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Lesson Topic
Page No
No.
Background: Medical educational Research Page | 1
1
Objectives of the workshop
3
Contributors and Acknowledgements
5
Introduction to Educational Research
1 6
Educational Techniques: Trends, Utility & Effectiveness
2 18
Research Methodology: Outline of Qualitative,
3 23
Quantitative & Mixed Research Designs & Methods
Quantitative Methods: Data Collection, Questionnaire
4 46
Preparation
Qualitative & Mixed methods in Educational Research
5 70
Focus Group Discussions: Participatory and Non-
6 Participatory Techniques of Qualitative Data Collection 78
in Medical Education
Descriptive & Inferential Statistics
7 83
Areas of Research in Medical Education & Ethics
8 123
Qualitative Techniques and Computer aided Analysis
9 127
Research Project Proposals Prepared by Participants
10 133
List of Participants
140
Teaching & Learning Methods for the Revised MBBS
142
Curriculum
Report
Workshop
Medical Educational Research: Concepts and Methodologies
Background:
Page | 2
The basic issue is not whether our students and our medical colleges are
better than those of a generation ago, but whether the quality of today‟s
education is sufficient to meet tomorrow‟s demands, which will be infinitely
more complex than those of the past or the present. In other words, it is not
a matter of whether, through research, we can prove that our medical
institutions are better, but whether, through research and implementation,
we can make them good enough.
Medical Education has been conventionally taught and learnt in an
inductive way and has been considered as difficult to both impart and
imbibe. Already, there have been some major breakthroughs in education
towards accommodation of individual differences, improved learning theory
and practice, better tests and measurements, more effective counselling and
guidance, use of new media, team teaching, evaluation of teacher
effectiveness, and in other areas. Still, many areas have gone with out
investigation and many “good” teachers have been so busy with the twin
problems rising from combined pressures of the explosion of knowledge and
rapid increases in enrolment of medical students.
Basically we need to know a great more deal about how people learn. If we
are to attract and prepare the best possible teachers, we must learn what
kind of person makes a good teacher, what his motivations, attitudes, and
values are likely to be. Stated in more general terms, we need to know how
to maintain quality and enhance it, how to guarantee that the educational
programmes of the future will stimulate the fullest development of every
individual in spite of the raising costs of providing for longer periods of
duration.
At present we have laboratories, Classrooms, and teachers and patients to
initiate research in education. The addition of teaching machines
(computers), multimedia and television, self instructional material etc lead
to experiment the teaching and learning procedures ultimately to find out
the most effective processes. This means we move rapidly and judiciously in
trying out new technologies and constantly evaluating them. By persistent
refinement of the process and tools, we should consistently improve the
product. This calls for research, not guess work.
Page | 3
The total research effort requires adequate planning, prompts
communication and should cover all levels of educational curriculum. The
present medical research has the following setbacks.
1 It has focused too much on what happens to cohort of students and
less on the individual cognitive, emotional and attitudinal changes that
occur during the course and how these affect learning.
2 There were no attempts to be systematic in the efforts to rate the two
styles of learning. In this golden age of evidence-based medicine, where were
the calls for active comparator trials of teaching methods? There are no
trials of the use of placebo teaching, let alone "sham" lectures. Could not the
lecturers/tutors be blinded? What about random allocation of academic low
performers to different teaching methods? As to long-term follow-up, has
anyone given consideration to the comparison of patient satisfaction when
treated by doctors trained by the different styles of teaching?
3 There is no evidence available to either refute or support the major
curricular reforms embarked on by Many Indian Medical Institutions
4 The suggested curricular reform should be carefully researched and
evaluated. A major barrier to this is lack of funding available for such
research despite the possible „consequences for the future of our profession
and our patients'.
Research efforts are of little value unless the educational enterprise is able
to put the findings into practice. Many Medical Institutions in Maharashtra
are devoid of sufficient resources for current programmes and are unable to
implement the recommendations
Topic Objectives
1. Sensitize the issue on Medical educational Research
Introduction to 2. Understand the types of Research
Educational Research 3. Delineate the necessity of Documenting the
evidence on effectiveness of techniques
1. Describe the various techniques of Teaching and
Educational Techniques: Page | 4
learning
trends, Utility &
2. Understand the limitations of each method
Effectiveness
3. Outline the basic learning concepts in adults
Tea Break
1. Describe the educational research proposal
Research Methodology: preparation
outline of Qualitative & 2. Enumerate the General research designs adopted
quantitative and Mixed for qualitative and quantitative data.
Research Designs & 3. Able to outline the Experimental research
Methods 4. Understand the importance of quasi-experimental
and single-case designs in educational research
1. Describe the various categories of data(Nominal,
ordinal, interval & Ratio)
Quantitative Methods:
2. Understand the sampling procedures used in
Data Collection,
educational research.
Questionnaire preparation
3. Devise a questionnaire for data collection and data
quality checks
Lunch Break
1. Understand the types of qualitative research
(phenomenology, ethnography, grounded theory
and case study)
2. Describe the various qualities (SWOT) of qualitative
Qualitative & Mixed research
Methods in Education: 3. Understand the data collection tools and
techniques for qualitative data(questionnaire,
Interview, Focus group, Observation ).
4. Devise a suitable tool for educational data
collection
Tea Break
1. Describe the merits and demerits of Focus group
discussions
Focus Group Discussions 2. Understand the method of conducting Focus group
and Non participatory and and small group Discussions.
Participatory techniques 3. Understand the method of Participatory Learning
of qualitative data Appraisal(PLA)
collection in education 4. Describe the concepts of non participatory
educational techniques like Objective structured
examinations/assessments
1. Understand the concepts in Frequency
distribution, Measures of central tendency,
measures of variability.
2. Describe the various sampling distributions and
Descriptive & Inferential
Procedures used in educational research (
Statistics:
purposive, opportunistic, critical case)
3. Able to conduct Hypothesis testing.
4. Understand the concept of t-test, Analysis of
Variance and Chi-square tests.
1. Understand the areas in Education and Learning
requiring research
Areas of Research in
2. Delineate the Priority areas of educational research
Medical Education &
in India
Methods
3. Describe the Ethical problems involved in
Educational Research Page | 5
1. Familiar with the basic operational and data
handling techniques with SPSS software
Analysis of qualitative
2. Understand the techniques used in qualitative data
data: Use of computers &
analysis software
Software
3. Able to analyse data collected through interviews
and focus group discussions
Tea Break
Group Work: Preparation
of Research Projects in
Dr Amol Dongre
1)Innovative Teaching
Dr S P Rao
techniques
Dr Pradeep Borle
2) Academic Assessment
Dr J V Dixit
3) Impact evaluation
4) Economic assessment
Lunch Break
Presentation and
Discussion of Research All Faculty
Projects
Tea Break
POST TEST and
Concluding Session
Contributors:
The authors wish to acknowledge the following experts for their invaluable support
Dr Hemant Apte, Anthropological Society on India
Dr Payal Bansal, Maharashtra University of Health Sciences
Dr Avinash Supe, KEM Medical College
Dr Biranjan JR, Government Medical College, Dhule
Dr Patil , ACPM medical College, Dhule
Dr Haribhai Patel, Ahmedabad
The Authors acknowledge the generous financial support rendered by the National
Academy of Medical Sciences, New Delhi
Lesson I: Introduction to Educational Research
Objectives:
1 Sensitize the issue on Medical educational Research Page | 7
2 Understand the types of Educational Research
3 Delineate the necessity of Documenting the evidence on effectiveness of
techniques
Lesson Outline:
The 300 odd medical schools in India are fortunately equipped with medical
education Units (MEU). Thanks to the untiring efforts of Medical Council of
India and their inspectors. Mere existence of these units would not be able
to usher in required sea changes in medical education. Because most
medical schools in India, currently are experiencing difficulties in providing
the right quality and quantity of educational experiences as the curricula
have failed to respond to the needs of the community and country. The
pedagogic shift from traditional approach to a need-based approach requires
a fundamental change of the roles and commitments of educators, planners
and policymakers. Teachers of health professional education are to be well-
informed of the trends and innovations and utilize these to increase
relevance and quality of education to produce competent human resources.
There are now 18 International Medical Education Journals and the three
major journals in medical education are Medical Education, Academic
Medicine and Medical Teacher.
Is it true that a physician must be a good teacher?
Yes. Doctors have to teach their patients how to get well. They have a
responsibility to teach and educate the members of community how to stay
well. They have additional burden to teach their colleagues all that they
learnt. And if they choose to become medical teacher, they have the
responsibility for medical students.
Although we would never allow a patient to be treated by an untrained
doctor or nurse, we often tolerate professional training being delivered by
Page | 12
untrained teachers. Traditionally students were expected to absorb most of
their medical education by attending timetabled lectures and ward-rounds,
moving rapidly from one subject to the next in a crowded curriculum. Our
junior doctors learnt by watching their seniors in between endless menial
tasks. In recent years the importance of active, self directed learning in
higher education has been recognised. Outcome led structured programmes
for trainees are being developed in the face of reduced working hours for
both the learners and teachers. These all constitute new challenges for
teachers in medicine of all levels of seniority.
Throughout the world there is great interest in developing a set of
qualifications for medical teachers, both at the elementary “teaching the
teacher” level and as part of progressive modular programmes leading to
formal certification. In addition to acquiring new qualifications and
standards, teachers also need access to literature resources that describe
essential components in medical education and supply tips and ideas for
teaching.
What is expected from MBBS doctor now?
Medical Council of India expects that Graduate students to undertake the
responsibilities of a physician of first contact who is capable of looking
after the preventive, promotive, curative & rehabilitative aspect of
medicine. In addition to clinical competencies, students must develop
generic competencies or transferable personal skills essential to their roles
as health professionals, which include bio-ethics and communication skills,
interpersonal skills, problem-solving ability, decision-making capability,
management and organization skills, working in team, IT skills and doctor-
patient relationship.
Why to change the present system of teaching and learning?
The trends in present day medical education are as follows
1 Education for Capability
2 Community Oriented Medical Education
3 Self directed/ Learner centered Learning
4 Problem Based Learning (PBL) and Task Based Learning (TBL)
5 Integration and Early Clinical Contact
Page | 13
6 Continuing Professional Development
7 Unity Between Education and Practice
8 Evidence Based Medical Education/Best Evidence Medical
Education(BEME)
9 Communication and Information Technology
More than a dozen peer reviewed journals are available for research in
medical education. However, Indian authors‟ contribution to these journals
is miniscule. Hence it is necessary to inculcate the methodology of
educational research among the faculty of medical educators and promote
the evidence based teaching and learning methods. Until now medical
teachers are confined to the domain of clinical care and devoted less
importance to medical education research
Unfortunately, it has been reported that the majority of published studies
and dissertations on medical education are seriously flawed, containing
analytical and interpretational errors. Some of these flaws have arisen from
ill conceived statistical concepts, inappropriate research methodology both
qualitative and quantitative, deep rooted beliefs of various erroneous
"mythologies" about the nature of research and from a failure,
unwillingness, or even refusal to recognize that analytical and
interpretational techniques that were popular in previous decades no longer
reflect best practices and, moreover, may now be deemed inappropriate,
invalid, or obsolete.
The present understanding in medical education is such that the
standard/traditional methods on instruction/ teaching are ineffective. It has
been emphatically proved that learning among medical students is passive
rather than active. There is now enough evidence to prove that Traditional
Methods do not stimulate critical thinking, Creative thinking and
Collaborative Problem Solving. The explorative knowledge in Cognitive
Psychology proved beyond doubt these facts. The emphasis should be on
Andragogy rather than Pedagogy. It is to be kept in mind that the present
teaching is in an environment of Internet expansion/explosion.
Page | 14
Government of India and Medical Council of India revamped the curriculum
for MBBS course in a draft circulated to all medical colleges in India during
2007. The draft has rightly incorporated the various newer teaching
methods and encouraged to use newer assessment methods. The teaching
methods suggested are as follows:
Teaching Methods:
• Lectures
• Structured interactive sessions
• Small group discussion a) Demonstrations.
b) Tutorials.
c) Seminars.
d) Problem Based Learning.
• Focus group discussion (FGD)
• Projects
• Participatory learning appraisal (PLA)
• Video clips
• Written case scenario
• Self learning tools Interactive learning
• e-modules
• Skills Labs
• Preparation of scientific article
Assessment Methods:
• MCQ
• SAQ
• OSCE
• OSLER
• MiniCEX
• Case Based Discussion
• Multi Source Feedback 360 Degrees
• Client Satisfaction
Types of Research:
BASIC…………………………MIXED………………………….APPLIED
2 Evaluation Research:
• Formative: for programme improvement
• Summative: programme summary judgments & decision to continue
A good researcher‟s basic quality is the ability to reason. There are two kinds
of reasoning namely deductive and inductive.
Deductive reasoning (i.e., the process of drawing a specific conclusion from
a set of premises). In this approach of formal logic, a conclusion from
deductive reasoning will necessarily be true if the argument form is valid
and if the premises are true.
Inductive reasoning (i.e., reasoning from the particular to the general). The
conclusion from inductive reasoning is probabilistic. It is based on the
assumption that the future might not resemble the present.
Common Assumptions in Medical Education Research:
• World out there that can be studied
• World is unique. Some of it is regular and predictable. But most of it
is Dynamic and complex
• Researchers can examine/ study the unique, regular and complex
world
• Researchers follow agreed norms/ practices
• It is possible to distinguish between good & poor research
• Science can not provide answers to All questions.
Scientific Methods: There are many scientific methods. The two major
methods are the inductive method and the deductive method.
• The deductive method( Quantitative technique) involves the following
three steps:
Page | 17
1. State the hypothesis (based on theory or research literature).
2. Collect data to test the hypothesis.
3. Make decision to accept or reject the hypothesis.
• The inductive method(Qualitative technique) also involves three steps:
1. Observe the world.
2. Search for a pattern in what is observed.
3. Make a generalization about what is occurring.
Diagramatically, these two methods are represented as below.
Collect Tighter
More Data Specification
of Question
Qualitative Research
Quantitative Research: Based on Assumption that Random Events are
Predictable. Any application of science includes the use of both the
deductive and the inductive approaches to the scientific method either in a
single study or over time. The inductive method is as “bottom up” method
Page | 18
that is especially useful for generating theories and hypotheses; the
deductive method is a “top down” method that is especially useful for testing
theories and hypotheses. This is called “Research Wheel”.
Lesson II: Educational Techniques: trends, Utility & Effectiveness
Page | 19
Objectives:
1 Describe the various techniques of Teaching and learning
2 Understand the limitations of each method
3 Outline the basic learning concepts in adults
Lesson Outline:
Exercise I
Enlist the merits and demerits of lecture as a method of teaching and
learning
The Panel
A group of four or more persons sit with a moderator in front of an
audience; they hold an orderly and logical conversation on an
assigned topic Page | 22
Each member makes an opening remark for 3 to 5 minutes before
exchanging ideas
Each member has a special knowledge or holds a particular view of
the topic
Merits
Identifies and explores a problem or issue from many angles
Audience can understand various aspects of the issue
Frequent change of speaker and view point maintains attention and
interest of audience
Establishes informal contact with the audience
Demerits
Panelists may not cover all aspects of the problem and may over
emphasize only certain aspect
Skilled moderator is necessary to ensure logical and balanced
coverage by the panel
Audience is passive unless some question time is permitted
Team Teaching
It has evolved since late 50s‟ with the objectives of improving the
quality of teaching by utilizing better talents and skills of a team of
teachers. The team may act in four styles:
– Relay style of team teaching
– Team teaching in the same period (like a symposium)
– Ability based team teaching
– Specialization based team teaching
Exercise II
Select appropriate T-L method
– Convince a woman to use copper T
– Inform about side effects of a medicine to patients
– Educate about drug policy of India
– How to inject BCG vaccine
– Preparing a patient for operation
– Autoclaving
– Vaccination campaign
Objectives:
1. Describe the educational research proposal preparation
2. Enumerate the General research designs adopted for qualitative and
quantitative data.
3. Able to outline the Experimental research
4. Understand the importance of quasi-experimental and single-case designs in
educational research
Lesson Outline:
B. Strong Designs:
Volunteers
No
Inter Agreed to participate Refused to participate Interv
ention
venti
(Contr
on
ol)
Page | 43
Baseline (A) Post Test (B) Baseline (A)
Objectives: Page | 47
4. Describe the various categories of data(Nominal, ordinal, interval & Ratio)
5. Understand the sampling procedures used in educational research.
6. Devise a questionnaire for data collection and data quality checks
Lesson Outline:
It should be remembered that the evidence for the specific use of a given test
is available rather than validity as residing in the test itself. Hence instead of
using the traditional terms such as content validity, predictive validity and Page | 52
construct validity, general term validity evidence is being used in
educational research. Validity evidence is based on three broad sources:
content, relations to other variables, and construct. Not all test uses must
meet all three types. Different types of tests are used for different purposes
and, therefore, need different types of evidence. E.g. Intelligence test is
designed to predict academic achievement and is based on psychological
theory or construct. Thus it needs demonstration of evidence for both
construct and prediction but not necessarily demonstrate evidence for the
content.
It refers to the degree to which the test items actually measure, or are
specifically related to, the traits for which the test was designed and is to be
used. The content includes the issues, the actual wording, the design of the
items, or questions, and how adequately the test samples the universe of
knowledge and skills that a student is expected to master. The content
should match the course text books, syllabi, objectives and the judgements
of subject experts. It is high importance for achievement tests but not so for
aptitude tests. Also assess whether the test‟s content is appropriate for the
persons to be tested.
Validity is a unitary concept based on all of the evidence, the totality of the
evidence should be considered as evidence for validity of a given test use.
Page | 54
Reliability
Reliability refers to consistency or stability. In psychological and educational
testing, it refers to the consistency or stability of the scores that we get from
a test or assessment procedure. A test is reliable to the extent that it
measures whatever it is measuring consistently. Reliable tests are stable
and yield comparable scores on repeated administration. It is usually
determined using a correlation coefficient (it is called a reliability coefficient
in this context). The correlation coefficient is a measure of relationship that
varies from -1 to 0 to +1. Increase in the number of items in a test would be
able to increase the reliability because a test with few items has a great deal
of measurement error. There are a number of types of reliability.
1 Stability over time (test-retest): The scores on a test will be highly
correlated with scores on a second administration of the test to the
same subjects at a later date.
2 Stability over item samples (equivalent or parallel forms): Some tests
have two or more forms that may be used interchangeably. In these
cases, scores on one version will be very similar with scores on the
alternate form of the test. This can be practically carried out through
the administration of a longer test comprising of both the versions of
the test. Later separating the two versions, scores can be compared.
3 Stability of items (internal consistency): Test items should be highly
related to other test items. This is important because the test, or in
Page | 55
some cases the subtest, needs to measure a single construct. This can
be achieved by a) Split halves (test through Spearman-Brown formula)
or Coefficient of consistency (test through Kuder-Richardson
formula).
4 Stability over scorers (inter-scorer): Projection tests have a great deal
of judgement of the person scoring the test. Scorer reliability can be
determined by two independent scorers scoring the same test papers
or video tapes of the test.
5 Stability over testers: Differently trained testers and their personality
or other attributes can affect the test scores. This can overcome
through two different testers administer the two testings, with each
one giving the test first half of the time.
6 Standard error of measurement: This statistic permits the
interpretation of individual scores obtained on a test. No tests are
perfectly reliable. The standard error of measurement tells how much
difference can be expected by obtained score which is away from the
true score.
A test may be reliable even though it is not valid. However, for a test to be
valid, it must be reliable. That is, a test can consistently measure (reliability)
nothing of interest (be invalid), but if a test measures what is designed to
measure (validity), it must do so consistently (reliability).
Economy
Tests that can be given in a short period of time are likely to gain
cooperation of the subjects. Ease of administration, scoring, and
interpretation are important factors in selection of the test.
Interest
Tests that are interesting and enjoyable help to gain the cooperation of the
subject. Those that are dull or seem silly may discourage or antagonise the
subject. Under these unfavourable conditions the test is not likely to yield
useful results.
When psychological tests are used in educational research, one should
remember that standardised test scores are only approximate measures of
Page | 56
the traits under consideration. This limitation is inevitable and may be
ascribed to a number of possible factors.
1 Errors inherent in any psychological test-no test is completely
valid or reliable
2 Errors that may result from poor test conditions, inexpert or
careless administration or scoring of the test, or faulty tabulation
of test score
3 Inexpert interpretation of test results
4 The choice of an inappropriate test for the specific purpose in
mind.
Methods of Data Collection
There are six major methods of data collection.
• Tests (i.e., includes standardized tests that usually include
information on reliability, validity, and norms as well as tests
constructed by researchers for specific purposes, skills tests, etc).
• Questionnaires (i.e., self-report instruments).
• Interviews (i.e., situations where the researcher interviews the
participants).
• Focus groups (i.e., a small group discussion with a group moderator
present to keep the discussion focused).
• Observation (i.e., looking at what people actually do).
• Existing or Secondary data (i.e., using data that are originally
collected and then archived or any other kind of “data” that was
simply left behind at an earlier time for some other purpose).
Tests
Tests are commonly used in research to measure personality, aptitude,
achievement and performance. Tests can also be used to complement
other measures (following the fundamental principle of mixed research).
A researcher must develop a new test to measure the specific knowledge,
skills, behaviour, or cognitive activity that is being studied. For example,
a researcher might need to measure response time to a memory task
using a mechanical apparatus or develop a test to measure a specific
mental or cognitive activity (which obviously cannot be directly observed).
Page | 57
Remember that if a test has already been developed that purports to
measure what is intended to measure, then consider that test.
Strengths and Weaknesses of Tests
Strengths Weaknesses
Can provide measures of many Can be expensive if test must be
characteristics of people. purchased.
Often standardized (same stimulus Reactive effects such as social
is provided to all participants). desirability can occur.
Allows comparability of common Test may not be appropriate for a
measures across populations. local or unique population.
Strong psychometric properties
Open-ended questions and probing
(high measurement validity). not available.
Availability of reference group data.Tests are sometimes biased against
certain groups of people.
Many tests can be administered to Non response to selected items on the
groups which saves time. test.
Can provide “hard,” quantitative Some tests lack psychometric data.
data.
Tests are usually already developed. Can be expensive if test must be
purchased.
A wide range of tests is available. Reactive effects such as social
desirability can occur.
Response rate is high for group Test may not be appropriate for a
administered tests. local or unique population.
Ease of data analysis because of Open-ended questions and probing
quantitative nature of data. not available.
Three primary types of tests viz. intelligence tests, personality tests, and
educational assessment tests are commonly used in educational research.
1) Intelligence Tests: Intelligence has many definitions because a single
prototype does not exist. Although the construct of intelligence is hard to
define, it still has utility because it can be measured and it is related to
many other constructs.
2) Personality Tests: Personality is a construct similar to intelligence in
that a single prototype does not exist. Personality is the relatively permanent
patterns that characterize and can be use to classify individuals. Most
personality tests are self-report measures. Performance measures of
personality are also used. A performance measure is a test-taking method in
which the participants perform some real-life behaviour that is observed by
Page | 58
the researcher. Personality has also been measured with projective tests. A
projective test is a test-taking method in which the participants provide
responses to ambiguous stimuli. The test administrator searches for
patterns on participants‟ responses. Projective tests tend to be quite difficult
to interpret and are not commonly used in quantitative research.
3) Educational Assessment Tests.
There are four subtypes of educational assessment tests:
• Achievement Tests: These tests are important in Medical
Education. These are used in placing, advancing, or retaining
students at particular grade levels. These will measure the degree of
learning that has taken place after a person has been exposed to a
specific learning experience. They can be teacher constructed or
standardized tests. Many of these achievements tests are non-
standardised, teacher-designed tests which lack content validity.
Concurrent validity might be used to help establish a new
achievement test‟s validity. The only forms of reliability that are
critical are test-re-test, stability over test items, and the standard
error of measurement.
• Aptitude Tests: These focus on information acquired through the
informal learning that goes on in life. They are used to predict future
performance whereas achievement tests are used to measure current
performance. Aptitude tests attempt to predict an individual‟s capacity
to acquire improved performance with additional training. Eg.
Stanford-Binet Intelligence scale. These tests, particularly those that
deal with academic aptitude, that are used for purpose of placement
and classification have become highly controversial because of the
culturally different content. It is extremely difficult to eliminate
culture totally and develop one test that is equally fair to all
communities including the minority. For these tests, Predictive
validity and construct validity are important. The forms of reliability
that are critical to these tests are test-retest, stability over test items,
and the standard error of measurement. The tests that have some
degree of subjectivity also require inter-scorer and inter-tester
Page | 59
reliability.
• Personality Inventories: Personality scales are usually self-report
instruments. Because of the individual‟s inability or unwillingness to
report their own reactions accurately or objectively, these instruments
may be of limited value. They provide data useful in suggesting the
need for further analysis. Test setting also influence the results. Eg. A
test applied in clinical setting correlate well with psychiatrist‟s
diagnosis; but when applied to college students, it‟s diagnostic value
might be disappointing.
Diagnostic Tests: These tests are used to identify the locus of
academic difficulties in students.
Omitting the centre point on a rating scale (e.g., using a 4-point rather than
a 5-point rating scale) does not appreciably affect the response pattern.
Some researchers prefer 5- point rating scales; other researchers prefer 4-
point rating scales. Both generally work well.
Rankings (where participants put their responses into rank order, such as
most important, second most important, and third most important) can be
Page | 62
converted into Likert Scale.
Semantic differential (i.e., where one item stem and multiple scales that are
anchored with polar opposites or antonyms, are included and are rated by
the participants). It is similar to Likert Method in that the respondent
indicates an attitude or opinion between two extreme choices.
Checklists (i.e., where participants "check all of the responses in a list that
apply to them") can also be used.
Principle 11: Use multiple items to measure abstract constructs. This is
required to have high reliability and validity. One approach is to use a
summated rating scale also known as Likert Scale(such as the Rosenberg
Self-Esteem Scale that is composed of 10 items, with each item measuring
self-esteem).
Principle 12: Use multiple methods to measure abstract constructs. Use of
only one method might result in artefact of that method of measurement. If
more than one method is used, check can be kept whether the answers
depend on the method.
Principle 13: Use caution if reverse wording is used in some of the items to
prevent response sets. (A response set is the tendency of a participant to
respond in a specific direction to items regardless of the item content).
Reversing the wording of some items can help ensure that participants don't
just "speed through" the instrument, checking "yes" or "strongly agree" for
all the items. Evidence suggests that the use of reverse wording reduces the
reliability and validity of scales.
Principle 14: Phrase questions so that they are appropriate for all
respondents. Also, avoid unwanted assumptions. Design questions that will
give a complete response. Develop a questionnaire that is easy for the
participant to use. The participant must not get confused or lost anywhere
in the questionnaire.
Principle 15: Always pilot test the questionnaire with a small group of
persons similar to those who will be used in the study. These dry runs will
be worth the time and effort. Based on the observations of pilot study, revise
and re-revise the questions if necessary.
Page | 63
Principle 16: Questionnaire should seek information that can not be
obtained from other sources such as college record/ reports or census data.
Principle 17: Questions are to be presented in good psychological order,
proceeding from general to more specific questions.
Principle 18: It is advisable to pre-construct a tabulation sheet, anticipating
how the data will be tabulated (Dummy Tables) and interpreted, before the
final form of the questionnaire is decided on.
Principle 19: Questionnaire should be attractive in appearance, neatly
arranged, and clearly duplicated or printed.
Principle 20: It should be as short as possible and only long enough to get
the essential data
Strengths and Weaknesses of Questionnaires
Strengths Weaknesses
Good for measuring attitudes and eliciting Usually must be kept short.
other content
Inexpensive (mail questionnaires & group Reactive effects may occur (e.g., interviewees
administered questionnaires). may show only what is socially desirable).
Can provide information about participants‟ Non-response to selective items.
internal meanings and ways of thinking.
Can administer to probability samples. People may not recall important information
and may lack self-awareness.
Quick turnaround. Response rate may be low for mail and email
questionnaires.
Can be administered to groups. Open-ended items may reflect differences in
verbal ability, obscuring the issues of
interest.
Perceived anonymity by respondent may be Data analysis can be time consuming for
high. open-ended items.
Moderately high measurement validity (i.e., Measures need validation.
high reliability and validity)
Closed-ended items can provide exact
information
Open-ended items can provide detailed
information
Ease of data analysis for closed-ended items.
Useful for exploration as well as confirmation.
Interviews
In an interview, the interviewer asks the interviewee questions (in-person or
over the telephone). It is often superior to other data gathering devices.
Through this technique, the researcher may stimulate the subject‟s insight
in to his/her own experiences, thereby exploring significant areas not
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anticipated in the original plan of investigation. It is the appropriate
techniques when dealing with children. Trust and rapport are important.
Probing is available and is used to reach clarity or gain additional
information. It is necessary to consider the gender, race, and possibly other
characteristics of the interviewer. However, distilling the essence of the
reaction is difficult, and interviewer bias may be a hazard. In interviews
actual wording of the responses should be retained. The validity can be
increased by conducting a structured interview. Though time consuming,
this technique, is useful in areas where human motivation is revealed
through actions, feelings, and attitudes. Interviews can be classified as
qualitative and quantitative. Quantitative interviews utilise closed-ended
questions and are standardised. Unlike qualitative interviews consist of
open ended questions. These can be further subdivided into informal
conversational interview (which is spontaneous and is loosely structured);
Interview Guide Approach (which is more structured having interview
protocol. Wording and sequence of questions can be altered by the
interviewer); and
Standardized Open-Ended Interview (where the questions are in a protocol
strictly adhered to and the wording can not be changed).
Strengths and Weaknesses of Interviews
Strengths Weaknesses
Good for measuring attitudes and most other In-person interviews are expensive and time
content of interest. consuming.
Allows probing and posing of follow-up Reactive effects (e.g., what is socially desirable).
questions by the interviewer.
Can provide in-depth information. Investigator effects may occur (e.g., untrained
interviewers distort data due to personal biases
and poor interviewing skills).
Can provide information about participants‟ Interviewees may not recall important
internal meanings and ways of thinking. information and may lack self-awareness.
Closed-ended interviews provide exact Perceived anonymity by respondents may be low.
information.
Telephone and e-mail interviews provide very Data analysis is time consuming for open-ended
quick turnaround. items.
Moderately high measurement validity (i.e., Measures need validation
high reliability and validity)
Can use with probability samples.
Relatively high response rates are often
attainable.
Useful for exploration as well as Page | 65
confirmation.
.
Q Methodology
Q-Methodology is a technique for scaling objects or statements. It is a
method of ranking attitudes or judgements and is primarily effective when
the number of items to be ranked is large. The procedure is known as Q-
Sort, in which cards or slips bearing the statements or items are arranged in
a series of numbered piles.
Social Scaling
Sociometry: It is a technique for describing the social relationships among
individuals in a group. In an indirect way this technique attempts to
describe attraction or repulsion between individuals by asking them to
indicate whom they would choose or reject in various situations.
Diagrammatically, it can be represented as Venn or Chapati. In medical
education, health care seeking behaviour of a community or group can be
studied.
Sociogram: Sociometric choices may be represented graphically on a chart
known as sociogram. In this chart, those most chosen are referred as Stars,
and those less chosen as Isolates. Small groups made up of individuals who
choose one another are Cliques. Sociometry is a peer rating rather than a
rating by superiors. Students of group relationships and classroom
teachers may construct a number of sociograms over a period of time to
measure changes that may have resulted from efforts to bring isolates into
closer group relationships or to transform cliques into more general group
membership. Another technique used also determines the social-Distance.
This Social-Distance Scale attempts to measure to what degree an
individual or group of individuals is accepted or rejected by another
individual or group. The target sociogram is depicted as below. In this
diagram, nested series of concentric circles are drawn based on the points
that are equal in terms of how frequently they were chosen. Points in the
central circle are more central in the sense that they were chosen more
often. Points at the edge were chosen less often. The lines connecting them
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represent the primary links between pairs. And all the points are placed in
the rings in such a way that the lines connecting them are relatively short. d
“Guess-Who” Technique
Developed by Hartshorne and May, 1929, Guess-Who technique is a
process, consists of descriptions of the various roles played by children in a
group. Children are asked to name the individuals who fit certain verbal
descriptions.
Name the teacher who always comes late to the class
Name the teacher who always uses the word” you know”
Name the student who always smiles and happy
Focus Groups
A focus group is a situation where a focus group moderator keeps a small
and homogeneous group (of 6-12 people) focused on the discussion of a
research topic or issue. Focus group sessions generally last between one
and three hours and they are recorded using audio and/or videotapes.
These groups are useful for exploring ideas and obtaining in-depth
information about how people think about an issue.
Strengths and Weaknesses of Focus Groups
Strengths Weaknesses
Useful for exploring ideas and Sometimes expensive.
concepts.
Provides window into participants‟ Difficult to find a moderator with good
internal thinking. facilitative and rapport building skills.
Can obtain in-depth information. Reactive and investigator effects occur if
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participants feel they are being watched
or studied (Hawthorne Effect).
Can examine how participants react to May be dominated by one or two
each other. participants.
Allows probing. Difficult to generalize results if small,
unrepresentative participants sample
Most content can be tapped. May include large amount of extra or
unnecessary information.
Allows quick turnaround. Measurement validity may be low.
Usually should not be the only data
collection methods used in a study.
Data analysis can be time consuming
because of the open-ended nature of data
Observation
In the method of data collection called observation, the researcher observes
participants in natural and/or structured environments as participant or
non-participant. Observation can be carried out as time sampling technique
(based on observation of individuals behaviour for every 60 seconds or more)
or it can be carried out as a frequency count (based on the number of
occurrences of a particular type of behaviour). Observation is specifically
used effectively to scout the performance of opposing teams in sports. It is
important to collect observational data (in addition to attitudinal data)
because what people say is not always what they do! Observation can be
carried out in two types of environments namely Laboratory observation
(which is done in a lab set up by the researcher) and Naturalistic
observation (which is done in real-world settings). However, observation
should always be systematic, directed by a specific purpose, carefully
focussed and thoroughly recorded. Criterion-related and construct validity
are necessary. It is recommended that observations should be double-blind
(both the observers and the observed are unaware of the purpose of the
study and are unaware of the observation process). It is also suggested in
order to reduce observer bias, conduct study by more than one observer.
Always have a dry-run phase before the implementation. Simultaneous
recording of observations is highly recommended. Educational research
seeks to describe behaviour under less rigid controls and more natural
conditions. There are two important forms of observation.
1 Quantitative observation involves standardization procedures, and it
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produces quantitative data (The following data is collected: Who is observed;
what is observed; when the observations are to take place; where the
observations are to take place; and how the observations are to take place).
Standardized instruments (e.g., checklists) are often used in quantitative
observation. Two sampling procedures are also often used in quantitative
observation. Time-interval sampling (i.e., observing during time intervals,
e.g., during the first minute of each 10 minute interval) and Event sampling
(i.e., observing after an event has taken place, e.g., observing after teacher
asks a question).
2 Qualitative observation is exploratory and open- ended, and the
researcher takes extensive field notes. The qualitative observer may take on
four different roles that make up a continuum:
• Complete participant
• Participant-as-Observer (i.e., spending extensive time "inside" and
informing the participants that you are studying them).
• Observer-as-Participant (i.e., spending a limited amount of time "inside"
and informing them that you are studying them).
• Complete Observer
Strengths and Weaknesses of Observational Data
Strengths Weaknesses
Allows one to directly see what people do Reasons for observed behaviour may
without relying on what they say. be unclear.
Provides firsthand experience. Reactive effects may occur when
respondents know they are being
Observed( Hawthorne Effect).
Can provide relatively objective Investigator effects (e.g., personal
measurement of behaviour. biases and selective perception)
Observer may see things that escape the Sampling of observed people and
awareness of people in the setting. settings may be limited.
Excellent way to discover what is occurring Cannot observe large or dispersed
in a setting. populations.
Helps in understanding importance of Some settings and content of
contextual factors. interest cannot be observed.
Can be used with participants with weak Collection of unimportant material
verbal skills. may be moderately high.
Provide information on things people would More expensive to conduct than
otherwise be unwilling to talk about. questionnaires and tests.
Observer may move beyond selective Data analysis can be time
perceptions of people in the setting. consuming.
Good for description.
Provides moderate degree of realism. Page | 69
Secondary/Existing Data
Secondary data (i.e., data originally used for a different purpose) are
contrasted with primary data (i.e., original data collected for the new
research study). The most commonly used secondary data are documents,
physical data, and archived research data.
1. Documents. These are Personal documents (i.e., Letters, diaries,
family pictures) and Official documents (i.e., Newspapers, annual reports,
yearbooks, minutes).
2. Physical data (are any material thing created or left by humans that
might provide information about a phenomenon of interest to a researcher).
3. Archived research data (i.e., research data collected by other
researchers for other purposes, and these data are save often in tape form or
CD form so that others might later use the data).
Strengths and Weaknesses of Secondary Data
Physical Data
Strengths Weaknesses
Can provide insight into what people think May be incomplete.
and what they do.
Unobtrusive, making reactive and investigator May be representative only of one
effects very unlikely. perspective.
Can be collected for time periods occurring in Access to some types of content is
the past (e.g., historical). limited.
Provides background and historical data on May not provide insight into
people, and organizations. participants‟ thinking for physical
data.
Useful for corroboration. May not apply to general populations.
Grounded in local setting.
Useful for exploration.
Objectives:
1. Understand the types of qualitative research (phenomenology, ethnography, Page | 71
grounded theory, case study and concept maps)
2. Describe the various qualities (SWOT) of qualitative research
3. Understand the data collection tools and techniques for qualitative
data(questionnaire, Interview, Focus group, Observation )
4. Types of Qualitative data. Common misconceptions about qualitative research
5. Mixed Methods
Lesson Outline:
1 Phenomenology
Phenomenology is a descriptive study of how individuals experience a
phenomenon. In this , researcher study what is the meaning, structure, and
essence of the lived experience of this phenomenon by an individual or by
many individuals. The researcher tries to gain access to individuals' life-
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worlds, which is their world of experience; it is where consciousness exists.
Conducting in-depth interviews is a common method for gaining access to
individuals' life- worlds. The researcher, next, searches for the invariant
structures of individuals' experiences. Phenomenological researchers often
search for commonalities across individuals (rather than only focusing on
what is unique to a single individual). For example, what are the essences of
peoples' experience of the death of a loved one?
After analysing the phenomenological research data, a report has to be
documented which provides rich description and a "vicarious experience" of
being there for the reader of the report.
2 Ethnography
Ethnography is the discovery and description of the culture of a group of
people. Here is the foundational question in ethnography: What are the
cultural characteristics of this group of people or of this cultural scene?
Because ethnography originates in the discipline of Anthropology, the
concept of culture is of central importance. Culture is the system of shared
beliefs, values, practices, language, norms, rituals, and material things that
group members use to understand their world. One can study micro
cultures (e.g., such as the culture in a classroom) as well as macro cultures
(e.g., such as the Pawra or bhil tribal culture in nandurbar district.).
Multiple methods of data collection are often used in case study research
(e.g., interviews, observation, documents, questionnaires). The case study
final report should provide a rich (i.e., vivid and detailed) and holistic (i.e.,
describes the whole and its parts) description of the case and its context.
4 Grounded Theory
Grounded theory is the development of inductive, "bottom-up," theory that is
"grounded" directly in the empirical data. Here is the foundational question
in grounded theory: What theory or explanation emerges from an analysis of
the data collected about this phenomenon? It is usually used to generate
theory. Grounded theory can also be used to test or elaborate upon
previously grounded theories, as long as the approach continues to be one of
constantly grounding any changes in the new data.
Four important characteristics of a grounded theory are
• Fit (i.e., Does the theory correspond to real-world data?),
• Understanding (i.e., Is the theory clear and understandable?),
• Generality (i.e., Is the theory abstract enough to move beyond the
specifics in the original research study?),
• Control (i.e., Can the theory be applied to produce real-world results?).
Data collection and analysis continue throughout the study. When collecting
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and analyzing the researcher needs theoretical sensitivity (i.e., being
sensitive about what data are important in developing the grounded theory).
Data analysis often follows three steps:
1. Open coding (i.e., reading transcripts line-by- line and identifying and
coding the concepts found in the data).
2. Axial coding (i.e., organizing the concepts and making them more
abstract).
3. Selective coding (i.e., focusing on the main ideas, developing the story,
and finalizing the grounded theory).
The grounded theory process is "complete" when theoretical saturation
occurs (i.e., when no new concepts are emerging from the data and the
theory is well validated). The final report should include a detailed and clear
description of the grounded theory.
Mixed Research:
Mixed research is research in which quantitative and qualitative techniques
are mixed in a single study. Proponents of mixed research typically adhere
to the compatibility thesis as well as to the philosophy of pragmatism. The
compatibility thesis is the idea that quantitative and qualitative methods are
compatible, that is, they can both be used in a single research study. The
philosophy of pragmatism says that researchers should use the approach or
mixture of approaches that works the best in a real world situation. In
short, what works is what is useful and should be used, regardless of any
philosophical assumptions, paradigmatic assumptions, or any other type of
assumptions.
Today, proponents of mixed research attempt to use what is called the
fundamental principle of mixed research. According to this fundamental
principle, the researcher should use a mixture or combination of methods
that has complementary strengths and non-overlapping weaknesses.
Quantitative research Qualitative research
Strengths
Already constructed theories Data based on participants meaning
Already constructed hypothesis Useful to describe complex phenomenon
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Random samples, sufficient size Provide individual case information
generate findings
Quantitative predictions possible Provides insider‟s view point
Confounders eliminated Dynamic process is documented
Data collection is quick Data collected in naturalistic setting
Precise quantitative data Data useful to generate hypothesis/
theory
Analysis less time consuming
Researcher independent results
Higher credibility
Large population can be studied
Weaknesses
Local constituents may not May not be generalizable
understand
Focussing on hypothesis might miss Difficult to quantitative prediction
some phenomenon
Abstract knowledge Difficult to test hypothesis/ theory
Low credibility
Data analysis time consuming
Researcher bias can influence results
Data collection takes more time
Mixed Research
Strengths Weaknesses
Words, pictures, narrative add Difficult for single researcher to
meaning to numbers conduct qualitative & quantitative
Can have strengths of both More exepensive
qualitative and qualitative methods
Can generate and test theory More time consuming
Can answer broad range of questions Complex analysis
Can provide stronger evidence
Increases generalizability
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Collect Collect
Qualitative data Quantitative
Data
Lesson Outline:
1 Qualitative methods include Participatory techniques, in-depth
techniques and systematic techniques. The participatory techniques are
valuable and popular. Identifying the health resources, drawing socio-
cultural relationships, mapping of health needs, transects etc are
utilised by the educationalists for teaching and learning in medical
curriculum.
Introduction:
Qualitative research is type of formative research that includes specialized
techniques for obtaining „in-depth responses‟ from respondents. Qualitative
research is often conducted to answer the question - why? A purpose of qualitative
research is the construction (not the discovery) of new understanding. At present
there is a revival in the qualitative methods. The reasons for this revival of interest
in qualitative Methods are depicted below. 1) Growing realization of unsuitability of
survey research methods in the context of developing countries where population is
predominantly oral and illiterate and where magnitude of non-sampling errors is
high in surveys. 2) Increased interdisciplinary team work. 3) Demand of quick
results from the ethnographic work.
The latest trend in the field of research is the combined use of quantitative and
qualitative research methods i.e. mixed-method design within a single data set.
According to Morse (2005), it is in this area that the largest abuses of qualitative
data are occurring, largely because methodological principles have not been
followed.
Types of Qualitative Methods:
The qualitative data collection techniques range from the highly structured
systematic techniques to the highly flexible people-centered participatory
techniques.
Participatory research (PR) techniques
Page | 80
In-depth techniques
Systematic techniques
Rajesh Tandon (Ed). Participatory Research: Revisiting the Roots. New Delhi
(India), Mosaic books; 2005.
Page | 81
2 In Depth Techniques:
These are qualitative in-depth flexible discussions or interviews with the group or
person who knows what is going in community about the topic on which we want
to get information. Some commonly used methods are Focus Group Discussion
(FGD), Key Informant Interviews (KII) and In-depth Interview (IDI).
Application of in-depth techniques in medical education
Formative exploration of students‟ perception about Community Medicine
teaching at Mahatma Gandhi Institute of Medical Sciences, Sewagram, India.
Online J Health Allied Scs. 2008;7(3):2. Link:
http://www.ojhas.org/issue27/2008-3-2.htm
Portfolio based approach for teaching public health among medical under-
graduates and assessment of their learning in a Medical college of rural
India
3 Systematic Techniques:
These techniques can be used with almost any qualitative research methods such
as focus group or participatory research to collect systematic and structured data.
Principle - Respondent make sense of their words by grouping their observation or
experiences in class known as domain. Examples - Free listing, Pile sorting, Delphi
panel etc. Free list combined with pile sort can be used for systematic exploration
of the perceptions of respondents on a given research topic.
Application of Systematic Techniques in Research Page | 82
Process Documentation of Health Education Interventions for School
Children and Adolescent Girls in Rural India. Education for Health, Volume
22, issue 1, 2009.
Objectives: Page | 85
1. Describe the merits and demerits of Focus group discussions
2. Understand the method of conducting Focus group and small group
Discussions.
3. Understand the method of Participatory Learning Appraisal(PLA)
4. Describe the concepts of non participatory educational techniques like Objective
structured examinations/assessments
Lesson Outline:
Guidelines for the FDG Participants: One participants speak at one time and
clearly. Try gathering everyone‟s perspective/opinion and encouraging
participation.
Process of FDG: FGD guidelines are to be pre-tested in advance. More than one
FGD is to be conducted Moderator /note-takers should be trained in advance. In
recruitment of the participants take help from key informant so that homogeneity
can be maintained. The process need to be recorded in addition to the routine
note-taking. Ideally FGD should be of 90 minutes duration. Make physical
arrangements for setting, equipment, food and drinks, and child care if necessary.
Select the location and time for FGD.
Exercise:
• Select a study topic
• Prepare three questions for FGD discussion
Exercise:
• Select a study topic
• Identify key informant for your research topic
Lesson VIII:
Descriptive & Inferential Statistics
Objectives:
1. Understand the concepts in Frequency distribution, Measures of central Page | 90
tendency, measures of variability.
2. Describe the various sampling distributions and Procedures used in educational
research ( purposive, opportunistic, critical case)
3. Able to conduct Hypothesis testing.
4. Understand the concept of t-test, Analysis of Variance and Chi-square tests.
Lesson Outline:
Descriptive Inferential
Estimation Hypothesis
Testing
Point Interval
Timing of Number of
menarche girls
Early (<11Yrs) 80
Average (11-14Yrs) 140
Late (>=14Yrs) 40
Total 260
60
50
40
No of cases
30
20
10
0
Pain in Backache Discharge Bleeding PV Urinary Pelvic
abdomen PV complaint pressure
Symptoms
25
20
Page | 100
ICU stay (Days)
15
10
0
0 2 4 6 8 10 12 14
Days of delirium (Days)
c. Frequency curve:
When the numbers of observations are very large with small class intervals, it gives
smooth curve known as frequency curve. It is slightly modification of frequency
polygon. Here by taking class interval on X-axis and the frequency on Y-axis.
Joined this points by smooth curve instead of straight line.
d. Cumulative frequency curve or Ogive curve:
We are interested to knowing “How many cases attending the hypertension clinic
had cholesterol level less than 200 mg / dl and more than 200 mg / dl”,
“Percentage of students who have failed” etc. To answer these questions, it is
necessary to add the frequencies. When the frequencies are added, they are called
cumulative frequencies. The curve obtained by plotting cumulative frequencies is
called a Cumulative frequency curve or an Ogive curve.
There are two types:
1. Less than type: We start with the upper limits of the classes and go on adding
the frequencies. Plot these points we get a rising curve.
2. More than type: We start with the lower limits of the classes and subtract the
frequencies of each class. Plot these points we get a declining curve.
e. Line chart:
This is a frequency polygon presenting variation by line. It shows an event
occurring over a period of time rising, falling or fluctuations. This kind of diagram
is best used to show trend in a metric measurement over time or over age. Growth
charts, or “Road to Health” card, used for assessment in children, are line diagram.
Eg. This is a temperature chart for a patient of tuberculosis for these consecutive
days. Evening rise in temperature in this case can indicate toxaemia.
Eg. Birth rate, growth rate, IMR, death rate from 1951 to 1991.
f. Scatter or dot diagram:
To show the nature of correlation between two variable in the same persons or
groups. Eg. Height and weight, BMI and BSL in your batch. The points are plotted
on graph paper, one for each observation. Such type of diagram shows how far the
points are scattered. Hence it is called scatter diagram. Draw a line passing Page | 101
through these points maximum points on a line, half point lie above and half lie
below, to show the nature of correlation at a glance.
Eg. BMI and BSL are recorded for 23 persons; a point can be plotted for each
person with BMI on horizontal axis and BSL on the vertical axis. The vertical axis
in a scatter diagram should be dependent or the outcome variable. Eg. BSL depend
on BMI and BMI does not depend on BSL. Thus BSL should be on vertical axis.
The trend of these points may show that BSL increases when the BMI increases.
Presentation of qualitative data: Continuous or measured data is done by graphs
and those in common use.
a. Bar Diagram:
It is easy and popular method. Length of bars, vertical or horizontal indicates the
frequency of a character to be compared. Bar may be drawn in ascending or
descending order of magnitude or serial order of event. Spacing between two bars
should be equal. There are 3 types of bar diagrams.
-Simple bar diagram
-Multiple bar diagram
-Proportional bar diagram
b. Pie or Sector diagram:
This is another way of presenting discrete data of qualitative characters such as
blood group, Rh group, social group, sex group etc. Pie diagram has circular shape.
A circle is divided into sectors with areas proportional to the frequencies or the
relative frequencies of the categories of the variable.
Eg. Number of episodes of respiratory, digestive, cardiovascular, injuries etc.
attending a clinic are additive. On the other hand, some rates are not added (birth
rate: rural 30/1000 populations, and urban 16/1000 populations). So pie diagram
cannot draw for such rates. Rate will be in between 16 and 30.
Note: Since one patient can and will have more than one sign-symptoms, pie
diagram is not appropriate for this depiction also. All sign-symptoms do not add to
any thing, certainly not to the total number of patients, nor to the total number of
episodes. Thus pie diagram is not applicable.
Pie diagram showing gestational age wise distribution of cases in study
group
4%
32%
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28 – 31
32 – 34
35 – 37
64%
c. Pictogram:
It is a popular method to impress the frequency of the occurrence of events to a
common man. Eg. Accidents, attacks, deaths, admitted, discharged etc. The
pictures are drawn on horizontal lines. Each picture indicates a unit of 10, 20, 100,
1000 etc. happenings. The number of pictures in each row gives quick idea of
frequency.
d. Map diagram or Spot Map:
To show the geographical distribution of frequencies of a characteristic. A dot
indicates on unit of occurrence such as attacks or deaths. The number of dots will
indicate the frequency in units.
e. Run chart: to display serial data points over time. Because our minds are
not good at remembering patterns in data, a visual display will allow you to
see the measurement of an entire process. This in turn will enable you to
see trends over time and to make adjustments accordingly.
Use; Run charts are particularly useful in conjunction with simple data from
tally or check sheets. Record tallies of a particular event that you would like
to capture, e.g. a patient's weight or times you are late for a meeting. Plot
the values on the y-axis versus number of measurements on the x-axis.
Page | 103
Note on the chart where any changes in the process are made. Then analyze
the data for trends. Is your patient's weight stabile over time? Did a
decrease coincide with the start of new medication? Since you bought your
electronic organizer, have you made it to more meetings on time. See
examples below.Examples
Example 1: Patient's weight over time.
SAMPLING
Sampling: The process of selecting a sample from a population.
Sample: A finite subset of statistical individuals in a population. Or sample is that
part of the target population, which is actually enquired on or investigated.
Sample size: The number of individuals in the sample. Or the number of sampling
unit included in the sample. Eg. Investigating mineral density in hipbone, you may
like to include 150 persons. In this case, this is the sample size. For ocular ailment,
the sample may be of 80 eyes irrespective of the number of persons. For clinical
trial, the sample size may be 200 cases divided equally to receive treatment and
placebo.
Sampling Unit: The unit of selection in the sampling process. Eg. a person, a
household, or a district. It is not necessarily the unit of observation or study.
In a large scale study that covers, eg. The entire country, it is desirable to select a
sample of states in the first stage, district in second stage, etc. Thus the sampling
unit is state for first stage sampling, district for second stage sampling etc.
The ultimate sampling unit is generally the same as the unit of study.
Eg. In a study on family pattern in hypertension, the sampling unit and the unit of Page | 104
study is the same i.e. family.
Eg. But in other set up such as for incidence of injuries, the sampling unit could be
a family but the unit of study would be the individual. In this case, the families are
not further sampled and all individuals in the selected family are enquired
regarding the incidence of injury.
Sampling frame: A list of all units in the target population from which a sample is
drawn. If the target population comprises the deliveries in your hospital in one-
year period, the population size is known. Suppose this is N=7000. If you want to
include n=140 of these in your sample, the sampling fraction is n/N = 140/7000
=0.02 = 2%
Parameter: the statistical constant computed from the population value.
TYPES OF DATA COLLECTION DESIGN USED IN HEALTH AND
MEDICINE
Data collection
n=400, then each part will have 4 subjects. The parts are identified by 99 cut
points of the measurement under consideration i.e. P1, P2, P3, - - - P99.
Ungroup / Discrete series:
Kth percentile = (k*n/100)th value after arranging in ascending order from lowest
to highest.
Group / Continuous series:
Pi = L1+(((iN/100)-c)*h/fi) i=1,2,3, - - - 99
P10=D1, P20=D2, - - - P90=D9
P25=Q1, P50=Q2=D5=Me, P75=Q3
Percentile curve is a cumulative curve drawn on a percentage basis (<type)
Deciles, Quartiles and Tertiles:
Deciles divide the group of subjects into 10 equal parts, quartiles into 4 equal parts
and tertiles into 3 equal parts. The procedures are same as above. The
denominator, which was 100 in the case of percentiles in formula Kth percentiles
mentioned above, would be 10 for deciles, 4 for quartiles and 3 for tertiles.
Measures of Variation (Dispersion)
The deviation of each and every observation from any measures of central tendency
is called measures of variation or dispersion.
When the mean value of a series of measurements has been obtained, it is usually
a matter of considerable interest to express the degree of variation or scatter
around this mean. Are the reading all rather closed to the mean or are some of
them scattered widely in each direction?
Eg. The daily Calorie requirement for a man of 25 years is given as 3200. This
requirement must very from one person to another, how large is the variation?
Types of measures of variation:
Range, Variation, Standard deviation and coefficient of variation.
Range:
The difference between the maximum value and the minimum value and denoted
by R.
R= Xmax. – Xmin.
Eg. Systolic blood pressure
Group I: 128, 132, 129, 130, 131
Group II: 140, 150, 120, 130, 110
Systolic level in-group I is 128 to 132, so that the range is 4 mmHg. In-group II,
this is from 110 to 150 and the range is 40 mmHg. The difficulty in measuring
dispersion by range is that an alteration in just one value to an extremely high or Page | 113
extremely low value, drastically changes the range. If the last BP in-group I is 161
instead of 131, the range shoots to 33 mmHg. Although the other 4 values are still
closed to one another and the dispersion is not high, but the range unnecessarily
will indicate a very high dispersion because of one extremely high value. Because of
this demerit, we look for a measure that considers all the values, and not just the
minimum and the maximum value.
Standard deviation:
It is the square root of the mean of the square deviation from their mean and
denoted by sd/ (sigma)
Ungroup / Discrete series:
= √ (Xi-X)2/n =√(1/n){X2 –(X)2/n}
The square of sd is called variance and denoted by var. / sd2 / 2.
Steps:
1. Calculate the mean ie. Xbar
2. Find the difference of each observation from the mean ie. (Xi-X)
3. Square the difference of each observation from the mean ie. (Xi-X)2
4. Add the square value to get sums of square ie. (Xi-X)2
5. Divide this sums of square by number of observation –1 to get variance ie.
2 = (Xi-X)2/n-1
6.find the square root of the variance to get sd.
Coefficient of variance:
The ratio of sd to the mean and denoted by CV.
CV = sd/x
It is used to compare the variability of a characters in two group or two characters
in the same group. OR When measurements are for different persons and
parameters are different.
NORMAL DISTRIBUTION AND NORMAL CURVE
When the number of observation is very large of any variable characteristics are
taken at random to make it a representative sample eg. Height, Weight, Blood
Pressure, Pulse Rate etc. Prepared a frequency distribution table by keeping small
class interval then it will be seen that:
-Some observations are above the mean and other are below the mean.
-If they are arranged in order, deviating towards the extremes from the mean, one +
or – side, maximum number of observations will be seen in the middle around the Page | 114
mean and fever at the extremes, decreasing smoothly on both sides.
-Normally half of the observations lie above and half lie below the mean
and all observations are symmetrically distributed on each side of the mean.
A nature or shape of this distribution is called Normal Distribution or Gaussion
Distribution.
If mean and standard deviation are known:
a. Mean ± 1 SD covers 68.27% observations. Remaining 32% observations lie
outside the range mean ± 1 SD.
b. Mean ± 2 SD covers 95.45% observations. Remaining 4.55% observations lie
outside the range mean ± 2 SD. (Mean ± 1.96 SD covers exactly 95% observations )
c. Mean ± 3 SD covers 99.73% observations. Remaining 0.27% observations lie
outside the range mean ± 3 SD. (Mean ± 2.58 SD covers exactly 99% observations )
You know that the normal range of fasting blood glucose level is 80 to 110 mg/dI.
Do you know how is this range obtained?
Opposed to a range for fasting blood glucose level, the normal body temperature is
a single value 98.6F. Why is this not a range?
Normal Range:
Most medical measurements show a substantial variation even in healthy subjects.
Thus a range of normal values is obtained. In above case, fasting blood glucose
level, the normal range may be 80 to 110 mg/dI but there will be people with 79 or
75 mg/dI yet absolutely healthy and other healthy people with 115 or 118 mg/dI
level. In other words, for any parameter, there will be healthy people with very low
or very high values. If such values are also included in the normal range, the
difficulty is that many diabetics would have overlapping levels such as 115 or 118
mg/dI. Similarly there will be hypoglycemic with levels 79 or 75 mg/dI.
No matter how a normal range is chosen, there is always a risk of exclusion of
healthy subjects and inclusion of non-healthy subjects. The best course, of course, Page | 115
is to find levels beyond which persons or patients start feeling sick, or the levels
that have increased risk of early mortality. Such level can indeed be considered
pathologic. But this procedure is highly nonspecific and too difficult to adopt. Also,
even in such delineation there would still be a chance of exclusion of healthy and
inclusion of nonhealthy subjects. In view of these difficulties, it is considered
convenient to use statistical principles to determine the normal range.
Normal value:
Any biological measurement must very from person to person, and even in a person
from time to time. The variation could be small or large. Whenever the variation is
small, a single value is obtained as the representative value. There is no need to
worry about SD of such measurement. This is true for body temperature.
Although there would be some healthy people with temperature 98.5 F or 98.7 F,
even with 98F but those will be few. A 5% rise in body temperature has an
enormous clinical significance whereas 5% rise in cholesterol level may not be
much consequence. When the variation is small, the mean is generally chosen as
the reference value.
If you want to establish normal body temperature of adolescent boys in your area,
select a random sample of at least 300 apparently healthy boys, measure their
body temperature and calculate the mean. That will be the normal level for these
boys. No such exercise has ever been undertaken for Indian boys, girls, children‟s
or adults on a large scale. Thus our normal body temperature is not known.
However the internationally recognized level of 98.6 F, which actually was
established for Swedish adults, seems to work for Indian as well.
Characteristics of Normal Curve:
1. It is bell shaped curve.
2. It is symmetrical.
3. Mean, Median and Mode coincide.
4. It has two inflections never touches to the baseline.
5. Area under curve is one.
6. If standardized then mean is zero and SD is one.
Standard Normal deviate/ Standard Normal viriate/ Standard Normal curve:
This process of subtracting mean and dividing by SD is standardization or
sometime normalization and denoted by Z
Z =(X-)/SD
Inferential statistics: is the branch of statistics that is used to make inference
about the characteristics of a population based on sample data. Page | 116
Sampling variation:
The sample after all the part of the population and they may or may not truly
represent all the features of the population.
One sample would differ from the other even if both were taken from the same
target population. Mean and SD obtained from one sample would be different from
the other sample. This is called sampling variation / sampling fluctuation /
sampling error.
Standard error:
The point estimate is simply the corresponding sample statistics of the population
parameter. The forced expiratory volume in one second (FEV1) in students of age
18 to 22 years. Take a random sample 40 students and found that mean FEV1 is
2.71 l. He was somehow not happy with this mean. He took another sample of 40
and found mean FEV1is 2.50 l. He repeatedly took sample of 40 students another
eight times. Considering the variation in various sample mean, he was not sure
how to express this uncertainty. He was then advised to find the SD of these 10
means obtained in 10 different samples. He then understood that the SD of these
10 sample means is the measures of variability in sample means. This SD of
sample mean is called the standard error (SE) of mean.
Estimation: There are two types estimation.
Point Estimation: is the value of your sample statistic (Sample mean or sample
correlation) and it is used to estimate the population parameter (Population mean
or Population correlation) eg. If you take a sample of Dr. living in pune city and you
find that the average income of Dr. in your sample is Rs 25000 then your point
estimate of Dr in pune city will be Rs 25000.
The value of the Sample Mean / Median is an estimate of the population Mean /
Median. Similarly, Sample Proportion is an estimate of the population Proportion.
These are called point estimates.
Point estimate for is Xbar and for P is p.
Interval estimation: is a range of numbers inferred from the sample that
has a known probability of capturing the population parameter over the long
run.
Consider the average haemoglobin (Hb) level in women going into hypertension
during labour. This enquiry for Hb level can possibly lead to some etiology of
hypertension during labour. In a random sample of 300 such women, this average
is 10.6 g/dl. Would you accept this 10.6 g/dl as the absolute truth for these
women or you would allow for some sampling fluctuation and say that it is most Page | 117
likely somewhere between 10 and 11 g/dl? Obtaining such interval for any
parameter is called interval estimation.
It is used in patient care when you inform the relatives of a cancer patient that the
survival duration is somewhere between 2 and 7 months at that stage of disease.
Point estimates have reliability only when SE is small. If SE is large, interval
estimates are obtained.
Confidence level:
The 95% or any other level that is fixed as a measure of hope or expectation is
called the confidence level.
It must be very clear that uncertainties in medical practice can only be minimized
but not eliminated. You can never be 100% confident about the outcome. This is all
the more true while dealing with the samples. Thus a confidence level is fixed at a
sufficiently high level to ensure reasonable reliability. There is a tendency around
the world to consider 95% confidence as adequate while dealing with samples – be
it sample of patients, blood samples or sample of healthy people.
Confidence Interval:
The interval within which a parameter values expected to lie with a certain
confidence level.
* Specifically, if you have the computer provide you with 95 percent confidence
interval then you will be able to be “95% confident” that it will include the
population parameter. That is “level of confidence” is 95%.
Eg. The point estimate of annual income of Dr. in pune city is Rs 25000 and
surround it by a 95% confidence interval. You might find that the confidence
interval is Rs. 22000 to Rs. 27000. In this case, you can be 95% confident that the
average income is somewhere between Rs. 22000 and Rs. 27000.
TEST OF SIGNIFICANCE
A statistical procedure to test whether or not the observations fall into a specified
pattern, such as equal mean of two or more groups or following a linear trend. If
they do no, the result is called statistically significant. This requires prior fixing of
the level of significance that specifies the maximum tolerable probability of type I
error.
Hypothesis: Any statement regarding population parameter is called as
hypothesis. Or A statement of belief that is made before the investigation regarding
the status of parameters under study, including those that measure relationship.
Null Hypothesis: A hypothesis that says that there is no difference. The initial
assumption will be that the new regimen is not better. This kind of assumption is Page | 118
called null hypothesis and denoted by Ho.
Eg. 1. The two regimens or two groups have no difference.
2. The incidence of leukemia in the four blood groups is same.
2. There is no difference in the mean aspartate amino-transferase (AST) level in
the case of hepatitis, cirrhosis and liver malignancy.
Alternative Hypothesis: A hypothesis, which is accepted by default when the null
hypothesis is rejected and denoted by H1.
Note: The null hypothesis is never completely right or wrong, or true or false, but is
only rejected or not rejected at the probability level of significance concerned.
Type I error: The probability of rejecting a null hypothesis (Ho) when it is in fact
true and denoted by alpha ()
= P(Rejecting Ho/Ho is true)
Type II error: The probability of not-rejecting i.e. accepting a null hypothesis (Ho)
when it is false and denoted by beta ()
= P (Accepting Ho/Ho is false)
Level of significance: Size of the type I error (). Or the distance from the mean at
which Ho is rejected. Or the maximum tolerable probability of type I error that is
fixed in advance, such as 5%, denoted by alpha ().
P-value: The probability of committing type I error is called the P-value. Or P-value
is the chance that the presence of difference is concluded when actually there is
none.
One tail Test: Checks only one of the tail (upper or lower of the normal
distribution curve).
Eg. 1. Comparing the rate of cancer between a population exposed to known
carcinogen and a control population. This test can be used because the only
alternative hypothesis of interest is that the exposure was harmful. It is assume
that the exposure was not harmful.
2. Consider a new haematinic that is supposed to increase the Hb. level among
anaemics. In a trial for this preparation, the null hypothesis again is that it is not
effective. This hypothesis implies that the average Hb. level will not alter taking this
preparation. What is the alternative hypothesis?
If the Ho is rejected, the conclusion will be that the new haematinic is effective or
that the average Hb level has increased. In this situation, the possibility of
reduction in Hb level is ruled out. Thus, H1 is one sided and is called one tail test.
3. While comparing a test regimen with placebo, if there is an assurance that test
regimen cannot be worse than placebo. This requires one tail test. Page | 119
Two tail Test: Checks the upper and lower tails of the normal distribution curve.
Eg. 1. Comparing the rates of death between two neighboring communities. This
test is used to look for significant differences because no assumption is made about
the H1.
2. For dilating cervix by Misoprostol Vs the existing ethinyl estradiol, there is a
possibility that the efficacy of new regimen is even less than the existing regimen.
The efficacy can be higher or can be lower who know! The null hypothesis in this
case would be usual saying that the two regimens are equally effective.
When null hypothesis is rejected, what is accepted is called alternative hypothesis.
For Misoprostol efficacy, the alternative hypothesis is that it is either lower or
higher than the efficacy of the existing procedure. This type of alternative is called
two-sided because both possibilities are envisaged. A test in a situation where the
alternative hypothesis is two sided is called a two-tail test.
3. While testing equality of two groups. This happen, when a test regimen is being
compared with the existing regimen. This requires two-tail test.
Commonly used test of significance as per type and size of data:
Type of data Quantitative Qualitative
Size ↴
Small sample t-test (Paired & unpaired) χ2 test with Yates correction
(n < 30) N-P test N-P test
rejected, hence this area is called zone of rejection for null hypothesis.
Now let us discuss the various situations where we have to apply different test of
significance. For the sake of convenience and clarity these situation may be
summed up under the following three heads:
1. Test of significance for Attributes.
2. Test of significance for Variables (large sample).
3. Test of significance for Variables (small sample).
1.Test of significance for Attributes.
As distinguished from variables where quantitative measurement of a phenomenon
is possible, in case of attributes we can only find out the presence or absence of a
particular characteristic.
Eg. In a study of attribute „Literacy‟ a sample may be taken and people classified as
literates and illiterates. With such data the binomial type of problem may be
formed. The selection of an individual on sampling may be called „event‟ the
appearance of an attribute A may be taken „Success‟ and its non-appearances as
„Failure‟.
a. Test for number of success:
The sampling distribution of the number of success follows a binomial probability
distribution.
SE of number of success = √npq
Where n = Size of sample, p = Probability of success in each trial and q = 1-p =
Probability of failure.
Eg. In a hospital 480 female and 520 male babies were born in a week. Do this
figure; confirm the hypothesis that males and females are born in equal number?
Ho: The male and female babies are born in equal number. i.e. p = ½
H1: p =/ ½
n =1000, p = ½, q = ½
SE = √npq = 15.81
Difference between observed and expected number of female babies =520 – 500 =
20
Z = Observed difference / SE = 20 / 15.81 = 1.265
Since the difference is less than 1.96 SE at 5% LOS. Hence the male and female
babies are born in equal number. Or
Z < 1.96, Accept Ho, hence the male and female babies are born in equal number.
2.Test of significance for Variables (large sample). Z – test.
The Z-test for mean has two applications Page | 121
Ho: there is no association between blood groups and the time taken for
development of AIDS in HIV infected cases.
Page | 129
H1: there is a association between blood groups and the time taken for
development of AIDS in HIV infected cases.
Calculate expected frequency of each cell. (12 expected frequency)
Apply χ2 test χ2 = 22.72. ,
df = (r-1)(c-1) =6 Table value χ26,0.05 = 12.59
Comparison: χ2 > χ26,0.05 , R eject Ho.
Conclusion: Hence there is a association between blood groups and the time
taken for development of AIDS in HIV infected cases.
Lesson IX:
Objectives:
1. Understand the areas in Education and Learning requiring research
2. Delineate the Priority areas of educational research in India
3. Describe the Ethical problems involved in Educational Research Page | 130
Lesson Outline:
Understand the areas in Education and Learning requiring research
including Teaching and Learning methods, Assessment, Evaluation and
interventions. Able to formulate priority areas based on the need of the
institution.
• The barriers and opportunities of initiating the medical education research
• Ways to strengthen the research capabilities in medical education
• Describe the specific Ethical problems involved in Educational Research
Introduction:
In India, medical institutions are established with an objective of three legged stool
consisting of research, education and service. Medical teachers hence referred as
„triple threat academicians‟. Medical teachers are thus original and productive
investigators, committed teachers and compassionate practicing physicians. Fourth
obligation recently emphasized is „social responsiveness‟. Medical schools are
confronted with the challenge of making their curricula relevant to the needs of the
times. One response to this challenge is increased interest in research in medical
education.
It has been under fire that Medical education in Asia has colonial-biased, subject-
oriented, teacher-centred, discipline-based, lecture-focused and hospital-based
traditions, which failed “to train medical students appropriately for national health
needs and for medical schools to assume leadership role in shaping services
oriented to the needs of the community”. However there are signs of positive winds
in medical education from government of India and Medical Council of India. The
recent trends in Medical Educational Research suggest that Research is either
quantitative or qualitative. Biomedical or objectifying and holistic or humanizing
research confined to more quantitative, experimental or quasi-experimental
approaches. There is a need to change the direction of research to shift towards
qualitative and descriptive methods
The priority areas in medical education are many and depend on the needs and the
mission of individual institutions. Need based research is a pragmatic approach for
budding medical education researcher or for a newly established medical education
unit. Need based research directly answers the questions related to individual or
institutional needs and is of immediate interest to the faculty and administrators.
The research in medical education has contributed significantly in our
understandings of teaching and learning medicine. Medical education research is Page | 131
not merely academic and esoteric in nature. On the contrary, the vast majority of
the studies and publications address issues that are practical and of immediate
interest to medical teachers.
Hardens Approaches to Medical Education Research:
Experimental
Fact-finding
Action-research
Open ended research
Creative research
*Due to the practical and problem solving nature, action research is
becoming popular among teacher-researchers
Areas in Education & Learning Requiring Research:
Outcomes
Interventions
Teaching & Learning Methods
Assessment
Evaluation
Exercise:
Suggest areas in medical education which need research
Prioritize the areas of research by giving justification
Ethics deals with values and morals. It is based on people's personal value
systems. What one person or group considers to be good or right might be
considered bad or wrong by another person or group. There are three major
approaches to ethics.
1. Deontological Approach - This approach states that we should identify and use a
Universal code when making ethical decisions. An action is either ethical or not
ethical, without exception. Page | 132
2. Ethical skepticism - Concrete and inviolate ethical or moral standards cannot be
formulated. In this view, ethical standards are not universal but are relative to
one's particular culture, time, and even individual.
3. Utilitarianism - Decisions about the ethics should be based on an examination
and comparison of the costs and benefits that may arise from an action. Note that
the utilitarian approach is used by most people in academia (such as Institutional
Review Boards) when making decisions about research studies.
Ethical Concerns
There are three primary areas of ethical concern for researchers:
1. The relationship between society and science.
• Should researchers study what is considered important in society at a given time?
• Should the government and other funding agencies use grants to affect the areas
researched in a society?
• Should researchers ignore societal concerns?
2. Professional issues.
• The primary ethical concern here is fraudulent activity (fabrication or alteration of
results) by scientists. Obviously, cheating or lying are never defensible.
• Duplicate publication (publishing the same data and results in more than one
journal or other publication) should be avoided.
• Partial publication (publishing several articles from the data collected in one
study). This is allowable as long as the different publications involve different
research questions and different data, and as long as it facilitates scientific
communication. Otherwise, it should be avoided.
3. Treatment of Research Participants
• This is the most fundamental ethical issue in the field of empirical research.
• It is essential that one insures that research participants are not harmed
physically or psychologically during the conduct of research.
OSPE: 1 Skill
2 Knowledge
3 Attitude(communicating skills)
CONSENT
CONVINCE
Study Design:
PBL for small group of 8 – 10 students. Over a period of 2-3 weeks
Initial disclosure of patients complaints
Session I---- Learning issues
Swelling in the neck
Swelling in the midline
Progress of disease
Change in symptoms
Facilitators- 1-2
What are resources to satisfy the knowledge seeking
Faculty
Internet
Library 3-5 days for study
Session II:
Division of students------ Chairman, scribe, topic presenter for each learning
issue, 2-3 students as observers
Disclosure no2
Symptoms of thyrotoxicosis/ myxedema
Biochemical investigations---TFT, S.Cal, S Cholesterol, Bl.
Sugar, Pulse, BP, Biopsy,
ECG, Weight, imaging
investigations: X-ray neck, USG,
Radioactive uptake
scan
Learning Issues
3-4 days for learning
Session III:
Reassemble
Regroup Missing investigations FNAC
Expert Common: Ca. Thyroid, other thyroid diseases
Study Design:
Qualitative Research
Focus Group Discussion
Objectives:
To create better physician
Methods:
Using tools such as CDs, Photographs and Case studies
Equipment Required:
Lectures
Structured
interactive Page |
sessions 141
Small group
discussion
a)
Demonstrati
ons.
b) Tutorials.
c) Seminars.
d) Problem
Based
Learning.
Focused
group
discussion
(FGD)
Projects
Participator
y learning
appraisal
(PLA)
Family and
community
visits
Institutional
visits
Practical
including
demonstrati
ons
Problem
based
exercises
Video clips
Written case
scenario
Self
learning
tools
Interactive
learning
e-modules
Dissection / Page |
Prosected 142
parts
demonstrati
ons /
Instructions
on
mannequins
.
Skills Lab
with CDs of
various
stages of
dissection.
Histology
Lab.
Surface
marking.
Imaging
anatomy
Lab.
Visit to the
museum.
Preparation
of scientific
article.
Preparation
of practical
drawing
book
Role Play
Seminars
Algorithms
Integrated
teaching
Field visits
Problem
based
paper &
real cases
Simulated
Patient Page |
Manageme 143
nt
Problems
Case
Studies
Tutorials
Workshops
One to one
teaching in
theatre
Departme
ntal
Morbidity,
Audit,
Journal
Club
Self
Assignmen
ts