| Abstract|| |
Context: Education can be effective when combined with entertainment making it edutainment and this includes dramas, flashcards, board games, etc. Flashcards are handy, valuable, useful, and easy to carry at various locations.
Aim: The aim of this study is to use educative flashcards designed for clinical undergraduate students to learn bioethics and its application.
Settings and Design: Experimental double-blinded study was conducted to use educative flashcards on Bioethics and its application, designed for clinical undergraduate students.
Materials and Methods: Participants were divided into three groups, Group 1 was traditional teaching method where class was taken for 1 h, for Group 2 only flashcards were given, and for Group 3 both classes was taken and flashcards were given. After a week, semiconstructed pretested questionnaire was given to all the participants.
Statistical Analysis: Data were collected, coded and fed in SPSS (IBM version 23) for further analysis.
Results: Nearly 43.3%, 13.3%, and 30% of them from Group 1, 2, and 3, respectively, thought that professionalism was same as bioethics (P< 0.05, χ2 = 6.599). Nearly 86.7%, 96.7%, and 100% of them from Group 1, 2, and 3 respectively, knew it was important to highlight the cost involved before taking consent for any procedure (P > 0.05 and χ2 = 5.506). Only, 53.3%, 53.3%, and 86.7% of them from Group 1, 2, and 3, respectively, knew that there is an ethical committee in this institution.
Conclusion: Participants from Group 2 and 3 have fairly more knowledge compared to participants from Group 1 where majority of the answers were not right.
Keywords: Bioethics, educational flashcards, traditional teaching method
|How to cite this article:|
Sadhu BJ, Bopanna N. Teaching bioethics to the young learners using flashcards. J Educ Ethics Dent 2017;7:19-24
| Introduction|| |
Health-care professionals should have the basic knowledge of theories, principles of bioethics and skills for ethical decision-making. Health-care professionals including dentists provide comprehensive care for patients but patients still express dissatisfaction over the services provided to them which can be because of the poor ethical conduct. Dental curriculum makes merely a passing mention of the principles of ethics., There is no comprehensively utilized gold standard with respect to ethics teaching in the health sciences.
Education is something which should not only fill their head with some facts but also inspire the recipient's mind. One method by doing this is adding entertainment with education, thus making it edutainment, which includes game-based teaching, flashcards, dramas, etc., which assists in reasoning and building memory strategies. Use of flashcards is very popular in the world. Flashcards are basically pieces or set of paper or note cards that have written information or pictures on one side or both the sides which can be used in classroom drills or private study. They are simple, convenient, handy, valuable, useful, and easy to carry at various locations. They are more effective, interesting, and makes learning enjoyable than attending long sessions of classes or studying.,,,
The present study was conducted to evaluate and compare the effectiveness of edutainment flashcards and chalk and talk method on bioethics and its application among clinical undergraduate students of a dental institute in Karnataka, India.
| Materials and Methods|| |
An experimental double-blinded study was conducted to use educative flashcards designed for clinical undergraduate students to learn bioethics and its application. The study was conducted in September. Clinical undergraduate students included all the 3rd year and final year BDS students. The study was conducted after obtaining the Institutional Ethical Approval. All the participants were informed about the purpose of the study, and a written consent was obtained before the start of the study.
Bioethics and its application were addressed to all the participants into five important domains – introduction to bioethics, ethical principles and its importance, duties of a dentist, duties of a researcher and unethical practices. Flashcards were designed and there were a total of 72 cards in a set of flashcards. For classroom-based traditional teaching method, a Microsoft Powerpoint Presentation was made covering all the above topics. All the clinical undergraduate students were divided randomly into three groups. Group 1 was traditional teaching method where class was taken by chalk and talk method; in Group 2, flashcards were given to the participants to read and study on their own, and in Group 3, class was taken and flashcards were also given.
There were two investigators who conducted the study, one principal and one coinvestigator. Simple randomization was done. The blinded coinvestigator generated the sequence. The sequence was generated using www.random.org by the coinvestigator and this was concealed, given to the principal investigator, who divided the participants into three groups accordingly. The class was taken on bioethics and its application to teach the participants of the Group 1 and 3 by the principal investigator for 1 h covering the above topics. On the same day, flashcards were given to each participants of Group 2 and 3 by the principal investigator. The participants were informed that, questionnaire would be given to all of them after a week to assess their knowledge and to evaluate the effectiveness of each teaching method.
Questionnaire was semi-structured and consisted of 25 close-ended questions. It was pilot tested on 10 subjects to demonstrate if the questionnaire is well accepted and understood. It was amended for clarity and modified accordingly. Cronbach's alpha was used in assessing the reliability, and the value was found to be 0.82, i.e., good internal reliability of the questionnaire. After a week, questionnaire was distributed to all the participants to evaluate their knowledge. Only three demographic questions, gender and which year and group they belong to were included at the beginning of the questionnaire. The responses to the questionnaire took 15 min for each participant.
The statistician was also blinded to avoid any bias in the result. The raw data from responses were coded and entered in Statistical Package for Social Sciences (SPSS Inc, IBM version 23) for analysis. Interpretation of the collected data was done using appropriate statistical methods like percentage and frequency. Chi-square test was also employed to compare the responses from the participants among three groups. The significance level was set at P < 0.05.
| Results|| |
A total of 45.6% and 54.4% of participants were from 3rd year and final year BDS, respectively. In Group 1, there were 53.3% from 3rd BDS. In Group 2, there were 53.3% from 3rd BDS. In Group 3, there were 70% from final year BDS. There were a total of 28.9% and 71.1% of males and females, respectively. In Group 1, 2, and 3, there were 56.7%, 76.7%, and 80% of females, respectively. [Table 1] and [Table 2] show the distribution and comparison of each question response among the 3 groups.
|Table 1: Distribution and comparison of responses of 23 questions among 3 groups|
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|Table 2: Distribution of participants according to how often they come across Ethical issues and the Institutional Ethical Committee|
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| Discussion|| |
Practicing dentistry is an ethical venture and treating patients is just not technical, but patients are also invulnerable position as dentists do invade patient's body and take on their consciences.
In the present study, the majority of the participants, 90%, 93.3%, and 96.7% of them from Group 1, 2, and 3, respectively, knew that ethics are a science of morals in human conduct which deals with how one ought to behave and this was not statistically significant. The basic knowledge of what is ethics was known to maximum participants from all the 3 groups.
In the present study, 86.7%, 96.7%, and 100% of the participants from Group 1, 2, and 3 respectively, said it was important to highlight the cost before taking consent for any procedure. In a study conducted by Tahir et al., among medical and dental undergraduates, 88.7% of them agreed that patient should be informed about any costs involved before taking consent for procedure. As some of the dental treatments or materials used can be expensive, it is important for the dentist to discuss it with the patient before taking the consent so as to avoid any problems later.
In the present study, 86.7%, 96.7%, and 96.7% of the participants from Group 1, 2, and 3 respectively, said that patients should always be informed about the wrong doing. The results of a study conducted by Bharadwaj et al. among doctors and nurses, where 61.6% and 70.3% of the physicians and nurses, respectively, said that it is not always necessary to inform the patient of wrong doing by anyone involved in his/her treatment and this result was not statistically significant which is similar to the present study. The study revealed that the physicians were not in favor of accepting their mistake in front of the patients. In a study conducted by Tahir et al., among medical and dental undergraduates, 37.6% of them agreed that patient should be informed about any mistake made by the doctor.
In the present study, 83.3%, 93.3%, and 80% of the participants from Group 1, 2, and 3 respectively, knew that it is wrong if a physician gives a medical certificate of leave from work to a person who is not really sick and needs time off. In a study conducted by Tahir et al., among medical and dental undergraduates, only 33.9% of them disagreed that a physician should give a medical certificate of leave from work to a person who is not really sick and needs time off.
Majority of the participants, 83.3%, 93.3%, and 90% were from the Group 1, 2, and 3 respectively, said that confidentiality can be maintained in modern care and should not be abandoned, and this result was not statistically significant. In study conducted by Garbin et al., it was mentioned that all dental professionals including the dental assistants, hygienists, or technicians, should not neglect the professional confidentiality and it should be maintained. Dental professionals are responsible for confidentiality, as they have access to information when handling files of clinical documents. In a study conducted by Janakiram and Gardens, majority of the dental students, 85.3% of them disagreed that confidentiality cannot be maintained in modern care and should be abandoned. In a study conducted by Aacharya and Shakya, among medical intern students in a Medical college in Kathmandu, none of the participants agreed with the statement – “Confidentiality cannot be kept in modern era and should be abandoned.”
In the 1st case, 26.7%, 73.3%, and 60% from Group 1, 2, and 3, respectively, agreed that investigator cannot continue with research without any written consent and ethical responsibility and this result was highly statistically significant. In a study conducted by Mohammad et al., the medical faculty members (100%) and residents (64.5%) also agreed that taking written informed consent is important for any treatment procedures or to enroll participants in a research.
In 2nd case question, about 36.7%, 86.7%, and 83.3% of them from Group 1, 2, and 3, respectively, agreed that patients' research files should be coded to ensure patients' confidentiality. In study conducted by Garbin et al., it was mentioned that some situations such as disclosure of the existence of infectious – contagious disease or information considered essential to continue the patient's dental treatment, cannot be considered breach of confidentiality. The law also provides expectations in keeping confidentiality when the professional's or someone else's health is at stake.
In the present study, 53.3%, 53.3%, and 86.7% of them from Group 1, 2, and 3, respectively, knew that there is an ethical committee in the institute. Very few did not know about the committee, may be because of the limited role of the committee which perhaps only relates to research ethics and not to the clinical ethics training. In a study conducted by Mohammad et al. among the medical faculty members and residents, only 77.5% and 46.5% of them knew that there is an Institutional Ethical Committee in the institute. Here, the faculty was more aware than residents owing to their long experience but still like the present study, where the number is far from satisfaction.
The findings of the present study clearly showed the difference in the knowledge between all the three groups and maximum people did have basic knowledge of bioethics. However, the response rate of the participants from Group 2 and 3 is good as we can see they have fairly more knowledge compared to the participants from Group 1 where many questions were not answered correctly.
This difference between the groups can be because of the use of flashcards in Group 2 and 3. Flashcards are consolidated, motivating, eyecatching, inexpensive, and effective way to learn, and it can also create logical reasoning or thinking. Students are active participants when they are offered a learning environment rather than passive recipients of information.
It is important for the students to know how to overcome the gap between the theory knowledge and practical aspect of bioethics. For this, proper education enables teaching and learning to be self-motivated and directed both to resolution of specific problems and to acquire skills. Numerous studies reported there is difficulty for some students in learning and these difficulties are related to motivation, prior knowledge, student age, role of teaching, use of teaching strategies, learning conditions, etc. Students prefer methods that encourage discussion or interaction in groups which help in understanding the content and confidence in their ability to cope.,
Limitations of the study include
- The research did not ask in detail how they used the flashcards to study and if any help or assistance was taken from other sources
- Baseline data of the knowledge regarding bioethics was not collected to assess the difference between before and after the intervention
- The study did not compare the gender- and year-wise comparison among the groups
- All the undergraduates stay in the hostel, so we are not sure, how many of them did not exchange the flashcards with the participants who were not provided with the flashcards.
| Conclusion|| |
Despite the limitations, there was a good response rate and participation of all the students leading to better results. The findings of the present study clearly showed the difference in the knowledge between all the three groups. Participants from the Group 2 and 3 have fairly more knowledge compared to the participants from Group 1 as majority of the questions were answered correctly and they knew much more than basics. The study also reveals that there is a need to develop innovative and educational initiatives. Due to financial constraint and smaller sample size, future studies are warranted at a larger level to investigate the knowledge, attitude, and practices using different teaching methods.
The authors would like to thank the study participants for their participation and kind cooperation throughout the study. All persons who have made substantial contributions to the work are the authors (e.g., technical help, writing and editing assistance, general support). If we have not included an acknowledgements, then that indicates that we have not received substantial contributions from nonauthors.
Financial support and sponsorship
This study was financially supported by IDA Karnataka branch selected it for Students Research short-term project in general category.
Conflicts of interest
There are no conflicts of interest.
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Dr. Bhakti J Sadhu
Department of Public Health Dentistry, Coorg Institute of Dental Sciences, KK Campus, Maggula Village, Virajpet - 571 218, Karnataka
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]