Journal of Education and Health Promotion

Abstract BACKGROUND: To motivate students toward the path of lifelong learning, it is important to train
them for a self‑directed learning (SDL) approach, where they identify the need of learning the content
as well as look forward to attaining the learning outcome, independently. The level of readiness
for SDL will allow the learner to be self‑disciplined, self‑organized, an effective team builder and
communicator, a self‑assessor, and a self‑reflector, thus being a self‑learner with the ability to accept
and give constructive feedback. The aim of the study was to develop, validate, and implement the
SDL readiness scale for health professional students.
MATERIALS AND METHOD: The readiness scale of 43 items was used in four sub‑titles (awareness,
learning strategies, and style, motivation, team building) was developed using the Delphi method with
12 experts and was implemented for the medical students at Karamsad, Gujarat as a cross‑sectional
survey after a pilot trial scale from May 2021 to September 2021, using mean, the standard deviation
for each item, and arrived sub‑titles. The ANOVA test was used to find differences in readiness
scores as per different years of the medical program.
RESULT: The result demonstrates that the maximum score was obtained for the first‑year medical
student (149.89 ± 24.72), which dropped in year 2 (136.35 ± 32.26) but increased by the final
year (147.67 ± 56.66), although not as high as the initial joining year. However, a statistically
significant difference per gender was identified for a few items of the scale [(items 24 (P < 0.034),
26 (P < 0.0005), 37 (P < 0.035), and 40 (P < 0.013)]. The logistic regression analysis showed no
statistical significance for the DSVS‑self‑directed learning readiness scale (SDLRS) score and
demographic variables.
CONCLUSION: The outcome of the study strongly suggests training/sensitization sessions for
students to highlight the importance of a SDL approach in a digital millennium. Moreover, a longitudinal
follow‑up needs to be conducted for the readiness score of the students based on the developed
scale and subsequent training sessions need to be organized for students as well as faculty for better
outcomes for the students toward SDL sessions.

Abstract BACKGROUND: Improvement of the learning in undergraduate bedside teaching needs to be
promoted through innovative interventions. Changes in the structured format (SF) for bedside case
discussion may help students improve their learning experience and gain insights into collaborative
self‑directed learning. The aim of the present study was to encourage collaborative and self‑directed
learning strategies by MBBS undergraduate students through a new case presentation format
structured for this purpose.
MATERIALS AND METHODS: This was an interventional study carried out in the year 2010–2011.
A new SF for bedside cases presentation was developed. A comparison with the traditional format
was done by holding one session in each format. Uniformity of topic and teaching style was ensured
by having the sessions on pulmonary medicine cases with the same teacher. The student perspective
of the educational process was analyzed using evaluation pro forma, Likert scale, and narratives.
RESULTS: Ninety final year and prefinal year MBBS students participated in this study. There was
significantly higher participation in history taking (50.7%) and clinical examination (60%) in the SF.
A higher statistically significant number of clinical possibilities were considered in the SF (85.3%
vs. 66.6%). Similarly, significantly higher number of students indulged in self‑directed learning and
referred to learning resources in the SF. The SF provided students an active role (96.9%), encouraged
access to resources (93.9%), and control of learning (75.7%). The additional interactive session was
productive (90.9%), discussions were streamlined (66.6%), and the role of a teacher was considered
important (75.7%).
CONCLUSION: The SF generated higher participation in the aspects of history taking, clinical
examination, and consideration of differential diagnoses. It led to a perceived improvement in
self‑directed and collaborative learning among students.

Abstract INTRODUCTION: Medical education in India is experiencing a paradigm shift from traditional
curriculum to competency‑based medical education (CBME). It de‑emphasizes time‑based training
and promises greater accountability, flexibility, and learner centeredness. Faculty development is
integral in the context of CBME. Considering faculty perceptions toward the new CBME and addressing
the difficulties will play a vital role in successful implementation.
MATERIALS AND METHODS: A cross‑sectional study was carried out among 297 teaching faculty
in 91 medical colleges across 20 states all over India between February and July 2020. A structured
validated questionnaire on CBME was used to collect the responses through Google forms and was
exported and analyzed in Microsoft Excel.
RESULTS: More than 80% opined that Faculty members in departments are not adequate for
successful CBME implementation. Reflective learning, early clinical exposure, and elective posting
were accepted by 60.2%, 70.4%, and 45.5% of the faculty, respectively. Around 81.8% welcomed
horizontal integration, whereas only 54.2% favored vertical integration during the Phase I MBBS.
CONCLUSION: Few reforms such as curtailing the duration of foundation course, sensitization of
all medical teachers through faculty development programs, better synchronized vertical integration,
increasing the strength of faculty in each department, and adequate infrastructure for skills laboratory
can be undertaken as per faculty suggestions.

Abstract BACKGROUND: The flipped classroom pedagogy allows students to introduce a topic and gather
their own meanings outside of the classroom, then explore the topic and create their meanings
or exclude their misconceptions during class. Our aim was to enhance the ability of self‑directed
learning (SDL) among medical undergraduates. Pedagogical benefits of the model are highlighted
along with potential challenges to its use.
MATERIAL AND METHODS: Kemp’s Instructional model was used to design flipped classroom.
Need analysis was done to assess the perceptions of the students on the current teaching practices
and their expectations for adoption of innovative methods. Validation of content was done by Delphi
method by subject experts across the institutions. Content included objectives; case scenarios and
extended multiple choice questions. Students were divided into two groups. Group A and Group B,
50 in each. A topic was given 1 week prior and both groups were subjected to a pretest to identify
their self‑study performance. Group A was exposed to 4 sessions of flipped classroom. They were
provided with PowerPoint slides with voice recordings. In the classroom, first 30 min was meant for
quiz and next 30 min was meant to clarify the doubts. Group B were exposed to the 4 regular lecture
sessions. Both the groups were subjected to the posttest and test after 4 weeks. Later with another
topic, flipped classroom was conducted for all the 100 students and the feedback was taken from
all the students and faculty using a validated questionnaire.
RESULTS: Posttest scores of students who were flipped were statistically significant (p < 0.001).
Most (98%) students opined that these interactive sessions evoked interest in the topic. Flipped
classroom sessions were found to be effective in improving students’ learning behavior toward SDL,
collaborative learning skills and critically analyzing the basic concepts.
CONCLUSIONS: By following a systematic process (Kemp’s instructional Model, it is possible
to design need‑based flipped classroom sessions. They are found to be effective in improving
students’ learning behavior toward deep learning, self‑efficacy, SDL, collaborative learning skills,
critically analyzing the basic concepts. In a flipped classroom, “the learning environment transforms
into a dynamic and more social space where students can participate in critiques or work through
problems in teams.

Abstract BACKGROUND: Following the COVID‑19 pandemic, the Government of India announced lockdown
from March 25, 2020, which included measures such as social distancing, canceling mass gatherings,
and closure of schools and colleges. Since the present generation of students spends a lot of time
on social media, especially WhatsApp, the utility of the same to discuss the various public health
domains of COVID‑19 through multiple‑choice questions (MCQs) was explored.
MATERIALS AND METHODS: This longitudinal study was conducted among 154
participants (undergraduates, interns, postgraduates, and teaching faculty) for 3 months. MCQs on
COVID‑19 were disseminated through WhatsApp status of the investigator, and feedback regarding
the same was taken at the end of 3 months. The activity log was maintained, and the information was
downloaded as a comma‑separated value (CSV) file and exported to MS Excel. Descriptive statistics were
applied. The location of the participants was entered into the Microsoft Excel sheet and converted into
CSV file. The Geographical data were analyzed in the Quantum Geographical information System (QGIS).
RESULTS: Among the 154 study participants, 48% were undergraduates, 10.4% were interns,
30.6% were postgraduates, and 11% were teaching faculty. Eighty‑nine percent of the participants
felt that WhatsApp can be used as a platform for discussing MCQs. 89%, 93%, and 89.6% of the
participants felt that the exercise improved their analytical skills, helped in self‑directed learning, and
improved collaborative learning, respectively.
CONCLUSIONS: Majority of the participants responded that WhatsApp can be used as a platform
to discuss MCQs and that the exercise helped in collaborative and self‑directed learning.

Abstract BACKGROUND: Stress and low psychological well‑being among students in higher education impact
their academic performance. The purpose of this study was to determine the relationship between
SOC, SDLR, and academic performance in year 3, 4, and 5 undergraduate dental students.
MATERIALS AND METHODS: Two hundred and ten students completed a validated questionnaire on
SOC and SDLR. The percentage of marks obtained by these students in their year‑end examination
was used as their academic performance. The SOC scores were further divided into three hierarchical
clusters using cluster analysis. The data were analyzed to determine the difference in the SDLR
scores and academic performance among the three clusters. Furthermore, the relationship between
SOC scores, SDLR scores, and academic performance was assessed.
RESULTS: The SDLR scores significantly increased from the low SOC cluster to the high SOC
cluster (P = 0.026). However, there was no significant change in academic performance. A positive
relationship was found between the SOC and the academic performance(R = +0.025; P > 0.05). The SDLR
had a significant positive relationship with both SOC and academic performance (R = +0.27; P < 0.001).
CONCLUSION: Although SOC may not have a direct influence on academic performance, SDLR
can play an intermediary role. Early identification and timely intervention in students with a weak
SOC and low SDLR can have a beneficial influence on their academic life.

Abstract INTRODUCTION: Medical education is tricky to imbibe and difficult to apply. Various
teaching–learning  (TL) methods have been tried from time to time to enhance the proficiency of
students. The aim was to assess the students’ perception toward three different TL methods (pedagogy,
andragogy, and heutagogy) in medical education.
MATERIALS AND METHODS: A comparative experimentalquestionnaire‑based study was done
on population of second‑year MBBS students of SMS Medical College, Jaipur, in October 2019.
They were taught topic of anticancer drugs using pedagogy, andragogy, and heutagogy methods.
Then, their opinion regarding these methods was collected and evaluated. The reliability of the
questionnaire was ascertained by Cronbach’s alpha value which turned out to be 0.89. The data
collected were analyzed statistically using one‑way Analysis of Variance (ANOVA) and Principal
Component Analysis (PCA).
RESULTS: The results showed that all these methods differ significantly from each other as the
P < 0.05 considering 5% as level of significance. PCA revealed that andragogy and heutagogy were
found to be most effective in this study.
CONCLUSION: Competency‑based andragogy and capability‑based heutagogy are more effective
TL methods than didactic lecture‑based pedagogy for MBBS undergraduate students.

Abstract CONTEXT: Currently, self‑directed learning (SDL) is emphasized in medical institutions all over the
world. The skills of SDL enable one to be a lifelong learner, a necessity to cope up with fast‑expanding
medical knowledge.
AIMS: This study aims to develop and implement an “SDL” module for medical undergraduates and
find out their perception about the same.
SETTINGS AND DESIGN: A cross‑sectional study using a mixed‑method design (having both
qualitative and quantitative components) was conducted in the Department of Community Medicine,
UCMS, Delhi, India.
METHODS: A module was developed following an extensive literature review and focus group
discussions with the teaching staff of the institute. First‑semester undergraduate students were
invited to participate in the study and asked for feedback using a semi‑structured questionnaire.
STATISTICAL ANALYSIS: Quantitative data were expressed in mean, range, and frequency. For
qualitative data, thematic analysis was performed.
RESULTS: The module was implemented with 160 students, in November for 10 hour distributed
over 5 weeks. Feedback could be obtained from 130 students. Sixty‑seven percent of students were
satisfied and 66% reported as motivated to study the allotted topic further. Qualitative analysis showed
that though the students liked the learning process based on this module, they also felt facilitators
could have been more active in imparting knowledge and skills.
CONCLUSIONS: To make learners equipped with the ability to learn throughout a professional
learning course, SDL as a learning tool should be introduced in the medical undergraduate curriculum.

Abstract BACKGROUND: Women during menopause stages experience many symptoms, for which they
lack enough knowledge to manage them. This study aimed to compare the effect of self‑directed and
support group health education on the quality of life (QOL (and self‑care of postmenopausal women.
MATERIALS AND METHODS: This field trial study was carried out with three groups. One hundred
and eight menopause women were selected through convenient sampling method based on the
inclusion criteria from three comprehensive health centers. Health centers were randomly assigned to
support (n = 36), self‑directed (n = 36), and control groups (n = 36). In the self‑directed group, education
was provided through educational package, and the control group received routine care from the
health center. The support group received education through four group sessions by trained healthy
volunteers. Data were collected by menopause‑specific QOL and self‑care standard questionnaire.
RESULTS: Immediately after the intervention, the mean scores of QOL in the self‑directed
group, support group, and control group were 41.82  ±  7.61, 40.31  ±  4.80, and 48.17  ±  8.45,
respectively (P  <  0.05). In addition, the mean scores of self‑care were significantly different
between the self‑directed (40.67 ± 7.36) and support (36.50 ± 3.36) groups compared to the control
group (47.83 ± 8.47) (P < 0.05). After 1 month from intervention, QOL scores in the self‑directed
group (40.67 ± 7.36), support group (36.50 ± 3.36), and control group (47.83 ± 8.47) were significantly
different (P < 0.05). In addition, the mean scores of self‑care were 64 ± 6.79 and 65 ± 8.32 in the
self‑directed and support groups, respectively, compared to the control group (49.09 ± 9.43). Post hoc
test (least significant difference) revealed higher effectiveness of the support group (P < 0.001).
CONCLUSIONS: Results indicated QOL and self‑care in menopause women in self‑directed and
support groups improved. However, the support group provided higher effectiveness. Therefore,
we recommended paying more attention to the capabilities of healthy volunteers for the promotion
of QOL in menopause women.

Abstract INTRODUCTION: Recently, medical education has made significant progress, and medical teachers
are trying to find methods that have most impressive effects on learning. One of the useful learning
methods is student active participation. One of the helpful teaching aids in this method is mobile
technology. The present study aimed to determine the effect of sending educational questions through
short message service (SMS) on academic achievement and satisfaction of medical students and
compare that with lecture teaching.
SUBJECTS AND METHODS: In an semi‑experimental, two chapters of urology reference book,
Smiths General Urology 17th edition, were taught to 47 medical students of Isfahan University of
Medical Sciences in urology course in 2013 academic year. Kidney tumors chapter was educated
by sending questions through SMS, and bladder tumors part was taught in a lecture session. For
each method, pretest and posttest were held, each consisting of thirty multiple choice questions.
To examine the knowledge retention, a test session was held on the same terms for each chapter,
1 month later. At the end, survey forms were distributed to assess student’s satisfaction with SMS
learning method. Data were analyzed through using SPSS 20.
RESULTS: The findings demonstrated a statistically significant difference between the two learning
methods in the medication test scores. Evaluation of the satisfaction showed 78.72% of participants
were not satisfied.
CONCLUSIONS: The results of the study showed that distance learning through SMS in medical
students could lead to increase knowledge, however, it was not effective on their satisfaction.