students learn from one another and encourage students to work in a group and this events goes a long way to retain subject. 8 And GBL also created a fearless environment for students to learn and express their doubts.
Learning is transferred to the extent the learning sees possibilities for transfer and has opportunities to apply his knowledge 9 so usefulness of biochemistry concepts actually come in pharmacology and medicine in later stage, CBL which helped students to place themselves as future doctors and reasoning also prescribe effective treatment. The CBL in biochemistry made the learning more enjoyable and encourage the students ask a question in class and CBL which improve clinical reasoning, interpretation of lab report and improve ability to think logically. 10,11

Conclusion
Through the study, depending on the topic to be covered the combination of the teaching methods is beneficial to improve the understanding and retaining of the subjects better as perceived by the students. As per the study bonding of traditional and modern teaching methods better than a single method because inherent cons of each teaching method is compensated by the other.
Combination of teaching is the most satisfied teaching method because the students actively involved and more learning happen. Judicious use of different method's reproducibility and thus the academic performance of the students. Questionnaire for Combination of all method 1) It was helped me to understand biochemistry better 79 13 8 2) It was helped me to learn biochemistry better 83 11 6 3) It was helped me to find out important of biochemistry in future medicine 84 11 5 4) It was helpful to prepare for university examinations. 81 11 8 Therefore, it is recommended that combined teaching method's may be apply for the process of knowledge formation of future MBBS students.

Acknowledgments
The authors would like to thank all participants who contributed to this study and spent their time.

Source of funding
None.

Conflict of interest
None.

Ethical approval
The study was approved by the Institutional Ethics Committee