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Ezem B.U, Okeudo  C.

Department of Obstetrics and Gynaecology -Imo State University, Orlu, Nigeria.

Medical students are required to acquire a  lot of knowledge during their course. This information is delivered via many teaching modes.  It is desirable to determine which of these modes are most effective in transferring knowledge.
This was a questionnaire study of sixty one students doing their obstetrics and gynaecology rotation in Imo state University Teaching hospital Orlu.
Only 58 of the students returned the questionnaires. The mean age of the students was 27.4+/-2.43 and they had spent between eight and nine years. Clinics contributed most (26.8%) to the knowledge acquired by students. It was followed  by ward rounds and ,books 14.3% each, resident doctors 13%  and lectures 12.9%. Internet and theater sessions contributed very little. Although many deficiencies were identified 56 (96.6%)   of  the  students scored the posting at  least satisfactory.
There is a need to place more emphasis on clinics  and ward rounds which are considered very effective by the students. The relatively ineffective lectures could be improved by making all medical teachers undergo teaching courses. Activities like theater sessions which consume a lot of time but impart very little knowledge  should be modified  while cheaper internet facilities should be provided.

Key words : learning  mode, preferences, obstetrics , gynaecology students

In  the mid nineteenth century   the study of medicine followed an apprenticeship model. The prospective doctor acquired the knowledge by working with  and understudying his teacher  for many years[1]. There were no uniform standards to be met before one embarked on the study of medicine and standards varied a lot. The mode of teaching has  gradually evolved over time and now  to qualify as a doctor in most medical schools students  having achieved a minimum standard in the relevant core subjects ,   then  undergo a five year course in the medical school .
There has been a quantum leap in medical sciences knowledge[2], yet the time available to impart this knowledge to  students remains fixed. The apprenticeship model is thus no longer  possible[3]. In addition there are increasing distractions for the student in Nigeria. Hostel accommodation is often inadequate, there are incessant strikes which disrupt the training program, and  inadequate staffing thus forcing reliance on adjunct staff whose services are often erratic. Also medical lecturers are  hired without  any  formal training in teaching to compound the issue. In spite of their deficiencies  most schools  emphasize  the attendance at lectures with some requiring the attendance of at least 70% of lectures  before being allowed   entry to any professional examination[4]. There is however some evidence[5] that only a minority of students routinely attend lectures. It has also been shown  that learning style may be affected by age, and culture[6]. It thus became necessary to find out the learning mode preferences of our students  so that adjustments could be made to the obstetrics and gynaecology posting  to give students  the best opportunity to acquire knowledge.

A semi-structured  pretested questionnaire  of   twelve major sections   was  administered to the sixty one   medical students at the end of their sixteen week  rotation in the Department of Obtsetrics and Gynaecology of the Imo state University Teaching Hospital, Orlu in May 2012. The questionnaire   had   twelve sections  which delved into  socio-demographic details ,length of  stay in the medical school ,preferences in mode of instruction, students perception  of the lectures and the whole obstetrics and gynaecology posting . There was also a section for  suggestions for improvement. The questionnaire were completed anonymously. Approval was obtained from the ethical committee of the hospital. Descriptive statistics such as means ,mode and standard deviation was used for continuous variables  and proportions for nominal characteristics.




Sixty two  questionnaires were distributed but only fifty eight were returned giving a response rate of 93.5%.They formed the basis of our analysis. Age of the students ranged between 23 and 36 years  with a mean of 27.4+-2.43.Thirty three of the students were female out of which 10(43.5%) were married , while thirty five were male and unmarried. All but one were of the Ibo ethnic group. The students had spent between 8-9  years in  the university.   Table 1 shows the students response to the question on the contribution to their knowledge made by  various aspects of the  learning opportunities in the department.  Clinics were the most important mode of learning. They were deemed to contribute 26.8% of the students knowledge of obstetrics and gynaecology, followed by  books  and ward rounds  14.3% each  and residents 13.0%.and lectures 12.9%. Students used between one and five books for study with a modal value of two. Table  2 shows that forty three (74%)   of the students considered the lectures either satisfactory, good or very good  while fifty six (96.6%) considered the rotation satisfactory, good or very good. Suggestions made by the students included improved infrastructure, reduction in overcrowding, teaching of students in smaller groups, holding of more ward rounds, encouragement of residents to teach and the use of teaching aids. Others included not allowing lectures to exceed one hour, and more interactive lectures.

Medical education should be dynamic and there should be a relentless and continual search for the best ways to impart knowledge to the student. Medical students in developing countries are faced with a lot of problems which militate against adequate transfer of knowledge .These  include over admission, which stretches  the limited facilities available, inadequate infrastructure  and teaching aids ,few and poorly motivated teachers, and frequent industrial strike actions which prolong the stay of these students etc. Most of the students in this class had stayed for nine years through no fault of theirs for  a course which was to last six years. Nearly half of the women had married thus creating further distraction in their studies.  Our study shows that students gained most (26.8%) of their knowledge from the clinics in spite of the deficiencies  already identified. Greater emphasis should therefore be placed on clinics and ward rounds as they appear to be important  sources of knowledge for students. This is consistent with the fact that students  generally prefer multiple modes of learning7,8 which is offered by clinics and ward rounds to the single mode of learning. The importance of books is also illustrated in this study. These are single modes of learning which were preferred by 2.1 -7.8% and 2.1% of students  in  some studies7,8 respectively. The greater relative contribution of books in our study may result from the poor embrace of lectures making books an important alternative source of information for those who don’t attend lectures. The low ranking  of lectures was surprising  given the importance attached to lectures in most schools. This study suggests that students view lectures  differently with about a quarter 14(24.1%) scoring  lectures  as poor or worse than poor. However it is consistent with the fact that  only a small percentage  (4.8-11.6% ) of students prefer  only the auditory mode of learning  which is the group to which lecturing belongs. Dissatisfaction with lectures led to students staying away hoping to get  the same or better information from books. Our finding is consistent with a study5 which showed  that  in one medical school only 17% of students reported attending lectures regularly while another study9 showed that 16% nap during lectures. There is therefore a need  to improve the quality of lectures.  Virtually all medical, teachers have no training in teaching2 as they are recruited directly after their post graduate to teach. The false assumption  being that being  a consultant guarantees good teaching skills.  It has been shown that formal training in teaching skills improves performance of medical teachers[2,11,12]. There is thus a need to introduce short courses or diplomas in teaching to improve the quality of teaching.
Unfortunately also professional progress of medical teachers  is linked  largely to journal publications not  teaching excellence. There is thus a need to include this in the medical teachers assessment for promotion. The role of resident doctors in imparting knowledge is also highlighted in this study. This has also been shown to improve with the introduction of workshops in teaching[13,14].
Although huge chunks of time are allotted to theatre sessions  students felt that these contribute very minimally (4%) to their knowledge. Since  young doctors are not required to do complex operations it is wasteful  to require  them to spend long hours standing round in theatre watching   operations which many of them will never see again. Often because of overcrowding they don’t even get to see what is being done. Moreover these operations can be better demonstrated in shorter time and more convenient environment using video. The low contribution of internet is not surprising given the fact that accessing internet facilities is presently  relatively expensive in Nigeria .
The limitation of the study  is that it was done only on students doing their obstetrics and gynaecology rotation. Similar studies  need to be carried out in other  clinical  departments to validate the result.

There is a need for teachers to place more emphasis on clinics and ward rounds since the students appear to gain most of their knowledge from these activities. The popularity and effectiveness of lectures should be improved by  compulsory teaching course for all would be medical lectures. The incorporation of a lecturers teaching performance in the assessment for promotion of lectures  is suggested  to  promote  better lectures. Cheaper bulk purchase institutional internet  facilities should be made available and  time consuming activities like theater sessions should be abandoned for shorter video sessions .


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