|ORIGINAL RESEARCH PAPER
|Year : 2011 | Volume
| Issue : 3 | Page : 591
The benefits to medical undergraduates of exposure to community-based survey research
AR Dongre, G Kalaiselvan, T Mahalakshmy
Department of Community Medicine, Sri Manakula Vinayagar Medical College, Pondicherry, India
|Date of Submission||09-Dec-2010|
|Date of Acceptance||01-Nov-2011|
|Date of Web Publication||03-Dec-2011|
A R Dongre
Department of Community Medicine, Sri Manakula Vinayagar Medical College, Pondicherry
Source of Support: None, Conflict of Interest: None
Introduction: In India, there has been little effort to teach medical students about public health research. Few medical institutions in India and nearby Nepal formally offer exposure to field surveys or projects to medical undergraduates as a part of their training in community medicine. Little is known about the effect of such activity on students or how they apply what they learn. We implemented a systematic, hands-on experience in the public health research process with medical undergraduates in Puducherry, India to evaluate its effect on students.
Material and Methods: Two groups, each with 30 third-semester (second year) medical undergraduates, participated in a 15-day, two and one-half hours per day course on the public health research process. At the end of course, a retrospective post-then-pre self-assessment of students' skills was obtained. One year later, we resurveyed students with open-ended questions to assess their impressions of what they had gained from learning about the field survey process.
Results: Out of the 60 students, 55 (91.6%) provided complete responses for analysis. The mean post-exposure Likert scores of students' self-perceived skills and knowledge were significantly higher than their retrospective assessments of themselves prior to the course in areas such as being aware of the public health research process, their skills in interviewing and communicating with local villagers, and ability to collect, enter via computer and present gathered information (p<0.005). Six categories of common responses, all positive, emerged from the open-ended feedback: 1) ability to apply learning to research work, 2) communication skills, 3) awareness about local epidemiology of injury ,4) awareness of local first-aid practices and health care seeking behavior, 5) awareness of survey techniques, and 6) anticipated application of this learning in the future and its effect on the student.
Conclusions: Overall, the initial implementation of a program exposing medical students to the community survey research process was well received. Early exposure of medical undergraduates to the survey research process appears to help them be better clinicians, who are able to understand and use field level data.
Keywords: Community, faculty, health surveys, medical students, research
|How to cite this article:|
Dongre A R, Kalaiselvan G, Mahalakshmy T. The benefits to medical undergraduates of exposure to community-based survey research. Educ Health 2011;24:591
In India, efforts to orient medical students to public health research are lacking1. It has been suggested that schools should provide a brief skill-based training program on community-based research as a part of the undergraduate curriculum2. A few medical institutions in India and Nepal have reported on their formal exposure to field survey and on projects for medical undergraduates as a part of posting in community medicine3-6. Apart from this, little is known about the effects of exposure to public health surveys on students’ learning and how they apply this in the future. Due to limited supportive evidence, it remains a challenge to design, introduce and catalyze such a training approach in the traditional medical undergraduate teaching curriculum. Hence, we developed a formal, hands-on experience for medical undergraduates in the public health research process and evaluated how students anticipate it will effect their further studies. The present study was a part of our ‘continuous renewal’ effort to refine, plan and strengthen this recently started student-centered and community oriented activity for medical undergraduates.
Material and Methods
Setting and Study Design
The present study was a sequential mixed-method design where immediate quantitative feedback from surveys was followed a year later with qualitative feedback7. It was carried out by the Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital (SMVMCH) in rural Puducherry. Puducherry is a union territory of India, a sub-national administrative division of India within the federal framework of governance, which is directly overseen by the federal government. Puducherry is located on the Malabar Coast, 162 km south of Chennai, the capital of Tamil Nadu. SMVMCH is a new medical college and each year admits 150 medical students.
Exposure to Short Course
During posting in the Department of Community Medicine, two groups of 30 students third-semester (para-clinical phase of the second year) medical undergraduates were exposed to a short course of fifteen days duration (two and half hours per day) on survey methods. The course was comprised of an orientation of students to the process of designing surveys and importance of informed consent, discussing the questionnaire, its administration, interview skills, types of data (quantitative and qualitative) and tackling some situations in the field such as barriers in communication and ‘desirable response’ to hospitality/hostility of the respondents. It was followed by hands-on exposure to field surveying, data entry and demonstration of its analysis using Epi_info (version-3.5.1) software program. The survey was done in the villages of our field practice area to study the epidemiology of injuries in local community, village level first-aid practices and people’s health care seeking behaviors. This information was useful to plan our health education efforts to prevent injuries in the local community, a relatively neglected public health problem. The details of the present survey and its findings have been reported elsewhere8. A team of social workers (masters prepared in social work) facilitated the field survey and a statistician supervised the data entry by students. The faculties in Community Medicine ensured daily dialog with the students before each field visit, accompanied and motivated them to respect local beliefs, customs and wisdom while interviewing the local community. At the end of posting, a faculty used software to demonstrate basic analysis of data such as making frequency tables and calculation of ‘measures of central tendency’ and demonstrated interpretation of findings. Students presented the survey findings before all the faculties and field staff. Later, survey findings were used for developing a flip-book on injury prevention to be used in educating the local community. The present approach to community orientated teaching and health education of community members was based on our previous experience9. We used guidelines of National Family Health Survey of India for sensitization of students in survey technique and interview skills and ensured the active involvement of all the students10.
Quantitative Data Collection and Analysis
At the end of posting, ‘retrospective post-then-pre’ self-assessment data was obtained from all students using a six point Likert scale to know their perceptions of their abilities within the course content before and after participation. The ‘post-then-pre design’ was adopted to control the response ‘shift bias’ which was likely to take place due to limited knowledge of students about survey research process at the beginning of exposure11. The data was entered in software Statistical Package for Social Sciences (version 11.5). Paired-t test was applied to find out difference in the mean post and pre- score values and p values less than 0.05 were considered as significant.
Qualitative Data Collection and Analysis
One year later, a group of 30 students—a subset of original sample—was again posted in the Department of Community Medicine. We qualitatively assessed students’ feedback to assess their retention of acquired knowledge/skills during the survey research process and the application of this knowledge and its effect on their further studies. Students were given a feedback questionnaire having four open-ended questions: What did you learn? How was that learning useful to you? How do you plan to use it in future? Any other comments? They were asked to respond freely and elaborately. To avoid social desirability bias, information such as name, roll number and background characteristics were not collected. Students’ written responses satisfied the criterion of ‘low inference descriptors’ as they did their own transcribing while writing the feedback in English language, which was their medium of instruction. The unit of analysis was response statements. We looked for commonalities in the statements. Statements with similar or related meaning were grouped to form categories for interpretation and description. The first author performed the manual content analysis to describe/explore the emerging categories of response and the second and third authors reviewed it. There was no discrepancy between the first and other two authors.
Oral permission from the director of the Medical College and the written consent from students were obtained.
Post-then-pre Feedback from Students Soon after Exposure to Community Surveys
Out of 60 participating students, 55 (91.6%) responded with complete data and were included in analysis. There were 23 males and 32 females. The mean post-exposure scores were significantly higher for perceptions such as getting sensitized to public health research process, improvement in interview/communication skills with local villagers and ability to collect, computer enter and present data than in mean pre-exposure scores (p<0.005) (Table I). The mean post-exposure score for students’ willingness to participate in such research work in future was significantly higher than the mean pre-exposure score (p=0.006).
Table 1: Post-then-pre ratings from students (n=55) soon after exposure to the survey research process
Feedback from Students after One Year of Exposure to Community Surveys
As presented in Table II, six categories of common responses emerged from the content analysis of feedback responses. These were – 1) Application of their research skills: Two students noted that they had been able to apply what they learned about research in a short-term research studentship under the Indian Council of Medical Research. 2) Improved communication skills: Students generally perceived improvement in their skills in communicating with local villagers and history-taking in the hospital setting. 3) Greater awareness of local epidemiology of injury, local first-aid practices and how people sought health care: Students reported that they were more aware of common injuries among local people, local health beliefs and customs, and of some potentially harmful first-aid practices within villages. 4) Greater understanding of survey techniques: Students noted that they had learned the important steps in survey planning and had learned to see surveys as an opportunity to educate people in local villages. 5) Ability to apply this education in the future: Students believed that it would help their future research work and higher studies and 6) Its effect on self: Students became aware that how rural people live, suffer and do worry and what is the importance of medical care in their life? One of them went through the first-aid book to know the scientific management of injuries.
Table 2: Feedback from students after one year of exposure to survey research process (n=30)
As a result of exposure to community-based survey research process, students perceived that they became sensitized to the importance of the use of structured questionnaires, data collection and its analysis as an integral part of research process. Students perceived they would be able to apply what they learned in their future research work. The other outcomes which explored the ‘hidden curriculum’ of this activity were improved communication skills, sensitization to local health problems and awareness about local epidemiology of injury (survey topic) helped them in history taking skill and patient care in hospital settings. It is noteworthy that one of the competencies of primary health care physicians is to use epidemiological skills to appreciate health risks and health educate people in specific local context12.
As a result of exposure to survey; students’ willingness to participate in such work in future has increased significantly. The previous evidence shows that two factors, ‘presence of good skills’ and ‘having participated previously in research work’, are important to future willingness to take up research as a career in the future. In India, Kumar et al. have reported that considerable proportion of students was not fully aware of the benefits of engaging undergraduate students in research13. Hence, the early hands-on exposure of all students to research process should be ensured in the traditional teaching curriculum.
In India, the Indian Council of Medical Research (ICMR) has been awarding Short Term Studentship (STS) Program to selected deserving medical undergraduates14. ‘Problem Solving for Better Health’ (PSBH), a global movement by Dreyfus health foundation, which is coordinated by a non-profit organization called as Health Action by People in India has the specific focus on sensitizing medical students on community health through individual projects15. We found that prior exposure of medical students to community-based survey research is expected to help students who wish to undertake community-based projects under STS or PSBH activities in making a questionnaire, its administration in field, data entry and analysis.
The present approach offered learning to the students, incentives to the faculties in the form of publication of research papers, which in turn retained their interest and service to the local community members in the form of need-based health education. The entire activity was undertaken within the existing curriculum and resources. World Federation for Medical Education recommends initiative at medical schools to engage students in medical research16. It was an opportunity to teach students to respect and be sensitive to local belief, culture, and local wisdom (medical humanity) of community on survey topic, which is one of the recommended fundamental requirements of accreditation system for medical schools in South-East Asia region17. However, providing training in community research is not without its challenges: Mostafa et al. from Egypt reported problems their school faced in facilitating students' community research, including curriculum overload, too little time, inadequate student training for research, lack of staff guidance and cooperation, lack of interest and motivation, and lack of incentives18.
The findings should be seen in the light of the limitations that it was a small scale study conducted over a short duration of one year. Long-term follow up and objective quantification of the perceived benefits is required.
In conclusion, the first iteration of exposure to survey research process within the existing curriculum was well-received. Exposing medical undergraduates to the survey research process during the para-clinical phase appears it will help them in their future research work and in their studies in the clinical settings. Chaturvedi et al. also found that exposure to population-based research during para-clinical phase can be effectively placed on a systematic basis, without requiring additional resources19. A need for ‘research training’ as an integral part of the undergraduate curriculum by introducing a short duration (one week) course has been recently expressed2 and the present study came out with a feasible approach for medical schools in developing countries and its effects.
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