Innovative Teaching Learning Methods for Health Professional Educators – Experiences Shared by Participants during an Online Learning Forum

Background: There is a need to introduce self-styled innovative teaching learning (TL) methods to make class room or bed side teaching more interesting for medical graduates. Methods: This research work show cases the experience shared by 26 FAIMER fellows who participated in a Mentor-Learner (ML) web discussion on self-styled innovative TL methods. Selfstyled TL methods conducted earlier either in large or small group setting were shared by the participants. Results: Self-styled T-L methods in the large group settings involved group activities and usage of different teaching modalities. It improved the attention span of students. Self-styled T-L methods implemented in the small group settings improved group discussion. Students felt benefitted by learning from one another. These sessions helped in better retention of facts and the setting favoured easier clarification of doubts from the facilitators. Assessment methods were used more in small compared to large group settings. Challenges involved during preparatory stage and inability to bring about universal student participation during implementation stage of various suggested methods were experienced by most facilitators in both types of setting. Majority of the methods could not touch beyond the “Cognition” component of the Miller’s Pyramid of Assessment. Conclusion: Effective implementation of self-styled methods require good pre-planning and a wellsupported feedback/evaluation process during the post implementation phase. It is also recommended to introduce innovative TL methods which strengthens the “Behaviour” component of the Miller’s Pyramid of Assessment at various teaching institutions.


Introduction
Medical schools need to periodically update their teaching learning (TL) methodologies so as to ensure that classroom TL experience is an interesting experience for the students. In order to avoid the learning experiences in classrooms from becoming monotonous, there is a need to redefine it by introducing innovative TL methods.
This would further validate the principle of learning and reaffirm that students learn best Dr. Nitin Joseph, Associate Professor, Member of Medical Education Unit, Department of Community Medicine, Kasturba Medical College, Light House Hill Road, Mangalore, Manipal Academy of Higher Education, Manipal, India. Email: drnitinjoseph@gmail.com when they see, listen, and do an activity simultaneously.
There is a need to tap information on several such innovative TL methods implemented by academicians during their teaching experiences so as to replicate the same at various professional colleges.
Listserv based discussions serve an excellent platform for discussion on innovative TL methods and other important issues concerning medical education among academicians placed in different parts of the world. This research work is the scholarly report of one such discussion on experience DOI: http://doi.org/10.4038/seajme.v14i2.224 sharing of self-styled TL methods by the participants.

Methods
These asynchronous online discussions took place using the listserv hosted by PSG FAIMER Regional Institute, Coimbatore, India. It was held in 2015 during the last week of December. The participants were of a varied back ground i.e. from Medical, Dental, Nursing and Physiotherapy sciences based in India and abroad. They were invited to share their experiences, perceived benefits and challenges, regarding any self-styled innovative TL methods implemented by them, in large or small group setting in the past. Participants were given the opportunity to share from others' (colleagues/ friends) experiences too.
Identification of the immediate learning needs of learners just prior to the start of the discussion was done using survey monkey. Even questions on perceived barriers in relation to the topic of discussion was part of the survey. This was found to benefit participants in a previous online discussion moderated by Dongre et al., (2010).
The moderators had a separate channel of communication using WhatsApp.
The key challenge in ML web discussion was to maintain an optimum level of online participation. Therefore to encourage active participation in this web discussion, the moderators sent frequent reminders through phones and emails to the non-participants.
To maintain the enthusiasm of the participants and to encourage their contribution throughout, a case scenario with fictitious names were framed in the present web discussion, as also done by Ladhani et al., (2011) in a previous online discussion.

Results
A total of 26 participants took part and a total of 103 mails related to the topic of discussion were posted in the listserv during the week.
The various self-styled TL methods narrated by the participants is presented in Table 1.
Majority of the self-styled large group TL methods involved usage of multiple teaching modalities and multiple activities, with the aim of increasing attention span of the students.
The multiple teaching modalities which were used were videos, power point slides and flash cards. The multiple activities involved case based learning, open book evaluation, framing of problem based reasoning type of short answer questions and solving of picture based case scenario stems by the students. However, a common challenge faced by the facilitators, in spite of using multiple activities in sequence during large group teaching was, inability to involve all the participants. Moreover ensuring availability of teaching aids like video lectures for all the topics and of flash cards for all the students, required good amount of preparation during the preimplementation stage. Assessment methods were observed to be minimal in large group setting. Another important drawback of these large group TL methods were that it could not touch beyond the "Knows" and "Knows how" level of the Miller's Pyramid of Assessment.
Majority of the self-styled TL methods in small group setting were directed towards integrated teaching of basic sciences with clinical and applied sciences. Factors which favoured learning process in this setting was learning from one another, better clarification of doubts from the facilitators and better retention of concepts. Few of these small group TL methods touched the "Shows how" level of Miller's Pyramid of Assessment. This included "Triangular model" to teach Anatomy and "Role play in Orthopaedics". Only two models namely, "Integrated teaching with early patient encounters" and its reverse model touched the "Does" level of Miller's Pyramid of Assessment by involving real patient for teaching medical undergraduates. Challenges identified with respect to prior preparations in small group setting were, in areas such as, faculty coordination, patient availability, drafting of case scenarios and framing suitable questions. Moreover in small group teaching, requirement of prior preparation by the participants for the exercise, played a crucial role in the success of the model.
For active participation of silent students and for further improvisation of any newly implemented T-L method, taking feedback from students soon after the session was suggested by few fellows. This along with private conversation and counselling were the other suggested remedies for helping demotivated students. Helped them in career building process.

Discussion
The collective and collaborative learning opportunities offered through this discussion might have helped the participating fellows in framing newer innovative TL methods at their respective institutes. However it was observed that only few methods could go beyond the "Cognition" component of the Miller's Pyramid of Assessment. To touch the "Behaviour" component under Miller's Pyramid of Assessment, it is necessary to introduce TL methods at teaching institutions which strengthens the "Shows How" and "Does" levels.
Competency based medical education (CBME) in the recently revised medical curriculum by the Medical Council of India (2017) supports the need to introduce more such innovative TL methods in medical education.

Conclusion
The various self-styled TL methods implemented by the participants addressed several short comings in the current medical education system. However, effective implementation of self-styled methods require good pre-planning and a well-supported feedback/evaluation process during the post implementation phase. It is also recommended to introduce innovative TL methods which strengthen the "Shows How" and "Does" levels under "Behaviour" component of the Miller's Pyramid of Assessment at various teaching institutions.
Archana A. Dharwadkar, Dr. Anila Mathews, Dr. Girija Sivakumar and Dr. Rukmini MS and all the participants for their valuable guidance, active participation and continuous support throughout the preparatory and discussion phase. I also express my gratitude to Dr. Thomas V Chacko, Director, PSG FAIMER Regional Institute, Coimbatore, India for his constant support, guidance and encouragement throughout this fellowship programme.