Lest the Doctor in Making Forget the Art of Visiting the Library: An Institutional Survey

INTRODUCTION

Dusty books, creaky benches, the earthy scent of wood, the serene silence-isn’t that what comes to mind when one thinks of a library?

Sir William Osler famously said, “To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.” A century has passed since he said that and today, we are witnessing a watershed moment in the history of modern medicine where bedside and chalk board learning is being seriously challenged by the onslaught of information technology.¹

The word library comes from the Latin word liber which translates to “book.” This study has taken library synonymous with books- textbooks, journals, reference books—all conventional methods of gaining knowledge.²

There has been a rapid decline in the use of traditional methods, including bedside teaching, owing to the new, digital sources of learning which has been precipitated by the deadly pandemic of coronavirus disease-2019 (COVID-19) among various others reasons.^3,4 Teaching, too, has evolved over the years but more so in last few years.⁵ The traditional teaching, no doubt, has innumerable advantages that affect the students in a positive manner and even the least motivated learner can be involved with right teaching methods.⁶ If a preceptor acts as a role model by adequately demonstrating and guiding clinical reasoning and problem-solving, students and residents are shown to be encouraged to do so. However, the advent of technology brought with itself the new concepts of e-learning that have caught the attention of students, and have yielded higher satisfaction rates among them with medical students being no exception of this. ^7–9

This research is focused on drawing conclusions regarding learning from actual, physical books, traditional classroom teaching, and the new-onset era of digital learning. Digital learning has grown tremendously through the unfortunate COVID-19. Even before the pandemic, medical students had begun to drift toward digital resources.^10,11

Gaining and imparting knowledge is no less than an art. Though, e-learning is a noteworthy development that has the potential to transform medical education in India, but can it gain an edge over the traditional teaching and learning? This study aims to answer that.

The question also arises if this dynamic shift is a boon or a bane for medical undergraduates? How much has this affected the development of clinical skills in young medicos? And most importantly, do the educational institutions and the future doctors have enough awareness of their situation to make the appropriate changes needed? To establish this crucial cog in the medical education of today; to look for the loopholes; to fill the existing lacunae of the system, if any, we have shaped this research.

MATERIALS AND METHODS

This descriptive cross-sectional study is questionnaire-based survey and has been conducted online in a teaching institute. This research was conducted after receiving approval from the institute’s ethics committee. The questionnaire for the survey was initially presented to a group of experts to identify dimensionality of construct, determine questionnaire and items format and review and revise initial items pool. It followed with preliminary pilot testing with a group of 30 respondents to remove confusions, if any. Subsequently, the questionnaire was validated for content and construct validity; and reliability was assessed for internal consistency, test–retest reliability, and inter-rater reliability.

The study collected data on the usage of library and traditional teaching methods of the college and the use of digital resources for the purpose of learning among medical students, besides other parameters (supplement provided). These data were collected through an online Google Form, which is a credited method of online data collection.^12,13 The study invited all undergraduate (UG) students pursuing MBBS (Latin: Medicinae Baccalaureus Baccalaureus Chirurgiae) course across all four professional years in the college. The Google Form was circulated among the students through their respective batch WhatsApp groups. The data were collected over May–June 2023. No identifying data were sought to allow unbiased answers. The analysis is descriptive in nature. Chi-square test is applied for paired analysis.

RESULTS

This research had 271 students in total, 119 of whom were male and 152 of whom were female. Eighty-seven students (45 male and 42 female) were from 1st professional year, 53 students (31 male and 22 female) from 2nd professional year, 43 students (26 male and 17 female) from 3rd professional year and 88 students (50 male and 38 female) from 4th professional year. Ninety-one students reported annual family income above Rs. 7,00,000 while 180 reported below it.

The responses given by the students for few of the mentioned questions are represented in the pie-charts (Figs 1 to 4). Forty-six (17%) students mentioned that the location of the library was difficult to access. Of all, 75.3% of the students preferred blended learning while 12.2% preferred traditional teaching and 12.5% preferred digital learning. The 36.5% of the students did not know about the availability of variety of resources in the Central Library while 14.8% chose not to answer that question. While 71.2% of the students reported to have inadequate clinical skills at their level but 56.5% are satisfied with their overall learning methods and outcomes.

On being asked as to why do they visit the library, while 77 (28.4%) said they do not visit the library, 160 (59%) students said they go there to prepare for exams/self-study. Only 59 (21.8%) students went to consult other books and resources. 20 (7.4%) students lacked personal textbooks and hence visited the library while 27 (10%) students went in for the free Wi-Fi. Other reasons mentioned were to wait for the next lecture/clinical-posting and study during the gap, to achieve regularity in studies, to meet friends and to save time in between lectures.

On the subject of adequate attendance, 204 (75.3%) students said to have adequate attendance. Among those who do not, 34 (12.5%) felt they are capable of learning through other resources or by themselves, 25 (9.2%) felt most lectures are ineffective, 33 (12.2%) felt lectures are not scheduled properly and 35 (12.9%) students liked to go with their own pace. Other reasons given included mass bunks and illness.

The digital resources were preferred by 124 (45.8%) students on account of ease of access. Nearly, 38% found online content to be easier to understand. Ninety-nine (36.5%) did so as they believed it saved time and energy. Ninety (33.2%) students preferred digital resources as they could make their own routine with them. Nearly, a quarter (28.8%) felt that the online resources are more updated. Data to the questions of frequency of visits, time spent, usage of digital resources, and general screen-time is presented in Figure 1.

Independent Chi-squared test was performed to examine the association between gender, family income, different MBBS episodes, and library usage patterns. The visits to the library did not vary significantly based upon gender, family income, and for students of second, third, and fourth professional year of MBBS.

There is a significant relationship between the students of first and second year MBBS students and the visiting of the library. Second Professional students are more likely to visit the library [X² (1, N = 140) p < 0.01]. Similarly, final professional students are more likely to visit the library compared with first-year students. [X² (1, N = 175) p < 0.01].

DISCUSSION

In a study by Lal and Ingle, it was found that 82% of undergraduate students of a medical college consulted textbooks and 41% made regular visits to the library.⁶ Similar observations were noted by Fafard et al. too. Even back then, the authors concluded that the students needed to be motivated to make better use of the advantageous library resources. In our study, we found 12.2% of the students prefer textbooks as their learning methods while 75.3% prefer blended learning. Furthermore, 17.7% students made daily visits to the library. We find a greatly reduced proportion of students visiting library and using textbooks probably due to Lal’s study done before era of IT revolution in India. These differences can also be attributed to rise of online coaching platforms that provide more concise study material which is easier to access when compared with textbooks. Another reason could be the advent of licentiate examination that has undermined the value of university examinations.^14–17

According to research by Chatterjee et al., interns used the library to study for exams (62%), attend seminars (14%), review manuscripts, dissertations, and project reports (12%), and use it since they did not have personal books (10%). In this study, 59% students said they go there to prepare for exams/self-study. Only 21.8% of the students went to consult other books and resources. And 7.4% students lacked personal textbooks and hence visited the library while 10% students went in for the free Wi-Fi. Another significant element that may impact library utilization is its location. About one-third of both students and instructors in Chatterjee’s survey felt that the site was challenging to access. In our study, only 17% of students felt the location was difficult to access.¹⁸

According to Nair and Coughlan’s study, there are a variety of practical obstacles to traditional bedside teaching, such as time restraints, patients who are not in bed, and cacophony of wards. In our study, it could be due to improper scheduling of teachings, overburdened faculty, easy availability of content online. After the advent of COVID-19, more emphasis was given on completing theoretical knowledge instead of clinical skills. This has led to further decline of the already doomed traditional teaching.^5,9

Availability of audio-visual methods have proved to enhance knowledge. The lack of such facilities in libraries may also be responsible for the decline of usage of the library.^19,20

Low-quality evidence was identified in research by Kyaw et al. demonstrating that digital education is equally beneficial as conventional learning in the development of communication skills in medical students. Blended digital education seems to be at least as beneficial for knowledge and communication skills as traditional learning. According to the findings of our study, surprisingly, 56.5% students were satisfied with their learning outcomes.¹¹

Recently, state government has started with free distribution of tablet devices to all medical students, to promote e-learning complemented with free Wi-Fi and internet through National Knowledge Network (NKN). This brings all students at par as far as the availability of material resources is concerned and blurs the line between students of various socioeconomic strata.

Our study found that the second year students are more likely to visit the library than the first years. This could be due to the fact that first years have a restricted mobility, to prevent incidences of ragging, in the college. It could also be due to the fact that the second year of medical education introduces an array of conceptual subjects which indirectly may lead to an attitude of seriousness towards studies among students. The same reasons can be attributed to final year students visiting the library more than the first-year students.

CONCLUSION

The evolution of medical education from traditional to digital has, to a great extent, made the students lose touch with bedside manners and clinical knowledge. The loss of human touch from medical education has led to deterioration of skills. A blend of traditional bedside teaching and digital learning will reap the best results, as any one alone cannot replace the other in the world of today. With the efforts of both the teachers as well as the students, a holistic approach towards medical education can be achieved which will be beneficial to the society as a whole and a rekindling is needed amongst students to keep the libraries briming and art of learning alive. Also, the students need to be encouraged the use of library by sorting the various impediments like timings and infrastructure. It will also be useful if some senior faculty is present in library to provide sense of safety, while in library, to first-year medical students.

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