An Interventional Study on the Impact of Pictorial Primed Lecture Session towards the Performance at Lower and Higher Cognitive Domain Levels among Ist Year Medical Undergraduates

Introduction: Lectures play a major role in teaching large group of learners in a medical institution. Priming involves familiarising students with background information on the cognitive content just before its actual delivery during lecture sessions. Considering the monotonous textual lectures of present day medical education, there is always a need for making the lecture sessions interactive at the same time improving the performance of the learners at the cognitive level.

Aim: To assess the performance of 1st year medical undergraduates at lower and higher cognitive domain levels after pictorial concept priming before lecture session.

Materials and Methods: The present study was an educational interventional study and a prospective cohort design, the study was conducted during March to April 2019 in Department of Biochemistry, Melmaruvathur Adhiparasakthi Institute of Medical Sciences (MAPIMS) Tamil Nadu, India, as a part of Advance Course in Medical Education (ACME) 2018B Project work. With sample size suggestion made using universal sampling techniques, 120 Phase I medical undergraduates of both sexes aged 17-21 years were enrolled into the study who were divided into two groups, randomised, cohort-60 and control-60 students. The lecture delivery was on glycolysis pathway for both groups with cohort alone being primed using standardised polygonal pictorial concepts during priming session before lectures. Cognitive performance assessment after lecture being made using validated Multiple Choice Question (MCQ) questionnaire which included five lower cognitive level questions at recalling aspects and five higher cognitive level questions at creating aspects and total attainable cognitive performance score at 10. Scores obtained were tabulated and statistical analysis was done using Independent sample t-test for mean score comparisons and relative risk estimation at lower and higher cognitive domain levels using Statistical Package for the Social Sciences (SPSS) version 18.0.

Results: The results of the present study showed that cohort group who were primed with pictorial concepts had significantly higher mean score at total cognitive performance score (7.03±1.37) than the control group (6.15±1.83) at (t=-2.98, p=0.003) and significantly higher mean score at higher cognitive performance score (3.75±1.14) than the control group (3.20±1.33) at (t=-2.42, p=0.01) who were not primed with pictorial concepts. However, the results obtained at the lower cognitive performance scores which although shows a higher score among cohort group with mean value (3.28±1.09) when compared to control group with mean value (2.95±1.01), the mean difference obtained remains insignificant (t=-1.73, p=0.08). Exposure outcome relative risk estimation on priming exposure to outcome (50% total cognitive score) showed primed group which is RR=1.567 (0.895-2.744).

Conclusion: The study concludes that priming sessions using pictures have a significant impact on improving the cognitive performance of the learners when delivered during lecture sessions in a medical college. Adding to the conclusion, the impact of the pictorial priming sessions is even more on the higher level cognitive performance, which includes evaluating and creating aspects of the knowledge domain. This reiterates the role of the importance of dual added benefits of pictures and priming during teaching cognitive domain aspects of lecture sessions in medical institutions.