How undergraduate medical students reflect on instructional practices and class attendance: a case study from the Shifa College of Medicine, Pakistan

The goal of this study was to assess student perceptions of a variety of instructional practices and attitudes toward class attendance. Data were obtained and analyzed by administering a questionnaire to students of the Shifa College of Medicine, Pakistan in 2011 and 2012. The subjects positively assessed most instructional practices, and in particular felt that teaching sessions conducted in small groups were more valuable than formal lectures in large groups. Students did not like having to give presentations, quizzes, panel discussions, and journal club. A positive correlation was found between the perceived importance of attendance and levels of academic motivation. Of the students surveyed, 11.8% were against mandatory attendance, saying that it reduced motivation and that attendance should be optional. In conclusion, the students had a positive perception of a range of instructional practices, and felt especially positively about practices that involve student activity in small groups. Programmatic improvement in instructional practices might increase class attendance.

Various types of small-group and large-group sessions have been used for instruction at the Shifa College of Medicine, Islamabad, Pakistan, including case-based techniques such as case scenarios or multiple vignettes about a particular theme.Small group sessions include small group discussions, problem-based learning, objective structured clinical examinations, and practical labs.Large group sessions include interactive sessions, lectures, reviews, quizzes, panel discussions, student presentations, and journal club.Instructors encourage students to acquire evidence-based knowledge.It is desirable that students attend these sessions of their own free will and out of genuine interest.The goal of this study was to assess how students responded to these instructional practices and how stu-dents perceived class attendance.
A questionnaire was administered in English to two consecutive groups of third-year medical students in the Shifa College of Medicine.The survey contained 21 closed questions, of which two were related to income group and gender, and three open-ended questions.This survey was conducted during the cardiovascular module of the third-year class in 2011 and 2012.Ninety-eight students in the 2011 group were surveyed three times each, at the beginning, midpoint, and end of the cardiovascular module, whereas 99 students in the 2012 group were surveyed at the beginning of the cardiovascular module.Quantitative data was analyzed with SPSS version 17 (SPSS Inc., Chicago, IL, USA).Homogeneity test for questions dealing with the importance of attendance were performed.Goodness of fit test for students' responses to questions dealing with teaching strategies and for students' perception of instructional practices were done.P-values less than 0.05 were considered to indicate statistical significance.Qualihttp://jeehp.orgJ Educ Eval Health Prof 2015, 12: 7 • http://dx.doi.org/10.3352/jeehp.2015.12.7 tative data were analyzed in terms of the percentage of the students who gave the same response.
The total number of participants was 314, including three sets of responses from the 2011 group and one set of responses from the 2012 group.Of the participants, 55% were female and 45% were male.Their parents belonged to the middle class, with average monthly incomes of PIKR 100,000-500,000 (USD 1,000-5,000).A total of 188 students (69.1%) said that class attendance is important, whereas 32 students (11.8%) said that class attendance is not important since it reduces motivation and that attendance should be optional; uncertain, 52 students (19.1%) (Table 1).The students who were aware that attendance was important for learning believed that it lead to improved learning, improved performance, and higher grades; while, the students who thought that attendance was not important believes that it did not lead to improved learning, improved performance, and higher grades (Table 1).The attitudes of students towards attendance did not depend on instructor, topic, or type of delivery.Moreover, the students indicated that they are willing to attend class even if the teaching material is available online (Table 2).A majority of students said that small group discussions are the most informative (63.7%, P = 0.000) and that they found this method of teaching to be the most interesting (56.5%, P = 0.000), as compared to reviews, lectures, and large-group interactive sessions.All knowledge delivery techniques were assessed positively, including large-group interactive sessions, problem-based learning, reviews, lectures, objective structured clinical examinations, skill-based lab sessions, outpatient department learning, and inpatient observation.Students had a negative opinion about student presentations in class and journal club.They indicated that they would like to utilize most of their time for self-directed study, study in the classroom, studying online, studying from textbooks, evidence-based study, lab work, operational theater observation, inpatient department learning, and outpatient department learning (Table 3).
Corresponding to the results of previous studies, students perceived active learning through case-based group activities more positively than traditional lectures [1].Most students in this study also preferred case-based learning and stated that it

Table 2 .
Goodness of fit test for students' responses to questions dealing with teaching strategies from a questionnaire administered to students of the Shifa College of Medicine, Islamabad, Pakistan in 2011 and 2012

Table 1 .
Homogeneity test for questions dealing with the importance of attendance, according to the responses of students of the Shifa College of Medicine, Islamabad, Pakistan in 2011 and 2012