A NEED-BASED ANALYSIS TO DEVELOP A CURRICULUM FOR THE SUBJECT OF RESEARCH METHODOLOGY AND BIOSTATISTICS FOR POSTGRADUATE HOMOEOPATHY STUDENTS

Devangini Broker, _{MD (Hom)}^1*
Prashant Tamboli, _{MD (Hom)}²

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¹ Assistant Prof, Department of Repertory and Senior Research Fellow, Department of Research

²  Associate Prof, Department of Repertory and Head, Department of Research,

Dr. M. L. Dhawale Memorial Homoeopathic Institute (MLDMHI)

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*Address of correspondence: Dr Devangini Broker

Email: devangini.broker@gmail.com

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How to cite this article:

Broker DR, Tamboli PP. A Need – based analysis to develop a curriculum for the subject of Research Methodology and Biostatistics for postgraduate Homoeopathy students. Journal of Integrated Standardized Homoeopathy (JISH) 2018; 01(02):

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Received on: December 20, 2018

Accepted for Publication: December 26, 2018

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Introduction:

Medical research is primarily disseminated through publications. Recent studies of MBBS undergraduates in India have shown that 81.7% students felt that knowledge of research was essential to understand and improve their clinical knowledge. However, only 20.9% of the students had actually published anything.¹ The numbers further reduce when it comes to the Homoeopathy stream of medicine. The Central Council of Homoeopathy (CCH) and Central Council of Research in Homoeopathy (CCRH) have been promoting research in academic institutions. For most postgraduate (PG) students, their dissertation is the first formal research they conduct to learn their subject in depth and apply scientific research methodology. To establish knowledge of research, the CCH has introduced a full paper on Research methodology and Biostatistics (RMB). The Maharashtra University of Health Sciences (MUHS) is additionally stipulating a basic RMB workshop for all postgraduate students and teachers². Despite such concerted efforts, students’ performance in the formal assessments conducted by the MUHS in the past few years indicated that the competency was far below the desired level. Many teachers in different forums have also shared that students are not applying the learnt knowledge of RMB in their dissertations. It is important to understand the reasons for the discrepancy in the expectation and performance. A useful starting point would be to identify the gap between the university syllabus, the perception of the Homoeopathy students for studying the subject, the perspectives of the teachers, and the facilities available in the colleges. Understanding this may help to devise a student-centric curriculum of RMB.

Worldwide, teaching is focusing more on a student-centred approach rather than a traditional teacher centred one.² To formulate the curriculum, assessing the needs is the first step.³ There is no stable concept of need despite its extensive application in curriculum development.⁴ Specialists like Mattimor and Knudson have used alternative terms such as situation assessment and situation analysis, whereas other specialists like Kliaton believed that the term needs must be deleted from the literature of education. The National Health Services’ development plans for healthcare professionals describes that learners needed to feel a necessity to learn and that identifying one’s own learning needs was an essential part of self-directed learning.⁵

Kourosh – a faculty of education has introduced multiple definitions of needs as a want or preference – need is more subjective as it is based on one’s view point. It is criticized as it may happen that the people are often not aware of their real needs. The second aspect is needs as a deficit or as a problem – the definition is referred as problem – approach. The third concept can be needs as a gap or as a discrepancy. In this survey research, needs is considered as the discrepancy between the present situation and the ideal situation.⁵ Kaufiman defines needs as a gap between current outcomes and expected outcomes. The latter definitions mesh well with Kern’s concept of general needs assessment and the needs assessment of targeted learners & Grant’s view point. Grant shares another aspect, reflection on action and reflection in action, which focuses on what was done well and what could have been done better with self-assessment and peer review. This category indicates the learning needs. The other aspect of need is critical incident review and significant event auditing, which helps to identify the competencies of a profession or for quality assurance.⁶ Despite different definitions, one should use the appropriate situational approach in connection with their application.

Questionnaire and structured interviews seem to be the most commonly reported methods of needs assessments; such methods are also useful for evaluation and revalidation.⁶ The main purpose of the needs assessment must be to help educational planning and hence the focus of the questionnaire should be widened. Macdonald shares different components of apprenticeship clinical learning in postgraduate training. Learning by doing is the most suitable method for mastering research and biostatistics, as it involves the experience of working on projects and using the knowledge and skills in practice.⁶

In this study, need assessment was considered a gap discrepancy and was, to some extent, reflected in the questionnaire responses of the students and guides / teachers.

 

Aim:

To develop a curriculum for the subject of RMB for PG studies in Homoeopathy

Objectives:

1. To understand the challenges faced by PG Homoeopathic students in learning the subject of RMB
2. To estimate the challenges faced by PG Homoeopathic teachers in teaching the subject
3. To assess the type of learning environment provided by the colleges for teaching-learning in the subject
4. To summarize the issues identified through appropriate analysis
5. To enlist the recommendations helpful for developing the curriculum

Materials and methods:

Research Type & Design: The study was planned as a cross-sectional survey. The data was collected as per the devised self-administered questionnaire form for PG students and teachers.

Sample: Five PG Homoeopathic colleges functioning under the aegis of MUHS were randomly selected. A survey was conducted among students who had completed at least 6 months of learning the subject. The institutional ethics committee approved the study. Consent was taken from the principals of the participating colleges. A total of 90 students (18 per college) and 25 guides/teachers (5 per college) voluntarily participated.

Sampling Technique: Probability and the cluster sampling method were used for selecting the colleges. All the PG students and available teachers from the selected colleges participated in the survey.

Inclusion Criteria:

1. PG students who had completed at least 6 months of learning RMB
2. PG students who had appeared for a university exam on RMB
3. Recognized teachers of the subject/ guides from the selected PG Colleges.
4. The teachers / guides / students who had undergone the training Basic Research Methodology workshop

 

Flow of Execution of Research:

The institutional ethical committee’s permission was taken before commencing the work. A self-administered pilot questionnaire was formulated for stakeholders. Participants were selected as per the inclusion criteria by following the abovementioned sampling technique. To maintain uniformity, a researcher visited each college to conduct the survey. Data analysis was performed using frequency distribution and summarization technique.

Design of Self – administered Questionnaire form:

Two separate questionnaires for teachers/ guides and students were prepared covering the following points:

• Teachers’ and students’ experiences of teaching and learning the subject of RMB, respectively.
• Teaching methodology employed by the teachers and students’ expectations from the teacher
• Perceived stress amongst students regarding learning RMB
• Teachers’ expectations of students applying learning of RMB in their dissertations
• Desirable assessment pattern for RMB
• Teachers’ and students’ suggestions for changing the syllabus

Observations and Results:

Descriptive statistics were prepared using mode and co-relation between two variables by calculating Spearman’s correlation coefficient. Statistical analyses were performed with IBM SPSS (Statistical Package for the Social Sciences) version 24.0. All the tests were two-sided with alpha 0.05.

a. Teachers’ experience of Teaching / Guiding & Students’ experience

The guides supervise students for their research project / dissertation for an average of 6.97 ± 4.86 years. Out of 25 guides, only 4 have been teaching RMB for an average 1.44 ± 3.4 years. All the guides have attended the RMB training workshop organized by MUHS. Unfortunately, 95% of the students have not grasped the basic principles of research.

b. Teaching Methodology and Students’ expectations:

Only 20% of the teachers answered these questions. The majority followed one text book and explained the concepts to the students. However, they clearly indicated the challenges they face while teaching RMB, which are listed in Table 1.

Table 1: Difficulties experienced by guides while guiding / teaching research methodology and biostatistics to the students

	Response
Unavailability of books for explaining Homoeopathic examples	12 (42%)
Students’ approach to the subject	7 (24%)
No clarity – correlation of research with Homoeopathy	4 (14%)
Low interest in teaching the subject	2 (7%)
Limited resource faculty for guidance	2 (7%)
Difficulty in demonstrating the practical utility	1 (3%)
Exam Pattern	1 (3%)

The student survey yielded elaborate answers on the methodology adopted by the teachers while teaching this subject. These are listed in Table 2

Table 2: Various teaching learning methods currently adopted for teaching the subject: students’ view points

	Response
Only theoretical lectures	28 (25%)
Demonstrating theory with medical examples & medical examples for calculating statistical tests	24 (22%)
Demonstrating theory with medical examples & Homoeopathic examples for research methodology	20 (18%)
Giving Homoeopathic examples for research and biostatistics	15 (14%)
Giving Homoeopathic examples for research & biostatistics using past dissertation	11 (10%)
Practice of sums using Homoeopathic examples	8 (7%)
No response	4 (4%)

 

c.Students’ Expectations:

In the current scenario, 35% lectures are taken by Homoeopathic teachers and 65% by statisticians. The teaching plan is 4-8 hours a week or once in 2 weeks; 69% discuss the objectives of the session, 51% give assignments, and 53% give handouts for reference. Students expect more Homoeopathic examples and more hands-on experience of understanding researches conducted on the basis of Homoeopathic philosophy. A good 49% of students feel stressed due to unavailability of Homoeopathic books on the subject.

d. Students’ perceived stresses for learning RMB:

Figure 1. The percentage of students who experience stress while studying RMB

Table 3. Reasons provided by students for having stress while studying RMB

Reasons	Response
Fear of mathematics	40 (24%)
No clarity of why to learn the subject	24 (14%)
Limited time to study	24 (14%)
No practical utility of the subject	19 (11%)
Limited resource of faculty for guiding & solving doubts	17 (10%)
Exam pattern	14 (9%)
Taught the subject without giving Homoeopathic examples	13 (8%)
Appearing for exams in a short time	9 (6%)
Unavailability of the books explaining Homoeopathic examples	7(4%)

 

Fear of mathematics is undoubtedly the most predominant reason for the stress. Another category is of those students who either feel that they do not have clarity for learning this subject or there is no practical utility.

Statistical analysis:

The data has been analysed to understand the influence of these reasons on the application of knowledge. The Mann-Whitney U test was applied; the U value is 537. The p value is 0.00014, which is statistically significant. The indicates that these factors reduce the application score i.e., the students’ ability for applying RMB knowledge in their dissertations.

e. Teachers’ expectations for students applying learning of RMB in their dissertation

Figure 2: Teachers’ / Guides’ expectations from students for applying the learned knowledge in dissertation

 

Figure 3: Scatterplot graphical representation of the effect of Teaching Learning Method on application of the subject knowledge in future

 

Statistical Analysis:

Spearman correlation coefficient (rho) = 0.33. The two-tailed value of p is 0.00093. This shows a positive statistically significant correlation between two variables.

f. Assessment pattern for RMB

Figure 4: Multiple bar graph representing the guides’ perceptions for the assessment pattern for the subject

Figure 5: Multiple bar graph representing the students’ perceptions regarding the current assessment pattern of examination

 

g. Teachers’ perceptions about the current syllabus along with the students’ suggestions for change in the syllabus

Figure 6: Multiple bar graph representing the guides’ perception for the RMB syllabus and devising the curriculum

Figure 7: Pie graph representing guides’ suggestion on the teaching – learning method required to teach the subject

Table 4: Guides’ suggestions on inclusion of new modules in the curriculum planning

	Response
Planning dissertation	14 (23%)
Writing protocol / synopsis	10 (16%)
Literature search	10 (16%)
Writing scientific articles	10 (16%)
Research aptitude	9 (14%)
Data collection process	8 (13%)
Not needed	1 (2%)

 

Discussion:

1. Teaching Facilities:

Based on our findings, we can understand that colleges have made arrangements for the statisticians along with Homoeopathic teachers to teach this subject, which is considered beneficial by the guides and students. While planning the curriculum, both the teachers can be part of the teaching schedule, which will further enable integration of the Homoeopathic aspect in RMB. Most colleges spend 4-8 hours weekly or once in 2 weeks teaching the subject, which is sufficient for input, as it has been observed that students can apply the learning in practice of research.

 

1. Teaching methods for RMB thus increasing application of learned RMB

The currently adopted lecture method, as mentioned in Table 2, is considered primarily theoretical. However, the practicality of the lectures may be enhanced by providing Homoeopathic or medical examples through handouts and practice of sums. If this method is followed, students feel that they can apply the learned theory in subsequent projects or dissertation. However, it is observed that students need more Homoeopathic examples to understand this subject more clearly. However, teachers find it more challenging to give Homoeopathic examples. The possible reason for this is they are not actively involved in day-to-day research activity. Figure 3 indicates that around 72% teachers expect that the students should apply this knowledge while writing their dissertation. The same Figure also clearly shows the statistically significant relationship between teaching methods and application of knowledge. Hence, there is a strong need for action-based teaching and learning. This will increase students’ experience, resulting in an increase in their application.

RMB can be better learned and taught through action. Therefore, it is most important that Homoeopathic teachers should take up small research projects to enhance their teaching skills.

 

1. Stress of studying RMB:

A whopping 69% of students perceived academic stress while learning RMB. However, among those who felt the stress, 72% felt that knowledge of research methodology helps in improving clinical knowledge and skills, while 48% feel that the knowledge of biostatistics helps them to improve these. Some teachers are using the practical approach while teaching RMB. The students who have been exposed to this teaching method are confident in the application of knowledge of RMB in their dissertations. However, it is observed that despite the efforts of colleges and the employment of theoretical lecture methods, the stress level for the subject remains the same [rho = -0.22]. This may be due to the predisposing factor of fear of mathematics among the students. One of the reasons for students to choose medicine as their stream of higher education is that they are not comfortable learning subjects where mathematics is a major component. Many statistical software programs are currently available. Therefore, proper thought must be given to how many biostatistics calculations are necessary for the student to actually perform. It is important for the student to have the knowledge of application of different statistical tests rather than knowing the actual calculations. This will definitely increase the applicability of learning of RMB by reducing the fear of mathematics.

 

1. Assessment Patterns:

The current examination pattern demands that the student should be able to write long answer questions (LAQ) integrating RMB with Homoeopathy. Students’ perception of application of this knowledge has improved, but their fear of mathematics and exam-related anxiety produces stress and the focus is reduced to merely passing the examination. Students are not aware of their needs, due to which self-directed learning is compromised⁶. Both students and guides feel that the existing exam pattern of short answer questions, solving mathematical problems, and application-based multiple-choice questions (MCQ) are proper assessment methods, although students are stressed due to the exam pattern. Among the students, 50% agree that LAQs constitute an adequate assessment whereas others are neutral. However, the guides agreed to bring changes in the formulation of LAQs and introducing application-based MCQs. Students might require a book on writing the answers in exams; question banks might help to reduce the stress and thus improve acceptance of the subject. Students feel there are adequate books to understand the subject of research but not its Homoeopathic application. Similar difficulty is faced by the guides and hence both agree there are limited resource faculties in Homoeopathy who can guide them.

 

1. Teachers’ and students’ suggestions for changing the syllabus and curriculum

The CCH and MUHS have given syllabus in a broad way. Each college has devised the curriculum based on the syllabus. However, a clearly defined syllabus helps in developing a proper curriculum. Based on the survey findings, it is evident that the current syllabus needs some modifications. For reviewing the syllabus and identifying the issues in it, we can use our well-proven Homoeopathic concepts of causation! Issues in the syllabus can arise due to difficulties in the design, conception, and implementation. These can be seen as fundamental and precipitating factors; in other words, predisposing and enabling factors. Maintaining factors can be considered as reinforcing factors. Tables 5 and 6 clearly state these factors.

 

Table 5: Guides’ / Teachers’ perspective about issues in the syllabus

PREDISPOSING	ENABLING	REINFORCING
Lack of standard curriculum (68%) Clarity in CCH syllabus (62%) Less interest in teaching the subject (7%)	Unavailability of the books explaining Homoeopathic examples (42%) Students approach towards the subject (24%) Difficulty in demonstrating the practical utility (3%)	Limited resource faculty for guiding & solving the doubts (7%) Exam pattern (9%)

 

Table 6: Students’ perspective about issues in syllabus

PREDISPOSING	ENABLING	REINFORCING
Fear of Mathematics (24%)	No clarity why to learn the subject (14%) No practical utility of subject (11%) Taught subject without giving Homoeopathic examples (8%) Unavailability of the books explaining Homoeopathic examples (4%)	Limited time to study (14%) Limited resource faculty for guiding & solving the doubts (10%) Exam pattern (9%): Mathematical calculations, cognitive recall level, SAQ – LAQ

To resolve these issues, there is a strong need for revising the syllabus. Teachers have also provided some suggestions for introducing a few new modules, which are listed in Table 4. These will help in reducing the gap between the expectations (application of RMB in projects / dissertations) and the students’ need of learning this new subject with relatively less stress. Both students and teachers have suggested that some modifications are needed at the syllabus and the curriculum design should be based on the ‘must know’, ‘good to know’, and ‘nice to know’ phenomena. This can bridge the gap between students’ needs and teachers’ expectations.

 

CONCLUSIONS:

• There is a need for revising the syllabus.
• Focused curriculum in Research methodology & Biostatistics will be helpful in learning this subject.
• Teaching the appropriate learning methods play an important role in reducing academic stress among the students
• Correct instruction in the learning methods develop students’ confidence in being able to apply RMB in future projects/dissertations.
• Students and teachers / guides want a practical application-based curriculum
• There is a need to introduce a few new modules to make this subject more relevant, especially in terms of dissertation.

 

Note:

This study was carried out between October and December 2016. Based on the findings, suggestions for modifying the MUHS syllabus were provided to the university. The Dean of Homeopathy and the Post Graduate – Board of Studies promptly acted on the suggestions and a new syllabus was implemented by the MUHS from the academic year 2017 onward.

 

ACKNOWLEDGEMENTS:

The authors would like to express their gratitude to the principals and students of the following colleges for granting permission and to conduct the study / survey in the colleges:

• Motiwala Homoeopathic Medical College & Hospital & F. G. Motiwala PG Homoeopathy and Research Centre, Nashik
• SNJB’s Smt. K. B. Abad Homoeopathic medical college, Chandwad, Dist. Nashik
• Dr D. Y. Patil Homoeopathic Medical college & Research Centre, Pimpri – Pune
• Dhondumama Sathe Homoeopathic Medical College & Hospital, Pune
• Dr M. L. Dhawale Memorial Homoeopathic Medical Institute, Palghar

Authors are thankful  to the faculties of IMETTT, MUHS, and especially Dr Payal Bansal for providing insight into educational technology.

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