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Applying innovative educational principles when classes grow and resources are
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DOI: 10.1002/bmb.20210 · Source: PubMed
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BIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION
Vol. 36, No. 6, pp. 387–394, 2008
Articles
Applying Innovative Educational Principles When Classes Grow
and Resources are Limited
BIOCHEMISTRY EXPERIENCES AT MUHIMBILI UNIVERSITY OF ALLIED HEALTH SCIENCES
Received for publication, April 28, 2008, and in revised form, May 13, 2008
Selma Omer*†, Gilles Hickson†, Stephanie Taché†, Raymond Blind†, Susan Masters†, Helen Loeser†,
Kevin Souza†, Charles Mkony‡, Haile Debas†, and Patricia O’Sullivan†
From the †University of California San Francisco (UCSF), San Francisco, California, ‡Muhimbili University of
Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
Teaching to large classes is often challenging particularly when the faculty and teaching resources
are limited. Innovative, less staff intensive ways need to be explored to enhance teaching and to
engage students. We describe our experience teaching biochemistry to 350 students at Muhimbili University of Health and Allied Sciences (MUHAS) under severe resource limitations and highlight our
efforts to enhance the teaching effectiveness. We focus on peer assisted learning and present three
pilot initiatives that we developed to supplement teaching and facilitate student interaction within the
classroom. These included; instructor-facilitated small group activities within large group settings,
peer-led tutorials to provide supplemental teaching and peer-assisted instruction in IT skills to enable
access to online biochemistry learning resources. All our efforts were practical, low cost and well
received by our learners. They may be applied in many different settings where faculties face similar
challenges.
Keywords: Biochemistry education, peer assisted learning, small groups, limited resources.
This article describes the challenges of teaching biochemistry to large number of students in a severely
resource-limited environment. Muhumbili University of
Health and Allied Sciences (MUHAS) is the only publicly
funded Health Sciences University in Tanzania and it
attracts some of the best students in the country.
MUHAS leads in the training of doctors (approximately
73% of medical graduates) nurses, and other public
health personnel, and is the sole professional school for
dentists and pharmacists in the country. Tanzania, like
several other African countries, is experiencing an
extreme shortage of qualified health professionals stemming from long-term under-investment in institutions and
human resources [1]. Reports from the Ministry of Health
and Social Welfare (MoHSW) show that in September
2006 only 32% of the required human resources for
health were in place in public hospitals [2, 3]. In an
attempt to address the chronic and serious shortages of
healthcare professionals, MUHAS began a fourfold
* To whom correspondence should be addressed. 3333 California St., Suite 285, San Franicisco, California 94122, United
States. Tel.: 415-502-6047; Fax: 415-502-6052 E-mail: omers@
globalhealth.ucsf.edu.
This paper is available on line at http://www.bambed.org
expansion of student enrollment in 1997 [4]. However,
the exponential rise in student numbers was not accompanied by a scaling up of resources at the institution. In
fact MUHAS experienced a 10 year hiring freeze preceding the student expansion program, which caused both a
deficit and a skewed distribution of teaching faculty, with
a limited junior and disproportionately senior cadre.
The teaching of biochemistry in a department with a
single faculty member provided one catalyzing crisis for
innovation. In 2004, MUHAS and the University of California San Francisco Global Health Sciences (UCSF-GHS)
formed a collaboration [5] centered on medical education
and teaching strategies to cope with the large number of
students and the limited number of lecturers. One of the
outcomes of the collaboration was a visiting postdoctoral
lecturer program to assist in the undergraduate teaching
in the Biochemistry Department. The single faculty member in the Biochemistry Department was responsible for
teaching the 350 first year students from all four schools
as well as the seven postgraduate students taking Biochemistry courses. Two UCSF postdoctoral scholars
went to MUHAS three times to assist in teaching Biochemistry, January–March, 2006, September–December,
2006, and January–March, 2007. This initiative aimed at
developing innovative teaching strategies to enhance
387
DOI 10.1002/bmb.20210
388
BAMBED, Vol. 36, No. 6, pp. 387–394, 2008
TABLE I
Interventions introduced in the visiting postdoctoral lecturer program
Intervention
Interactive review
sessions
Type of teaching
Description
Instructor-facilitated
One-hour weekly sessions
Small groups (5–6 students) in large class setting
Based on interactive ‘‘games’’ to encourage learning
Large group discussion facilitated by two faculty members
One-hour tutorial
Each tutorial group had approx. 20 students working in sub- groups
(5–6 students) in seminar rooms
Discussion based on an assigned problem set completed by
students before the tutorial
Large group discussion facilitate by one student instructor
Two hour weekly sessions, total of four sessions
Conducted at MUHAS teaching IT lab with a 30-student capacity
Introduced basic computer skills, for accessing programs, managing
files, using Microsoft Word, the Internet, and accessing e-mails
Organized, facilitated and instructed by four computer literate students
Student-led tutorial
Peer-led
Basic IT course
Peer-assisted
teaching in large classes and to incorporate technology
for teaching and assessment.
The postdoctoral scholars were selected for this program based on their previous teaching experience and
small group facilitations skills. They also attended a 2day teaching workshop at UCSF prior to their departure
to help them to advance their teaching and exam writing
skills and to develop instructional innovations. The two
postdoctoral lecturers implemented three pilot initiatives
to augment the capacity and effectiveness of the teaching of biochemistry: 1) incorporating instructor-facilitated
small group activities within the large group setting, 2)
developing supplemental peer-led learning sessions to
provide additional teaching resources to the students,
and 3) offering peer-assisted instruction in IT skills to
enable access to free online biochemistry learning
resources. In this article, we will present each pilot
describing the intervention along with our studies assessing their effectiveness (see Table I for a summary of the
interventions).
INCORPORATING INSTRUCTOR-FACILITATED SMALL GROUPS
WITHIN LARGE GROUPS: INTERACTIVE REVIEW SESSIONS
We incorporated small-group review sessions within
the large biochemistry class. During the first semester
350 medical, dental, pharmacy, and nursing students
jointly took biochemistry. The course comprised 11 hours
a week of large group lectures and four practical sessions. This joint teaching posed challenges, not only in
engaging large audiences but also in addressing the
diverse backgrounds of the students who have vastly different entry requirements to their chosen fields. In an
effort to promote active learning in large class settings
[6], an hour of class each Friday was reassigned to a
‘‘review session’’ where students worked in small groups
of 5–6 on biochemistry learning activities. These sessions
created an opportunity for peer teaching and gave the
lecturer a chance to circulate among the small groups
and answer questions that the students were reluctant
to ask during the lectures. It facilitated formative ass-
essment of the students’ understanding of the lecture
material.
The literature indicates that ‘‘games’’ or ‘‘fun with a
purpose’’ foster active learning allowing interactivity and
collaboration and increased motivation [7]. Consequently,
we designed our sessions as ‘‘games’’ that varied each
week (see Table II for an example of a game). Games
included crossword puzzles, timed quizzes, and even
competition with ‘‘Biochemistry hangman.’’ Sometimes
multiple choice questions were projected and students
worked in their small groups to obtain the answers. At
the end of the exercise, the entire class voted for the
correct answer. Students provided rationales for their
answers and the instructors could provide clarification.
During another session, students became ‘‘temporary
lecturers.’’ First the class was divided into three big
groups and each group was assigned one of three short
answer questions. Within each of the three divisions, the
students divided themselves into smaller subgroups of
5–6 and worked on preparing a presentation for the
question they were assigned. Any subgroup had the
chance of being randomly selected to present their answer (using an overhead projector) to the rest of the
class. The postdoc lecturers recapped the presentation
to help reinforce the learning.
We evaluated these sessions in three ways: participation, student ratings, and videotape analysis. The sessions were held from 4 to 5 P.M. on Fridays for the duration of the semester. The lecturers gave a 2-hour lecture
(2–4) and announced at 4 P.M. the beginning of the voluntary review session. Students rarely chose to leave. The
class rated the Friday sessions on a 5-point scale ranging from strongly disagree (1) to strongly agree (5) with
40% completing the evaluation. The students found the
sessions useful (mean of 4.36 (SD ¼ 0.72)), enjoyed
working in small groups (4.05 (SD ¼ 0.84)) and found
that sessions influenced ability to learn (4.35 (SD ¼
0.84)). The course received an overall rating of 4.49 by
the students.
Several of these sessions were videotaped. Review of
the videotapes verified observations made by the postdoctoral lecturers. In the large lecture sessions, students
389
TABLE II
Educational material
I In-class games: Cross word puzzle on the citric acid cycle
From Osgood M and Ocorr K (2005) The absoloute, ultimate guide to ‘‘Lehninger Principles of Biochemistry’’, 4th ed, W H Freeman and
company, New York.
were quiet, attentive, and focused. While initially reluctant
to abandon their roles as passive recipients in favor of
active participants in problem solving, this changed as
the students engaged in the interactive session. The videotapes showed extensive dialogue among learners
within the group and engagement with the larger group:
students enthusiastically volunteering answers, waving
hands and willing to come to the front of the room and
present their answers. This allowed the entire class to
join in, and even shy students who normally hesitated to
volunteer had answers. The students seemed particularly
excited about the possibility of presenting to their classmates, and listened very attentively to the presentation
conducted by their peers.
390
BAMBED, Vol. 36, No. 6, pp. 387–394, 2008
TABLE II
Educational material (Continued)
II Tutorial session problem set on Endocrinology
INTRODUCING PEER-ASSISTED LEARNING:
STUDENT-LED TUTORIALS
Although the pilot interactive review sessions were
successful at mobilizing students to work in small
groups, we believed that students would benefit from
individual instruction in organized small group tutorials.
However, neither faculty nor tutorial assistants were
available. To tackle this, we enlisted students to help
teach their peers. Peer-assisted learning is a successful
approach in facilitating student learning [8]. A recent
study reported that peer tutors struggled with basic facilitation skills, such as the ability to ask questions that
would lead to further understanding of the tutorial problem [9]. For this reason, the tutors were required to
attend a tutorial preparation session, having completed
the problem set that ‘‘their students’’ would be working
on (see Table II for an example of the problem set). This
consisted of new material that was not discussed in
class and was designed to highlight key lecture topics
and to emphasize their clinical relevance. The preparation session aimed at giving the tutors’ tips on conducting a more effective discussion during the tutorial, as
well as clarifying the material to be covered. The tutors
formed two small groups and worked through the problem set. The faculty member convened the whole group
and modeled conducting a discussion. Tutors saw how
to maintain a lively discussion and how to prompt with
leading questions without releasing the correct answer.
391
TABLE III
Peer teaching evaluation and Peer-tutor self evaluation
Question
Peer evaluation
Preparation
I prepared for the session (answered the problem sheet/ studied the topics beforehand)
The problem sheet facilitated my ability to learn lecture material
Group dynamics
I worked well in this small group
The interaction between small group members was good
Small group members explained concepts to each other
The peer teaching environment made it easy to ask questions/participate in discussion
Peer teachers (fellow students) are helpful
Tutor facilitation skills
My tutorial leader was prepared
My tutorial leader taught to my level
My tutorial leader created a comfortable learning environment
My tutorial leader maintained the order/flow of the discussion
Overall
Overall the session was well organized
I would recommend continuing this tutorial in the future
Peer-Tutor Self Evaluation
Preparation
Rate the extent to which the problem sheet facilitated your ability to learn lecture material
Rate how the faculty member helped you prepare for leading the tutorial session
Students’ preparation/participation
Rate the extent of participation of the small groups in the discussion you were leading
Rate the preparedness of the tutorial participants on the discussion topics/problem sheet
Tutor facilitation skills
Rate your preparedness for the tutorial session
Rate your ability to teach to the groups’ level of understanding
Rate your ability to create a comfortable learning environment
Rate your ability to maintain the order/flow of the discussion
Overall
Rate the overall organization of the tutorial session
Rate your overall experience in leading the tutorial session (usefulness/enjoyment
of the experience)
The faculty coached the tutors to encourage the participation of all the members of the group and to draw in
the shy students. Finally, tutors received extra reading
material and instructors’ notes with answers to the
problems.
A total of 167 (52% of the class) attended and evaluated the first tutorial session that we conducted.
Attendance was voluntary with 73% of nursing, 52% of
medical, 57% of pharmacy, and 45% of dentistry students attending. Students rated the tutorial on 13 items
(Table III). Peer-tutors self assessed their skills and the
tutorial on 10 items using a 5-point scale from strongly
disagree (1) to strongly agree (5) (Table III).
We calculated Pearson correlation coefficients among
the student items to examine the interrelationships of
preparedness, participation, and group dynamics on the
perceptions of the effectiveness of the tutorial (See Table IV,
Sections A and B). The correlations support that preparedness increased active participation during the session particularly when solving the problem set. The interaction
between small group members influenced the students’ experience during the session. Small groups in which group
members interacted well were better able to explain concepts to each other and elicited greater individual active
participation during the discussion.
Overall leader evaluation by the students positively
correlated with the students’ perceptions of peer teaching experiences (Table IV, Section C). The higher the
Mean
SD
% Agree or
strongly agree
4.29
4.58
0.79
0.56
86.5
95.8
4.45
4.56
4.56
4.58
4.61
0.68
0.69
0.58
0.59
0.56
94.0
94.0
95.6
96.3
96.3
4.58
4.38
4.46
4.51
0.54
0.72
0.65
0.56
97.6
91.4
94.5
96.9
4.44
4.60
0.67
0.65
90.3
94.0
4.86
4.71
0.378
0.49
3.57
3.14
0.79
0.69
42.9
28.6
4.00
4.29
3.86
3.86
0.54
0.76
0.90
0.90
71.5
85.8
57.2
57.2
4.14
4.43
0.69
0.54
75.7
100
100
100
leader was rated, the more favorable were the ratings for
the overall organization of the tutorial, the helpfulness of
peer teaching and the ability of group members to interaction explain to each other and actively participate.
The peer-tutors who completed the post-tutorial evaluation also included comments on the questionnaire such
as; ‘‘I think the whole thing is great, enjoyed doing it
even though I didn’t have that much experience in leading small groups, I think I want to do this more . . .’’ ‘‘It is
a great idea to have a tutorial session where fellow
student teach each other and creating a comfortable
environment for students without being hesitant to ask
questions or contribute to the discussion.’’ All the tutors
recommended the continuation of tutorials and indicated
their interest in continuing to be involved as a tutorial leader.
PEER-ASSISTED LEARNING: IMPROVING COMPUTER SKILLS
Most MUHAS students did not have a biochemistry
textbook. The library, which the students had limited
access to, also had extremely limited biochemistry textbooks. The postdoctoral fellows were aware of the
wealth of online learning resources, including free textbooks, journal articles, biochemistry lectures, and practice MCQ. A few students were very skilled at using
computers while others had never operated a computer
before. The postdoctoral fellows developed and had
knowledgeable students teach a basic IT course as a
392
BAMBED, Vol. 36, No. 6, pp. 387–394, 2008
TABLE IV
Correlation among items
All correlations significant at p < 0.05.
pilot to teach other students core skills, so students
could access the Internet and e-mail, use software programs including word processing, and manage electronic
files. Each course had a 30 student capacity and was
repeated three times to accommodate the high demand
for the course during the pilot phase.
The course consisted of four, 2-hour sessions led by a
peer student instructor facilitated by three peer teachers
who helped students at their computer terminals to enable ‘‘hands on’’ experience. The student instructors conducted the course in Kiswahili since many students with
limited computer experience also had lower English pro-
TABLE V
IT course evaluation by students
Question
Overall evaluation
Rate the course organization
Rate the usefulness of written material
Rate the overall quality of instruction
Effect of IT course on perceived skills
The course improved my knowledge of computer parts
The course improved my ability to get to programs
The course improved my ability to handle files
The course improved my ability to use Microsoft word
The course improved my ability to navigate the Internet
The course improved my ability to access my e-mail
The course encouraged me to keep working on IT skills
Mean
SD
3.82
3.73
4.18
1.17
0.79
0.88
4.27
4.36
4.18
4.18
4.36
4.36
4.27
0.65
0.67
0.98
0.98
0.67
0.67
0.79
% very good or excellent
63.7
72.7
72.8
% Agree or strongly agree
90.9
90.9
81.9
81.9
90.9
90.9
81.9
393
ficiency. Student leaders maintained an informal environment where the learners felt comfortable to ask questions or ask the instructors to repeat if they had not
understood the first time. The students also received a
course syllabus with detailed instructions on the core
topics to guide them during future computer labs use.
The IT course pilot was evaluated by a subset of students who had attended the course. This particular
cohort consisted of 15 nursing students, 67% of whom
attended all four session. Students provided favorable
ratings of the course (see Table V ). Course organization
was highly correlated with the usefulness of written material (r ¼ 0.70) and the overall quality of instruction (r ¼
0.80). The students also commented on the helpfulness
of the peer teachers, 100% found peer teaching useful
and 90% found it helped to have the sessions conducted
in Kiswahili. The main criticism of the course was its
brevity. Students reported subsequently visiting the lab
daily to access the Internet and weekly to e-mail and
create word documents.
DISCUSSION
This article describes alternative ways to teach 350
Biochemistry students in an environment with limited
resources. These challenges were not limited to Tanzania
or even Africa; some institutions in Europe and in the
United States face similar limitations on faculty resources
and often have similarly large classes. As guests, the
postdoctoral fellows were able to initiate limited pilot
efforts to introduce small group learning within the large
classroom and peer assisted learning to provide additional teaching resources to students at MUHAS. The
efforts were low cost, practical, and sustainable strategies that may be applied in any setting and can give
educators an insight on means to overcome these challenges to improve learning in their own classes.
The strategies introduced were different from the traditional teaching model at MUHAS by digressing from customary large class teaching and involved students in their
learning. The faculty-student relationship at MUHAS to a
certain degree lacked cooperation [10]. Faculty wanted
students to work hard for their learning and disapproved
of ‘‘spoon-feeding’’ and perceived students as complainers about the workload looking to cut back on their
studying. These pilot efforts demonstrated that students
were capable of taking charge of their learning and
assisting each other within the classroom setting.
The postdoctoral fellows wanted students to acquire
desirable attributes gained when moving from large
lecture settings to small groups such as team working
and communication, sharing of information, and problem
solving [11]. Additionally, we wanted to develop a more
positive relationship between the teacher and student
and encourage the type of interaction in class that does
not ‘‘put students on the spot’’ and make them feel
judged and evaluated. While we provided some types of
interactive sessions, there are other models to consider
in the biochemistry classroom. One example is a casebased approach where students work on cases rather
than problem sets [12]. In another approach, students
watched a trigger video followed by work in small groups
in the large classroom. Researchers found no difference
in the educational outcomes between those students
and ones who had a traditional tutor-led small group
problem solving sessions [13].
We piloted several peer-led approaches. Peer-assisted
learning is increasingly utilized as a resource within education where the restrictions on resources forced teachers to look at creating new educational environments
which can be delivered at a lower cost [14, 15]. A recent
study examined the effectiveness of using students as
tutors and showed no difference in educational outcomes between students who received student-led
tutorials and those who receive faculty-led tutorial [16]
provided that the tutors were adequately trained as facilitators. In fact, student tutors were perceived to be better
in understanding the difficulties students face in tutorials
[17, 18]. Both of our peer-assisted learning activities
were ranked favorably by students and considered as a
valuable activity that they would recommend to other
students. The peer tutors thought that it was a valuable
teaching opportunity which improved their understanding
of the topic, which was an additional educational benefit
to this approach. In fact, other studies have shown that
peer tutors demonstrate greater cognitive gains than their
peer learner counterparts [19]. Further follow up studies
need to be done to measure the effectiveness of our
interventions relating to student outcomes and to determine if the strategies have been taken on in other
departments at MUHAS facing the same teaching shortages.
Our third intervention aimed at improving basic computer literacy among the first year students. We believe
that improving IT knowledge among undergraduates will
not only increase the students opportunities for selfdirected learning by tapping into the rich online biochemistry educational resources, but will allow faculty to
enrich the curriculum with more interactive education
technology (ET)-based learning activities so that the students can learn more efficiently. In developing countries,
ET activities in undergraduate curricula are not widely
used due to limited facilities, unavailability of computers,
or poor Internet connectivity [20]. While MUHAS has
improved computer capacity [21], most of the enrolling
students have very little if any IT literacy. Our pilot, student-run IT gave all the students the opportunity to use
computers by engaging computer literate students to
organize, run, and teach this course. The course became
very much in demand, highly recommended, and appreciated by both students and peer teachers. We believe
that this pilot not only demonstrates a practical and sustainable way to improve the students’ computer skills at
MUHAS but also empowers students to explore their
leadership skills and create changes to enhance their
learning and benefit their institutions.
In summary, we have described initiatives that help to
address critical issues in biochemistry education when
classes are large and resources are limited. We have
focused on creating student interactions where learning
occurs among peers. These activities were favorably
received and engaged students in their own learning. Our
394
BAMBED, Vol. 36, No. 6, pp. 387–394, 2008
pilot studies demonstrate that peer-assisted learning is a
large potential resource which if properly harnessed can
address some of the limitations that come with insufficient teachers.
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