The results of our study provided several interesting insights. Usually, medical students use textbooks and their classroom notes to prepare for assessments in biochemistry during their first year. The resources on the e-learning website were an additional source of information made available to the students in the current study. Almost all the students used the e-resources that were provided by the department. The majority of students (96%) gave a high rating to the quality of the material provided.
It has been shown that provision of e-learning material in the form of audio-visual podcasts consisting of PowerPoint sides with a voice-over narrative was popular among students as a revision aid prior to assessments [11
]. Fifty two percent of students in this study said that they used the e-resources primarily to prepare for the periodic assessments during the course. We found that the number of students who used e-learning resources as their major source (high users) to prepare for the periodic formative assessments increased steadily as the academic year progressed (Figure ). This was also reflected in the fact that the number of students who primarily depended on text books (low users) declined steadily as the year progressed. This trend may be because of two reasons: firstly, the students may have found that the e-resources provided information that was concise and comprehensive to use to prepare for assessments. It often takes longer to prepare to the same extent using textbooks. On being asked specifically about what they liked about the e-resources (item 12 in questionnaire), some of the responses from students were: “e-resources were easily accessible, concise, comprehensive and easy to recollect in examinations
”, “It was helpful to know what the important topics were; it is often not possible to get such info from text books
”. These features obviously made the use of e-resources attractive to students. Secondly, the students may have found that some of the topics were not covered adequately or in an easily comprehensible way in the textbooks they use. Indeed, some students did say that “there was more information on the e-learning website than in textbooks for some topics
”. This was true of some of the topics towards the end of the academic year (e.g., carcinogenesis). In fact, more than 80% of students were high users of the e-resources for this topic (Figure ). This may account for the fact that high users of the e-resources scored significantly higher marks in the assessment on carcinogenesis (Figure ). When asked about their preparation for the final summative assessment, it was found that students used textbooks to a greater extent than they did to prepare for periodic assessments (Figure ). Nevertheless, we found that e-resources still remained the major source of information for students to prepare for the final summative assessment in many of the topics in biochemistry (Figure ).
Note-taking during lectures is a useful strategy that many students use for learning purposes, as it keeps them attentive to the lecturer and helps them avoid having to refer to diverse sources to get information required on a particular topic [13
]. A major disadvantage of this, however, is that it is often difficult to listen to the lecturer and take notes at the same time. This frequently results in students’ lecture notes being patchy and incomplete. If students are assured of access to the lecture presentations outside of class hours (via the e-learning website), they would give their full attention to the lecturer and refer to the presentation later. When asked about this, some of the responses from students were: “since I could get the lecture material later, I stopped scribbling notes in class and paid more attention to the teacher. This really helped me
”, “I write very slowly; this helped me just listen to the teacher and prepare my notes later
”. We found that 36% of students said that their note–taking during lectures had decreased, when they knew the presentations would be available on the e-learning website for them to refer to. In addition, 29% of students said that their attentiveness in class increased as they were able to give their full attention to the lecturer. Thus, about a third of the students have benefited in these ways.
Performance of students in assessments depends on the extent of their understanding of the subject and their ability to focus on its most important elements. In this regard, the fact that 86% of students thought that they were better equipped to answer questions in assessments, as a result of access to e-resources, is an important observation. Many students said that “e-resources helped to quickly revise all the topics prior to exams
” and “it helped me make sure that I was prepared to answer the most important questions in exams
”. Some studies have shown that e-learning improved performance of students when compared to traditional teaching methods [15
]. However, we did not find significant differences in the performances of the various usage groups in the final summative examination at the end of the course, when using the marks that they obtained in their test as the outcome. Nevertheless, the fact that being able to access and study from the e-resources gave students a sense of mastery over the subject and gave them confidence to perform is a very positive aspect of this intervention.
We have frequently found that first-year medical students are unable to appreciate the clinical relevance of biochemistry and hence tend to perceive it as being uninteresting. The undue and unwarranted importance placed on rote learning of various biochemical pathways in the subject and failure of teachers to adequately emphasize its clinical relevance contribute a great deal to this situation. In this context, it is extremely encouraging to find that 73% of students in the study said that they found biochemistry interesting. In addition, 86% of students said the e-resources enabled them to understand the subject better and 59% said they felt motivated to study it (Figure ). Hence, the students’ interest in and understanding of the subject seemed to have improved as a result of access to e-resources. These are extremely encouraging findings and will help in sustaining interest of medical students in biochemistry, as they progress into the clinical phase of the medical course.
While providing access to e-resources appears to have helped first-year medical students in many ways, one has to be aware of possible disadvantages as well. In this study, 42% of students said that their dependence on text books to learn biochemistry decreased as a result of having access to the e-resources (Figure ). When asked about the aspects of e-learning that students disliked (item 13 in questionnaire), some of the responses were: “I read textbooks extensively initially but I found that my classmates who studied from the lecture presentations were scoring more marks than I did. So, I started studying from the e-resources too. However, I don’t think that this was good”, “I did not feel the need to read textbooks. The info from the e-resources appeared sufficient to do well in the exams”
. This can be a cause for concern since the habit of reading textbooks is an important aspect of self-directed learning [18
]. Dependence on e-resources as the sole source of information on a topic may limit the knowledge acquired by students to the bare essentials required to pass examinations. In order to circumvent this, it is necessary that medical teachers emphasize that e-resources are only a supplemental aid to learning and that frequent student-teacher interactions and textbooks should remain the primary sources of knowledge. In addition, teachers should also design formative and summative assessments in the course such that students are also tested on additional material that is not available in the e-resources and/or on aspects that test the ability of students to apply their knowledge.