DOI: 10.7860/JCDR/2018/35791.

11829
Original Article

Perceptions and Effectiveness of Use of

Pharmacology Section
E-Learning in Pharmacology Education

Parvati B Patel1, Tejas Patel2, Manoj Kumar Saurabh3, Sejal Thakkar4

ABSTRACT Results: A total of 124 (97.7%) out of 127 participating students

Introduction: E-learning improves learning by easy access to completed pre and post-test assessment. A medium (45.9%)
learning content, teaching material for revision and clarification and high (76.6%) class-average normalised gain were observed
at learning sequence and pace. in Short Answer Questions (SAQ) and ADR form filling exercise,
respectively. Students perceived the module positively about the
Aim: The present study aimed to design an e-learning module
amount of time to complete it (73.6%), the pace of learning (84.0%),
in the subject of pharmacology and assess its effectiveness,
self-learning opportunity (98.4%), their future performance (91.7%)
acceptability and feasibility in undergraduate teaching.
and achieving learning outcomes (98.3%). The analysis of general
Materials and Methods: E-learning module was prepared with comments suggests students felt module was informative, easy to
the help of Microsoft office, 2007 and iSpring Suite 8.3 software. understand, interesting and systematically explained. The faculty
Six learning objectives from a must know area of a subject perceived it positively about the appropriateness of the content
(pharmacovigilance) were selected for the present module. Pre- (81.3%), self-directed learning resource (81.3%) and achieving the
post intervention study was conducted on undetrgraduates (2nd learning objectives (93.8%).
year MBBS students) to assess its effectiveness through the
Conclusion: E-learning module was effective in acquiring cognitive
class average normalised gain. Students and faculty perceptions
gain. Students and faculty perceived it easy to understand,
were collected through SurveyMonkey tool.
interesting and facilitating a method for self-directed learning.

Keywords: Education, Distance, Formative feedback, Medical education

INTRODUCTION e-learning assessment tools [9,11]. The demand for e-learning has
E-learning refers to the use of information technology or internet increased due to its flexibility, access to reach a wider audience and
for learning activities [1]. It includes video or audio power point the potential for cost reduction in the long-term [12]. In a recent
presentation, animation which can be delivered in multiple modes, vision document, Medical Council of India (MCI) emphasised the
including offline or via the internet [2]. This technology delivers a use of e-learning as an advanced teaching method [13].
broad array of solutions that enhance knowledge, performance and The use of e-learning is limited in medical education in India [3,14].
responsiveness of the learners [1,3]. It can improve quality of higher It is generally perceived that infrastructural resources and human
education and lifelong learning [3]. It can be used alone or as a readiness is not always present in low and middle-income countries
supplement to conventional teaching methods including blended [14]. The present study aimed to design e-learning module in the
learning [2]. subject of pharmacology with the freely available resources, evaluate
The current generation of learners is “digital natives” due to their its effectiveness by comparing the pre and post-test performance,
presumed familiarity and reliance on information and communication the perception of students and faculty about the acceptability and
technology [4]. Students easily adapt the new generation of feasibility of e-learning.
smart phones (mobile phones) and tablet personal computers.
Competency-based curricula emphasise the learning outcome, not MATERIALS AND METHODS
the process of education [1]. It shifts medical education from teacher- The present prospective, single-group, pre-post intervention study
centered to more student-centred, enhances student’s retention, was carried out in the Department of Pharmacology, Gujarat Medical
application of knowledge and promote self-directed learning Education and Research Society Medical College, Gotri, Vadodara,
environments compared to conventional learning, it engages the Gujarat, India, over a period of five months from April 2016 to August
students in to active learning with ease of access and choice of 2016. The study was approved by the Institutional Ethics Committee,
own learning goal, content, sequence, time, place and pace [5-9]. GMERS Medical College, Gotri. The informed consent was obtained
The active learning engages the student in higher-order thinking, from the second year undergraduate medical students and faculty
practical application of knowledge and improves exam scores [2]. before their participation and collection of feedback.
It also provides an extra tool for students to use the lecture material
for revision and clarification [10]. Preparation of E-Learning Modules
E-learning helps the academics or educators to meet the growing Initially, the informal discussion with pharmacology faculty was
needs and expectations to improve the quality of education [9,11]. conducted to decide the topic for the e-learning activity. Based on
They help the educators in improving the distribution, standardisation a suggestion, the pharmacovigilance (a must know area topic of
and updating of course materials [8,9,11]. Educators can check pharmacology) was selected to prepare e-learning module. This
the individual learning activity and progress of the students with had been traditionally taught in pharmacology practical.
12 Journal of Clinical and Diagnostic Research. 2018 Jul, Vol-12(7): FC12-FC16
www.jcdr.net Parvati B Patel et al., Perceptions and Effectiveness of Use of e-learning in Pharmacology Education

The standard textbooks on pharmacology, websites of WHO and and feedback procedures. All willing students were asked to
Indian Pharmacopoeia Commission, Uppsala monitoring center register their name, roll number, mobile number and email ID for
were used to prepare resource materials for e-learning module. communication. The 'WhatsApp' group was created to inform the
The contents were divided into the five units as per the learning participants. In the next contact session, pre-test (SAQ and filing
objectives [Table/Fig-1]. of ADR form based on CBE) was conducted to collect baseline
data. In the department, only four pharmacology faculties were
Units Learning objective Links available to participate and provide the feedback for the module
Student shall be able to understand the different https://youtu.
after excluding investigators and faculty involved in validation.
1 So, pharmacology faculty of other institute (Government Medical
terminologies related to “ADR” be/4aUC4mrNqhQ
College, Bhavnagar) of all academic positions (tutor, assistant
2a
Student shall be able to understand criteria to https://youtu.be/ professor, associate professor and professor) were approached
suspect ADR wJahGtmTkrg
telephonically to participate and informed about study objectives
Doctor -patient conversation in a vernacular https://youtu. and feedback procedures. All willing faculty were asked to register
2b
language to detect ADR be/5CymLoOTqjQ their details (their name, designation, mobile number and email
Student shall be able to understand ID) and communicated through e-mail/WhatsApp as per their
- Causality assessment (How likely that drug is the
3 cause of reaction in this particular patient?)
https://youtu. preferred mode of communication.
be/6VTlkHzTSOA
- Which adverse drug event or reaction is Six videos of learning resource material were uploaded on YouTube
considered serious?
and their links on the specially designed website [Table/Fig-1].
Student shall be able to understand Participating students were duly informed about the videos through
- What should be reported in ADR forms https://youtu.be/
4
- Different components of ADR form and how to LM_qhMRFJ4E email and WhatsApp group. They are supposed to download the
fill details in ADR form videos from any of these resources. Students were provided 14
Student shall be able to understand days to use e-learning resources before the post-test assessment.
5
- Need of pharmacovigilance program https://youtu.be/ Similarly, the participating faculty were informed about the
- Functioning of pharmacovigilance program of hlwT8KmrrOA
India
resources.

[Table/Fig-1]: Learning objective and link of e-learning session of each unit.

On the third contact session, A post-test assessment of students
Note: ADR: Adverse drug reaction was conducted to assess the effectiveness of the module. The
same pre-assessment questions were used in the post-test. The
Multimedia presentations (Microsoft Office PowerPoint, 2007; feedback questionnaires were delivered by using the SurveyMonkey
Microsoft Corporation, Redmond, Washington, United States) tool to students and faculty. They were requested to complete it
were prepared as per the learning objectives of each unit. The within a week.
learning objectives were included at the beginning of each
presentation. The animations, pictures, case-based exercises statistical analysis and Evaluation
were added in the presentation. The content was validated with The level 1 and 2 of Kirkpatrick’s Model were used to check the
the help of pharmacology faculty. With the help of iSpring Suite effectiveness of e-learning [15]. In a level 1 evaluation, student
8.3 software free trial version (iSpring Solutions Inc., Alexandria, and faculties’ perception were analysed based on their feedback.
Virginia, United States), audio was added in the presentation and Data of close-ended questionnaires were presented in percentage.
converted into a video (Unit 1,2a,3,4,5). One role play video of Data were presented in three categories: ‘disagree’, ‘undecided’
doctor-patient conversation was also prepared (Unit 2b). Learning and ‘agree’. The ‘strongly disagree’ and ‘disagree’ categories were
objectives and audio-visual contents of the presentations were merged into ‘disagree’; ‘agree’ and ‘strongly agree’ were merged
pre-validated. into ‘agree’ category. The open-ended responses were organised
based on questions and coded according to their answer. The
Designing of Website: The website was designed to upload the
descriptive analysis was used for the open-ended questionnaires.
learning resource materials (Address: http://pharmacologygmersgotri.
weebly.com/adr-module.html). In the level 2 evaluation, cognitive learning gain of the students was
analysed by comparing the pre and post-test assessment score. The
Preparation of Questionnaires for the Assessment of pre and post-test assessment were evaluated simultaneously. The
Learning Gain and Feedback answer sheets of both tests were coded to hide the identity of the
To assess the learning gain, SAQ and CBE to fill the ADR form assessment (pre and post) as well as students using a single block
were prepared. The suspected ADR reporting form of Central technique through random allocation software 2.0. Data of those
Drug Standard Control Organisation, India was used in ADR form students who appeared for both pre and post-test assessment
filling exercise. A structured checklist was prepared to assess the were analysed using Student’s paired t-test. The absolute learning
ADR reporting form. All assessment questions were prepared as gain (% post-test score-% pre-test score) and relative learning gain
per present learning objectives of the module to ensure content (% post-test score-% pre-test/% pre-test score) were calculated.
validity. The effectiveness of the intervention was evaluated by using class
The closed and open-ended feedback questionnaires were average normalised gain (g=(% post-test score-% pre-test score)
prepared to collect students and faculty perceptions through the /(100-% pre-test score). The class average normalized gain of 0.3
online version of the SurveyMonkey tool (Survey Monkey, 2012). (30%) was considered significant, as per Hake’s criteria for the
Questionnaires focused on e-learning activity, utilisation of learning effectiveness of educational interventions [9]. Statistical analysis
resource materials, future performance, learning outcome and their was done by using GraphPad Prism 6.0 demo version (GraphPad
recommendation for future batches. The close-ended questionnaires Software, Inc., La Jolla, California, United States). p<0.05 was
were prepared using the five-point Likert scale (1=strongly disagree, considered as the statistically significant difference.
2=disagree, 3=undecided, 4=agree, 5=strongly agree). Suggestions
and comments were also asked from the participants. All the RESULTS
feedback questionnaires were pre-validated.
Demographic Details
E-learning Sessions A total of 127 undergraduate students (second year) consented to
In the first contact session, students were informed about learning participate in the study. Of the participated students, 53.54% were
objectives of the course module, its duration, assessment female and 46.46% male. The students used their personal internet

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 Parvati B Patel et al., Perceptions and Effectiveness of Use of e-learning in Pharmacology Education www.jcdr.net

connection to use e-learning module and feedback. A total of 17 Barriers Facilitating factors Suggestions/specific
faculty members gave their consent to participate and provided the comments
feedback. Students
Depends on internet Simple, systematically Provide e-learning
Level 1 Evaluation-student Perception accessibility and facility explained, easy to modules for other topics of
understand and revise pharmacology
A total of 125 students (98.43%) gave the online feedback.
Lack of interaction Interesting than reading Provide preparation
Student’s perception of e-learning activity: As shown in [Table/ (Doubts can’t be books material in hard copy for
Fig-2a], most students perceived that the amount of time took to cleared on the spot) future assessment
complete this module was appropriate for the content (73.6%), the -- Learning at own time, Provide self-practice
pace of learning was proper (84.0%), the module was interesting place and pace exercises at the end of
modules
(85.6%), and important resources for the self-directed learning
(98.35%). Most of the students perceived that audibility (73.6%), -- Incorporation of case- Incorporate more doctor-
based exercises and patient conversation
visibility (89.6%) of multimedia and overall rating of entire e-learning doctor-patient interaction
module (90.0%) were very good.
-- Self-learning opportunity It was good initiative and
Student’s perception of utilisation of learning resource material: innovative idea
As shown in [Table/Fig-2b], most students agreed that the learning -- Use of animations --
resource material was user-friendly (93.6%), informative and logically Faculty
structured (96.8%), makes studying easier (88.3%). They also felt
Depends on internet Informative, easy to Provide exercises at the
that it had increased their understanding of the subject-matter accessibility, computer/ understand, case-based end of modules for self-
(95.2%). They found the use of problem-based exercises helped to smartphone examples with clear practice
explanations
gain a clear understanding of the content (98.4%).
Lack of interaction Interesting, attractive, Incorporate module of
Student’s perception of future performance, learning outcome (One-way innovative in this common mistakes done
and recommendation: Majority opined that e-learning will enhance conversation), passive technology-oriented era by students while filling of
their performance in future assessment (91.7%) and they have learning ADR form
achieved the learning outcomes (98.3%). When students were Students may not Learning at own time,
acquaint with e-learning place and pace
asked for the suggestions for future batches, most opined that
module should be taught online only (43.7%) or adjuvant to the Alignment of content with
learning objectives
classroom (40.3%).
[Table/Fig-3]: Barriers, facilitating factors and suggestions for e-learning session
Analysis of general comments: Open-ended questions were by students and faculty
analysed qualitatively and categorised as barriers, facilitating factors
and suggestions [Table/Fig-3]. (81.3%) and important resources for the self-directed learning
(81.3%). Most of the faculty said that audibility (81.3%), visibility
Level 1 Evaluation-Faculty Perception (93.8%) of multimedia and overall rating of entire e-learning module
A total of 16 faculty (94.1%) gave the online feedback. (93.8%) was very good. Most of the faculty opined that the module
Faculty perception of e-learning activity: As shown in [Table/Fig- should be taught as an adjuvant to the classroom (75.0%) for future
4a], majority of faculty agreed that the amount of time allotted to batches.
complete this module was appropriate for the content (81.3%), the Faculty’ perception of utilization of learning resource material:
pace of learning was proper (93.8%), the module was interesting As shown in [Table/Fig-4b], majority of faculty said that course
content of e-learning module was informative and logically
structured (100.0%), clearly explained and consistent with the
learning objectives (93.8%) and can achieve the stated learning
objectives (93.8%).
Analysis of general comments: Open-ended questions were
analysed qualitatively and categorised as barriers, facilitating factors
and suggestions [Table/Fig-3].

Level 2 Evaluation-Cognitive Learning Gain

A total of 124 students (97.6%) completed both pre and post test
for the level 2 evaluation-learning gain. Mean test scores of SAQ
and ADR form filling exercise improved significantly from 31.3%
to 62.5% and 38.8% to 85.3%, respectively. Mean test scores of
absolute learning gain and relative learning gain are presented in
[Table/Fig-5]. Medium and high class-average normalised gains
were observed in SAQ and ADR form filling exercise, respectively.

DISCUSSION
In the present study, the e-learning module of pharmacovigilance
was prepared and its effectiveness was analysed among the under­
graduate medical students through one-group pre-test/post-test
study design. Its acceptability and feasibility were assessed through
the perception of the students and faculty.
In line with the earlier studies, a significantly higher post-test
score of e-learning session (p<0.001) was observed [10,11]. The
[Table/Fig-2]: a) Students’ perception of e-learning activity; b) Students’ perception effectiveness of present intervention was observed in terms of
of utilisation of learning resource material.
absolute learning, relative learning and class average normalised
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www.jcdr.net Parvati B Patel et al., Perceptions and Effectiveness of Use of e-learning in Pharmacology Education

about their operating conditions, mechanisms and magnitudes [19].

Third extraneous variable includes the practice effect-improvement
in performance due to earlier exposure to the test [20]. The meta-
analysis suggests retesting produces practice effects on cognitive
ability. It is heterogeneous in nature, increases with the number of
retesting and not affected by study context. However, it is not clear
how retesting changes the valid inferences that can be drawn from
test scores [21].
The positive perception of students was observed for the e-learning
activity and use of learning resource material. As per “technology
acceptance model”, perceived usefulness and ease of use are the
key variables that influence users attitude, intention, and actual
behaviour to use a new technology [22,23]. Atkins S et al., in a survey
of African and Asian students observed the perceived usefulness
and experience of no technical problems as key factors associated
with a more positive perception of the usefulness of the online
component of the blended courses [24]. In the present study, the
students showed a positive perception toward the learning activity,
use of learning resource material, future performance and learning
outcome. The “unified theory of acceptance and use of technology”
suggests performance expectancy, effort expectancy, social
[Table/Fig-4]: a) Faculty’ perception of E-Learning Activity; b) Faculty’ perception influence, and facilitating conditions influence user intentions to use
of utilisation of learning resource material. an information system [25]. Students felt e-learning module simple,
systematically explained and interesting. In the study, e-learning
was facilitated with the use of social media like WhatsApp. Students
Mean±SD
found a self-learning opportunity in e-learning. Through self-directed
Score/Gain (%) Short answer questions ADR form filling
learning, students identify their learning needs, formulate goals,
(n=124) exercise (n=124)
find learning resources, make appropriate learning strategies and
Pre-test score (%) 31.3±1.0 38.8±0.9
evaluate learning outcomes [26]. It motivates the students to learn
Post-test score (%) 62.5±1.5 85.3±1.4 independently [27].
Absolute learning gain (%) 31.8±1.4 46.51±1.3
The present module was well perceived by the teaching faculty.
Relative learning gain (%) 123.6±10.9 136.2±9.6 They felt e-learning informative, easy to understand, interesting
Class-average normalised 45.9±1.9 76.6±2.1 and attractive. These video-based e-learning modules are easy to
gain (%) prepare with the help of available resources across medical colleges
[Table/Fig-5]: Pre and post-test scores and learning gain. in India. This e-learning module was prepared using Microsoft
SEM: Standard Error Of Mean; p<0.001 for comparison of pre and post-test score of short PowerPoint and the free software. It was uploaded into free website
answer questions and ADR form filling exercise by paired t-test
and YouTube. Higher participation (127 vs. 42) and completion
rate (97.7% vs. 38.1%) were observed in the study as compared
gain. An earlier literature review of e-learning in pharmacy education to earlier e-learning Indian study involving undergraduate medical
reported learning gain of 7% to 46% [16]. The absolute learning students [3]. In an earlier study, the majority of students depended
gain depends on a student’s pre-test score. Students with lower on the institutional internet facility and found hindrance in accessing
pre-test scores tend to show more gain than students with higher resource material [3]. The successful implementation of e-learning
pre-test scores. The relative learning and class average normalised activity requires easy access to a computer, internet facility and
gain overcome this inherent bias of absolute learning gain. Although, positive attitudes toward e-learning. In the present study, almost all
relative learning gain corrects absolute learning gain by the pre-test participated students could readily access to personal mobile (tablet,
score, it can show the skewing effect of outlier students with very smartphone) or computer (desktop, laptop) internet. Another reason
high or very low pre-test scores [17]. The class average normalised could be due to the type of e-learning tools used among the studies.
gain is independent of the study group’s pre-test level of knowledge. Gaikwad N and Tankhiwale S, used the kiosk mode PowerPoint
It corrects absolute gain with maximum possible gain achievable presentations and only used the website to deliver the contents
by each student. Earlier studies used the class average normalised [3]. A recent United States study using PowerPoint with visual aids
gain to measure the effectiveness of the educational intervention and recorded narration did not show the benefit of e-learning [28].
[3,9,17]. In the present study, a class average normalised gain This module was prepared as a smartphone friendly video-based
for short answer questions and ADR form filling exercise were e-learning tool and was available to students via website, email,
off 46% and 76%, respectively. Hakes PR, criteria of educational YouTube and WhatsApp during e-learning session.
intervention suggest present e-learning module was moderately to
highly effective in terms of cognitive gain [9]. LIMITATION
The findings of present study need to be interpreted in terms of The present study has several limitations. The impact of e-learning
extraneous variables which can affect the pre-test/post-test was not compared with the traditional teaching methods in the
assessment model. It includes the halo, Hawthorne, and practice study. Only single topic of pharmacology was covered. Only
effect [17]. The “halo effect” represents observer bias in which short-term cognitive gain was assessed. The long-term gains and
positive ratings in one domain affect other domains and inconsistency behavioural change among the students were not assessed. In the
across faculty raters [18]. The blinding and structured checklist in study, e-based interactivity in the form of self-evaluation exercises
assessment was used to minimise this effect. The “Hawthorne effect” and formative feedback interactivity between students and faculty
is a type of reactivity in which results or behaviour may be affected were not explored. E-based interaction encourages the students in
by knowing of participant that he is being tested or observed. The an active learning process [29]. The present study has barriers like
literature suggests its existence, but little understanding prevails lack of interaction with faculty. Preparation of the e-learning module

Journal of Clinical and Diagnostic Research. 2018 Jul, Vol-12(7): FC12-FC16 15

 Parvati B Patel et al., Perceptions and Effectiveness of Use of e-learning in Pharmacology Education www.jcdr.net

is a time consuming task. This limits its feasibility to cover the vast [11] Silva CS, Souza MB, Silva Filho RS, Medeiros LM, Criado PR. E-learning program
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PARTICULARS OF CONTRIBUTORS:
1. Assistant Professor, Department of Pharmacology, Gujarat Medical Education and Research Society Medical College, Gotri, Vadodara, Gujarat, India.
2. Assistant Professor, Department of Pharmacology, Gujarat Medical Education and Research Society Medical College, Gotri, Vadodara, Gujarat, India
3. Professor, Department of Pharmacology, Gujarat Medical Education and Research Society Medical College, Gotri, Vadodara, Gujarat, India.
4. Associate Professor, Department of Skin and VD, Gujarat Medical Education and Research Society Medical College, Gotri, Vadodara, Gujarat, India.

NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR:

Dr. Parvati B Patel,
Assistant Professor, Department of Pharmacology, Gujarat Medical Education and Research Society Medical College,
Gotri, Vadodara-390021, Gujarat, India. Date of Submission: Jan 31, 2018
E-mail: [email protected] Date of Peer Review: Mar 29, 2017
Date of Acceptance: May 04, 2018
Financial OR OTHER COMPETING INTERESTS: None. Date of Publishing: Jul 01, 2018

16 Journal of Clinical and Diagnostic Research. 2018 Jul, Vol-12(7): FC12-FC16