Impact of Autonomous Learning for Advanced Acquisition of Physiology (ALAAP) module among undergraduate health-care professional students

INTRODUCTION

Autonomous learning is a type of learning occurring from time immemorial. It is a well-treaded path since the times of Aristotle and Socrates and has been known to be highly efficacious with remarkable outcomes with regard to in-depth understanding and cognitive development. In the everyday life of a teacher, there arise many situations in the classroom wherein, giving scope for self-directed learning (SDL) to the students will enrich the learning experience rather than just reiterate the information. Experience is the founding stone for learning and education. Learning happens based on the experiences of the past and presents integrating with one’s understanding, perception, and interpretation of the subject matter.^[1] Thus, the role of a teacher as a facilitator allowing to explore, tread new paths, formulate queries, and test the hypothesis only becomes apt in this type of learning.

Andragogy or adult learning is based on the fact that all humans are capable of unlocking their cognitive scaffolding and should be responsible for their own higher mental development.^[2] In this digital era, there is no dearth of information and resources. The processes for doing an activity such as concept-based project charts include locating the resources, unravelling, and correlating the information. Preparing concept-based project charts can be mentally stimulating, enabling the attainment of a higher level of a deeper understanding of the topic and subsequent application of the knowledge in healthcare. The more the students feel pride in deducing the information, the more will be the feeling of empowerment and satisfaction which leads to further learning and thus affective domain synergises with cognitive domain by internalising the values to enhance the learning experience.^[3]

Deeper learning can happen only if there is open-mindedness for other possibilities and avenues. The teacher as a facilitator here has an important role in building up learning communities that contribute significantly by elevating, empowering, and supporting each other to attain a transformative level of active learning. The present-day teaching-learning and assessment methods are mundane and concentrate more on didactic lectures and written tests where the student often regurgitates what has been just a superficial learning process. This approach is not sufficient for preparing the student as a future healthcare professional. Hence, the need of the hour is to shift the focus to more means of deeper integrated learning.^[4,5] In addition, student involvement and interest in the routine summative assessment are on the decline. Even though few studies have shown the effectiveness of SDL,^[6] not many studies exist for documenting its effectiveness in learning endocrine physiology, especially in allied health courses, who in the future will be one of the core team members of interprofessional approach in the delivery of healthcare.^[7] There are very fewer studies in the Indian health education scenario done on allied health professional students to document the effectiveness of SDL in understanding the endocrine system. Hence, we decided to develop a SDL module and Autonomous Learning for Advanced Acquisition of Physiology (ALAAP module) on the endocrine system for undergraduate physical therapy students and explore its efficacy in comparison with the traditional teaching-learning method.

MATERIALS AND METHODS

In the Bachelor of Physiotherapy (BPT) programme offered by the Physiotherapy College of a Private Deemed to be University of Dakshina Kannada, Karnataka, India, students learn physiology in their first two semesters of the course. Their curriculum includes didactic lectures, tutorials, and practical demonstration exercises.

The present study was a prospective interventional study done under the department of physiology. It was conducted following approval by the Institutional Ethics Committee.

ALAAP module

The ALAAP module was developed [Figure 1] based on the feedback obtained from the previous batch students, who had opined that it was difficult to comprehend and correlate the applied aspects of endocrine physiology with only didactic lectures as it is more clinical oriented.

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Figure 1:

Flowchart of the ALAAP module.

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RESULTS

[Table 1] shows the gender and age distribution of the students. There was no statistically significant difference between the age distribution of the male and female students. [Table 2] shows the triad approach employed to compare the scores of pre-test and post-test after the ALAAP module intervention implying the effectiveness of the module to be strong (P < 0.001). There was a significant increase in the number of high performers in the post-module online MCQ-based test when compared to the pre-module test [Figure 2]. The majority of the students agreed that the activity-based endocrine learning module enhanced their cognitive domain of learning [Table 3]. Based on the student responses, we could conclude that our intervention resulted in stimulation of the student’s cognitive domain of learning. The majority of the students agreed that the activity-based endocrine learning module enhanced their affective domain of learning [Table 4]. The majority of the students opined that they had positive learning experiences from this module. Few students opined that this module was of no use to them and the time given for preparation was inadequate [Table 5].

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Figure 2:

Number of high performers before and after self-directed study module of endocrine system (n=55).

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DISCUSSION

The present study aimed at studying the effectiveness of a self-directed study module called the ALAAP module for learning endocrine physiology. As physiology is a basic science subject and forms the cornerstone for all healthcare professionals, a deep approach to active learning is very essential rather than a surface approach.

The first and foremost duty of a healthcare professional is toward patient care and safety. With the world moving toward an interprofessional approach to healthcare,^[10] we must strive to equip allied health students with better knowledge in all fields of medicine. By improving the academic performance of allied health students, we can ensure a better contribution; smooth functioning, and fruitful role of these professionals during the interprofessional approach to healthcare.

First-year of undergraduate physical therapy course work is very crucial, as this is the time of transition of the learner from pedagogy to andragogy type of learning. They must adapt to learning the medical subjects in an adult fashion and hence it is the right time to gently mould and equip them to be a lifelong learner. It is also necessary to expose them to the right kind of learning experiences and thus facilitate them to be a lifelong learner. SDL of systems in physiology instils and promotes a sense of being autonomous and; being organised, self-disciplined, ability to communicate effectively, ability to accept constructive feedback, engage in self-evaluation, self-reflection, and keep up with the ever-evolving face of healthcare.^[11] Pai et al. also found that SDL was an effective means of learning.^[12] Their study was a case-based SDL and they also concluded that there is no additional benefit gained by supplementing SDL with the lecture to facilitate learning in physiology. In this context, a SDL module, the ALAAP module was planned and implemented.

Assessment completes the learning process and formative assessment is better than summative in mapping a student’s progress of learning. The assessment is done after the ALAAP module showed a significant improvement in the average marks of the students. In addition, there was a significant increase in the number of high performers following the module.

Learning endocrine systems in physiology can be a tedious process and knowledge gained can be volatile with poor registration, perception, integration, retention, and recall. In our study, it was found that applying ALAAP to the endocrine system helped the physical therapy students in remembering and better understanding the concepts, as this module provided an opportunity to refer additional resources including visual clues and multimedia resources thus enhancing their ability to improve the cognitive domain of endocrine physiology.

The ALAAP module employed in our study enhanced the affective domain as portrayed in the feedback and was a positive learning experience because it provided a platform for the interactive student-centric approach of learning. Similarly, Walankar et al., who conducted a cross-sectional study to determine the learning approaches on 435 physiotherapy students, found that 94.5% of students preferred the deep approach and concluded that multiple methodologies focussed on the student-centric approach will yield positive learning outcomes.^[13] Innovative teaching-learning practices help facilitate deeper learning, create aptitude and interest in gaining knowledge. Thus, the affective domain synergises with the cognitive domain to enhance the learning experience.

With the advent of technology and tech-savvy ‘Generation Z’ students, it is imperative that we add on if not replace the age-old and redundant methods of didactic lectures and summative assessments with more productive SDL methods and formative assessments. The ALAAP module used technology not only as a learning resource but also in the assessment. Undergraduates preferred multimodal learning strategies based on the type of learner, they are in learning medical subjects.^[14] Using innovative and technology-friendly methods that cater to the needs of all kinds of learners including visual, auditory, read/write and kinaesthetic learners are the need of the hour.^[15-17] The activity-based SDL module was well-received among the student community and improved the learning of all types of learners.

In our study, in addition to facilitating the innovative self-directed way of learning, students also experienced the effectiveness of teamwork and team dynamics in learning. This non-technical skill is an essential component of the overall development of healthcare professionals.^[6] Teamwork enhances the quality of learning by promoting critical thinking, communication skills, fostering friendship, loyalty, and encouraging the development of accountability, role clarification, shouldering responsibilities, and working toward common goals. Learning can happen in a group through collaborative and cooperative learning.^[18]

A minority of the students opined that lack of coordination was a hindrance to learning in the ALAAP module; the negative experiences can be attributed to both task-related factors such as group composition, contribution, and socio-emotional components such as conflict and group climate.^[18] For a group member to perform well in a group, adequate time is essential for forming, storming, norming, performing, and adjourning the group.^[19] Maybe the time given for group development was less which could have contributed as a hindrance to the student’s (2%) learning and this also forms the limitation of our study.

CONCLUSION

This study showed that the ALAAP module employed for second-semester physical therapy students was found to be significantly effective and has positively targeted all types of learners. It helped their transition from pedagogy to andragogy type of deep learning. The group work done by the students as a part of this module instilled collaborative learning in them. The effectiveness of this study was reflected in the significant improvement not only in the post-module assessment scores but also in the number of high achievers. The collective feedback obtained on the module from the students showed that the affective domain synergises with the cognitive domain by internalising the values to enhance the learning experience.