Effectiveness of video role play with PowerPoint lecture on knowledge domain among medical students—An open label randomized control trial

Abstract

BACKGROUND:

Video is an effective teaching and learning tool as it is one of the few mediums that has been used effectually in all facades of medical education both with face-to-face teaching and at a distance. During a specified amount of space and time, video description can provide more details, converting complex concepts into simpler ones. The aim of the study is to assess the effectiveness of video role play (VRP) on knowledge domain among medical students.

MATERIAL AND METHODS:

The study was done as an open label randomized control trial among first-year medical students in a private medical college in a rural district in Tamil Nadu, where the subjects were randomized into two groups. The intervention group was given video role-play demonstration of the specified topic with a minute description. The control group was given PowerPoint lecture of the same topic. Baseline pretest and posttest score after two weeks was done to assess the effectiveness of video role play on knowledge domain among the students.

RESULTS:

The mean age of the population was 18.72 (0.71) years. The gender distribution showed that 70 (47.3%) were males and 78 (52.7%) were females. The result showed that Mean ± SD score of VRP posttest [9.36 ± 0.92] was significantly more in comparison with that of post score of PowerPoint [5.16 ± 1.98].

CONCLUSION:

This concludes that VRP can act more effectively in understanding a lecture than using PowerPoint method. It is an interesting and exciting teaching–learning method involving the active participation of the students and the faculty.

Introduction

“When one teaches, two learn.”

–Robert Heinlein

Effective communication is a vital skill for clinical practice across healthcare settings.[1] The communication skill is preceded by the acquisition of knowledge which makes the student more competent. Learning can usually be categorized into three domains: cognitive, affective, and psychomotor. Inside each domain are multiple levels of learning that develop from more basic, surface-level learning to more complex, deeper-level learning. The domain attained depends on the type of experience of the students about the learning and its duration along with the nature of impact it created.[2]

The studies have shown that mere lecture or PowerPoint presentation is less efficacious as the interaction would be less and more of a teacher-centered one. This holds the reverse for teaching methods which used to visualize the topics including videos and role plays.[3,4] This method can be used for the teaching of communication skills, to impart a particular concept more clearer and the technique of differentiating closely resembling situations. The advantages include—active participation, the creation of interest, real-life demonstration give more confidence in terms of learning skill. In terms of students, it increases motivation, more active participation of the students, skill to talk up, reducing shyness, acquiring new attitudes and accepting the social norms, reinforcement of management and organization skills, along with communication skills.[5,6]

The video is an effective teaching and learning tool which can be used as supplement in a didactic or Socratic method. Visual images always are more efficient and effective over verbal communication in terms of gaining audience attention. During a specified amount of space and time, video description can provide more details, converting complex concepts into simpler ones. Learning retention increased when images are incorporated in the curriculum. Videos can be deliberately made with actual voluntary participants such as students, faculty, interns, and even actors or it can be animated to convey the concept. Already created videos may also be utilized for educational purpose.[7,8,9,10]

Video role play (VRP) is predominantly effective in refining undergraduate communication skills and application of knowledge. It essentially reconstructs the clinical scenario; the teacher needs the student to experience. Students unswervingly state this method as the most relevant and stimulating aspect of their training.[4] Video role-play augments the students’ retention power of learned subject knowledge, since it is germane, helps in developing learning skills, and remains green throughout their professional life. Studies showed that more than traditional teaching methods, role plays accentuate the social aspect of learning and endorse supportive attitude of the students by provoking the students cerebrally and socially.[4,5,11,12,13] The study tries to give an evidence to improve the existing pattern of medical education through the prescribed video role play. This will obviously change the monotonous way of teaching and impart some interest in the stake holders. The study thus aimed to assess the effectiveness of video role play on knowledge domain among medical students.

Materials and Methods

Study design and setting

The study was conducted as an open-label randomized control trial with 1:1 allocation among medical students belonging to first year of a private medical college hospital. The study was done for a period of two weeks.

Study participants and sampling

According to a previous study, considering the mean (μ₁) and standard deviation (σ₁) of video role play with traditional methods as 73.1 ± 27, and mean (μ₂) and standard deviation (σ₂) of traditional methods of teaching as 60.4 ± 15, at 95% confidence interval (Z₁₋ₐₗ₂ = 1.96), with 90% power (Z₁₋ᵦ = 1.28), the sample size is calculated with the formula, N = (Z₁₋ₐₗ₂ + Z₁₋ᵦ)² *2 * σ²/(μ₁ − μ₂)². Thus, the total sample size required for each group is 57 and the total minimum sample size for the study is 114. The study was conducted among first-year MBBS students studying in the medical college hospital in a rural district, Tamil Nadu, India, and was included in the study. Those who were absent for the day or made an incomplete assessment were excluded from the study.

Ethical consideration

After obtaining Institutional Ethics committee approval [IECHS/IRCHS/DSMCH no: 83, 23/02/2021], the study was commenced, and informed consent was obtained from all participants. The study was registered in clinical trial registry of India with the number CTRI/2022/07/043916.

Study procedure

A total of 148 first MBBS students were randomly divided into two groups (Group A and B) of 74 students each. The students were randomly divided into two groups based on computer-generated random numbers. Thyroid disorders topic was taught to the two groups at two different lecture halls, simultaneously to avoid the contamination bias. Both the groups were given pretest using evaluation questionnaire pertaining to the topic. The questionnaire included demographic details age and gender and the evaluation questionnaire.

Group A students were given a lecture using PowerPoint regarding the topic and Group B students were subjected to video role-play demonstration at the same time. The video role play was made with the help of students regarding the signs and symptoms of thyroid disorders. The students were acted as the patients with the specific signs for thyroid disorders both hypo- and hyperthyroidism, and another student acted as a physician where showed the various techniques he/she have used to came to a diagnosis [physiology and mechanism of thyroxine production]. The role play has been recorded in a video format and laid before the intervention group for a period of 20 min. After the end of the video role play, students were again sensitized for the details which are given in the video as a normal lecture for five minutes. The session was subsequently done at two lecture halls to avoid contamination bias.

Post-evaluation was conducted for both the groups after two weeks of the session. This session was also planned as a surprise evaluation to prevent the students from preparing differently for the evaluation. The posttest was also planned at the same time for the two groups. The schema of the study is represented in Figure 1.

Figure 1.

Schema of the study

Statistical analysis

The demographic data were described in mean, standard deviation, frequency, and percentage. The pre- and post-evaluation was analyzed using paired t test with SPSS 23 [IBM Corp. Released 2015. IBM SPSS Statistics for Windows, version 23.0. Armonk, NY: IBM Corp.].

Results

The mean age of the population was 18.72 (0.71) years. The gender distribution showed that 70 (47.3%) were males and 78 (52.7%) were females. The mean (SD) pretest score of PowerPoint and VRP was 1.00 (1.11) and 1.53 (0.95), respectively. The minimum and maximum pretest score for both the group was 0 and 4, respectively. The mean (SD) posttest score of PowerPoint and VRP was 5.16 (1.98) and 9.36 (0.92), respectively. The minimum and maximum pretest score for the PowerPoint group was 1 and 10, respectively. The minimum and maximum pretest score for the VRP group was 6 and 10, respectively. The age [18.79 (0.74) years vs. 18.64 (0.67) years] and gender distribution [males—48.6% vs. 51.4% and female—51.3% vs. 48.7%] among the groups [ PowerPoint vs. VRP] were not significantly different showing the success of randomization (P value >0.05).

The comparison of pre- and posttest scores of PowerPoint group using Wilcoxon signed-rank test showed a significant difference in the median score of posttests[5] in comparison with pretest (1.00) and the result was statistically significant. The comparison of pre- and posttest scores of VRP group using Wilcoxon signed-rank test showed a significant difference in the median score of posttest[10] in comparison with pretest (1.00) and the result was statistically significant [Table 1].

Table 1.

Comparison of pre- and posttest scores of PowerPoint

	Variable	Median (interquartile range)	Table value	P
PowerPoint	Pretest	1.00 (1.00, 2)	−7.46	<0.001*
	Posttest	5 (4, 6.25)
Video role play	Pretest	1.00 (0, 2)	−7.54	<0.001*
	Posttest	10 (9, 10)

Wilcoxon signed-rank test expressed as median (interquartile range). *P<0.05 is significant

The independent t test showed that the Mean ± SD score of VRP posttest [9.36 ± 0.92] was more in comparison with that of post score of PowerPoint [5.16 ± 1.98]. The difference between the scores was 4.20 and the result was statistically significant [Table 2].

Table 2.

Comparison of post score of PPT and VRP

Variable	Mean±SD	Mean difference	Table value	P
PPT	5.16±1.98	−4.20	28.45	<0.001
VRP	9.36±0.92

Independent t test

The comparison of mean difference in pre- and posttest scores among both groups PowerPoint presentation and video role play also showed significant difference [4.16 (1.74) vs. 7.84 (1.14), P value <0.001].

Discussion

The study was conducted with the objective to compare the effectiveness of video role play and lecture with aid of PowerPoint among medical students. In our study, we found that video role play is more effective than PowerPoint presentation in establishing knowledge domain.

Hong-Gu He et al.[1] found that video role plays enabled the teaching and learning process, and heightened the understanding and application of communication skills of students. Hurtubise L et al.[7] said that video clips are predominantly useful in prompting emotions, warranting students’ engagement to the session. Concepts adhere to students’ minds when it is projected in the form of a story that provokes emotion. Stories of patients stimulate the acquisition of medical knowledge in more fascinating way.

Knowles, C et al.[4] demonstrated that video role play with structured feedback is efficacious in tutoring medical students for application of clinical in parallel hospital settings. Video role play is quite an innovative technique of teaching and learning that has numerous recompenses against the traditional teaching and learning methods. Moghadam MD et al.[11] showed that the role-playing technique had statistically significant higher scores than the traditional teaching methods (oral and PowerPoint presentation) [54.64 vs 21.45]. They suggest that the participants in role playing assume self to be in the real circumstances and act as required. Use of role play in medical education can help augment improvement in the patient-oriented interview skills by the students which is again proved by a study done in Iran.[6] Studies have shown that role paly is better in imparting midwifery skills.[14]

Boose et al.[12] in a study done to assess the effectiveness in change of communication after use of role play and standardized patients showed that posttest score of role play was significantly higher in comparison with use of standardized patients due to the performance in the domain understanding of parents’ perspective. Nestel et al.[13] showed that the students who reported the key aspects of helpful role play were prospects for observation, rehearsal and discussion, realistic roles, and orientation of roles with other facets of the curriculum. The study supported thinking, feeling, watching, and doing aspect of role play portrayed as experimental learning theory.[15] There are also studies which showed the dislike of students toward role play like student-centered methods.[16]

Limitations and recommendation

One of the limitations of this study was the lack of the ability to control the class during the role-play session. The study had a video role play conducted as single session and the comprehension of students for this single session was not assessed. The presence of interaction between the two groups may have led to contamination bias. The limited assessment of only knowledge domain would have reduced the real outcome of the intervention. The inclusion of only a single batch of students may have made the result weaker. The involvement of multiple teachers in the procedure would have impacted variation in the way of teaching. The absence of a particular structure for video role play would have influenced the students to be more memory oriented. Video role play may be used as an effective teaching learning tool in undergraduate medical education. It is an interesting and exciting teaching–learning method involving the active participation of the students and the faculty. The medical education is in imperative need to revamp the teaching methodologies and turn into a more effective integrated multimodal approach. The introduction of more innovative methods would reduce the monotony of the teaching methods. The new competency-based curriculum has made the whole topic compartmentalized into various competencies and many of these can be fulfilled with such techniques. The combined approach would make a better impact on the psychomotor and affective domains of learning rather than just touching the knowledge domain. The impact of this video role play should be assessed more with multiple topics and assessment should be made with various modalities like essay questions and skill evaluation. The few uses of the video role play in different academic subjects are depicted in Figure 2.

Figure 2.

Uses of video role play in different academic subjects in medical education

Conclusion

The study concludes that VRP can act more effectively in understanding a lecture than using PowerPoint presentation method. Some topics in the curriculum subjects need to be reinforced into the students for their future learning. Such topics can be learned through multiple teaching methods involving more than two domains of learning. An overall facelift of the teaching methods is needed which breaks the dullness of medical education and thus adds on to the learning in general.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.