Just-in-Time Teaching as a Learning Tool for First MBBS Students in Biochemistry

Abstract

Background:

Teaching biochemistry to first-year MBBS students is challenging due to issues with retention and comprehension. Just-in-Time Teaching (JiTT) integrates preclass preparation with adaptive in-class activities to enhance engagement and learning. This study evaluated the effectiveness of JiTT in improving knowledge, student perceptions, and the feasibility of biochemistry teaching.

Materials and Methods:

A prospective, randomized, controlled trial was conducted among 250 first-year MBBS students, stratified by prior academic performance and allocated to the JiTT (n = 95) or conventional teaching (n = 121) groups. The JiTT group received online preparatory materials followed by interactive classroom sessions. Validated pre- and post - test multiple-choice question and case-based questions were used to assess knowledge. Student perceptions were measured using a structured Likert-scale questionnaire. Statistical analysis compared outcomes between groups.

Results:

The JiTT group had significantly higher posttest scores than the conventional teaching group (P = 0.004). JiTT group reported improved motivation (56%), cognitive engagement (69%), problem-solving ability (72%), and enhanced collaboration (63%). About 79% of students spent <2 h on preclass preparation. Student satisfaction was high, with 80% rating JiTT as good to excellent. However, variability in active engagement in class was observed.

Conclusion:

JiTT is an effective and feasible teaching strategy that enhances learning outcomes and engagement in biochemistry. Deeper understanding and better clinical preparedness may be promoted by its integration into the medical curriculum.

Introduction

Teaching biochemistry to first-year MBBS students poses unique challenges due to its complex and abstract nature, which often leads to comprehension and retention difficulties.[1] Traditional didactic lectures may not be an effective teaching strategy to engage students and enhance their clinical application in biochemistry topics. Therefore, to promote active learning, critical thinking, and clinical application, innovative teaching methodologies are used.[2,3] Just-in-Time Teaching (JiTT) is one of the innovative teaching methods to integrate preclass learning by students with-in class interactive activities to address students’ current learning needs. It promotes active engagement and timely reinforcement of tough concepts.[4,5]

Despite growing evidence supporting JiTT’s efficacy across various disciplines, its effectiveness in teaching pre- and paraclinical subjects, especially biochemistry, remains unexplored.[1,6] Previous studies have shown that active learning methods, including JiTT, can improve students’ performance, decrease the cognitive overload, and facilitate self-directed learning characteristics needed for understanding complex subjects like biochemistry.[6,7,8] Furthermore, as the medical curriculum evolves and students need to be equipped for clinical practice, implementing evidence-based teaching methods is crucial.[9,10]

The current study primarily aims to evaluate the effectiveness of JiTT in improving first-year MBBS students’ understanding and academic performance in biochemistry. The secondary objectives include evaluating students’ perceptions of JiTT’s feasibility and usability as a teaching strategy. The study hypothesizes that using JiTT as a teaching-learning tool will result in improved student engagement, better learning outcomes, and optimistic perception by students, supporting its incorporation into the medical biochemistry curriculum.[2,4] Creating such evidence will contribute to promoting student-centered, innovative teaching strategies to enhance the learning experience and eventually better readiness among medical students.

Materials and Methods

Study design and setting

This study was a prospective, randomized controlled trial (RCT) designed to assess the effectiveness of JiTT to teach biochemistry to first-year MBBS students. To reduce bias and to allow direct comparison between the intervention and control groups, an RCT framework was chosen.[11] The study was conducted by the Department of Biochemistry over a period of 2 months. The study was conducted after obtaining Institutional Ethics Committee approval. Confidentiality and anonymity of the study participants were maintained throughout the study, and the ethical standards in medical educational research were followed.

Participants and sampling

First-year MBBS students currently enrolled at the institution during the study period were selected as eligible participants. The study included first-year MBBS students attending biochemistry classes and willing to participate voluntarily. Students who were absent and unwilling to participate were excluded. Voluntary students were included, and stratified randomization was done to ensure balanced distribution across the two groups. Students were informed about the study, and voluntary written informed consent was obtained before the study.

Stratification and randomization

Following enrollment into the study, students were stratified into three performance categories (high, average, and low achievers) based on their previous internal assessment marks. Within each stratum, they were randomly allocated into either the conventional teaching group or the JiTT interventional group using a computer-generated randomization sequence prepared by a faculty member who was not involved in teaching or assessment. An unequal number of students was allocated to the study groups after stratified randomization to achieve balanced representation of academic performance categories within each stratum. To maintain allocation concealment, sequentially numbered, opaque, sealed envelopes containing the group assignments were used. They were opened by the students only after enrollment. Blinding of students and faculty members involved in the intervention was not feasible due to the nature of the educational intervention. However, outcome assessment and statistical analysis were performed by investigators who were blinded to participants' group allocation, thereby minimizing assessment bias.

Intervention

Students were exposed to JiTT teaching method, which used an integrated blend of preclass preparation, adaptive classroom teaching, and active learning strategies. One week before the class, students received learning objectives, short video lectures, PowerPoint presentations, reading materials, and case-based assignments via the institutional learning management system. The preparatory work consisted of 10 multiple-choice questions (MCQs) and 2–3 case-based questions, requiring 45–60 mins to complete. Students were asked to complete the assignment and submit it within 24 hrs before the class. Faculty reviewed them before the class and revised the session to address misconceptions, knowledge gaps, discussion of difficult concepts, and application-based learning. Small-group activities involving problem-solving and application-based exercises were added to the one hr activities to deepen understanding and encourage engagement. All faculty involved were trained in advance to standardize delivery and interaction quality.

Control

The standard small group teaching format was used in the control arm. Traditional didactic lectures, in-class discussion, and problem-solving exercises without prior student preparation were used in this arm. The session consisted predominantly of faculty-led lectures with limited student interaction.

Assessment of learning outcomes

Pre- and post-test were used to assess the learning outcomes of the teaching methods. This comprised validated MCQs and clinical case-based problem-solving questions, both developed in line with the learning objectives. They were independently reviewed for content validity by three senior faculty members in the Department of Biochemistry. Item analysis was already done for MCQs as a part of routine departmental activity. The student perception questionnaire was reviewed for content validity by subject experts before administration. Before the intervention, pretests were administered, and immediately after the respective teaching method, post-test were administered to assess immediate learning gains.

Student perception and satisfaction

Student perception and satisfaction were measured using a structured questionnaire based on a five-point Likert scale. This used multiple dimensions such as perceived clarity of instruction, engagement, motivation, time investment, and overall satisfaction. The response was collected anonymously within a week after the intervention.

Statistical analysis

Descriptive and inferential statistics were used to describe quantitative data from test scores and qualitative Likert scale responses, respectively. An independent samples t-test was used to compare test scores between the groups. P <0.05 was considered statistically significant. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA) was used to conduct statistical analysis.

Results

Participant characteristics

Out of 250 students enrolled, 34 were excluded due to nonconsent, absence, or incomplete data. The remaining 216 students were randomized into JiTT (n = 95) and conventional (n = 121) groups and were included in the final analysis. Baseline characteristics were balanced through stratification by prior academic performance, categorized as high, average, and low achievers. There was an insignificant difference in pretest scores between the groups, which confirmed comparable baseline knowledge levels. Recruitment, allocation, and retention of participants are illustrated in the flow diagram [Figure 1]. The general demographic variables, such as age and gender distribution, were comparable across groups, supporting the study’s internal validity.

Figure 1.

Consolidated standards of reporting trials (CONSORT) flow diagram of participant enrollment, randomization, allocation, follow-up, and analysis

Learning outcomes

Post-test scores were higher in the JiTT group when compared to the conventional teaching group (7.08 ± 1.20 vs. 6.40 ± 1.60; mean difference = 0.68, 95% confidence interval: 0.31–1.05; P = 0.004). The corresponding effect size was Cohen’s d = 0.47, indicating a small-to-moderate educational effect [Table 1]. This enhancement was consistent across all achievement levels, with low and average achievers showing improvements, although this difference did not reach statistical significance.

Table 1.

Comparison of pre and post-test score of Just-in-Time Teaching and the conventional teaching method

		JiTT		Conventional teaching method		P
Pretest score, mean±SD		5.8±1.6		5.5±1.7		0.1
Posttest score, mean±SD		7.08±1.2		6.4±1.6		0.004

SD: Standard deviation; JiTT: Just-in-Time Teaching

Student perceptions and engagement

Analysis of Likert scale questionnaire responses showed an overall positive perception of JiTT among the students. Fifty-six percent of students agreed or strongly agreed that JiTT increased their motivation to prepare for the class and increased their cognitive engagement. In addition, 69% reported that their critical thinking abilities improved, 72% reported improvement in their problem-solving skills, and about 59% agreed that JiTT enhanced their understanding of difficult topics. Regarding collaborative learning, about 63% of students agreed that JiTT encouraged teamwork, and 59% agreed that their individual learning abilities and their interest in biochemistry improved through JiTT. Despite these promising perceptions, the majority of students expressed a neutral opinion about their active contribution to class activities, with a few students strongly agreeing with active engagement. Similarly, 47% of students responded neutrally regarding the achievement of learning objectives, suggesting that although JiTT improved cognitive engagement and perceived learning, these gains did not consistently translate into active classroom participation for all students.

Feasibility and time investment

About 79% reported spending <2 hr on preclass preparations, which highlights the feasibility of the approach without excessive workload. Only 20% reported spending 3–5 hr on preclass preparation. Feedback showed high satisfaction with resource availability and guidance: 80% agreed that learning resources were adequate, and 81% agreed that instructions on their use were clear. Eighty-three percent felt that the materials shared were well aligned with the textbooks, and 81% reported that the teaching session scheduling was appropriate.

Overall satisfaction

Overall satisfaction among students with the JiTT teaching experience was high. About 80% reported their experience as good to excellent. The structured learning materials, chances for preclass preparation, and improvements in their conceptual understanding were appreciated by the students. To summarize, the results of the present study show that JiTT is an effective, feasible, and accepted teaching strategy that can be used to teach biochemistry to first MBBS students to improve knowledge acquisition, enhance cognition, and enhance overall satisfaction [Tables 2 and 3].

Table 2.

Student responses to the perception questionnaire using a five-point Likert scale (%). n=95

Questions		Strongly agree		Agree		Neutral		Disagree		Strongly disagree
Increases motivation to prepare before the class		14		42		38		5		1
My ability to think is enhanced		16		53		27		4		0
Promotes the spirit of teamwork		24		39		30		6		1
Helps in improving problem-solving skills		19		53		23		4		1
Enable understanding of difficult topics		16		43		37		4		0
This kind of learning has enhanced my individual learning abilities and interest in study		16		43		35		5		1
I was able to contribute constructively during the class activities		12		60		19		8		1
I feel I have achieved the learning objectives		13		26		47		12		2
Teaching content was supported by adequate resources and references		26		54		19		1		0
Guidance was given on where to find the resources		29		52		18		1		0
Teaching contents are in agreement with textbooks		32		51		14		3		0
The teaching plan is appropriately scheduled		38		43		18		1		0

Table 3.

Overall course experience and time spent on pre-class preparation among students in the JiTT group (n = 95)

Parameter		Percentage
Overall course experience
Excellent		22
Good		58
Fair		19
Poor		1
Time spent on preparation for class (hrs)
<2		79
3–5		20
6–9		1
10–12		0

Discussion

Interpretation of key findings

The present study intended to assess the effectiveness of JiTT as a learning tool in biochemistry for first-year MBBS students. Our study found that JiTT significantly enhanced students’ academic performance compared to conventional teaching methods. Furthermore, students reported enhanced motivation, improved cognitive engagement, and enhanced problem-solving skills, although student participation during class activities was variable. This may be explained by differences in learning styles, confidence levels, or varied responses to a learner-centered teaching approach. Future studies are needed to explore strategies to increase active participation during JiTT sessions. Even though the improvement in the post- test scores in JiTT was modest in absolute terms, the observed effect size indicates a small-to-moderate educational benefit. These findings suggest that JiTT offers a meaningful improvement in immediate learning outcomes and can be implemented within the existing undergraduate medical curriculum.

The detected academic gain by the students aligns with the existing literature that indicates JiTT’s efficacy across medical domains. For instance, previous studies in medical ethics education have shown improved learner satisfaction and enhanced scores by JiTT-based interventions.[12] Similarly, JiTT has been shown to enhance self-directed active learning by students and to bridge knowledge gaps in students in foundational sciences.[1] Similar studies in other health professions showed that teaching using JiTT earlier caused better retention and better application of concepts.[13] These results from these studies may be explained by the JiTT’s capacity to provide personalized, timely remedy measures by recognizing misconceptions before the class, thus encouraging focused cognitive efforts during interactive sessions.[5] Moreover, JiTT nurtures metacognition by convincing students to prepare and reflect on the materials shared before the classroom learning, thereby enhancing a better understanding of concepts.[14]

Strengths and limitations

The randomized controlled design with stratification by prior academic achievement, which minimized selection bias and ensured comparability between the groups, is the main strength of the study. Internal validity was enhanced by allocation concealment and assessor blinding. The use of validated, peer-reviewed assessments further strengthened the study.

However, limitations exist. Due to the nature of educational interventions, complete blinding of participants was impractical, potentially introducing performance bias. The long-term retention and clinical translation were not possible due to relative short intervention and assessment period. Furthermore, variability in student engagement, as reflected in a moderate level of active participation, suggests heterogeneity in learner receptivity. As our study was conducted at a single institution, the generalizability of the findings to other institutions with different curricular designs and student demographics is limited.

Implications for medical education

The study’s results have significant implications for adding JiTT as a learning strategy for MBBS students, especially in preclinical subjects. This was supported by established effectiveness in enhancing knowledge and cognitive improvement as a feasible approach to improve the foundation among MBBS students. The capacity of JiTT to personalize the preliminary work and address core, difficult concepts offers a distinct pedagogical advantage for teaching the complex, bulk content of biochemistry. Appropriate faculty preparations to enhance active learning and classroom discussion are needed for the successful implementation of JITT. The learning materials were distributed electronically using readily available institutional resources, suggesting that JiTT can be implemented without major infrastructural modifications.[15]

Future research directions

Although this study advances data on JiTT in biochemistry learning, several gaps persist. Longitudinal studies are needed to establish the effect of JiTT on knowledge retention and clinical performance during internship and postgraduate training. Studying the effects of student characteristics, motivation, and active engagement during JITT will help refine its delivery and address participation differences.[16]

To improve external validity and create best practices for widespread adoption, multi-institutional RCTs that include diverse curricula and student populations are needed. Studies combining JiTT with artificial intelligence-driven adaptive feedback and a virtual learning environment may improve personalization to meet students’ needs.[13,17]

Future research, including faculty perceptions, workload impacts, and cost-effectiveness analyses, is needed to update sustainable implementation strategies. To link foundation science learning to clinical skills, measures of professional identity formation and clinical reasoning can be added to JiTT evaluation.[18]

To summarize, JiTT embraces substantial capacity to reform biochemistry learning through personalized, active, student-centered learning. Continual research and thoughtful curricular integration are needed to completely understand its potential.

Conclusion

Summary of key findings

The present study showed that JiTT is a feasible and effective teaching method for enhancing immediate knowledge acquisition among first-year MBBS students in biochemistry. Students exposed to JiTT demonstrated significantly better posttest performance. Students showed greater motivation, critical thinking, problem-solving, teamwork, and engagement than those receiving conventional teaching.

Overall implications

Even though the present study supports the educational value of JiTT, the results were limited to short-term learning outcomes in a single institutional setting. Further studies with a larger sample size, longer follow-up period in multicenter settings are needed to generalize the results and to evaluate the long-term impact on knowledge retention and academic performance

Final recommendations

Pioneers in medical curriculum committees should consider using JiTT as a complementary pedagogical strategy to improve the learning process. Faculty development programs should be considered for the design of interactive preparatory materials and for adaptive in-class activities. To support continual implementation, appropriate investments in technological infrastructure should be made. Additional longitudinal and multi-institutional research is needed to assess the effect of JiTT’s long-term impact on clinical performance.

Ethical clearance

The study was approved by the institutional Ethics Committee of Mahatma Gandhi Medical College & Research Institute (Approval No : Faculty project/08/2019/09).

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.