Assessment of Performance in Cognitive vs Affective Domain among First Year MBBS Students: A Cross-sectional Study

DOI: 10.7860/JCDR/2022/56640.16976 Original Article Education Section Assessment of Performance in Cognitive vs Affective Domain among First Year MBBS Students: A Cross-sectional Study Sharmila Aristotle1, Balaji Ramraj2 ABSTRACT Introduction: National Medical Commission (NMC) has revised MBBS curriculum and incorporated Competency Based Medical Curriculum (CBME) which describes various competencies. Most of the competencies are based on cognitive, psychomotor and affective domain, which an Indian medical graduate should attain. Both cognitive and psychomotor domains were taught as a part of curriculum however, students learned affective domain as a hidden curriculum only. Now CBME has incorporated affective domain as a part of MBBS curriculum in the form of Attitudes Ethics and Communication (AETCOM) module, teaching and evaluating the affective domain demands attention. Aim: To evaluate the performance of first year MBBS students in cognitive domain vs affective domain from their routine curriculum. Materials and Methods: This cross-sectional study was conducted in SRM Medical college Hospital and Research Centre, Chengalpattu, India, from September to October 2019 among 149 1st year MBBS students. Three students were absent on day of assessment. Hence, 146 students were assessed in both domains. The performance of both domains (cognitive and affective) were assessed in the form of Objective Structured Practical Examination (OSPE). Chi-square was used to compare the qualitative data and Unpaired t-test was used to compare the means. Results: The mean age of the students was 18.66±0.64 years. About 76 (52.1%) were male and 70 (47.9%) were female students. Out of total, 22 (15.1%) of students had scored less than minimum mark for pass in cognitive and 8 (5.5%) of students had scored less than minimum mark for pass in AETCOM. Only 2 (1.3%) of students had scored less than minimum mark for pass in both OSPE examinations. In addition, 49 (33.5%) students had scored more than average marks in cognitive and 94 (64.4%) students had scored more than average in AETCOM and 34 (23.2%) of students had scored more than average in both domains. The difference in the mean score was found to be statistically significant (p-value <0.0001). Conclusion: This study concludes that the learners performed better in affective domain, when compared to cognitive domain. Keywords: Attitude domain, Competencies, Curriculum, Psychomotor INTRODUCTION The MBBS curriculum in India has been reformed after 21 years and came into implementation from 2019-20 academic session onwards. The Competency Based Medical Education (CBME) incorporates many new teaching elements like foundation course, Attitude, Ethics, and Communication Module (AETCOM), early clinical exposure, integration and alignment, student doctor method of clinical training, electives, self-directed learning, critical thinking and research abilities, psychomotor skill development and simulation training, emphasis on primary healthcare centers to meet the global standards [1]. The outcome of CBME is expressed in terms of competencies for various domains such as cognitive, psychomotor and affective. To address the affective domain, the curriculum has integrated the AETCOM module, as a longitudinal program that emphasises the importance of development of proper attitude and communication skills to the student’s right from the foundation course itself. Each module offers suggestions of teaching learning methodology and assessment type. The first professional year consists of five AETCOM modules for teaching affective domain and foundations of communication is one among them, which emphasises formative assessment [1]. Cognitive domain were taught in the curriculum in the form of various competences, which includes subjectwise outcomes, so called sub competencies. In subject anatomy 82 total topics were designed by National Medical Commission (NMC) [1]. Graduate Medical Education Regulation (GMER 2019) has also proposed assessment in the form of summative and formative assessments, which covers all the three major domains cognitive, 10 affective and psychomotor domain [1]. Since, importance is given for all the three domains in the assessment part, the biggest challenge for CBME is to integrate ‘Knowledge, skill, attitude’ components and to bring a paradigm shift in teaching learning and assessment methods [2]. Many assessment methods are available globally which are proved to be effective in assessing the behavioural practice of trainees in clinical settings of attitude and professionalism. A 360° feedback assessment from multiple sources proves to be holistic in evaluating values and behaviour [3]. However, one of the tools to assess the AETCOM competencies are Objective Structured Clinical Examination (OSCE) and Objective Structured Practical Examination (OSPE) in a summative assessment examination setting [4]. The affective domain is taught in the MBBS curriculum as a hidden curriculum for years and NMC has revised the CBME curriculum, which now becomes mandatory for teaching such skills. Incorporation of this affective domain as a part of curriculum demands specific attention in the form of evaluating the progress of the learners. Moreover, there exists a lacuna in comparing the knowledge component with that of affective domain and integrating them. Hence, this study was carried out to evaluate the performance of the first year MBBS graduates in cognitive vs affective domain by an OSPE and to evaluate the progress of learning in teaching affective domain. MATERIALS AND METHODS This cross-sectional study was conducted in SRM Medical college Hospital and Research Centre, Chengalpattu, India, from September to October 2019 among 149 1st year MBBS students. The study Journal of Clinical and Diagnostic Research. 2022 Sep, Vol-16(9): JC10-JC13 www.jcdr.net Sharmila Aristotle and Balaji Ramraj, Learner Performance in Academic Knowledge vs Communication Skills was approved by the Institutional Ethical Committee [Ref no. 847/ IEC/2019]. Inclusion criteria: This study was a part of academic curriculum; all first year students admitted in the academic year 2019-2020 were included in the study. Exclusion criteria: All the students were taught in both the domains for a period of two months. However, students who were absent on the assessment day were excluded from the data analysis. Out of total 149 students, admitted in first year MBBS (2019-2020 batch), three students were absent on day of assessment. Hence, 146 students were assessed in both domains. Affective Domain The AETCOM module- Foundations of communication skills were taught to the students based on Kalamazoo Consensus Statement for communication skill as per NMC module [5]. The module was taught to them in the form of role play by faculties of Medical Education Unit (MEU) of SRM Medical College Hospital and Research Centre. Kalamazoo module is based on seven essential elements (...truncated)