Design and Implementation of Computer-aided Learning Module in Pharmacology for Vasoactive Drugs: An Experience from a State Medical College in Haryana, India

1. Professor and Head, Department of Pharmacology, Kalpana Chawla Government Medical College, Karnal, Haryana, India. 2. Assistant Professor, Department of Community Medicine, Kalpana Chawla Government Medical College, Karnal, Haryana, India.

Abstract

Introduction: In the Competency-based Medical Education (CBME) curriculum, one of the core competencies involves demonstrating the effects of autonomic drugs. It is a skill competency, and students have to learn to demonstrate the acquisition of this competency in a skill lab. Computer-aided demonstrations can enhance the teaching-learning experience and fulfill the learning objectives related to the effects of vasoactive drugs.

Aim: To design and evaluate a Computer-aided Learning (CAL) module to teach the effects of vasoactive drugs.

Materials and Methods: The study, being a curriculum implementation project, was conducted using a mixed methods study design at Kalpana Chawla Govt. Medical College, Karnal, Haryana, India over a period of one year from October 2020 to October 2021. Here, the impact of the intervention was measured through a multiple-choice quiz on the topics learned through CAL. The study population included all students undergoing the Phase-2 stage of the MBBS course at our institute. For skill acquisition in the cognitive domain, a video bank in the computer lab was made available to 120 undergraduate medical students. During practical training, in small groups, the training videos and animations were played, showing the effects of selected common vasopressors, vasodepressors, and their antagonists to the students. Simulated experiments on vasoactive drugs were shown to the students using ExPharm software (Free version). The achievement of learning objectives was assessed through a quiz. The perception of the students toward the new method was assessed through a questionnaire, and that of the faculty was evaluated with a Focused Group Discussion (FGD). Simple descriptive statistics, specifically the mean and standard deviation, were used to generate results.

Results: All the students who participated in providing feedback on the module 113 (100%) had used CAL-based learning to acquire the skills. 60.7% of students (n=68) used both the animation and simulation components of the CAL to achieve proficiency in learning about vasoactive drugs. All teachers (n=5, 100%) during the FGD expressed satisfaction with the development and outcomes of the learning module, while highlighting the need for better CAL devices and methods.

Conclusion: The CAL module developed for teaching and learning the effects of vasoactive drugs in experimental pharmacology was considered to be just about satisfactory.

Adrenergic, Learning, Pharmacology, Teaching

The study of the autonomic nervous system and medicines affecting it is very important for a good foundation in learning pharmacology. Demonstrating the effects of autonomic drugs is a core skill competency in the CBME curriculum. Students must learn and demonstrate the acquisition of this competency in a skill lab. Computer-aided demonstrations can enhance the teaching-learning experience.

Experimental Pharmacology is the cornerstone of pharmacology teaching, as experiments provide valuable insights into the mechanisms of action of drugs. The traditional method of conducting experiments to acquire skills related to vasoactive drugs on laboratory animals has been prohibited by regulators in line with global changes (1),(2). Alternatives mentioned include demonstrations using computers, the internet, and CAL software. Therefore, the development of a learning module for this purpose is necessary. The incorporation of innovative teaching methods, such as animated videos or the use of graphics, is known to enhance understanding and retention of concepts related to drug mechanisms (3). It is often said that a picture is worth a thousand words. However, an animated video of the same event significantly enhances the learning experience beyond those thousand words. The use of animation videos in pharmacology demonstrations has been reported to improve students’ test scores in formative and summative assessments (4).

According to a recent report by Andrews LB and Barta L, educational simulations are increasingly found to be effective in preparing medical students for real-world scenarios before they actually experience them in real time (5). Simulations have been most successfully used in teaching physiology so far. However, significant progress has been made in recent times in utilising the same techniques for learning Anatomy, Pharmacology, and Biochemistry as well (6). Based on the literature search, most published studies are specific to certain types of experiments and utilise some form of simulation (7),(8),(9). Many use a pre-post test to determine the acquisition of the learning objectives. Another aspect of Computer-Assisted Learning (CAL) is visually rich animations. There is a lack of information regarding the combined educational impact of CAL incorporating both simulation components and animations, as revealed by the literature search. Additionally, the current study aims to assess the educational impact of the CAL method on the holistic understanding of vasoactive drugs by students. It is believed that with the implementation of CBME curriculum mandated by the National Medical Commission (NMC) of India, the findings of this curriculum implementation project will significantly contribute to translating the philosophy behind CBME into action by developing a training module to teach the pharmacology of vasoactive drugs using CAL and determining the perceptions of both students and faculty towards it.

Material and Methods

The study, being a curriculum implementation project, was conducted using a mixed methods study design at Kalpana Chawla Government Medical College, Karnal, Haryana, India. The study took place over a period of 12 months from October 2020 to October 2021. The project involved the development of an educational module, which took about six months. Validation of data collection instruments, such as the questionnaire to seek feedback and the Multiple Choice Question (MCQ) quiz to determine understanding of the topic and achievement of the learning outcomes, was undertaken over two months by the teachers of the Pharmacology department. The module was administered to the students after obtaining approval from the Institutional Ethics Committee (IEC) via its letter No. KCGMC/IEC/2021/Jun/3 dated 27.6.2021.

Inclusion criteria: All students in Phase-2 of the MBBS course, totaling 120, were administered the teaching module and invited to participate in the study. Therefore, sample size calculation was not needed and was not resorted to. All students were invited to provide feedback on the module and were requested to provide consent to participate in the study.

Exclusion criteria: Students who did not consent to participate were excluded from the study.

Study Procedure

To design and implement a CAL module in pharmacology for vasoactive drugs, various online resources were meticulously searched using popular search engines Google and Bing to locate the URLs of relevant animation and training videos. Some topics of practical pharmacology were taught using this video bank to Phase 2 MBBS students. The focus was on drugs that affect blood pressure in humans. It was ensured that the selected material for CAL matched the learning objectives and related competency as per CBME. Instruction to the students was imparted in small groups of 30 students during practical teaching hours.

The effects of various vasoactive drugs on blood pressure were covered in a lecture prior to the conduct of small group teaching during practical hours. The practical class on the effects of vasoactive drugs was aligned with the topic taught in theory. During practical training in small groups, the training videos and animations were played, and the effects of selected common vasopressors, vasodepressors, and their antagonists were shown to the students. Simulated experiments on vasoactive drugs were demonstrated to the students using ExPharm software (Free version) along with an explanation of the dose-response relationships of these drugs. All teaching activities were aligned with the predetermined learning objectives for the learning session. Any concept not adequately addressed in the animations and simulations were explained to the students using a chalkboard or other teaching aids.

The module was validated by all the teachers in the department involved in teaching the topic before administration to the batch of 120 Phase 2 MBBS course students. The perception of students regarding the module was determined based on a 20-point self-administered questionnaire. The questionnaire was devised by the authors based on a few studies from the literature (6),(7),(8),(9),(10). The validation of the questions was done by the department teachers and a group of 10 students through a face-to-face interview. Validity and reliability scores were not calculated, and Cronbach’s alpha was not determined as the sample size was too small. The achievement of learning objectives was assessed through an MCQ-based quiz containing 10 questions on the mechanism of vasoactive drugs, with each question worth one mark. The quiz and the questionnaire were administered digitally using Google Forms, and the responses received were automatically populated to Google Sheets through the software. The perception of the faculty was determined through a FGD. Five teachers teaching the subject participated in the group discussion, and the discussion areas used the same questions that were posed to the students to determine their perception.

Statistical Analysis

The raw data from the study was downloaded from Google Sheets into Microsoft Excel software for analysis. Simple descriptive statistics, specifically the mean and standard deviation, were used to generate results. Only the 20-point questionnaire assessing students’ perceptions of the module was statistically analysed using descriptive statistics in the Microsoft Excel software package.

The MCQ quiz served as an assessment tool for achieving the learning objectives, and students were permitted to reattempt the quiz until they answered all questions correctly.

Results

The 20-point questionnaire was sent out to 120 students. 113 responses were received back. Among the responders, 68 were male students and 45 were females. All students were between the ages of 20 and 23 years, with a mean age of 21.5±1.07 years. Participation in the study was voluntary and based on their consent; some students chose not to respond, and some only answered some of the questions. All the students (100%) reported using CAL resources provided for learning vasoactive drugs.

Of the 112 students who answered the question about the type of CAL resources used, a majority of 68 students (60.71%) mentioned using both animations and simulations to achieve their learning objectives (Table/Fig 1).

A total of 54 students (48.6%) found learning using CAL very interesting, while 39 (35.1%) found it interesting only when combined with written text (Table/Fig 2).

An equal number of respondents (38.7% each) stated better understanding and better memorisation as the reasons for using CAL in their learning of the Mechanism of Drug Action (MODA) of vasoactive drugs (Table/Fig 3).

More than half of the respondent students, 70 (70%), felt that the animations were accurate, and 14 (14%) reported that they were more elaborate than needed to describe MODA. Some students 8 (8%) mentioned that a few steps in the animations were incorrect or missing (Table/Fig 4).

More than half (55.7%) of students mentioned that there is room for improvement regarding the accuracy of dose-response relationships as it is less clear than desired and confusing as well (Table/Fig 5).

As summarised in (Table/Fig 6), most students agreed that the simulated experiments are less error-prone 77 (70%) and save time in learning 69 (61%). The majority of students 67 (60.4%) agreed to more interaction with their classmates while using CAL for their learning, and almost a quarter 26 (23.4%) strongly agreed that they interacted more than usual. A total of 59 (53.15%) students thought that the use of computer animations helped them understand MODA better (Table/Fig 7), and 44 (39.3%) students were very satisfied with CAL (Table/Fig 8). 57 (51.35%) students thought that the use of computer animations helped them understand MODA faster than reading a description (Table/Fig 9), and almost half of the respondents would want to perform live experiments, even though almost everyone (107, 94.6%) thought that CAL should be acceptable as it prevents the killing of laboratory animals (Table/Fig 10).

More than 90% of students reported satisfaction with their learning of vasoactive drugs through CAL. The evaluation of learning the mechanism of action of vasoactive drugs undertaken through the MCQ quiz test revealed a good understanding of the subject among students and the achievement of learning objectives. It was also observed that the understanding of the topic and performance in the quiz improved after repeating the cycles of learning using CAL. All students needed more than one attempt to get all the questions correct. All students could achieve all correct responses in the questions either in the second or third cycle of learning.

The FGD undertaken with the faculty members revealed some recurrent themes, and certain conclusions were derived by coding and categorisation of the content of these discussions. The key issues revealed through the FGD were:

(1) The need for better and licensed animations that have offline access and functionality to depict the MODA of vasoactive drugs.
(2) The need for better and very high-fidelity mannequins for live demonstration of drug effects through intravenous infusion of vasoactive drugs and to provide a true picture of dose-response relationships.
(3) The currently available resources are not adequate for the purpose and are able to provide only a marginal experience in comparison to live experiments conducted using laboratory animals.

Discussion

Simulations and animations are now a worldwide norm for educational purposes. Complex processes involving multiple steps can be explained very easily using simulations and animations, which are common methods of CAL, as it is popularly known. In present study, the perception of students towards the CAL resources provided in the form of animation videos and simulated experiments of ExPharm software was generally positive, and the majority of the students reported beneficial effects on their learning.

The use of CAL in the teaching of pharmacology goes back over 20 years. The learning method has evolved from simple computer programs designed to demonstrate autonomic nervous system responses to desktop software platforms, part task trainers, and high-fidelity stimulators (10),(11). Added to this high-profile list are simple animation videos to illustrate the mechanism of action of various drugs that are largely non interactive, having some merits and demerits in their utility and application to various learning situations. However, one irrefutable fact is that this method is going to stay and expand in the foreseeable future. This projection is based on the explosive growth of options and the involvement of big tech giants in the development of hardware and software that facilitate the teaching and learning of computer processes via simulation, augmented reality, virtual reality, and serious gaming (12). In a nutshell, the range and scope of CAL are too wide and are growing leaps and bounds with each passing day.

The learning module developed and implemented in the current curriculum implementation project was a very small step in this direction. Vasoactive drugs-the vasopressors, vasodepressors, and their antagonists constitute a reasonably large group of pharmacotherapeutic agents that have applications in the management of shock, hypertension, cardiac arrhythmias, chronic heart failure, and numerous other conditions as a secondary or adjunct therapeutic modality. Considering the overwhelming importance of vasoactive drugs in therapy and the involvement of the autonomic nervous system as a whole in understanding and rational prescribing of vasoactive drugs, the module developed for this study focused on both aspects: understanding the basics of autonomic pharmacology and its application in understanding the MODA of active drugs. For the first part, understanding of autonomic pharmacology, the free version of ExPharm software was used. For the secondpart, learning the MODA of autonomic drugs, seven free to use animation videos sourced from the internet were utilised [Annexure-1]. Hence, the first part was an interactive simulation, and the second part was a video which has the advantage of being played repeatedly and at one’s own pace.

Simulations are considered to offer a constructivist and situational basis for learning as they allow learners to learn by experimentation (13). Experimentation involves manipulation of variables and observing the outcomes of changed variables (14). In the present learning module, students applied these principles to observe the dose-effect relationships of vasoactive drugs, the use of blockers, and observing the results of such manipulation. Involvement in dose selection and observing the effect creates an affective dimension that enhances concentration, understanding, judgment, and memory (15). Since participation in the learning process is compulsory, it initiates active learning with its well-established advantages (16),(17). In this study, students found the simulations interesting and useful, as evident from the responses provided by the students. The effort to improve the interactive dose-response simulation programs, which have high reliability, is a challenging and ongoing research by the software developers. Some such simulation programs are reported to produce results that are similar to actual experiments (18). Students have reported positively on the learning experience via animations, although some students have pointed out their shortcomings as well. Overall, students have expressed satisfaction with their learning using the CAL resources. The results of this study are quite similar to a study where student surveys have reported that CAL, like simulation, enhances their Pharmacology knowledge and improves their understanding to apply pharmacology knowledge to patient care and develop their interprofessional perception and attitudes (19). The study by Sharma K et al., used only simulations and a particular experiment to determine the educational impact of CAL, while the one by Singh S et al., had used two experiments for simulation, though the type of software used is not mentioned (20),(21). The current study is different in two ways: firstly, the emphasis is on understanding vasoactive drugs, and secondly, simulation software and animation videos have both been used as methods of delivery of CAL.

The acquisition of learning objectives was evaluated using a 10-question multiple-choice quiz. The quiz was designed to test conceptual knowledge and application of knowledge rather than recall of facts.

For many students, performance in the quiz was not good initially but improved with repeated cycles of learning using the module. The acquisition of practical skills through CAL is a well-established norm when used properly (22). The faculty who participated in implementing the module expressed satisfaction with the experience and learning outcomes of students in their FGD. However, they also expressed that the resources are not very accurately suited for the learning objectives. They primarily cited two concerns. First, in the present curriculum, the emphasis is on human responses only, whereas the simulation used has been designed to be used as an alternative to animal experiments and has been named as such. It is pertinent to note, however, that the responses being studied are known to be the same in humans as they have been represented in the animal experiments. Second, the animation videos used in the module have not specifically been designed for the purpose they are being used for. Hence, there is only a partial overlap of content that is desired. The problems associated with CAL have been well documented before (23).

To implement the mandate of NMC for the use of CAL in imparting teaching of experimental pharmacology, a significant investment is needed in terms of acquiring appropriate hardware and software, developing training modules, faculty development, and acceptance by statutory and regulatory bodies associated with medical education. Similar findings have been mentioned in the study by Mistry C et al., (24).

In summary, the present module on CAL for the teaching and learning of the mechanism of action of vasoactive drugs is just about adequate at present to meet the learning objectives. They need to be tailor-made to meet the specific nature of their usage. Acquisition of better-suited and licensed software and high-fidelity mannequins can help achieve the learning objectives better.

Limitation(s)

This training module was developed when Coronavirus Disease 2019 (COVID-19) lockdown disrupted teaching and learning in a significant way. In better times, it might have been possible to follow the planned schedule of work and execute it in a more relaxed and appropriate fashion. The lack of time forced some aspects of the work to a pace that might have affected the quality of the work now being reported.

Conclusion

The CAL module developed for teaching and learning the effects of vasoactive drugs in experimental pharmacology is satisfactory at the moment. Both students and faculty members expressed that more appropriate and sophisticated animations and simulations need to be developed for them to be genuinely useful for teaching and learning all the relevant aspects of experimental pharmacology.

Acknowledgement

The help received from faculty of Nodal Centre for Faculty Development at CMC Ludhiana, teachers from Dept of Pharmacology, KCGMC, Karnal in implementing this educational project is gratefully acknowledged.

DOI and Others

DOI: 10.7860/JCDR/2024/68334.19676

Date of Submission: Oct 28, 2023
Date of Peer Review: Jan 25, 2024
Date of Acceptance: May 07, 2024
Date of Publishing: Jul 01, 2024

Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
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