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Assessment, Pharmacology, Feedback, IntroductionSelf-learning in medical education makes learning more efficient, effective and meaningful and in this process effective time management for reinforcing skill and knowledge can be incorporated by the faculty ( 1,, 2,). Didactic lectures are one of the most common modes of teaching methods used in higher education institutes, making students passive listeners, and so they may lead to lack of attention and limited independent thinking with limited self-assessment ( 3,- 5,). There is a need to adopt and develop some modern pedagogic methodologies in Medical Education to promote critical thinking, problem solving and active learning in Medical students to enhance or supplement conventional lecture teaching ( 6,). Involving students in &,ldquo real life&,rdquo situations fosters the learning process and provides environments that are student-centered ( 2,, 3,, 7,). Active engagement of students with course material via problem-based learning, think-pair-share, group projects and other methods gives students a chance to reflect their own thoughts, listen to others as well as speak up and gear up to achieve objectives in the learning environment ( 2,, 4,, 8,). This process places a greater degree of responsibility on students, though didactic lectures still are essential in guidance ( 3,, 4,). Incorporating active learning strategies not only improves understanding and learning, but fosters the development of critical thinking, cooperative learning, concept formation and increased motivation, as well ( 4,, 9,). Many methods have been adopted to supplement traditional teaching including the use of card games and puzzles in gastrointestinal physiology, panel board games in immunology, jeopardy-style game in obstetrics, and frame game in psychiatry ( 9,). Crossword puzzles are one pedagogical tool that can motivate the students to know factual information and correct spellings, develop healthy skepticism and encourage logical thinking ( 6,, 9,). Crossword puzzles help students in critical thinking while they are pondering through various clues with narrowing the possible range of answers. These help in identifying areas with lack of comprehension and weakness, along with increase in confidence ( 3,). Many forms of crossword games are used which include US style symmetrical crosswords and cryptic crosswords to name a few ( 9,). Crossword puzzles provide a quick and effective method for reinforcing essential vocabulary and critical concept with a better recall, and providing appropriate discussion and humor ( 2, , 9,). Crosswords have been very useful for active learning in medicine and allied areas with promising results and substantial usability ( 6,).A study done is South Africa demonstrated that crosswords made them think critically and there was a positive relationship between student collaborative learning and crosswords, where this tool greatly enhanced students engagement ( 3,), and use of crosswords provided an opportunity to discuss and recall essential concepts, think critically and collaborate in small groups in Pathology, Forensic Medicine and Pharmacology ( 1,, 6,, 9,- 11,). Use of crosswords as an innovative and entertaining method was valuable to motivate students much more in the subject of Physiology ( 4,). A thorough literature search showed that most of the studies done were on the introduction of crosswords as a tool of assessment in either medical or allied health sciences hence, we planned this study to investigate the acceptability of students over subsequent batches on the use of crosswords as one of the methods for assessment in pharmacology.MethodsStudy settingThis cross-sectional study investigated the acceptability of a newer assessment technique/module i.e. crossword puzzles. The subjects of the study were 5th semester students of the second professional MBBS (Bachelor of Medicine and Bachelor of Surgery) course of Teerthanker Mahaveer Medical College, Moradabad, West Uttar Pradesh. The study was conducted for three consecutive MBBS batches over a period of three months at the same time of the year from 2018 to 2020 (between the month of August to September each year). The students, who had appeared for formative assessment, gave written informed consent. From the total of 450 students (150 students per year), a total of 425 students actively participated in this study. Nine students from the year 2018 participated for the validation of the questionnaire and hence were excluded from the study, and 11 students from the year 2019 and 5 students from the year 2020 missed one of the formative assessment methods and they were also excluded from the final analysis of the results. For the initial two years the mode of conducting crossword puzzles was offline, but during the year of 2020, due to the pandemic, the crossword puzzles were conducted online via the portals of Google form and Google classroom. Study designThis cross-sectional study was conducted on Second Professional MBBS students over a period of three years for three consecutive batches. Three consecutive sessions at the same time of the year were performed and analyzed. The students who had participated in this study were evaluated with the help of formative examination and formative examination and feedback questionnaire. The Institutional Review Board approval was taken before the start of the study.SensitizationBefore initiating the session each year the faculty members of the department were sensitized with the concept of crossword puzzles and inputs were taken from the faculty on the feedback questionnaire. The same feedback questionnaire, developed after the consensus of the faculty, was given to the students each year. The session was followed by another session and the students were explained the procedure and timing interval for answering the crosswords. The unit selected for each batch was the same and also it contained the same number of questions i.e. a total of 32 questions on the Unit of Drugs acting on the endocrine system, with the option of 15 questions in the down section and 17 question in the across section ( 2,). All the clues for the crossword were substantiated from standard textbooks of pharmacology that the MBBS students tend to follow. For validation of the feedback questionnaire a pilot study was done on 15 students who were not the part of our final result analysis. The feedback questionnaire was analyzed for coefficient of reliability by Cronbach&,rsquo s Alpha and gave an internal consistency of 0.841. The 10-item student feedback questionnaire was recorded on a 5-point Likert Scale with scores of 1 for &,lsquo Strongly Agree&,rsquo to 5 for &,lsquo Strongly Disagree&,rsquo ( 2,). The Topic of &,lsquo Drugs acting on Endocrine system&,rsquo was done as per the teaching schedule of each batch at the same time every year, the mode of teaching the present system was offline with the mode of didactic lecture for the year of 2018 and 2019, while the mode of teaching the system in the year 2020 was online. The teaching was done at the same time each year from 2018 to 2020. The day of the crossword puzzles was informed to the students one month prior to its conduct. For the year 2018 and 2019 the print copies of crossword puzzle were administered to the students, but for the year 2020, due to the unprecedented situation, the crossword puzzles were conducted via online media with the help of Google Form and Classroom. The time duration for each year was the same, 1 hour. After the completion of the crossword puzzle the students were given an anonymous feedback questionnaire for response and comment which was collected later. One week later the students took a formative examination, the results of both were compared.Statistical AnalysisThe evaluation was done by comparing student learning in both forms i.e. crossword puzzle, and feedback in the form of questionnaire. Feedback was expressed as percentage of response. The data was tabulated as mean&,plusmn standard deviation (mean&,plusmn SD), the results being analyzed using non parametric (Chi Square Test) and parametric (Unpaired Student &,lsquo t&,rsquo test and ANOVA for comparison of result of all the three batches) tests. A p&,lt 0.05 was considered statistically significant. The data was analyzed using the Graph Pad Software.Ethical ConsiderationThe study was approved by Institutional Ethics Committee (ICE) and conducted in accordance with ICH-GCP guidelines.ResultsFrom the total of 450 students of three batches - 25 students (9 students from the year 2018 participated for the validation of questionnaire and hence were excluded from the study, 11 from the year 2019 and 5 from the year 2020 missed one of the formative assessment methods and so they were also excluded from the final analysis of result). Therefore, a total of 425 students participated in the study and were the part of analysis of data. A total of 141 students in year 2018 139 students in the year 2019 and 145 students in the year 2020 took part in the study and the results of these students were analyzed. The crossword puzzles had a maximum of 25 questions each carrying one mark, the average percentage score of the students across all the three years being 62.7&,plusmn 5.7% with a range of score between 8-84%. The score of formative assessment across all three years was 45.2&,plusmn 2.8% with a range of scores between 8-68%. The scores of each year are tabulated in Table 1,. Year (n)Percentage Score in Crossword Percentage Score in Formative Assessment P*,2018 (n=141)57.4&,plusmn 4.838.0&,plusmn 1.7&,lt 0.00012019 (n=139)61.6 &,plusmn 5.344.8&,plusmn 2.9&,lt 0.00012020 (n=145)69.1 &,plusmn 6.452.8 &,plusmn 3.40.0114*p&,lt 0.05 as compared to formative assessment using unpaired student &,lsquo t&,rsquo test. |