H O W W E T E A C H

AN INNOVATIVE METHOD TO ENHANCE INTERACTION

DURING LECTURE SESSIONS

Sanjay Kumar

Department of Physiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal

he B. P. Koirala Institute of Health Sciences, Dharan, is following an innova-

T tive hybrid curriculum. Conventional lectures are replaced by “structured

interactive sessions” (SIS). SIS involves increased interchange between teach-
ers, students, and lecture contents by proper planning and organized efforts. It can
promote active learning and heighten attention and motivation. The present study
was conducted to enhance active interactions during such sessions. The students
were divided into two groups and asked to come prepared for the lectures. Students
were encouraged to ask questions and interact informally during lectures. A score-
board was maintained, and student feedback was taken at the end of the lecture
block. The entire student response was reduced to a student acceptability index
(SAI). Our results show a statistically significant increase in interactions per student
per day. A majority of the responses in the questionnaire and SAI were favorable.
Specific comments and suggestions of students were also positive. These results
show that simple innovative techniques enhance the interactions during a lecture
session.
ADV PHYSIOL EDUC 27: 20 –25, 2003;
10.1152/advan.00043.2001.

Key words: interactive; innovations; medical education

Medical education has seen major changes over the attitudes (26, 32). In addition, students are frequently
past decade. The advent of newer technology and seen as passive recipients of information (6) and, as a
innovations is redefining the role of conventional ap- result, not engaged in the learning process (8). Lec-
proaches. Conventional lecturing has been a means of tures can still be made very interesting and meaning-
instruction since even before printing was introduced ful by proper planning and organized efforts (17, 31).
(13, 31). In the past, it was widely respected, but in When done effectively, the lecture can transmit new
recent times, lectures as a method of teaching and information in an efficient way, explain or clarify
transmitting information have come under increasing difficult notions, organize concepts and thinking,
criticism (3, 23). A lecture may be considered worth- challenge beliefs, model problem solving, and foster
while today only if it aims at arousing students’ curi- enthusiasm and a motivation for learning (12, 14,
osity, motivating them to learn, and guiding them into 16, 37).
creative thinking, or, in short, if it accomplishes more
than what any book can. Critics argue that lectures B. P. Koirala Institute of Health Sciences is an auton-
are less effective than other methods when instruc- omous university following an innovative, hybrid cur-
tional goals involve the application of knowledge, the riculum. it has a community-based, integrated, and
development of thinking skills, or the modification of partially problem-based curriculum. Conventional lec-

1043 - 4046 / 03 – $5.00 – COPYRIGHT © 2003 THE AMERICAN PHYSIOLOGICAL SOCIETY

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 H O W W E T E A C H

tures are replaced by “structured interactive sessions” was maintained on the blackboard, giving one point
(SIS). SIS involves an increased interchange between for every question asked (relevant to ongoing discus-
teachers, students, and lecture content by proper sion and learning needs) and two points for every
planning and organized efforts. In a typical SIS, stu- right answer (to a question from the students or
dents come prepared and are encouraged to interact teacher). Scores for interactions by the same student
informally. Rao and DiCarlo (35) have shown that the were written together to calculate the interactions
cooperative-learning technique promotes critical- per student. After every lecture, total scores were
thinking, problem-solving, and decision-making skills. announced. Scores were converted to interactions
Indeed, interactive lecturing is a way to capitalize on per student per day. At the end of the lectures, stu-
the strengths of small-group learning in a large-group dent feedback was taken on a standard student eval-
format (5). uation questionnaire. Primary analysis of the teaching
evaluation questionnaire was done in terms of the
The present study was conducted to enhance inter- number of students who gave a particular type of
action during a lecture session. Our past experience response. These figures were converted into percent-
has shown that dental students usually have a very ages for better comprehension. This analysis is being
casual approach toward cardiovascular physiology used to guide the department and the individual
lectures. This could be due to different learning needs teacher toward a better course next year. The entire
of the dental students, the complexities of cardiovas- student response was reduced to a single value, i.e., a
cular physiology, and fewer allotted teaching hours. student acceptability index (SAI), on a scale from 0
The present study was conducted to make these lec- to 2.
ture sessions more interactive by cooperative learn-
ing. SAI ⫽ ¥ (weightage ⫻ number of responses at each
weight)/¥, total number of responses. A weighting of
2 was given for the most favored response, 1 for a
MATERIALS AND METHODS
mediocre response, and 0 for the least favored re-
This study was conducted at B. P. Koirala Institute of sponse (2).
Health Sciences, Dharan, Nepal. The experimental
group consisted of the first-year dental students (n ⫽ Descriptive statistics of parameters were computed as
40). The cardiovascular system was covered in a se- means ⫾ SD. The data were not normally distributed,
ries of five lectures in five days. The class was divided and a nonparametric analysis was selected. Fried-
into two groups by where they sat on the two sides of man’s test for repeated-measures analysis (nonpara-
the lecture theater. The groups were named Mt. Ever- metric repeated-measures ANOVA) was used to com-
est and Annapurna. The students were asked to come pare between interactions per student per day. The
prepared for the lectures. During the course of the Friedman analysis differs from a standard (parametric
lectures, students were encouraged to ask questions repeated-measures) ANOVA, as the analysis is per-
and interact informally. Brainstorming was used at formed on the ranks of the data rather than on the
different points in the lectures. In brainstorming, stu- actual data. Kendall’s coefficient of concordance and
dents generate a list of issues in response to a specific error term were also used for comparisons. Tukey’s
question or topic depending on their learning needs. multiple comparisons were performed, as the afore-
Judgment of the responses is initially suspended (32, said test showed significance (P ⬍ 0.05) between
38), and comments or critiques are invited only after ranks. Difference between ranks (⬎40), Q value (⬎4),
the list is completed. Straightforward questions are and critical q (3.86) were computed. Comparisons
also asked during the sessions. ⬍0.05 significance level (␣-level) are shown in RESULTS.

Two instruments were used for evaluation: a scoring

RESULTS
system for the interactions and an immediate postlec-
ture questionnaire. Scoring was primarily for motivat- The total interactions (questions and answers) and
ing and measuring the total interactions and not for score are shown in Table 1. There was a linear in-
comparing the groups’ performance. A scoreboard crease in total interaction over 5 days. Our results

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 H O W W E T E A C H

TABLE 1
Number of interactions and scores each day in Mt. Everest group, Annapurna group, and both groups

Mt. Everest Group Annapurna Group Total

Interactions,
Total Total
Questions Answers Questions Answers 5 days
Interactions Interactions

Day 1
Day 2 2 (2) 1 (2) 3 (4) 1 (1) 1 (2) 2 (3) 5
Day 3 3 (3) 6 (12) 9 (15) 2 (2) 5 (10) 7 (12) 16
Day 4 2 (2) 8 (16) 10 (18) 1 (1) 12 (24) 13 (25) 23
Day 5 3 (3) 12 (24) 15 (27) 1 (1) 13 (26) 14 (27) 29

Scores are shown in parentheses.

show a statistically significant increase in interactions who are actively involved in the learning activity
per student per day (Fig. 1). There was a statistically will learn more than students who are passive re-
significant increase in interactions on days 3, 4, and 5 cipients of knowledge (5, 9, 30). Other studies have
compared with day 1 and on days 4 and 5 compared demonstrated that increased attention and motiva-
with day 2. A majority of the responses in the teach- tion enhance memory (16, 25, 28). In fact, some
ing evaluation questionnaire were positive (Table 2). authors have said that increased arousal and moti-
This feedback also highlighted the general aspects of vation are the essential ingredients for learning and
lecturing for future planning. Specific comments and are often more important for retention than intelli-
suggestions of students were also favorable (Table 3). gence. Active involvement enhances the student’s
The SAI was 1.77 on the 0-to-2 scale. level of understanding and ability to integrate and
synthesize material (31, 34). It also improves the
DISCUSSION student’s conceptualization of systems and how
There is a fundamental shift in the role of the they function and increases the student’s level of
teacher (20) in student-centered education. If stu- retention (4, 10, 29). This is particularly important
dents are to learn desired outcomes in a reasonably in medical education, where the application and
effective manner (39), then the teacher’s funda- use of information is as important as the retention
mental task is to get students to engage in learning and recall of facts.
activities that are likely to result in their achieving
those outcomes. Learning is a dynamic process re- Our results show a statistically significant increase in
quiring the active participation of the students (1). interactions per student per day. There was a remark-
The educational research has shown that students able increase in student participation. Most of the

FIG. 1.
Interactions per student per day. Values are means ⴞ SD; nos. over the SD
bars indicate a statistically significant (P < 0.05) interaction with a cor-
responding day.

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TABLE 2
Results of the teaching evaluation questionnaire

Student No. Question Grading

1 SIS About right 31 (83.7) Too easy 5 (13.5) Too difficult 1 (2.7)
2 Coverage Just right 23 (62.1) Too extensive 13 (35.1) Inadequate 1 (2.7)
3 Relevance Very useful 18 (48.6) Useful 19 (51.3) Not useful
4 Presentation Good 34 (91.8) Tolerable 3 (8.1) Haphazard
5 Student participation Adequate 35 (94.5) Inadequate 2 (5.4) Absent
6 Questions by students Encouraged 35 (94.5) Tolerated 2 (5.4) Discouraged
7 Use of blackboard/OHP/slides Good 24 (64.8) Fair 9 (24.3) Poor 4 (10.8)
8 Pace About right 33 (89.1) Too rapid 4 (10.8) Too slow
Course improved understanding of
9 the subject A lot 30 (81) Not much 7 (18.9) Not at all
10 New method of teaching Good 28 (75.6) Fair 9 (24.3) Poor

Data show total responses in a category; percentages of responses are in parentheses. SIS, structured interactive sessions; OHP, overhead
projector. Student acceptability index (SAI), 1.77.

questions and answers matched the learning needs. lectures when the instructor paused to allow discus-
The value of effective questioning has been high- sion performed significantly better on free-recall quiz-
lighted by many authors (12, 38). Questions can stim- zes and comprehensive tests (36). Studies have
ulate interest, arouse attention, serve as an “ice break- shown that combining segments of lecture with short
er,” and provide valuable feedback to the teacher and activities is an excellent way to keep students inter-
student alike (3, 19, 24). Oral questioning with infor- ested and involved (7). By changing the pace and
mal responses encourages more participation and a incorporating a variety of techniques that arouse at-
sustained attention span. Attention span studies have tention, interactive lectures can stimulate interest and
shown that students’ interest and attention in the help maintain attention. Our study maintained the
traditional lecture diminish significantly after 20 min- collective attention and induced multiple attention
utes (12, 14, 33, 40). Similarly, students listening to peaks among the students.

TABLE 3
Selected comments and/or suggestions*

Student
Comments/Suggestions
No.

1 The approach to teaching is very nice. He encouraged us a lot to do more study.

2 Dividing in groups and giving marks makes us very energetic to study more.
3 Questions are entertained and students’ participation encouraged, and the help of a teacher makes it more interesting;
I think SIS is very effective.
4 New method of teaching in physiology is really very helpful and encouraging for me. It will be more beneficial if
other classes are also run in the same way.
5 It has helped me to do regular studies.
6 We are really satisfied with your teaching method.
7 Please don’t show the numbers that you give us during every SIS. Just keep them secret and flash them after the class
is over.
8 This method of taking class is very helpful, because I have started studying the topic on the same day of the class and
after the class. I am able to question and answer myself while studying. Thank you, sir.
9 This method encouraged regular study and active participation in the class.
10 If SIS is given the name for the sessions, this is the real SIS going on in physiology. This is the first time, I think, all
students have read before coming to class.
11 I like the technique of teaching.

*A total of 19 students provided written responses.

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 H O W W E T E A C H

The feedback from a standard student evaluation Address for reprint requests and other correspondence: S. Kumar,
questionnaire was quite encouraging. A majority of Dept. of Physiology, B. P. Koirala Institute of Health Sciences,
Dharan, Nepal (E-mail: [email protected]).
the responses from the teaching evaluation question-
naire and specific comments and suggestions of stu- Received 26 November 2001; accepted in final form 19 September
2002.
dents were also favorable. The SAI was 1.77. Feed-
back is important for learning (21). The rationale for
student evaluation was straightforward. Students are
References
in a position to judge instructional effectiveness (15,
18). Although the SAI tells us that a teacher is highly 1. Biggs J. What the student does: teaching for enhanced learn-
acceptable to the students, it does not help the ing. Higher Educ Res Devel 18: 1, 1999.
2. Bijlani RL and Nayar U. Teaching physiology: trends and
teacher concerned to improve his/her teaching fur-
tools. Proceedings of a Symposium on Medical Education at
ther. The responses to individual questions show that All India Institute of Medical Sciences, Delhi, India, June 24 –
there is ample scope for improvement (27). The only 26, 1983, p. 11–16.
legitimate and desirable objective of student evalua- 3. Blight D. What’s the Use of Lectures? Middlesex, UK: Penguin,
tion is improvement of teaching and individual teach- 1972.
4. Bonwell CC and Eison JA. Active Learning: Creating Excite-
ers (11). Interactive techniques allow teachers to re-
ment in the Classroom. Washington, DC: George Washington
ceive feedback at many levels: on students’ needs, on Univ. Press, 1991.
how information has been assimilated, and on future 5. Butler JA. Use of teaching methods within the lecture format.
learning directions. On the other hand, students re- Med Teacher 14: 11–25, 1992.
ceive feedback on their own knowledge or perfor- 6. Byrne PS, Harris CM, and Long BEL. Teaching the teachers.
mance (22). Med Educ 10: 189 –192, 1976.
7. Carbone E. Teaching in Large Classes. Thousand Oaks, CA:
SAGE Publications, 1998.
Although performance on examinations is the tradi- 8. Chickering AW and Zelda FG. Seven principles for good
tional test for teaching or learning success, we did not practice. Am Assoc Higher Educ Bull 39(7): 3–7, 1987.
analyze this, because each successive class of students 9. Cross PK. Teaching for learning. Am Assoc Higher Educ Bull
has different abilities. Our results show that simple 39(8): 3–7, 1987.
10. Elliott DD. Promoting critical thinking in the classroom. Nurs
innovative techniques enhance interaction during lec- Educ 21: 49 –52, 1996.
tures. Faculty members are often reluctant to incor- 11. Feinstein E and Levine HG. Impact of student rating on basic
porate active-learning activities in their classes. Inter- science portion of the medical school curriculum. J Med Educ
active lectures are probably avoided because of time 55: 502–512, 1980.
12. Foley R and Smilansky J. Teaching Techniques. New York:
constraints, fear of not covering all of the material,
McGraw-Hill, 1980.
need for more preparation, loss of control over stu- 13. Foley R, Smilansky J, Bughman E, and Sajid A. A depart-
dents, and anxiety at not knowing the answers to mental approach for improving lecture skills of medical teach-
questions posed by students (4). However, teaching ers. Med Educ 10: 369 –373, 1976.
experiences and the relevant literature do not sup- 14. Frederick P. The lively lecture— 8 variations. College Teach-
ing 34: 43–50, 1986.
port these apprehensions. Furthermore, the minimal
15. Frey PW. Student evaluation. Science 187: 557–558, 1975.
extra time pays dividends in the understanding and 16. Gage N and Berliner D. Educational Psychology. Dallas, TX:
retention of material. Finally, this active-learning strat- Houghton-Mifflin, 1991.
egy can be incorporated easily into large classrooms. 17. Gelula MH. Effective lecture presentation skills. Surg Neurol
Interactions allow discussion, reduce the monotony 47: 201–204, 1997.
18. Gessner PK. Student evaluation. Science 187: 558 –559, 1975.
of passive learning, and enhance the students’ level of
19. Gibbs G and Habeshaw T. Improving student learning during
understanding and their ability to synthesize and in- lectures. Med Teacher 9: 11–20, 1987.
tegrate material (35). This study, based on self-reports 20. Harden RM, Sowden S, and Dunn WR. Some education strat-
from participants as well as from observational data, egies in curriculum development: the SPICES model. ASME Med-
shows that interactive lecturing techniques are suc- ical Education Booklet No. 18. Med Educ 18: 284–297, 1984.
21. Jason H and Westberg J. Providing Constructive Feedback.
cessful.
A CIS Guidebook for Health Professionals. Boulder, CO: CIS, 1991.
22. Jason H and Westberg J. Making the Most of Instructional
I am grateful to Dr. S. S. Khannal, Rector, B. P. Koirala Institute, for Presentations: Using the Audience Response System. Kalama-
encouragement and guidance. zoo, MI: UpJohn, 1995.

VOLUME 27 : NUMBER 1 – ADVANCES IN PHYSIOLOGY EDUCATION – MARCH 2003

24

Downloaded from journals.physiology.org/journal/advances (190.251.200.162) on March 31, 2020.

 H O W W E T E A C H

23. Kimmel P. Abandoning the lecture: curriculum reform in the 32. Newble D and Cannon R. A Handbook for Medical Teach-
introduction to clinical medicine. The Pharos 55: 36 –38, 1992. ers. Boston, MA: Klower Academic, 1994.
24. Knox AB. Helping Adults Learn. San Francisco, CA: Jossey- 33. Pollio HR. What Students Think About and Do in College
Bass, 1986. Lecture Classes. Teaching-Learning Issues, No. 53. Knoxville,
25. Mannison M, Patton W, and Lemon G. Interactive teaching TN: Univ. of Tennessee Press, 1984.
goes to university: keeping students awake and learning alive. 34. Ramsden P. Learning to Teach in Higher Education. London:
Higher Educ Res Devel 13: 35– 47, 1994. Routledge, 1992.
26. McKeachie W. Teaching Tips. Lexington, MA: DC Heath, 1994. 35. Rao SP and DiCarlo SE. Peer instruction improves perfor-
27. Mendelson MA, Canaday SD, and Hardin JH. The relation- mance on quizzes. Adv Physiol Educ 24: 51–55, 2000.
ship between student rating of course effectiveness and stu- 36. Ruhl KL, Hughes C, and Schloss P. Using the pause proce-
dent achievement. Med Educ 12: 199 –204, 1978. dure to enhance lecture recall. Teacher Educ Special Educ 10:
28. Meyer C and Jones TB. Promoting Active Learning: Strate- 14 –18, 1987.
gies for the Classroom. San Francisco, CA: Jossey-Boss, 1993. 37. Saroyan A and Snell L. Variations in lecturing styles. Higher
29. Modell HI. Preparing students to participate in an active learning Educ 33: 85–104, 1997.
environment. Am J Physiol Advan Physiol Educ 15: S69–S77, 1996. 38. Schwenk T and Whitman N. The Physician as Teacher.
30. Murray HG. Effective teaching behaviors in the college classrooms. Baltimore, MD: Williams and Wilkins, 1987.
In: Higher Education: Handbook of Theory and Research 7, edited 39. Shuell TJ. Cognitive conceptions of learning. Rev Educ Res 56:
by Smart J. New York: Agathon, 1991, p. 135–172. 411– 436, 1986.
31. Nasmith L and Steinert Y. The evaluation of a workshop to 40. Stuart J and Rutherford RJD. Medical student concentration
promote interactive lecturing. Teach Learn Med 13: 43– 48, 2001. during lectures. Lancet 2: 514 –516, 1978.

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