European Journal of Cardiovascular Medicine

In the conventional curriculum, I MBBS Professional students studied Basic sciences (Pre-Clinical) Subjects concepts without interacting with patients or engaging in clinical discussions. As a result, they often struggled to remember key basic concepts when they entered clinical postings during their II Professional year. This made some aspects of their academic education seem irrelevant. (1) Therefore, it became clear that students should be introduced to clinical settings early in there I professional year training.

"Vision 2015" an initiative of the then Medical Council of India (MCI) for undergraduate education, highlighted the importance of ECE during the first year of the MBBS program, along with integrated teaching methods. (2-4) This module aims to connect pre-clinical and clinical subjects, making the study of foundational topics more engaging. ECE represents a form of vertical integration between these two areas of study. (5) Many medical colleges and universities worldwide have embraced ECE as an educational framework in their undergraduate medical programs.

The integration of ECE into the medical curriculum has been recognized as a pivotal strategy to bridge the gap between theoretical knowledge and clinical application, particularly in the foundational years of medical education. Traditional pedagogical approaches in biochemistry often emphasize abstract concepts, which may lead to challenges in student engagement and retention. ECE offers a transformative learning experience by introducing clinical contexts early in the educational journey, thereby enhancing comprehension and fostering a deeper appreciation for the subject matter.​(6)

Recent studies have underscored the efficacy of ECE in medical training. For instance, a study implemented an ECE protocol focusing on diabetes mellitus for first-year MBBS students. The findings revealed that students perceived ECE as an enjoyable and effective learning method, noting improvements in knowledge retention, attention, and motivation. The majority expressed a desire for ECE to be incorporated into other topics and subjects within the first professional course. (7)

Similarly, research assessing the impact of an ECE module on understanding the biochemical basis of diabetes mellitus demonstrated significant improvements in student performance. Post-intervention assessments showed enhanced comprehension of the disorder, highlighting ECE's role in making learning more interactive and clinically relevant. (8)

In the context of biochemistry, laboratory report interpretation serves as a critical conduit between theoretical constructs and clinical practice. Engaging first-year MBBS students in the analysis of laboratory data within real or simulated clinical scenarios can cultivate analytical prowess, critical thinking, and diagnostic acumen. This approach not only reinforces the clinical relevance of biochemistry but also prepares students for the complexities of patient care.​

In this study, we aimed to investigate the application of clinical laboratory reports from patients to enhance the understanding of biochemistry through real-world clinical situations.

The Objectives of this study were (a) to evaluate the effectiveness of laboratory reports as a tool for enhancing education in Biochemistry, (b) to assess the advantages of utilizing laboratory reports to teach basic and clinical biochemistry aspects for first-year MBBS students, (c) to create awareness to the students regarding applied Biochemistry, and (d) to identify any challenges encountered by students while studying and analysing clinical biochemistry case scenarios.

This research was conducted following the completion of both the theoretical and practical classes of the biochemistry CBME curriculum, serving as a revision activity prior to the University examinations for first-year MBBS students. Patient laboratory reports were collected from the central lab of biochemistry department. Subsequently, case scenarios were developed based on these reports. Approval was secured from both the Scientific & Ethical Committee of ACSR Government Medical College.

A total of 175 students were organized into three distinct groups. ECE activity was conducted with voluntary participation of 146 students. Each group was further subdivided into four teams on a daily basis. Prior to the activity, students received a briefing regarding the team-based task and were encouraged to come prepared. Each team was assigned a case scenario along with a laboratory investigation form. They were instructed to analyse the expected changes with normal laboratory values and also recommend the necessary laboratory investigations based on their understanding of the case. Each team presented their case scenario, followed by a discussion involving all teams, which was ultimately summarized by the faculty. The actual laboratory reports were also presented to the students for reference.

Example of case scenario:

A 45-year-old businessman, presented to the outpatient department with complaints of progressive yellowing of his skin and sclera for the past two weeks. He also reported dark coloured urine, pale stools, and generalized weakness. He has had intermittent episodes of nausea but no vomiting. There is no history of fever or significant weight loss. Past Medical History: No known history of diabetes or hypertension. Occasional alcohol consumption for the past 15 years. No history of blood transfusions or recent travel. Family History: No known history of liver disease or genetic disorders in the family.

Examination Findings: General: Icteric sclera, mild hepatomegaly (liver palpable 2 cm below the right costal margin). Vital Signs: BP – 120/80 mmHg, HR – 84 bpm, Temp – 98.6°F. Abdominal Examination: Mild right upper quadrant tenderness, no signs of ascites or splenomegaly.

Table 1 presents an example of the laboratory form. At the conclusion of the exercise, a feedback form was distributed to assess students' perceptions of this innovative learning approach.

Table 2 presents the percentage of student responses to close-ended questions,

Table 3 illustrates the percentage of feedback for open-ended questions.

The study's findings can be summarized as follows: (a) a significant majority of students expressed that the learning approach involving group activities to solve clinical scenarios based on laboratory investigations was highly encouraging. (b) Most of the students find that this method is superior to traditional teaching techniques, enhancing their understanding clinical biochemistry. (c) A large number of students indicated that the discussion component facilitated the connection between laboratory results and clinical scenarios, leading to a better understanding of theoretical concepts. (d) Many students noted that this approach would be beneficial for their theoretical and practical examinations, as well as during their future clinical postings. (e) The majority of students suggested that this type of activity-based teaching tool in clinical biochemistry, suggested for an increase in the number of such sessions and the assignment of clinical scenarios to students.

The MBBS curriculum contains preclinical, paraclinical & clinical disciplines. A comprehensive approach to patient care is necessary for the integration of basic sciences principles with clinical application. Nevertheless, a disconnect often exists between these areas, making it challenging for students to apply their foundational knowledge during clinical Postings. Efforts have been made to bridge this gap through the implementation of ECE in the first year of the MBBS program. First-year MBBS students typically possess a rudimentary understanding of biochemistry. Focusing solely on detailed biochemical concepts may not sufficiently engage students’ interest in the subject. Conversely, introducing clinical scenarios can enhance engagement and enjoyment in the learning process. Case discussions can be integrated into the classroom through various formats, such as written case studies, lab reports, images, radiographs, and ECGs.(9-10)

ECE helps to enhance the cognitive processes by application, analysis, synthesis, and evaluation. It plays a crucial role in improving critical thinking and enhancing reasoning and problem-solving abilities. (11-12) Research conducted by Warkar & Asia, 2020, Ghosh & Dawka, 2000, indicates that integrating ECE with theoretical topics can create a robust framework for effectively merging the teaching and learning of fundamental sciences within traditional educational programs.(13-14) Furthermore, ECE has been shown to reduce the stress associated with patient management, enhance clinical reasoning, and yield positive learning outcomes.(15-16) ECE facilitates the connection of prior knowledge with patient histories and laboratory results, promoting active learning about diseases and highlighting the significance of basic sciences in clinical practice. Evidence suggests that recognizing the clinical relevance of basic science subjects enhances retention and comprehension. (17) In our research, students expressed that the ECE approach, particularly when combined with patient laboratory reports, was more engaging and effective than conventional methods, significantly improving their understanding of the subject matter.(18) Many researches indicates that ECE plays a significant role in teaching basic science subjects within a clinical framework, thereby enhancing conceptual understanding.

A study conducted by Deolalikar, et al, 2020. demonstrated that utilizing case discussions and videos in physiology education through ECE helps in conceptual development and underscores the necessity of mastering basic science subjects. In conventional medical education curricula, students often struggle to recall essential scientific principles during their clinical postings. (19) Various studies have shown that ECE facilitates students’ ability to connect the practical applications of basic science in clinical environments. (20-22) Furthermore, ECE has been found to enhance medical students' comprehension of medical theory and practice by allowing them to apply their knowledge in real-world hospital settings. Our study revealed similar student responses, indicating that they were better able to relate theoretical concepts to actual clinical situations, thereby improving their understanding in both theoretical and practical contexts. Students expressed that this approach would be beneficial for their theoretical and practical examinations, as well as during future clinical placements. Those who experienced ECE in biochemistry and endocrine physiology advocated for its inclusion as a core component of the teaching-learning process, alongside traditional lectures in basic science subjects. They also recommended assigning clinical scenarios to students as part of their learning activities.

The strength of our research was the examination of the challenges faced by students during the implementation of ECE. In our findings, approximately half of the students had agreed and expressed their uncertainty regarding the difficulty of the ECE activities. This observation regarding the challenges associated with ECE has not been widely documented in existing literature. ECE can sometimes lead to confusion among students, as diseases can impact multiple systems at the cellular level. Therefore, a comprehensive understanding of not only biochemistry anatomy and physiology but also the pathology affecting various organs is crucial for studying any disease. The lack of knowledge in pathology of diseases among students may contribute to their confusion, making ECE appear more challenging. This situation may stem from insufficient exposure to pathology and limited patient interaction during the first year of the MBBS program. But this experience may serve as an initial step toward clinical exposure, potentially enhancing students' confidence as they progress to their clinical postings.

The limitation of the study was the lack of direct interaction between students and actual patients; instead, the focus was on case-based scenarios and discussions of laboratory investigations. Exposure to real patients in clinical settings, such as wards and OPDs, could significantly enhance students' learning experiences. However, arranging for patient encounters for ECE is not always feasible. Nevertheless, efforts can be made to incorporate ECE through alternative methods to enrich the learning of basic science subjects like biochemistry. Moreover, our study revealed an overall positive attitude among students, which supports the implementation of ECE through various feasible approaches.

The students’ observations indicates that the ECE program effectively merges fundamental science with clinical disciplines. This integration enhances their comprehension of the significance of basic science topics. ECE simplifies and engages students with the concepts of these subjects. Nevertheless, it is important to acknowledge the challenges encountered by students, suggesting that additional practice sessions could be beneficial.

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