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J Educ Eval Health Prof > Volume 12; 2015 > Article
Ahmed, Shaheen, and Azam: How undergraduate medical students reflect on instructional practices and class attendance: a case study from the Shifa College of Medicine, Pakistan


The goal of this study was to assess student perceptions of a variety of instructional practices and attitudes toward class attendance. Data were obtained and analyzed by administering a questionnaire to students of the Shifa College of Medicine, Pakistan in 2011 and 2012. The subjects positively assessed most instructional practices, and in particular felt that teaching sessions conducted in small groups were more valuable than formal lectures in large groups. Students did not like having to give presentations, quizzes, panel discussions, and journal club. A positive correlation was found between the perceived importance of attendance and levels of academic motivation. Of the students surveyed, 11.8% were against mandatory attendance, saying that it reduced motivation and that attendance should be optional. In conclusion, the students had a positive perception of a range of instructional practices, and felt especially positively about practices that involve student activity in small groups. Programmatic improvement in instructional practices might increase class attendance.

Various types of small-group and large-group sessions have been used for instruction at the Shifa College of Medicine, Islamabad, Pakistan, including case-based techniques such as case scenarios or multiple vignettes about a particular theme. Small group sessions include small group discussions, problem-based learning, objective structured clinical examinations, and practical labs. Large group sessions include interactive sessions, lectures, reviews, quizzes, panel discussions, student presentations, and journal club. Instructors encourage students to acquire evidence-based knowledge. It is desirable that students attend these sessions of their own free will and out of genuine interest. The goal of this study was to assess how students responded to these instructional practices and how students perceived class attendance.
A questionnaire was administered in English to two consecutive groups of third-year medical students in the Shifa College of Medicine. The survey contained 21 closed questions, of which two were related to income group and gender, and three open-ended questions. This survey was conducted during the cardiovascular module of the third-year class in 2011 and 2012. Ninety-eight students in the 2011 group were surveyed three times each, at the beginning, midpoint, and end of the cardiovascular module, whereas 99 students in the 2012 group were surveyed at the beginning of the cardiovascular module. Quantitative data was analyzed with SPSS version 17 (SPSS Inc., Chicago, IL, USA). Homogeneity test for questions dealing with the importance of attendance were performed. Goodness of fit test for students’ responses to questions dealing with teaching strategies and for students’ perception of instructional practices were done. P-values less than 0.05 were considered to indicate statistical significance. Qualitative data were analyzed in terms of the percentage of the students who gave the same response.
The total number of participants was 314, including three sets of responses from the 2011 group and one set of responses from the 2012 group. Of the participants, 55% were female and 45% were male. Their parents belonged to the middle class, with average monthly incomes of PIKR 100,000-500,000 (USD 1,000-5,000). A total of 188 students (69.1%) said that class attendance is important, whereas 32 students (11.8%) said that class attendance is not important since it reduces motivation and that attendance should be optional; uncertain, 52 students (19.1%) (Table 1). The students who were aware that attendance was important for learning believed that it lead to improved learning, improved performance, and higher grades; while, the students who thought that attendance was not important believes that it did not lead to improved learning, improved performance, and higher grades (Table 1). The attitudes of students towards attendance did not depend on instructor, topic, or type of delivery. Moreover, the students indicated that they are willing to attend class even if the teaching material is available online (Table 2). A majority of students said that small group discussions are the most informative (63.7%, P=0.000) and that they found this method of teaching to be the most interesting (56.5%, P=0.000), as compared to reviews, lectures, and large-group interactive sessions. All knowledge delivery techniques were assessed positively, including large-group interactive sessions, problem-based learning, reviews, lectures, objective structured clinical examinations, skill- based lab sessions, outpatient department learning, and inpatient observation. Students had a negative opinion about student presentations in class and journal club. They indicated that they would like to utilize most of their time for self-directed study, study in the classroom, studying online, studying from textbooks, evidence-based study, lab work, operational theater observation, inpatient department learning, and outpatient department learning (Table 3).
Corresponding to the results of previous studies, students perceived active learning through case- based group activities more positively than traditional lectures [1]. Most students in this study also preferred case-based learning and stated that it enhances their learning. A high rate of regular attendance and consistently good test results indicated that the team-based learning concept was widely accepted among this group. Large-group interactive sessions were also perceived as very useful by the surveyed students, as shown in Table 3. Therefore, a correct mixture of instructional practices and tools is essential for the optimal achievement of learning objectives. The answers to the open-ended questions in our study expressed positive attitudes, and there were no inappropriate or particularly negative remarks. Students also suggested that appropriate leave policies should be developed for students who have genuine problems in order to compensate for possible missed attendance. In conclusion, the students had a positive perception of a variety of instructional practices, and small-group activities received a particularly positive assessment. Programmatic improvement in the implementation of instructional practices might incentivize better attendance.


No potential conflict of interest relevant to this article was reported.


I sincerely acknowledge the participation of the students in the third-year classes of 2011 and 2012 who devoted their time to filling out the questionnaire.


Audio recording of the abstract.


1. Guagliardo JG, Hoiriis KT. Comparison of chiropractic student scores before and after utilizing active learning techniques in a classroom setting. J Chiropr Educ 2013;27:116-122.
crossref pmid pmc

Table 1.
Homogeneity test for questions dealing with the importance of attendance, according to the responses of students of the Shifa College of Medicine, Islamabad, Pakistan in 2011 and 2012
Q1. Is class attendance important? Q3. Does attendance affect student performance?
Pearson chi-squared asymptotic significance (two-sided)
Yes Uncertain No Total
Yes 157 14 17 188 0.000
Uncertain 25 9 18 52
No 9 5 18 32
Total 191 28 53 272

Q4. Does attendance improve learning?

Yes 142 21 24 187 0.000
Uncertain 24 9 19 52
No 7 4 20 31
Total 173 34 63 270

Q16. Does daily attendance help students improve their grades?

Yes 119 43 24 186 0.000
Uncertain 14 22 15 51
No 5 9 18 32
Total 138 74 57 269
Table 2.
Goodness of fit test for students’ responses to questions dealing with teaching strategies from a questionnaire administered to students of the Shifa College of Medicine, Islamabad, Pakistan in 2011 and 2012
Question asked Total responses (n) Yes Uncertain No P-value
Q13 Does your attendance depend on the instructor? 307 85 64 158 0.000
Q14 Does your attendance depend on the topic? 310 85 50 175 0.000
Q15 Does your attendance depend on the style of delivery? 303 95 71 137 0.000
Q17 Is the performance of instructors affected by the daily attendance of students or not? 302 127 92 83 0.005
Q18 Will you attend your sessions if your course material is made available online? 302 218 49 35 0.000
Table 3.
Goodness of fit test for Students’ perception of instructional practices in a survey administered to students of the Shifa College of Medicine, Islamabad, Pakistan in 2011 and 2012
Question asked Number of responses Yes Uncertain No P-value
Q8 Which method do you consider most informative? 300 0.000
 Small group discussion 191
 Review 41
 Lecture 18
 Large group interactive session 47
 None 3
Q9 Which method切 of teaching do you find interesting? 306 0.000
 Small group discussion 173
 Review 40
 Lecture 23
 Large-group interactive sessions 52
 None 18
Q11 Which type of session(s) would you especially like to attend?
 Large-group interactive sessions 277 179 64 34 0.000
 Small-group discussions 291 234 36 21 0.000
 Problem-based learning 282 187 48 47 0.000
 Review 280 206 49 25 0.000
 Lecture 271 187 54 3 0.000
 Objective structured clinical examination 275 200 53 22 0.000
 Practice 277 217 45 15 0.000
 Skill lab 288 250 27 11 0.000
 Outpatient department 294 258 30 6 0.000
 Inpatient department 286 247 29 10 0.000
 Student presentations 273 69 77 127 0.000
 Panel discussion 270 100 88 82 0.393
 Journal club 273 71 76 126 0.000
 Quiz sessions 277 109 78 90 0.071
Q12 You would like to utilize most of your time for:
 Self-directed study 289 236 31 22 0.000
 Classroom study 261 126 78 57 0.000
 Internet study 267 141 77 49 0.000
 Textbook study 271 229 26 16 0.000
 Evidence-based study 270 157 83 30 0.000
 Lab work study 262 150 72 40 0.000
 Operational theater observation 272 224 37 11 0.000
 Inpatient department learning 275 239 31 5 0.000
 Outpatient department learning 283 244 30 9 0.000
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