By Nafisa Iqbal, Islamabad
Since few years, didactic teaching and lecturing in the classroom has been criticized by many educationalists for it ineffectiveness, and in place various other teaching strategies have been recommended. At Shifa College of Nursing (SCN), most of the theory /content of a subject is taught using either didactic method with audio–visual help – mainly power point presentation or through case discussions. Since both the methodologies are most frequently used, we intend to determine which method is more effective and so that it can help us in modify the teaching learning strategies at SCN accordingly.
Use of case method of teaching has a long history in law, medicine and business studies. It is an approach to learning about a condition by setting the context of the learning around a case study. Typically, this approach is used to focus on clinical presentation, making a differential diagnosis, planning investigation or planning management. It provides greater relevance for learners and is often more engaging. There are many different approaches to the use of case study as a teaching strategy. Herreid (1997),or Kabella & Tippin(2000).The approaches are the case , learner preparation for engaging discuss the case & class room discussion. The process of case study requires that learners be given access to the case in advance so that they can individually or in a group prepare for a detailed whole class discussion. It emphasis the idea that learners need to engage in active learning experiences.(the pre-class preparation and in class discussion in order to challenge and reconstruct their understanding .Volpe(2002).There are two fundamental principle underpinning the case method. First the best learned lesson are the ones that students teach themselves through their own struggle .Second , many of the most useful kind of understanding and judgement cannot be taught but must be learned through practical experiences. Cases encourage learner to reach a deeper understudying of concepts and issues than they would from just reading or listening to a lecture (Volpe, 2002).Case study encourage learner to take responsibility for their own learning and to see the benefits of thinking about theoretical issues before they are discussed in class.
The lecture is an exposition of a given subject delivered before an audience or a class, as for the purpose of instruction. It is an oral presentation intended to present information or teach people about a particular subject, for example by a university or college teacher. Lectures are used to convey critical information, history, background, theories and equations.
A study of nearly 1,800 faculty members at five different types of institutions found that, regardless of institutional type (large or small, public or independent, community college or Research University), an average of 73 to 83 percent of respondents chose the lecture as their principal instructional method (Blackburn et al. 1980). The lecture is still the most frequently used method of instruction.
However, the traditional lecture method, in which the instructor does all or most of the talking, has a number of drawbacks. Lectures of this sort are based on “learning by listening,” which is a disadvantage for students who prefer to learn by reading, or by doing, or by some other method. Although the traditional lecture conveys factual information very well, it is not well-suited to the higher levels of learning; critical thinking, analysis, and problem-solving must be learned by doing. In a traditional lecture class, the student is passive, has little control over the flow of information, and is reduced to playing a stenographic role. Moreover, research has shown rather that students frequently forget, or never learn, much of the material taught through lectures.
Several studies have shown that the attention span for uninvolved listeners is roughly 15 to 20 minutes. After 15 minutes students begin to tune out and, although some may continue to take notes, they are no longer processing the information they receive. Since passive listeners have short attention spans, the way to overcome the problem is to involve them in some way.
The term “small group teaching” traditionally refers to teaching methods such as tutorials and seminars, and sometimes lab work, and student group work. Knowledge sharing and interaction is fundamental for enhanced learning in a small-group student-centred environment.
In small groups, learners have the opportunity to interact, question and elaborate with peers more frequently than they can in a teacher-centred environment, thus enhancing learning and understanding (educational principle). Working in groups also allows students to learn life skills such as how to work collaboratively and democratically with peers as well as communication and interaction skills.
The use of small groups for learning creates a non-threatening environment that allows all students to participate in discussions that they may not have the opportunity to do in a large group environment. Also the use of small groups creates a safe environment in which students can ask questions of their peers which they may not normally do to staff members for fear of asking the ‘stupid’ question. Another benefit from working in groups is called ‘process gain’, and is said to occur when solutions and ideas result from the group effort of sharing and generating information occurs. This does not happen when working alone in a tutor-centred scenario. Group work can help students to become more active in their learning (Ruel and Bastiaans, 2003).
A study has been done on orthopedic undergraduate students regarding group discussion and lecture in which a total of 77 students were assessed in 3 consecutive cohorts. The students were randomized into two groups. The first group received a series of 12 formal lectures. The second group covered the same topics in 12 group-discussion sessions with self-directed learning. They found that interactive teaching styles are more popular than didactic lectures in undergraduate orthopedic and trauma teaching. They also found some evidence that knowledge retention is better following an interactive teaching.
One of the studies has been done to compare the effects of the problem-based learning (PBL) method with the traditional lecture method on learning in the cardio-respiratory nursing section of the Adult Health Nursing course. Using pretest-posttest experimental design, 71 second-year nursing students in a three-year nursing program in Korea shows that level of learning in PBL group was significantly higher than that of students in the lecture group (t=2.007, p=.045). All PBL students with higher and lower grades showed a significant increase in the posttest score. But in the lecture group, only students with higher grades showed a notable increase. Students in the PBL group gained more knowledge and had higher motivation toward learning compared to students in the lecture group.
One more study has been done to compare problem based learning (PBL) and lecture-based learning (LBL) in Hong Kong secondary students’ science achievement. The results of this study suggest first that PBL is at least as effective as LBL in gaining the knowledge required to achieve the syllabus’ learning objectives; secondly, the PBL group shows a significant improvement in students’ comprehension and application of knowledge over an extended time. Seemingly, PBL is favored for knowledge retention compared to a more conventional teaching approach, by these early adolescent children in Hong Kong.
Similar kind of results are being shown by yet another study carried out in Germany regarding team- and case-based learning to activate participants and enhance knowledge. Most of the literature available suggests that interactivity and team-based discussion enhances students’ learning, however there is limited information on Pakistani students in general and no information on nursing students is available, hence it is expected that this study will in addition to guide institutional decision making will also add dimension to the existing knowledge base.
METHODOLOGY
A randomized control trial has been carried out. The nursing students Year II undergraduate BScN program at Shifa College of nursing (SCN) Islamabad was the targeted population for the study. There are a total of 28 students in year II .
done. 1 month was required to perform a study. Simple random sampling through lottery method by using their college ID numbers was done.
Year II BScN students were divided in two groups. Group A (n=14) was control group and was taught two topics: “Hyperbilirubinemia” and “Seizure” through traditional lecturing; group B (n=14) was intervention group and was taught the same topics using case study method. Multiple choice questions were used to assess students academic performance. A Pre and a Post test was given to both the groups and their results were calculated for comparative analysis. Also evaluation of teaching strategies was taken from the students.
Control group
Total duration of the both lecture was1.5 hours. At the beginning all students was given Pre–test. In between the lecturing, instructor asked questions to check the understanding of students. At the end of the discussion, students was given a Post test.
Intervention group
- Total duration of both session was1.5 hours. At the beginning all students were given Pre–test. All 14 students in the intervention group were given a patient related case one week prior to the scheduled class; simultaneously students were instructed to search background material/ literature related to the case. At the end of the discussion, students were given a Post test.
Content of Pre and Post test
Session 1 Pre test was comprised of 15 Multiple Choice Questions (MCQs).
Session 1 Post test: same as the pretest question.
Session 2 Pre test was comprised of 15 Multiple Choice Questions (MCQs).
Session 2 Post test: – same as the pretest question .
RESULT
Descriptive statistic is used to analyze the feed back of the students to see the effectiveness of two different strategies. 71% of the participant of case based group verses 78% of the participants of lecture group suggested that objectives were achieved. 28% of tutorial group and 35% of the lecture group suggested that content was understandable. Independent sample T test was used to observe the differences among the group. Two tailed P value is 0.15 showing that there is no statistical significance difference between groups (case based method and lecture groups).
DISCUSSION
The use of case based small-group discussion activities appeared to meet the educational objectives in creating an active, non-threatening learning environment, where students can freely question, share knowledge and learn from one another. Group participation appears to be valued as an enjoyable process as well as increasing motivation and responsibility.
Our findings are consistent with the literature which shows that the learners need to engage in active learning experiences in order to understand the concept. (Volpe,2002). But on the other hand the draw back of this strategy is that every student should come prepare with their literature and if they do not, they will not get the proper knowledge and correct information. Hence, their learning will be compromised.
One of the studies has been done to compare the effects of the problem-based learning (PBL) method with the traditional lecture method on learning in the cardio-respiratory nursing section of the Adult Health Nursing course. Nursing program in Korea shows that level of learning in PBL group was significantly higher than that of students in the lecture group (t=2.007, p=.045). All PBL students with higher and lower grades showed a significant increase in the posttest score. But in the lecture group, only students with higher grades showed a notable increase. Where as the findings of our study is inconsistent with the study .Result of case based group verses lecture group did not show any major difference. Which reveals that both strategies could be equally utilized in order to teach pediatric course in nursing.
The preference of our student is that they want lecture because their perception is that they get correct information and learning from teachers rather than from colleagues. Although the traditional lecture conveys factual information very well, it is not well-suited to the higher levels of learning; critical thinking, analysis, and problem-solving must be learned by doing. Moreover, research has shown rather that students frequently forget, or never learn, much of the material taught through lectures.
Our case based group appreciated that strategy because it give them the opportunity to do the self directed learning .They suggested that if case based strategy is applied to teach pediatric, at the end of the session there should be some discussion regarding the case, so the student can well understand the topic and it will help them to attempt question in the exam also.
CONCLUSION
The case based small-group discussion activities with pediatrics course appear to have allowed the opportunity for active learning. Students work hard to learn by their own or by the group members in the group. Cases encourage learner to reach a deeper understudying of concepts and issues than they would from just reading or listening to a lecture. How ever this type of strategy is well suited for that student who has well understood the case and well equipped with the knowledge, on the other hand lecture could also be utilize effectively if not taught in traditional way.