A heutagogical interactive tutorial involving Fishbowl with Fish Battle and Round Robin Brainstorming: A novel syndicate metacognitive learning strategy

Abstract

Background

The increasing tutorial size poses every teacher with the problem of student attention and participation; hence, newer strategies are needed to engage adult learners into cooperative learning. This study aims to assess the knowledge gained and retained and perceptions of students using an interactive syndicate learning style tutorial vis-a-vis conventional tutorials.

Methods

A quasi-experimental crossover study was conducted wherein students of phase 1 MBBS physiology tutorials were divided into two batches (interactive tutorials involving learning Fishbowl with Fish Battle and Round Robin Brainstorming and conventional didactic tutorials), with 65 students in each over 3 days. In the interactive tutorial group, students were seated in 2 concentric circles, the inner circle engaged in Fish Battle (a seminar followed by rebuttal), whereas the remaining students belonged to the Round Robin Brainstorming (outer circle) group, wherein brainstorming using index cards was carried out and a mind map was prepared, followed by a summary. Both batches underwent the pre- and post-MCQ test followed by the crossover study the subsequent week. For testing retention, an Multiple Choice Questions (MCQ) test was conducted after 3 weeks. In the end, 5 physiology tutorial modules were completed.

Results

There was a statistical improvement in the post-test scores (9.7%) gain in the Interactive Tutorial (IT) group as compared with the Conventional Tutorial (CT) group. Of the students, 56% retained the topics after undergoing IT compared with CT. Around (90%) students felt improved conceptual thinking, and 92% felt it encompassed active learning.

Conclusion

Interactive tutorials involving such learning styles facilitate active self-determined learning, develop mutual interdependence, equal representation, and group dynamics as adult learners, and transform them into lifelong critical thinkers.

Introduction

Medical education is in the midst of a major tectonic shift in the 21st century, with the increasing classroom size that has its inherent problem of student engagement and facilitation of learning for better outcomes.¹ In the wake of outcome-based medical education by Medical Council Of India (MCI), it is now a preamble for every institute to adopt a teaching–learning strategy to build up self-dependence in students to facilitate a two-way process of sharing ideas and concepts. The National Education policy that insists on one-size-fits-all policy is not the way forward, and hence, an attempt is made to extend the boundaries of education toward self-reliance. Creating an environment in which students can learn effectively and efficiently has become the new prerequisite and focused toward how students learn.² The current lacuna with the traditional didactic teaching, which is still the most prevalent technique of information transfer in the medical curriculum, is that it may not facilitate learning as it is still considered teacher centric, with most students not being attentive, and hence, there is no scope for active learning. To circumvent these problems, medical educationists have developed an array of teaching methods such as small-group teaching, seminars, tutorials, brainstorming, and so on. Research projects such as Tennesee's Student/Teacher Achievement Ratio (STAR) have elaborated the importance of reducing the class size in producing benefits for teachers and students.³ One such modality of teaching is tutorials, wherein the student number is restricted and better conceptual understanding can be encompassed, but they are inherently flawed if not made interactive, leading to loss of focus and boredom. Certain studies have proved benefits of interactive teaching over didactic lecturing for its positive influence on pupils.⁴ Peer-assisted strategies facilitate not only the acquisition of knowledge but also several other desirable attributes, such as communication skills, teamwork, problem-solving, creating rich educational environment, and so on. The Fishbowl technique was introduced by multinational companies to increase participation by employees,⁵ and the same principal has been used in medicine to promote cooperative learning as students learn by doing. It places the responsibility of learning on students, and responsibility of the teacher passes from the one who passes on the knowledge to a facilitator. Learning occurs through multiple interactions within the environment, especially when students are encouraged, expected to think critically, and analyze things. The “Fish Bowl with Fish Battle admixed with Round Robin Brainstorming” is a cooperative learning–teaching strategy in the form of dialog that aids active participation of students and acts as a primer for inducing self-directed learning.⁶ The practical disadvantage of the didactic tutorial is that the discussion can be literally hijacked by vocal participants. Silent members hesitate to participate with the fear of being rebuked on giving a wrong answer by the leader. Hence, they end up being passive disinterested spectators.⁷ The novel syndicate learning styles based on the heutagogical principles facilitate learning owing to greater interaction and peer review; introvert students develop group dynamism, their social skills are improved, and the students learn to be focused, which transforms them from a passive disinterested learner into an active experiential learner. In the era of information explosion, students are overburdened with an increasing academic load, making learning painful. Coles⁸ opined that the student's satisfaction is inversely proportional to the classroom size; hence, it is mandatory that colleges promote interactive sessions for the teaching–learning method for students who conventionally depended on tutorials for ages.⁴ In a study conducted by Saleh et al,⁹ it was suggested that the priority for improving the quality included methodologies that include blending unique self-directed learning styles across all years of the study. In the context of medical education in India, it is imperative to underscore the integration of various heutagogical principles to foster learning for young minds. Because there is a paucity of scientific data emerging from this genre of medical education with regard to the effectiveness of innovative syndicate learning styles among MBBS phase 1 students, an effort will be made through this study to ascertain if there is requirement to bring about a change in the teaching–learning method. We decided to conduct a study to assess the impact of the combination of two differential syndicate group learning styles in an interactive tutorial format, i.e., Fishbowl with Fish battle with Round Robin Brainstorming, in physiology among students and to analyze feedback from students and to identify intricacy in this regard so that learning can be facilitated.

Materials and methods

This is an experimental study. A quasi-experimental crossover study was conducted. A total of 200 participants were involved in the study. The following is the source of data:

• a)Phase 1 MBBS students
• b)Sampling technique: The sampling technique included purposive sampling of students into tutorial groups (n = 65) which included two groups (A and B [n = 32]) by using their odd/even roll numbers, wherein A indicates the interactive group and B indicates the comparison group.
• c)Study duration: The study duration included 8 months (October 2018–May 2019).
• d)Study setting: The study setting included physiology tutorials.
• e)Inclusion criteria: Participation was voluntary.
• f)Exclusion criteria: There were no exclusion criteria.

The entire purpose and protocol of the study was explained to the participants, and a voluntary written informed consent was taken from all of them after receiving institutional ethical clearance. The students were primed about the topic via a didactic lecture that lasted around 60 min before the conduct of the tutorial sessions. The tutorial groups consisted of 65 students, each divided across 3 days/week (3 batches). The 65 students of a tutorial were divided into 2 groups (A1, A2, A3: n = 32 and B1, B2, B3: n = 33), i.e., the interactive or comparison groups, respectively, using their roll numbers. The students as per their groups moved to separate rooms depending on whether they were having traditional tutorial teaching or the novel intervention, and both the groups were taught the same topic by faculty having similar proficiency. The students were separated into 2 groups: (a) interactive group (Fishbowl with Fish Battle and Round Robin Brainstorming) and (b) comparison group (traditional tutorial) every week. A sensitization program for the smooth conduct of the group formation was conducted a week before the actual commencement. A pre-test MCQ (Curate Critical thinking Higher order extended MCQ) was given to all the members (n = 65) before being allotted to the groups.

Interactive tutorial

Fish Bowl with Fish Battle and Round Robin Brainstorming technique

The intervention group consisting of 32 participants was divided into 2 circles: one inner circle and one outer circle. A total of 32 students were allocated to 2 circles depending on their roll numbers. The first group of 14 students (Fish group) was made to sit in the inner circle and was given a topic for discussion based on the teacher's lecture. They were instructed to hold a discussion with the representative members of their group. The inner fish group was further divided into two groups: one group of participants (n = 7) spoke on a subtopic allotted to them, and the other counterpart group (n = 7) rebutted them. The other group of another 13 students (Round Robins group) was made to sit in the outer circle and was asked to observe the Fish group. The Round Robins group would listen carefully to the Fish group and contribute to the discussion by brainstorming of missing ideas or concepts using index cards. The following are the manpower requirements of the Fish Bowl with Fish Battle and Round Robin Brainstorming Technique: (1) group leader, who starts and directs the discussion; (2) facilitator, who interacts with the rest for peer review, (3) neutral chairperson, who summarizes, (4) observer, who notes topics and important points, and (5) team referee, who motivates and acts as timekeeper.^7,9, 10, 11, 12

The aforementioned team of 5 members was seated in the outer circle (Round Robins group), and at the end of the session, they would get together and draw a mind map of the topic under discussion with the assistance of the entire team and reach out to faculty for assistance if any, and the same was distributed among all the 30 students in the intervention group.

The time taken was as follows: 30 min for Fish Battle, 15 min for answering queries and summarization (Round Robin Brainstorming), 10 min for mind map, and 20 min for the pretest and post-test.

In the first week, students were allocated to A1, A2, and A3 and B1, B2, and B3 based on their roll numbers.

In the second week, the interactive and comparison groups were swapped over in the consecutive week, and it was continued for 8 months to cover 5 different topic modules of physiology.

At the end of the interactive tutorial (session), this group prepares a mind map; a constructive, corrective, reflective feedback using Pendleton's technique was given immediately to beat the forgetting curve; and a feedback questionnaire that assessed their perception toward the novel learning style was duly filled by the participants. A post-test MCQ (Curate Critical thinking MCQ) was tendered to students of both the intervention and comparison group. After a period of 3 weeks, the retention and recall of the topics was assessed using the MCQ test of the topic discussed in Fish bowl with Fish Battle and Round Robin Brainstorming style.

The students (n = 33) allocated to the comparison group were taught the topic that was discussed in the interactive group by means of traditional conventional didactic explanatory tutorials. Time taken was 60 min 40 min for teaching and 20 min for the pretest and post-test.

The prestructured feedback questionnaire was piloted on 30 students to validate the instrument for internal consistency for face, content, and consensual validity and was rated by experts. The responses of the feedback form were graded using the Likert scale (scores ranging from 1 to 5). These scales were statistically analyzed and expressed as percentage. MCQ given as the pretest and post-test was given from the departmental question bank of the prevalidated and postvalidated MCQ for determination of difficulty and discrimination index. Learning outcomes and knowledge were assessed comparing pretest and post-test scores on MCQ. Perceptions regarding the use of the syndicate learning style were assessed using a prestructured and prevalidated comprehensive questionnaire.

Statistical analysis

The data were analyzed using IBM SPSS, version 25.0, with full crack keygen. The categorical variables were computed in the form of frequency table. Between-group analyses was carried out using the Mann–Whitney U test and Student's t-test. P values <0.05 were considered to be statistically significant.

Results

There was a statistical improvement in the post-test scores (9.7%) gain in the IT group as compared with the CT group. Of the students, 56% retained the topics after undergoing IT compared with CT. Around (90%) students felt improved conceptual thinking, and 92% felt it encompassed active learning. (Table 1, Table 2, Table 3, Fig. 1, Fig. 2)

Table 1.

Comparison of the students' performance.

Method	Pretest	Post-test	Gain in marks	P value
CT (n = 100)	2.7 (1.4)	8.6 (1.6)	5.9%	0.001aM
IT (n = 100)	2.5 (0.97)	10.2 (1.4)	9.7%	0.001aM

The table shows that the mean scores of students after IT were significantly higher than their counterparts having conventional tutorials. P values <0.05 is considered significant. IT represents the Interactive Tutorial group; CT represents the Conventional Tutorial group.

M stands for Mann- Whitney U test. Data was found statistically significant as per this, hence mentioned as superscript.

^aStatistically significant as per the Mann–Whitney U test.

Table 2.

Students showing the preferences for interactive tutorials over conventional tutorials.

Items	CT	IT
Most comfortable method	62%	38%
Most active way of learning	8%	92%
Method best suited for understanding and retention	28%	72%
Most interest arousal method	11%	89%
Method which improves conceptual thinking	10%	90%
Method of opportunity to clear doubts	6%	94%
Method best suited for recall	46%	54%

IT represents the Interactive Tutorial group; CT represents the Conventional Tutorial group.

Table 3.

Comparison of students' performance on recall after 3 weeks.

Recall method	MCQ test before 3 weeks	MCQ test after 3 weeks	% of increase	P value
IT (n = 100)	2.5 (0.97)	11 (1.0)	56%	0.001a
CT (n = 100)	2.7 (1.4)	5.6 (1.7)	19%	1.39

The table shows the mean scores of students on recall after 3 weeks of conduct of IT and CT. The group that underwent IT scored significantly higher than their counterparts undergoing conventional tutorials, depicting better recall after 3 weeks. P values <0.05 were considered significant. IT represents the Interactive Tutorial group; CT represents the Conventional Tutorial group; MCQ represents the Multiple Choice Questions.

^aStatistically significant.

Fig. 1.

Tutorial plan.

Fig. 2.

Students' performance and interactive and comparison group score.

Discussion

The present study was undertaken to study the effectiveness of a novel syndicate learning strategy that combined the Fishbowl with Fish Battle technique and Round Robin Brainstorming for teaching physiology to phase 1 MBBS students. In our study, we found that the mean scores of students after IT were significantly higher, with 9.7% gain in marks as compared with their counterparts having conventional tutorials, wherein there was only 5.9% gain in marks. Furthermore, in our study, students preferred interactive tutorials over conventional ones, which is in line with some other studies on undergraduates,¹³ with 92% stating IT to be most active way of learning, 72% finding it to be best suited for understanding and retention, 89% reporting it to be an interest arousal method, 90% finding that it improves conceptual thinking, 94% students finding it to be an opportunity to clear their doubts, and 54% reporting it to be suitable for recall. However, in our study, the majority, i.e., 62%, found conventional tutorials to be a more comfortable method of teaching. In addition, in our study, we found that students who were allocated to the interactive Fishbowl with Fish Battle and Round Robin Brainstorming technique (92%) showed an objective enhancement of knowledge and fared better on the retention and recall test conducted after 3 weeks (56% increase) than their counterparts who were exposed to the conventional didactic tutorials as they found the innovative technique dynamic and interactive. The probable explanation for the same could be that the traditional teaching learning strategy embodied by most of the institutes catering to health sciences is in the form of tutorials and is aimed toward major educational outcomes, wherein one or more instructors give instructions to a small group of students and in return students are supposed to develop and test ideas, define new problems, seek solutions, and indulge in self-learning. The main focus is to make learning multidirectional, wherein tutors can provoke thinking and create an environment wherein ideas can be freely exchanged. The conventional didactic tutorials unfortunately tend to be grappled with similar issues as students partake a more passive role, with no scope for asking questions and getting them cleared.^14,15 In our study, more than 94% students found it easier to get their doubts cleared as they seemed to shed inhibitions through this innovative strategy as it facilitates a role change of a teacher from sage on the stage to guide on the side, which allows students to assume a center stage with an active role to stimulate learning.¹⁶ Studies have shown that students acting as peer tutors are more appealing and constructive, allowing students to become critical thinkers and lifelong learners and to develop independence.¹⁷ In our case, the students (89%) remained constantly involved and interested in the entire process, and 90% learned to critically analyze questions. Active participation was the rule. The greater scores (56% increase) on recall were probably because this technique evoked interest, and enthusiasm remained for a longer time because of team spirit. Because each student was allocated a subtopic, each member from the group gained the capacity to help others. Because the speakers were not chosen by the teacher, there was an element of curiosity added to the task. On the background of the fear factor involved in answering in traditional tutorials, this novel style showed positive learning outcomes on the post-test. The Fish Battle arrangement increased active participation and deeper learning because the fear of being rebutted made them push their goals. This technique of learning promotes a strong sense of leadership and the ability to respond to a conversation. A novel creative blending of Round Robin Brainstorming with the Fishbowl tutorials allowed the students to generate ideas in a more structured manner irrespective of being influenced of vocal students who dominate the scenario in a traditional brainstorming session and have an equal say in the conversation. The enhancement of knowledge by the interactive syndicate learning strategy could be due to the following reasons:

• 1.It helps in more dynamic interactive learning.
• 2.It increases curiosity and interest in the subject.
• 3.It fosters critical reasoning and aids better retention.^4,16
• 4.Students gain confidence to ask questions and express their views on controversial topics.⁵

Such innovative syndicate learning strategies help increased self-identification of lacunae by students and promotion of self-directed learning by instant resolution of confusions and helping them learn the art of holistic problem-solving. Hence, it is highly recommended that for effective classroom management, such an innovative, more focused, and critically analytic learning strategy be adopted so as to generate a systematic approach to deliver better solutions in which a traditional didactic tutorial fails. It will help institutions to break free from the fixed frames of education and adapt to a barrier-less student-centric learning style.

Disclosure of competing interest

The authors have none to declare.