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Indian Journal of Community Medicine

Quiz as a Method to Teach Nutrition and Health

Author(s): S.B. Rotti, Shrihari Dutta, M. Danabalan, K.A. Narayan, M.B. Soudarssanane, G. Roy

Vol. 26, No. 1 (2001-01 - 2001-03)

Deptt. of Preventive and Social Medicine, JIPMER, Pondicherry

Abstract:

Research question: Whether quiz can serve as an alternative innovative method of teaching/learning to teach Nutrition and Health to medical undergraduates?

Objectives: To increase the awareness and interest in the topic; to test the knowledge in the applied aspects of nutrition in community health; and to enhance student participation in acquiring the knowledge.

Study design: Descriptive study.

Setting: Department of Preventive and Social Medicine, JIPMER, Pondicherry.

Participants: MBBS students studying in the third clinical semester during 1998 and 1999.

Results: A series of four quizzes were conducted to teach Nutrition and Health for two successive years to medical undergraduates. There were four teams of 4-5 students for quizzing. At the end of each quiz a set of five multiple-choice questions were asked from all the students and feedback was elicited. Out of 143 students enrolled, 60 to 83% attended the quizzes. The performance of students in quizzes was encouraging with the winning teams scoring between 70 and 95%. In the MCQ round majority of students (94-99%) scored 40-100 marks. The students appreciated the method as it was different from the routine lecture classes, innovative and interesting, helped them to come prepared, offered scope for participation of the whole class. Some students suggested more questions in each round; more rounds in each quiz and more quizzes on other topics also.

Conclusion: Quiz was used to teach nutrition in health to medical undergraduates successfully. The performance of the students and their participation were very much encouraging.

Keywords : Quiz, Nutrition and health, Medical undergraduates, Feedback

Introduction:

The subject of Preventive and Social Medicine is taught throughout the MBBS course. Nutrition and Health is generally taught in the para-clinical years. The Medical Council of India has observed under the "Regulations on Medical Education, 1997", that lectures alone are not generally adequate as a method of training and are poor means of transferring/acquiring information, even less effective at skill development and in generating the appropriate attitudes. It recommends that every effort should be made to encourage the use of active methods related to demonstration and on first hand experience1. There is scope for trying innovative approaches, especially in an Institute like ours where intake of students is 75 per year and staff-student ratio is good. It is already reported that in our department, group discussions have been employed successfully to teach majority of the topics in the pre-clinical years2. Modern audio-visuals such as television, video cassette recorder, slide projector with tape recorder are used to teach some topics in para-clinical years3. Small research projects given to students have been used as tools to teach epidemiology4. Since 1996, subject of Nutrition and Health has been taught using a series of four one-hour quizzes conducted in the existing timetable of lectures. It is learnt that St. John's Medical College, Bangalore has been using the method of quiz to teach nutrition and health. Though quizzes are conducted to hold competitions between a few teams, some modifications were made to serve the element of concurrent evaluation of all students in the class. The experience of two years, 1998 and 1999, is reported in this paper. The objectives were to increase the awareness and interest in the topic; to test the knowledge in the applied aspects of nutrition in community health and to enhance student participation in acquiring the knowledge.

Material and Methods:

The quizzes were conducted for MBBS students studying in the third clinical semester during the months of February and March in both the years. The schedule of the quizzes was announced two weeks in advance. The topics were divided as follows: (1) Sources, functions and deficiency states of proteins, fats, carbohydrates, vitamins and minerals and their daily recommended allowances (2) Nutritive values of Indian foods; balanced diet (3) Nutritional assessment, surveillance and monitoring and (4) Food hygiene, food toxicants, food-borne diseases, milk borne diseases, food fortification and national nutritional programmes.

There were 73 students in 1998 and 70 in 1999. Each batch was divided into four groups with 15-19 students in each group. For each session, 4-5 students from each group were chosen as quizzers and they were changed for subsequent sessions. This process ensured equal chance for every student to participate at least once. If anybody was absent, other students from their respective batches were chosen as quizzers. In any particular session students of each groups other than the quizzers formed the audience.

Rules for the quiz were as follows: there were four rounds in each session and the cumulative score of the rounds was taken to decide the winning team. The question not answered by a particular team was not passed to the next team, instead it was asked to the audience, failing which the quiz master gave the answer. There was no negative marking. The decision of the quiz master was final in deciding the correct answers and awarding marks.

For every session, there were four rounds, viz., oral, visual, short answer/clinical and rapid-fire. The details of contents of each round, time allotment, maximum marks for each round and one example of each is given below:

I Oral round (2 Minutes) Marks
Identify the nutrient with the help of clues
(i) It helps in the collagen formation. 20
(ii) Deficiency causes delayed would healing. 15
(iii) It is richly present in gooseberry. 10
II Visual round (2 Minutes)
Identify the condition with the help of clues.
(i) This is due to the deficiency of a fat-soluble vitamin. 20
(ii) It is used as an indicator of public health problem. 15
(iii) Consumption of carrot and mango can prevent this condition. 10
III Short answer round (3 Minutes) 30
There were three questions carrying 10 marks each.
One example is given below.
Mention two factors inhibiting iron absorption from the gut.
IV Rapid-fire round (1-1/2 minutes) 30
There are 3 true or false and 3 fill in the blank questions carrying 5 marks each. One example of each type is given below.
Protein energy malnutrition is primarily due to inadequate intake of proteins both in quality and quantity. True/False
The deficiency of vitamin........is related to blood clotting disorder.

At the end of each session a suitable prize was given to a team scoring highest marks. A set of five one-best type of multiple choice questions was administered to all the students using an over-head projector. Each question carried 5 marks. Time allotted was 2-1/2 minutes and the maximum marks were 25. One example is as follows.

Percent of polyunsaturated fatty acids in safflower oil is A. 45; B. 55; C. 65; D. 75.

The performance of the individual student was assessed by the cumulative total of answers for the MCQs at the end of fourth quiz, feedback was elicited by asking questions such as (a) what factors facilitated learning? (b) what factors hindered learning? (c) which round was liked the most? and (d) suggestions or comments to improve the sessions.

Results:

Table I: Winning teams and their performances.

Batch Teams & score (%)
Session I Session II Session III Session IV
1998 C(95.5) B(70.0) B(80.0) C(75.0)
1999 A(85.0) D(75.0) D(75.0) B(82.0)

Table I shows the winning teams and their scores. The overall performance was encouraging. The winning teams scored between 70% and 95%. It was accidental that the teams "B" and "C" were winners twice in 1998 and team "D" was the winner twice in 1999.

The attendance for various rounds was 81.8% (Ist round), 82.5% (2nd round), 76.9% (3rd round) and 59.4% (4th round). The combined attendance was about 75% for all the rounds. Students who scored between 40 and 60 ranged from 21 to 51%. About 40% of students scored between 80-100 except in third round where only 5-6% students obtained this score. Very few students (0.7-6.3%) scored between 0-20.

Table II: Details of feedback from the students.

Area of feedback Responses
What factors facilitated learning? Ensured active participation of majority of the students. Interesting, informative and interactive Generated competitive spirit Different experience Prizes
What factors hindered learning? Answers in the IInd round required memorisation Questions were not of the same difficulty level Some of the questions were difficult
Which round was liked the most? Topic I Visual round Topic II Rapid round Topic III Rapid-fire round Topic IV Rapid-fire round
Suggestions to improve sessions. More rounds and more questions in each round Quizzes to be used to teach other topics

Table II gives the summary of feedback from the students including students giving those responses. Quizzes facilitated learning as they ensured active participation of the students, were interesting, informative and interactive, generated competitive spirit and served as a different experience. The factors, which hindered learning, referred to characteristics of the questions. Majority of such responses referred to questions related to nutritive values. Visual round and rapid-fire round were the rounds liked by most in these quizzes.

Discussion:

There are very few reports of using quiz as a method of teaching/learning for medical students in the format we employed. We provided opportunities for competition among teams selected from smaller batches of the whole class, as well as for evaluating each student by asking MCQs after the quiz. This approach ensured greater participation of the students in the teaching/learning process. In a study from Michigan, U.S.A., interactive video disc units were used for teaching pathology laboratory cases. Each of these units had case studies followed by a quiz. These units were extremely valuable supplemental tools for students5. In another study from Australia, case study was used as a novel teaching/learning format. The learning experience consisted of a quiz followed by a class discussion. This format was beneficial both to the students and the teacher. It also served as an additional option for teaching/learning methods acceptable to students6. Finley et al used quiz format for learning about auscultation of heart sounds through computer-based independent learning, which was compared with classroom teaching. Both CD-ROM and class room teaching methods were highly rated by the students7.

Conclusion:

Quiz was used to teach nutrition in health to medical undergraduates successfully. The performance of the students and their participation were very much encouraging. Some of the students suggested that quiz might be employed to teach other topics.

Acknowledgements:

The authors wish to acknowledge their sincere thanks to all the past and present junior and senior residents for their assistance in conducting the quizzes successfully. They include Dr. D. Dutt, Dr. J. Sadhana, Dr. V.J. Purty, Dr. Joy Bazroy and Dr. Akshay Kumar.

References:

  1. Regulations on graduate medical education, New Delhi: Medical Council of India, 1997.
  2. Rotti SB, Soudarssanane MB, Srinivasa DK et al. A new approach in training pre-clinical medical undergraduates in Community Medicine. Medical Teacher 1992; 14: 379-81.
  3. Soudarssanane MB, Rotti SB, Premarajan KC. Teaching acute respiratory infections using low cost aids. An experience in Pondicherry, South India. Medical Teacher 1991; 13: 369-70.
  4. Soudarssanane MB, Rotti SB, Roy G et al. Research as a tool to teach epidemiology. World Health Forum 1994; 15: 48-50.
  5. Kumar K, Khilnany M. Innovative interactive video disc units for teaching of pathology laboratory cases. Five years' experience. American Journal of Clinical Pathology 1994; 101: 665-70.
  6. Jamison JR. Innovations in education: A case study of a novel teaching/learning format. Journal of Manipulative & Physiological Therapeutics 1996; 19: 92-8.
  7. Finley JP, Sharrati GP, Nanton et al. Auscultation of the heart: A trial of classroom teaching versus computer-based independent learning. Medical Education 1998; 32: 357-61.
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