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 Table of Contents  
Year : 2022  |  Volume : 11  |  Issue : 2  |  Page : 68-72

Perceptions of medical students on a three-step teaching approach to promote active learning in embryology

1 Assistant Professor, Department of Anatomy and Neurobiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman
2 Professor, Department of Biochemistry, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Sultanate of Oman

Date of Submission15-Feb-2022
Date of Decision19-Apr-2022
Date of Acceptance26-Apr-2022
Date of Web Publication26-May-2022

Correspondence Address:
Smitha Elizabeth Kore
Department of Anatomy and Neurobiology, College of Medicine and Health Sciences, National University of Science and Technology, Sohar
Sultanate of Oman
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/NJCA.NJCA_43_22

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Background: The study of embryology is an essential component of the anatomy course during the preclinical years of medical education. It is usually perceived as difficult to comprehend due to the rapid three-dimensional changes that occur during fetal life. Visual representation while explaining the developmental process can facilitate comprehension. Active discussion with peers is another important learning aid that can help with better retention of the concepts taught in embryology. The present study was conducted with an objective to evaluate perceptions about the three-step active learning in embryology using “do it yourself (DIY) construction models” as props, reciprocal peer tutoring (RPT) sessions, and case discussions. Methodology: A descriptive cross-sectional study was conducted on 80 students attending the embryology lecture on the gastrointestinal tract development. In step-1, the traditional lecture was delivered using a PowerPoint presentation which was complemented by three-dimensional (3D) visualization using “DIY” construction models used as props. Step-2 RPT session step-3 application exercises using real-time cases. Feedback was taken on a questionnaire administered using a 5-point Likert scale. Results: The descriptive analysis of the feedback revealed that most of the students were satisfied with the different active teaching strategies employed to conduct the sessions. The Chi-square test analysis showed a significant association between the questions posed in the feedback questionnaire. Conclusion: Our study provides insights into the importance of multiple active teaching techniques in learning embryology. The impact usage of props (DIY models) enhanced comprehension, peer teaching sessions helped the students to bridge the cognitive gaps, and case-based learning promoted critical thinking, and problems-solving skills.

Keywords: Development, embryology, models, peer review, teaching methods

How to cite this article:
Kore SE, Begum GS. Perceptions of medical students on a three-step teaching approach to promote active learning in embryology. Natl J Clin Anat 2022;11:68-72

How to cite this URL:
Kore SE, Begum GS. Perceptions of medical students on a three-step teaching approach to promote active learning in embryology. Natl J Clin Anat [serial online] 2022 [cited 2022 Aug 10];11:68-72. Available from: http://www.njca.info/text.asp?2022/11/2/68/346076

  Introduction Top

The study of embryology forms a substantial component of the anatomy syllabus for the undergraduate course. It helps in better understanding the human body's overall structure. It is considered a powerful supplement to an extensive knowledge of gross anatomical patterns.[1] It greatly aids to bridge the gap between fetal development, pediatrics, and clinical anatomy.[2] Undergraduate medical students usually find the study of embryology difficult to comprehend; this predicament in turn may lead to poor retention of the concepts.

Effective teaching methods are essential to create an environment that facilitates deep learning. To promote effective learning, an outcome-centered method is needed along with student-focused learning, which in turn will incite excellent cognitive engagement with the topic being taught.[3] According to Bender, interactive teaching can be effective when the lecturers guide their students to develop study skills and promote desirable attitudes toward education.[4] The study has shown that students, in general, show a predilection for visual and sequential learning. They show a preference for learning that is delivered as demonstrations using pictures and diagrams in a step-wise manner.[5]

As a facilitator, the teacher needs to employ multiple teaching techniques to address different types of learners as far as possible.[6] Students generally show a preference for PowerPoint-type presentations rather than traditional lectures, this may be because PowerPoint-type presentations provide better visual clarity, and the colorful illustrations can captivate the audience's attention for a longer period.[7] Demonstrations often help students comprehend and retain new concepts, especially when teachers try to convey intricate topics and those that occur in sequential order. The demonstrations are considered of greatest benefit if they are of short duration, are inexpensive, and convey the information thoroughly. In addition, students should be able to repeat the demonstrations independently when needed.[8]

Reciprocal peer tutoring (RPT) is described as a form of collaborative learning that involves students from similar academic years experiencing the roles of both tutor and learner by interchanging. It enables students not only to self-learn but also simultaneously it contributes to peer learning. The tutor and the tutee in the course of learning end up sharing mutual experiences, thus reducing power differences.[9] The RPT approach has shown improved learning in teaching gross anatomy. Other benefits of RPT seen were, promoting students' active learning through personal interactions, a better understanding that resulted from sharing-related discussions between peers, and reinforcement of learning by instructing others.[10] The advantages of student learning through RPT prompted us to use it as a tool in reinforcing the embryology topics.

The study of embryology not only helps us understand the normal development of the human body but it also helps us understand the cause of the congenital anomalies that occur during birth. The teaching of embryology without explaining the clinical relevance is a task incomplete. Discussions using clinical case scenarios are an excellent way to generate interest in the subject; it also assists in understanding the relevance and application of the concepts taught in the clinical setting.[11]

The reported session was conducted to improve the comprehension and retention of the embryology concepts taught using active teaching-learning strategies that included using “do it yourself (DIY) construction models” as props during teaching, review of the topic through RPT administered as role play, and learning the clinical aspects of the topic through case-based discussion. The present study was conducted with an objective to evaluate perceptions about the three-step active learning in embryology using DIY as props, RPT sessions, and case discussions.

  Materials and Methods Top

Eighty MD3 students of the 2019–2020 batch attending the lecture on gastrointestinal tract (GIT) development were included in the study. Nearly 92% of the participants were female as the college caters predominantly to female students. The mean age of the participants was between 20 ± 2 years. The college of medicine and health sciences offers an MD program which is a 7-year undergraduate medical degree. The 1st year is a foundation course. Years 2- and 3-MD1 and MD2 are premedical courses. MD3 and MD4 are preclinical years 1 and 2. MD5 and MD6 are clinical years. Anatomy courses with gross, histology, embryology, and osteology are termed as human structure courses taken by the MD3 (preclinical year 1) students.

Study design

A descriptive cross-sectional study was carried out on 80 MD3 (year 4) students.

Sample size calculation

The minimum sample size was calculated as 80 using Raosoft R software with a confidence level of 95%, a margin of error of 5%, and a response distribution of 50%.

The study participants were informed about the details of the session, and students who consented to attend the class. The Institutional Research and Ethics Committee approval of the institution was obtained (registration number: NU/COMHS/EBC0021/2020), and the study was carried out in line with the Helsinki protocol.


This study was divided into three steps, followed with the evaluation of the students' perceptions [Figure 1]. The topic chosen was GIT development, which was a part of the syllabus to be covered for the human structure course.
Figure 1: Flowchart showing three steps of the session

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The learning session was conducted in three steps each of 50-min duration with a break of 15 min in between the phases.

Step 1: Preparation of (do it yourself) construction models

Using the recommended textbooks, the traditional lecture was prepared and delivered using a PowerPoint presentation; this was complemented with an animation video depicting the development changes followed by a three-dimensional (3D) visualization using props like DIY models. These props used as teaching aids facilitate the students to understand difficult concepts in the development process of the stomach and the midgut, which involves the rotation of the organs. A DIY model of the stomach and its mesentery was prepared with a simple card box and paper, whereas to explain the rotation of the midgut, a flexible steel pipe was used [Figure 2].
Figure 2: (a) Prop prepared with cardboard to explain rotation of stomach. (b) Flexible metal pipe representing midgut loop, used as prop to explain the rotation of midgut

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Step 2: Reciprocal peer tutoring

To reinforce the topic, peer teaching was planned. Four students were guided and trained on the allotted topics a week before the session and were also asked to prepare a summary of important aspects of development. Peer tutoring is done under supervision using the teaching aids such as PowerPoint presentations, props, and role-play to reinforce the topics.

Step 3: Case-based learning and discussion

Application exercises in the form of cases scenarios with questions were given to the students. After the lecture and RPT, the students formed small groups to discuss the cases. Later, all the small groups discussed the cases with the facilitators.

The Kirkpatrick's evaluation model of teaching and learning was used to evaluate this model. It has four levels: reaction, learning, behavior, and results. In the present study, the evaluation was conducted at the level of reaction and learning.[12]

The questions asked in the feedback questionnaire along are depicted in [Table 1]. After reviewing the literature, a questionnaire was developed and was internally validated by three subject experts. The evaluation of the session was performed on a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree). The data were collected, tabulated, and statistically analyzed. The questionnaire was released online on the college learning management system SOLE (secure online learning environment) and was completed by students who attended the session immediately after the session ended. According to reliability statistics, Cronbach's alpha value was 0.739, indicating a good internal consistency for the scale for the learners' perceptions. Statistical analysis of the questionnaire is depicted in graph 1. Statistical analysis was done using IBM SPSS version 25 (IBM Corp, Armonk, NY).
Table 1: Questions asked in the questionnaire

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  Results Top

About 93.8% of the participants agreed that using DIY props as models in the lecture helped them understand the topic better. 70% of the participants agreed that after the review by their peers they effectively understood the topic. 75% of the participants agreed that the case discussion with their peers helped them correct their mistakes and it also increased their understanding of the concepts. Overall, 83.75% of the participants agreed that this type of active learning helps them to understand embryology better [Figure 3].
Figure 3: Response of the students to the questionnaire; Q = question no as mentioned in Table 1 (n = 80)

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Association between the questions

The Chi-square test was applied to determine whether observed frequencies are significantly different from expected frequencies (null hypothesis) [Table 2].The results of the Chi-square test showed most of the question statements to be significant, which reaffirmed that the observed frequencies of the students' responses are statistically significant.
Table 2: Association between the questions as observed with Chi-square test

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  Discussion Top

Our study provides insights on the importance of multiple active teaching techniques such as props (DIY models), peer review, and case discussions as reflected in the students' responses. The impact of props (DIY models) and enhanced comprehension of the topic taught through lectures were reflected in the students' responses. Peer teaching sessions helped the students to bridge the cognitive gaps in their understanding as reflected in the students' responses. Case-based learning with small group learning followed the educational theory of cooperative learning with inquiry-based learning, students discussed, using critical thinking, and problems-solving skills in answering the questions related to the case scenarios, and it is reflected in the students' responses.

Lectures are the common mode of instruction in medical education but are often criticized as they tend to be centered around the teacher and provide students with few opportunities to reflect on their learning.[13] It is even more challenging when the dynamic changes that occur during the developmental process are explained in a lecture using two-dimensional (2D) images. The failure of a 3D visualization of the intricate developmental process can be the reason why most of the students find the study of embryology challenging. Failure to comprehend may also be the reason why most of the students avoid studying the subject and thus end up performing poorly in the examinations.[14] Nevertheless, lectures do not engage students, but still, they have a place in learning anatomy, as they cover wider specific learning outcomes in a limited time. These can be made effective by planning interactive lectures for more meaningful teaching-learning experiences.

Interactive lecture allows students to participate actively in the session and helps them process the information effectively. It also increases motivation, student attention, and can initiate critical thinking.[13] In general, the student's attention in any lecture is for 20 min,[15] in order to maintain their interest, activities of a small duration can be planned in between the lectures. These activities should increase students' attention and aid in better comprehension of the topic taught. Slide sets must be modified to teach and repeat key points, first through a lecture and then through visual illustrations to effectively cater to the didactic teaching and visual learners.[16]

Tamari et al., in their study to analyze the role of props as instructional tools in lecture execution, found them to be valuable tools to promote active learning. The use of prop in demonstrations is found to be kinesthetically and cognitively engaging as they provide an opportunity for students to easily conceptualize concepts that may otherwise be difficult to understand.[8]

The use of DIY models as props in the present study was one of the means by which the lecture was made interactive, and a visual presentation was facilitated so that students were able to appreciate the rotational changes that take place during GIT development.

In embryology, clinical terms that are remotely appreciated elsewhere in medicine are used; hence, it becomes essential to specify definitions early and ensure retention through repetition.[16]

The review of the topic may not be effective if it is administered again as a lecture, students would prefer different modalities of administration for repetition of the topics. Studies found that students preferred pedagogical approaches such as small group discussion, case-based learning, team-based learning (TBL), peer tutoring, and flipped classroom, as these sessions need the student to play a more active role in learning.[15]

Three-dimensional animations and peer teaching have also been utilized as a means to boost student confidence in the comprehension and retention of embryology.[15] Studies have been reported where RPT was used as a mode of teaching in gross anatomy laboratories.[10] Although an effective aid, RPT has been rarely used as a teaching–learning aid. Jwalant et al. reported that conducting gross laboratory demonstration using RPT where the students in rotation were trained to teach their peers. The results of their study indicated that RPT not only improved learning but it also aided in retention of the topic.[17] In the present study, RPT was the preferred method to administer the review of the topic to and thus facilitate retention of the topic taught.

Another important active teaching methodology that can help in generating and maintaining interest in the topic is the use of role playing. Sturges et al. investigated the effectiveness of using role play in physiology class, they found it as an activity that greatly helped in student engagement.[18] Role play creates an atmosphere where students get a chance to understand the topic in a relaxed environment and when executed by their near peers gives them a chance to interact with them freely. It also helps them have a visual representation of the events that occur during the development process, which can further aid in strengthening the retention of the topic.

Student's interest in embryology can also be ignited by making the students understand the clinical importance of the topic taught. One of the best ways to arouse this interest can be done by initiating discussions of case-based scenarios. Scott et al. conducted a study to assess the attitudes of final-year medical students on learning embryology with clinical scenarios. They reported that the majority of the students expressed that teaching with case-based scenarios helped them not only in better learning but had also assisted them in understanding clinical management.[11] Ginani et al. reported the effectiveness of teaching embryology using clinical cases in a virtual environment. They expressed that the use of case studies in medical education is cardinal and contributes to the necessary organization of the details by the student, which will be essential in clinical reasoning and application.[19]

Other methodologies, such as problem-based learning and TBL activities, have also been used as methods to teach embryology using case scenarios. The authors have reported that the use of clinical cases through these modalities helped in improving students' performance by creating an active learning environment.[20],[21]

Learning using various reception channels can be effective, as the prefrontal cortex is activated when the stimulus enforced as short-term memory progresses into long-term memory. This was evidenced in the study conducted by Aversi-Ferreira et al. where 60 students were involved in the construction of embryonic models during the practical classes of embryology course. The students expressed that such activities helped them not only learn embryology but also enabled them to be self-learners, develop social relationships, and gain problem-solving ability.[22]

The use of technology in teaching the process of development in embryology has also been explored. 3D atlas and augmented reality have been utilized to teach the various developmental process in embryology.[23],[24] Alfalah et al. explored the use of Maya software and Unity engine to create a VR system containing a model of the human embryo. The model was created to demonstrate the development of the human embryo from fertilization to week 10 of intrauterine development in an interactive fashion.[25] In institutes where there is a limitation in using audiovisual aids, the teacher can make use of the various simple, cost-effective, and feasible teaching–learning methods used in the present study to create interest, enhance comprehension, and promote retention of the topics taught in embryology.

Limitations of the study

The present study was based on a single session and with no control cohort for comparison. More time is required for the preparation and execution of the session which might be sometimes difficult to implement with the cramped schedules.

Most of the students enrolled in the study were females; usually, 94%–96% of the students registering for the MD undergraduate program are usually females.

  Conclusion Top

Interactive lectures using PowerPoint, animation videos, and props are an effective teaching method for better comprehension of the developmental aspects of embryology. Further cognitive gaps are filled by peer tutors through RPT. Case-based learning sessions drive the student for inquiry-based learning, developing critical thinking, and problems-solving skills facilitating long-term retention of the topic. These active teaching–learning strategies not only help the students in better understanding and retention of embryology but also help them to develop interpersonal relations, collaborative learning, self-directed learning, and problem-solving skills.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2]


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