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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 21  |  Issue : 2  |  Page : 74-79

Does pre-lecture Whatsapp intervention; enhance the knowledge of medical students in Clinical Microbiology?


Department of Microbiology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India

Date of Submission25-May-2019
Date of Decision24-Oct-2019
Date of Acceptance29-Nov-2019
Date of Web Publication17-Jan-2020

Correspondence Address:
Dr. Ragini Ananth Kashid
Department of Microbiology, BGS Global Institute of Medical Sciences, No. 67, BGS Health and Education City, Uttarahalli Main Road, Kengeri, Bengaluru - 560 060, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacm.jacm_9_19

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  Abstract 


INTRODUCTION: The most common method used to teach Clinical Microbiology is lecture. Lectures may not be interactive and interesting. Hence, the facilitator has to adopt newer teaching methods. WhatsApp is an interactive and interesting method to enhance medical education. Therefore, we decided to evaluate the effect of WhatsApp teaching, on the knowledge gain, in medical students.
OBJECTIVE: To assess the knowledge gain, in medical students, using WhatsApp for teaching.
METHODOLOGY: With institutional ethical committee approval taken, 146 medical students, who had smartphones and were using WhatsApp, were included in this study. By simple random sampling, an interventional study was conducted, by dividing them into two groups. The students in the intervention group (n = 73) were primed through WhatsApp, before the lecture session. The students in the control group (n = 73) attended the lecture, without prior exposure to the WhatsApp session. Ten pre- and post-lecture multiple-choice questions were given to both the groups. For the next lecture, crossover of the groups was done.
RESULTS: 71.23% and 76.71% of the students in Group A and Group B, respectively, participated in the WhatsApp group discussion. In Session 1, the median score of pre-test of Batch A (intervention group) was 5 and Batch B (control group) was 4. The median score of post-test of both Batch A and Batch B was 7. In Session 2, the median score of pretest of Batch A (control group) was 4 and Batch B (intervention group) was 5. The median score of post-test of both Batch A and Batch B was 9.
DISCUSSION: The percentage increase in knowledge, after the lecture, was statistically significant (P < 0.001). It is similar in both the Groups (A and B), in both the Sessions (1 and 2). This means that the control group (unexposed to the WhatsApp intervention) has also done well in the post-test. This is attributed to the lecture and not to the WhatsApp intervention.
CONCLUSION: Although WhatsApp has several technical advantages, it has not contributed to the knowledge gain in the medical students.

Keywords: 2nd-year medical students, knowledge gain, pre- and post-lecture multiple-choice questions, WhatsApp intervention


How to cite this article:
Kashid RA. Does pre-lecture Whatsapp intervention; enhance the knowledge of medical students in Clinical Microbiology?. J Acad Clin Microbiol 2019;21:74-9

How to cite this URL:
Kashid RA. Does pre-lecture Whatsapp intervention; enhance the knowledge of medical students in Clinical Microbiology?. J Acad Clin Microbiol [serial online] 2019 [cited 2020 Feb 27];21:74-9. Available from: http://www.jacmjournal.org/text.asp?2019/21/2/74/276127




  Introduction Top


Didactic lecture is the most common traditional, teaching learning (T-L) methods used to teach Clinical Microbiology, to 2nd-year medical students. However, didactic lectures are not necessarily interactive and may fail to arouse interest among the students. Therefore, there is a need for the facilitator to make the lecture sessions more interactive and interesting. To do this, the facilitator has to adopt one or more T-L methods. In the recent years, the introduction of WhatsApp has changed how we communicate in our day-to-day life.[1],[2],[3],[4] There are a few studies which claim that WhatsApp can be an interactive and interesting T-L method for imparting medical education. WhatsApp will encourage active participation between students and facilitator.[5] WhatsApp has the advantage of sharing images, videos, text and voice messages. It can support interaction of up to 256 group members. It can be used on different devices and operating systems and is free of cost.[6] In our department, we had never used any form of social media to teach Clinical Microbiology. Therefore, we decided to use WhatsApp, as a new T-L method, to teach Clinical Microbiology, to assess its effect on the knowledge gain in 2nd-year medical students.

Objective

  1. To compare the knowledge gain, using a pre- and post-lecture, multiple-choice questions (MCQs)-based test, in the 2nd-year medical students, taught with WhatsApp and traditional lecture (intervention group) and traditional lecture alone (control group).



  Methodology Top


This study was done in BGS Global Institute of Medical Sciences (GIMS), Bengaluru, in August 2018. This medical college campus has free Wi-Fi. The institutional ethical committee (IEC) was approached for the necessary permission to conduct this study. The IEC reference number is BGS GIMS/IEC/533/2018-19. We conducted an orientation programme to inform the students about this Whatsapp study. We also appraised them about online etiquette and discussed how to search for articles, online study material and the various online learning resources that are available for learning Clinical Microbiology. Only those students with a smartphone, who use WhatsApp and who are willing to participate in the study were included in the study. Informed consent was obtained from the 2nd-year medical students, before the start of the study. The entire batch (n = 146) was divided into two groups (A and B) by simple random sampling, done by draw of lots. The Group A (intervention group, n = 73) was taught with WhatsApp and traditional lecture. The Group B (control group, n = 73) was taught by traditional lecture alone. A facilitator was provided to each of the groups. The facilitator moderated the activities of the group and kept the group focused on the learning objectives. Two days before the scheduled lecture session, the intervention group received study material in the form of case scenarios, relevant pictures, videos, articles, etc.

For Session 1, the morphology, classification, types of Polio virus, antigens, culture, cytopathogenic effects, clinical features, pathogenesis and laboratory diagnosis of Polio were covered. The students were appraised about the learning objectives for Session 1. The students in the Group A (intervention group) were encouraged to search for study material, before they post their answers/comments on the WhatsApp group. The students' comments were noted down, as their acknowledgement and interaction, in response to the study material posted.[4],[5],[6] Group B (control group) received learning objectives for that session, on the day of the lecture. Before the lecture, both the groups (A and B) received 10 pre-lecture MCQs, which the students had to fill in and hand it over to the facilitator. The scheduled lecture on Polio (Part 1) was conducted for both the groups (A and B) on the same day, in a single session and 10 post-lecture MCQs were administered to both the groups.

To assess the effect of WhatsApp on the knowledge gain in students, pre- and post-lecture MCQs (ten questions in each) was given to both the groups. The pre- and post-lecture MCQs were prepared by the facilitator and were peer reviewed by other faculty members, before it was administered to the students. The student answers were noted and the average score of each group was calculated. The average score of the Group A (intervention group) was compared with that of the Group B (control group) [Figure 1].
Figure 1: Schematic representation of methodology

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For Session 2, crossover of the groups was done and the same methodology followed. In Session 2, 2 days before the scheduled lecture session, the students in Group B (intervention group) received the learning material on their WhatsApp group. The content including learning material on immunity in polio, importance of breast feeding in polio, history and preparation of polio vaccines, advantages and disadvantages of Polio vaccines was shared on the WhatsApp group. The facilitator moderated the learning activity and also made a note of the students' answers, comments and interaction. The scheduled lecture on Polio (Part 2) was done for both the groups. The students in Group B (intervention group) and Group A (control group) were given pre- and post-lecture MCQs pertaining to the topic discussed. Their responses were noted and scores were given.

Statistical analysis

Data were entered into Microsoft excel data sheet and were analysed using SPSS version 22 (IBM SPSS Statistics, Somers NY, USA). Categorical data were represented in the form of frequencies and proportions. Chi-square test was used as test of significance for qualitative data. Continuous data were represented as mean and standard deviation. Mann–Whitney U-test was used as test of significance to identify the mean difference between two qualitative variables. Wilcoxon signed-rank test is the test of significance for paired data such as pre- and post-test for qualitative data.

Graphical representation of data

MS Excel and MS Word were used to obtain various types of graphs such as bar diagram..

Statistical software

MS Excel and SPSS version 22 ( IBM SPSS Statistics, Somers NY, USA) were used to analyse the data.


  Results Top


In our study, of the 150 students, 146 (97.33%) students had smartphones, were already using WhatsApp and gave consent for the study. The remaining 4 (2.66%) students did not have a smartphone and hence did not participate in the study.

In Batch A, 45.9% were males and 54.1% were females. In Batch B, 38.9% were males and 61.1% were females. There was no significant difference in the gender distribution between Batch A and Batch B. This ensures gender matching in the study [Table 1] and [Figure 2].
Table 1: Sex distribution comparison between two batches

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Figure 2: Bar diagram showing sex distribution comparison between two batches

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In Group A (n = 73), 71.23% (52/73) students participated in the pre-lecture WhatsApp teaching. 29% of students did not participate in this study. This is because they were not interested in the topic.

A total of 179 posts were received in the WhatsApp teaching group. Of the 179 posts, 85 posts were images, 78 posts were text messages, and 16 posts were videos that were posted by the students in the WhatsApp group.

In Group B (n = 73), 76.71% (56/73) students participated in the pre-lecture WhatsApp teaching. A total of 266 posts were received in the WhatsApp teaching group. Of the 266 posts, 175 posts were text messages, 81 posts were images, and 10 posts were videos that were posted by the students in the WhatsApp group.

  • In Session 1, the median score of pre-test of Batch A (intervention group) was 5 and Batch B (control group) was 4. After the scheduled lecture, the median score of post-test of both Batch A and Batch B was 7
  • In Session 2, the median score of pre-test of Batch A (control group) was 4 and Batch B was 5 (intervention group). After the scheduled lecture, the median score of post-test of both Batch A and Batch B was 9 [Table 2] and [Figure 3].
Figure 3: Bar diagram showing median scores comparison, between the two batches, at Session 1 and Session 2

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Among Batch A (intervention group) students, the median pre-test score was 5 and median post-test score was 7. There was significant increase in scores at post-test in Session 1. Percentage increase in scores at post-test was 28.5%.
Table 2: Median scores comparison between two batches at Session 1 and Session 2

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Among Batch A (control group) students, in Session 2, the median pre-test score was 4 and median post-test score was 9. There was significant increase in scores at post-test in Session 2. Percentage increase in scores at post-test was 55.5% [Table 3] and [Figure 4].
Table 3: Median scores comparison within Group A, pre-test versus post-test in Session 1 and Session 2

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Figure 4: Bar diagram showing median scores comparison within Group A students, pre-test versus post-test in Session 1 and Session 2

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Among Batch B (control group) students, in Session 1, the median pre-test score was 4 and median post-test score was 7. There was significant increase in scores at post-test, in Session 1. Percentage increase in scores at post-test was 42.8%.

Among Batch B (intervention group) students, in Session 2, the median pre-test score was 5 and median post-test score was 9. There was significant increase in scores at post-test in Session 2. Percentage increase in scores at post-test was 44.4% [Table 4] and [Figure 5].
Table 4: Median scores comparison within Group B, pre-test versus post-test in Session 1 and Session 2

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Figure 5: Bar diagram showing median scores comparison within Group B students, pre-test versus post-test in Session 1 and Session 2

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  Discussion Top


Through the ages, Clinical Microbiology has been conventionally taught by lectures. It is economical and effective and has stood the test of time.[7],[8],[9] The learning needs of the medical students are changing. They are more tech savvy and their attention span is low.[10] There is a need to incorporate changes, in the way Clinical Microbiology is taught, so as to make it interesting and interactive. To do this, the faculty has to adopt one T-L methods, where the students feel involved, in the learning process. WhatsApp has been identified as one of the platforms for e-learning, which is both interactive and interesting. It has been observed that WhatsApp improves the interaction between students and teachers, both for learning and motivation.[1]

WhatsApp is very popular among students and teachers alike as it has very low cost and is accessible at any place and at any time, used in English (which is the preferred medium of instruction) and few other languages, ease with which data can be sent and received at high speed.[11] In our study, 97.33% of the students used WhatsApp. The medium of instruction in our study was English. It works across geographical barriers and can connect students and faculty, across the world. Compared to the conventional classroom teaching, it was observed that the students were more forth coming in sharing and discussing on the topic.

In this study, we wanted to assess whether WhatsApp teaching can contribute to knowledge gain in the medical students who are learning Clinical Microbiology.

To begin with, both the groups (A and B) were matched well for the male and female genders [Table 1]. With regard to the students' participation, it was observed that Group B (76.71%) had more participation than Group A (71.23%). This could probably be because, by the time, Group B was taken up for WhatsApp teaching, there may have been communication among participating students that it is interesting to participate in the WhatsApp teaching group. This could also be the reason why we observe, more number of posts in Group B (266 posts) than in Group A (179 posts). In Group A, 29% of the students had not participated as they were not interested in the topic. In this study, WhatsApp T-L was to be a voluntary one; therefore, such students who are not interested will miss out on the learning. If the WhatsApp T-L was associated with marks (which will be considered for examinations), then probably we would see more participation from the students.

In this study, we observed that the number of posts were high, which is challenging to read both for the students and for the facilitator. Barring a few repetitive posts, the content of the posts were relevant and accurate to the topic. In WhatsApp T-L, if the students do not post adequate number of posts, then it is the facilitator's responsibility to motivate the students to contribute to the posts. If this too does not work, then the facilitator has to contribute to the posts.

  1. In Session 1: The knowledge gain (pre-test) in Group A was higher than Group B [Table 2] and [Figure 3]. However, after the lecture, the knowledge gain (post-test) in both the groups was similar [Table 2] and [Figure 3]
  2. In Session 2: The knowledge gain (pre-test) in Group B was higher than Group A [Table 2] and [Figure 3]. However, after the lecture; the knowledge gain (post-test) in both the groups was similar [Table 2] and [Figure 3].


The percentage increase in knowledge (post-test) after the lecture is similar in both the groups (A and B), in both the sessions (I and II). This means that the control group, which was not exposed to the WhatsApp intervention, has also done well in the post-test [Table 3], [Table 4] and [Figure 4], [Figure 5]. This is attributed to the lecture and not to the WhatsApp intervention. Therefore, in this study, WhatsApp has not contributed to knowledge gain. This finding is similar to the studies conducted by Gon and Rawekar, Bansal and Joshi and Alkhalaf et al.[6],[12],[13],[14]

In a study conducted by Arnbjörnsson it was observed that social media had no significant impact, on enhancing the learning process.[11] In a study conducted by Yeboah and Ewur, it was observed that WhatsApp had a negative impact on the performance of the students. It was also observed that WhatsApp was a source of distraction as students were not able to balance their online activities and academic activities.[13] In this study, although WhatsApp did not contribute to knowledge gain in the medical students, the availability of round the clock facilitator, limitless accessibility to videos, images and voice messages make WhatsApp an interesting method, to supplement conventional method of teaching.[15],[16],[17],[18],[19]

Limitations

The availability of an uninterrupted, free Wi-Fi in the campus is a challenge. Not all students can afford smartphones. The facilitator should motivate the students more often, to ensure that all students participate. Flooding of too many messages, not able to reply to each student, on a one-on-one basis and a potential for distraction are some of the challenges that were observed during this study. Lack of interest towards the topic and lack of knowledge about this topic are the reasons why few students did not participate in this study.


  Conclusion Top


WhatsApp has several technical advantages and helps in communicating with the students, anytime, anywhere. It can be used to supplement conventional methods of T-L. However, from this study, we conclude that using WhatsApp as a T-L method, it does not contribute to knowledge gain.

Acknowledgement

I would like to thank the Managing Director of BGS Group of Institutions Sri Sri Dr Prakashnath Swamiji for the encouragement he gives to research. I would like to thank our dynamic Principal Dr M.E. Mohan Sir for giving all the support required to conduct this study. I would like to thank the MEU team members and the Microbiology staff at BGS GIMS. I am grateful to all the medical students who participated enthusiastically in this study. I wish to convey my heartfelt gratitude to my mentors, Dr Nachiket, Dr Suneetha Lobo, Dr Farah, from the MEU team at St. John's Medical College and Hospital, for all their valuable inputs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Arnbjörnsson E. The use of social media in medical education: A literature review. Creativ Educ 2014;5:2057-61.  Back to cited text no. 11
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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