Assessment of the effectiveness and perception of different teaching techniques used in pharmacology among students
Pharmacology is a subject that deals with therapeutics and drug development; it is one of the essential pillars of medicine. It contributes significantly to the development of students’ knowledge of drug therapies. The fundamental goal of teaching pharmacology is to help students develop an in-depth knowledge of not only the therapeutic effects of medications but also their side effects, drug interactions, etc. Although knowledge of pharmacology is crucial, it is often perceived as a dry and volatile subject, especially because of its vast content and difficult-to-remember pharmacological terms, and concepts. A study reported that inadequate pharmacology knowledge is a major cause of incorrect prescriptions. Therefore, there is a constant need for periodic upgradation in pharmacology teaching techniques to enhance learning with due consideration to students’ preferences. Pharmacology is taught in various settings such as medical schools, nursing schools, pharmacy schools, dentistry, physiotherapy, and veterinary medicine. It is one of the most dynamic and rapidly developing branches of medicine. It is not only evolving in concepts but also in teaching methodologies. Many initiatives have been taken by various colleges across the world to make pharmacology learning engaging and pertinent. It is of interest to understand the common teaching techniques that have been evaluated by researchers and their influence on student learning. Hence, a review was planned to evaluate published literature on various pharmacology teaching techniques and their impact on students learning, knowledge, attitude, and satisfaction.   The study was a web-based literature review conducted between January and June 2021. Exemption from the institutional ethics committee was obtained (EC/OA-163/2019) as the data were freely available in the public domain. The research articles published between 2005 and 2020 were searched in the PubMed database. Only articles in the English language on teaching techniques in pharmacology published in peer-reviewed journals were selected. Teaching technique was defined by the authors as principles and methods used by various teachers to enhance student learning. We used key search terms with the Boolean operator “teaching technique” AND “pharmacology.” They were combined with additional terms such as “undergraduate medical education,” “postgraduate medical education,” “nursing,” “pharmacy,” and “dental.” To identify additional studies, we also hand-searched the reference lists of the studies, which were already included in our full-text review. Two of the authors went through the titles and abstracts of studies found in the search results and selected relevant articles for possible inclusion. The full-text of these articles was retrieved for further review based on our inclusion criteria, which were as follows: English language studies on various teaching techniques, new teaching interventions used on students in pharmacology, and published articles over the period of the past 16 years, that is, from 2005 to 2020. We excluded articles whose full-text reviews were unavailable, those published in conference proceedings, duplicate studies, and articles published in languages apart from English. Data extraction for each study was performed independently by two authors, and differences arising, if any, were resolved by the remaining authors. The variables included study authors, year of publication, description of the intervention (content, timing, and participants), intervention goals, study design, teaching method used, and significant findings. After data extraction, it was re-reviewed, and subsequently, different teaching technique categories were assigned to selected studies. The assessment of the effectiveness and popularity of each teaching technique were calculated using the following ratios: *Improvement was defined as more than 50% of study participants showing better scores. *Positive feedback was defined as more than 50% of study participants giving positive feedback.   Our initial database search results identified 1,093 articles, from which we selected 407 for abstract review after removing duplicates (50) and irrelevant titles (636). Following the abstract review, we selected 171 articles for full-text review, and finally, 95 studies meeting the criteria were included . We classified teaching techniques into nine different types: Computer-based teaching techniques, case-based learning, multiple teaching techniques, modules, team-based learning, integrated/flipped approach, simulation-based learning, student-led tutorials, and other innovative approaches. The most commonly used techniques were computer-based and case-based learning (21.05% each) followed by multiple teaching techniques (11.58%). Other innovative approaches included role-play, crossword puzzles, pre-lecture assessment, autobiography of drugs, observation of pharmacy, P drug selection, developing personal formulary, concept mapping, cooperative learning, drawing, clinical context teaching, games, poetry, museum, and using original research article; they were observed in 18 (18.94%) articles . Out of 95 studies, the majority of studies, that is, 61 (64.21%) studies, were conducted by MBBS students, 27 (28.42%) studies were conducted by pharmacy students, 6 (6.31%) studies were conducted by dental students, and only 1 (1.05%) study was conducted in nursing students. As far as assessment tests were concerned, 44 (46.32%) studies used both test scores and feedback methods, whereas 29 (30.53%) and 22 (23.16%) studies used only feedback and test scores, respectively. All studies involving the flipped technique showed good success and popularity ratios. The studies using other innovative techniques, modules, team-based learning, and simulation-based techniques showed a good popularity ratio but only the former two techniques showed a good success ratio between 88 and 91%, whereas the latter two showed scores of 67 and 33%, respectively. Also, 81 to 88% of studies involving multiple and case-based techniques showed good success and popularity ratios, whereas computer and student-led methods reported both ratios of less than 80% [ and ]. A summary of all teaching techniques with their important advantages and disadvantages is described in .   This study is the first of its kind to compile various teaching techniques of pharmacology used in different medical and paramedical courses and their impact on students’ learning. The improvement in test scores gives us a better understanding of how effective the teaching approach works to help students understand, memorize, and recall the concept. In contrast, the feedback assessment gives students’ perspectives and piques their interest in innovative teaching strategies. We found that the majority of the studies were computer-based learning, which has now become an integral part of recently introduced competency-based medical education. This might be a result of the easy availability of computer-based resources and the need to integrate technology and medicine. These findings are consistent with a study conducted by John on the nature of the trend in undergraduate pharmacology curriculum and the responsible factors. He found that until the 1990s, laboratory-based practical classes were the center of pharmacology teaching; thereafter, medical schools began incorporating computers and e-learning, starting a new trend. Although computer-based learning was widely employed, our analysis revealed that a few studies reported negative feedback and failure to improve test scores. It might be because such learning demands a cultural shift in how students are taught and requires careful strategic planning, adequate quality control, staff training, and multidisciplinary collaboration. Also, there is minimal direct interaction with teachers, which makes it challenging for the students to stay focused. Our analysis also discovered that many studies employed case-based learning (CBL), which may be due to the shift from a teacher-centered to a learner-centered approach to encourage student’s critical thinking and involvement and foster teamwork. Studies on CBL have shown improvement in test scores compared to didactic lectures, suggesting that this method leads to a deeper understanding of the subject. A study by Tikoo et al . found that most pupils favored CBL as a part of regular teaching for greater comprehension and correlation of medications used to treat disorders. Surprisingly, teaching techniques such as simulation and team-based learning received positive feedback; however, they failed to improve the test scores of students significantly. By providing the learner with a somewhat realistic environment, simulation-based techniques raise the bar and boost their confidence. Despite the fact that it primarily imparts practical knowledge without significantly enhancing the basic understanding, it offers a more enjoyable experience than traditional lectures. A study by Jabaay et al . found that simulation-based learning significantly improved objective performance on a standardized examination, and it is an effective tool for student learning in the pre-clinical stage of undergraduate medical education. Team-based learning (TBL) promotes student engagement, reasoning, and other non-cognitive qualities, namely, individual preparedness and contributions to team discussions. TBL harnesses the resources of students who were well-prepared to engage in the exercises and help their peers in the learning process. It increases the liking for the activity, as suggested by positive feedback. According to the result of our study, techniques such as the flipped teaching method have helped in improving the performance of the students, as evidenced by an increase in test scores along with positive feedback. In the flipped technique, teachers provide students the lecture materials and PowerPoint presentations to view at home the previous day, thus prioritizing active learning. It has been known to promote self-directed learning and help in retaining it longer. Recent evidence shows that the flipped classroom approach improves student perception, learning, critical thinking skills, and motivation in comparison to traditional lecturing methods. Modules are organized units of instruction that focus on a specific topic or concept. They can be used to break down complex material into smaller and more manageable parts. By employing modules, teachers can tailor their teaching to the individual needs of their students and provide more opportunities for student engagement and active learning. Studies have shown that the use of modules can produce improvement in learning outcomes and increase student satisfaction with the course. Student-led teaching approach involves giving a more active role to students in their learning by allowing them to take charge of certain parts of the course. Students could be asked to create and deliver their own presentations or facilitate small group discussions. This method can help students develop a deeper understanding as well as improve their critical thinking and communication skills. Additionally, it promotes a sense of ownership and responsibility for their learning, which can increase motivation and engagement. Finally, multiple teaching techniques can also be used in pharmacology to cater to different learning styles and preferences. Teachers can incorporate web-based interactive games, crossword puzzles, an instructional video, a music video, and fill-in-the-blank tables to help students better understand complex concepts. By using various teaching techniques, instructors can engage students in different ways and help them develop a more comprehensive understanding of the material. Limitations of our study were that we studied only free full-text articles published in the English language, which led to the inclusion of relatively few studies. We missed out on studies that were part of paid journals, which can contribute to the selection bias.   Teaching techniques such as innovative, flipped, case-based, multiple methods, and modules have been well received by students, and an increase in test scores further demonstrated their utility. The effectiveness and popularity of computer-based techniques and student-centered techniques were found to be moderate. Although popular, team-based techniques and simulations seemed to be less effective. There is a need for periodic upgradation in techniques utilized for teaching in pharmacology. Every teaching technique has its own strengths and weaknesses. They need to be utilized as per the student’s requirement. Conflicts of interest There are no conflicts of interest.   There are no conflicts of interest.   