Corresponding Author:

Name Dr. P. Ravi Shankar

Email: ravi.dr.shanakr@gmail.com

Dear Editor,

In mid-August 2011 Ms Rajani Shakya, Assistant Professor, Pharmacy, Kathmandu University (KU), Dhulikhel, Nepal asked me to facilitate and teach a module on clinical trial research for the Doctor of Pharmacy (PharmD) students. My experiences of facilitating a module will be of interest to other facilitators and educators who can learn about the challenges I faced, problems while conducting the module and how they were overcome.

Clinical trial research, a new subject area in Nepal: Based on a number of reasons including the small pharmaceutical industry, phase I, II and III clinical trials of new drugs are rarely conducted in Nepal unlike, the clinical trials of already marketed drugs, such as those used for altitude sickness, which are occasionally conducted in the Everest and Annapurna region.

PharmD students and small group learning: I emphasised both the drug development process and the clinical development process of a new drug during the module. The module consisted of 12 sessions with an additional concluding session to wrap up the proceedings and to obtain student feedback (Table 1). I used small group-based activity sessions which I had previously successfully used in teaching undergraduate medical students and other adult learners in various workshops. The module was undertaken in the third semester of the three-year post-baccalaureate PharmD programme. The programme is open to students who have completed a four year Bachelor of Pharmacy (BPharm) The Clinical Research module is a two credits course with a minimum requirement of 32 contact hours in the form of sessions and assignments. The 13 post-graduate students were divided into two smaller groups.

Venue for the sessions: The sessions were held at the University's School of Management campus in the Lalitpur district. The venue provided small tables and chairs which could be easily moved around, as well as a white board. In addition to the white board, the students also used flip charts and we had access to a LCD projector.

Creating an online mailing group: Based on my successful experience with effectively sharing information using an online mailing group with undergraduate medical (MBBS) students, I also created an online mailing group for the PharmD students. The online group was used by the students to submit their assignments and by the facilitator to share reading materials and other clinical trial research resources (e.g. free internet-based textbooks related to clinical trial research, and material from the United States Food and Drug Administration (USFDA) and the European Medicines Agency (EMA) sites among many others)

Assignments and formative assessment: Both group and individual assignments were used during the module. Students were typically given a week to complete and submit their assignments which are shown in Table 2. Both formative and summative assessments were carried out during the module. The formative assessment tasks (worth 40%) evaluated the students' attendance, punctuality, participation, presentation skills and their assignment submissions. Then at the end of the module, a 150 minute short answer examination was used as a summative assessment task (worth 60%) to evaluate the students' knowledge and understanding about clinical trials.

Group work: A 10-15 minute group work activity was an important part of each two hour small group learning session. Important clinical trial issues discussed during these group work activities included: developing a protocol for a clinical trial; focusing on different parts of the protocol; and good clinical trial practice. Table 3 clearly outlines the group work activities conducted during the different sessions. Informal feedback obtained from students indicated that small group activities contributed substantially to the module.

Student feedback on the module: Student feedback about the module was obtained informally at the end of the module. Their perceived knowledge, attitude and skills about different subject areas before and at the conclusion of the module were studied. The author also obtained structured written feedback at the end of each session. The feedback obtained will be used to further improve future sessions.

Possible lessons for other clinical trial research educators: To the best of my knowledge this is the first time a clinical trial research module has been taught in Nepal for pharmacy students. Based on my experience, clinical trial research training modules can be effectively delivered in small group activity-based learning sessions, using white boards, flip charts and the submission of both formative and summative assessment tasks. In addition, the availability of online resources, online group discussion forums and internet sites also contribute to this learning environment which can be successfully used to deliver new and innovative programs such as this one to the PharmD students.

Sincerely,

Dr. P. Ravi Shankar

KIST Medical College

Lalitpur, Nepal.

Audio files enhance classroom learning among medical students in Oman

Corresponding Author:

Bindu Susan Varghese

Email: bindu68@gmail.com

Dear Editor,

The students at Oman Medical College (OMC) are mostly Arabic speaking, with English as the medium of instruction at college and university. Since the curriculum at OMC is designed in the Western style and faculty from US lecture for a variety of courses, a good knowledge of English is essential. A variety of learning styles have previously been described and studied, with research demonstrating that the medium through which course content is disseminated may impact learning.1 Hence, complete understanding of lecture material presented in English may become difficult for many of the students. Audio recordings of lecture material which can be accessed through the internet or downloaded to a portable media player, have been suggested to be 'an educational revolution in the making'.2 In December 2005, Harvard became the first medical school to make its whole syllabus of lectures downloadable as MP3/4 files on the university intranet.3 Listening to audio files of course material helped students improve their grades.4 We therefore decided to make use of this educational tool to enhance understanding and learning of course material in medical pharmacology.

Audio recording of the lecture material using a Philips MP3 recorder was performed during regular lecture sessions and students were encouraged to listen to them. The file in MP3 format was then uploaded to the online site available to the students to access course material. The students downloaded them to an MP3 player or directly listened to them on their laptops. At the end of eight months of training an objective structured questionnaire was prepared to assess the effectiveness of usage of audio files. The questionnaire had close-ended questions as well as questions with options "strongly agree" to "strongly disagree". All students who attended pharmacology lectures took part in the survey. Results were compiled and analysed.

Eighty out of 110 students (77%) responded to the survey. 49/80 (62%) agreed that they used these audio recordings to enhance their understanding of the material in pharmacology. A high proportion of the students (83%) used their own laptops to listen to these and 10% of the students downloaded them to a mobile phone or an MP3 player. While 14% of the students listened to all the lectures, a significant number (83%) listened to selected lectures only. Lack of time was a factor for not listening to the lecture in its entirety.

Regarding the period during which the students listened to the lectures, 18% listened to them on the same day of the lecture, 18% accessed them just before an exam and 39% of the students accessed them within seven days of the lecture. The remaining 25% listened to them whenever they liked (Figure 1). When asked how many times they accessed the files, 60% listened only once while 29% listened to them two or three times and a small number of students (11%) listened to them several times to understand the material. Of the students 84% agreed that listening to audio recordings helped them to understand and learn the lecture material in detail (Figure 2). A further 76% of the students indicated that listening to the recordings improved their understanding of medical terminologies and their language in general. Moreover 44% of the students who used the recordings agreed that repeated listening was necessary to enhance their overall knowledge of the subject. The majority of the students 46/49 (94%) who listened to these files recommended usage of this learning tool in other courses also (Figure 3). There were 38% of students who did not use the audio recordings and they had various reasons for not doing so. The major factors responsible were lack of time (60%)1,2 and 23% were happy with the clarity of the lectures that they did not have to listen to the audio recordings.

In order to fully understand the potential value of audio recordings as a supplementary learning tool a detailed understanding of students' experiences with the use of audio recordings is required. As medical educators, it is important in the context of a demanding curriculum to provide alternative resources and a supportive academic environment to facilitate individual success. This is especially true in this situation where the educational and cultural background is very different from the West. Furthermore, the medium of instruction and language also differs from that which is familiar and comfortable for this group of students.

Our findings are similar to reports mentioned in the literature.1 The use of audio recordings of lecture material has definitely improved understanding and learning the pharmacology subject in this small group of students. In future it is worth studying the value of this tool in a larger population to define a relationship between the use of this educational tool and performance in assessments.

Sincerely,

Bindu Susan Varghese1, Geener John2

1Assistant Professor, Department of Pharmacology.

2 Assistant Professor, Department of Pathology and Medical Education.

Oman Medical College, Sohar, Sultanate of Oman.

References

1. Whitney ER and Pessina MA. Does Availability of Audio Podcasts Enhance the Classroom Experience for First Year Dental Students? Data on use and perceived benefits. Int J Instr Tech and Dist learning 2008; 5(8): 27- 32.

2. Meade O, Bowskill D and Lymn JS. Pharmacology podcasts: a qualitative study of non-medical prescribing students' use, perceptions and impact on learning. BMC Med Educ 2011; 11:2.

3. Rainsbury JW and Mc donnell SM. Podcasts: an educational revolution in the making? J R Soc Med 2006; 99(9): 481-82.

4. Kardong-Edgren S and Emerson R. Student adoption and perception of lecture podcasts in undergraduate bachelor of science in nursing courses. J Nurs Educ 2010; 49(7):398-401.