A questionnaire was administered in English to two consecutive groups of third-year medical students in the Shifa College of Medicine. The survey contained 21 closed questions, of which two were related to income group and gender, and three open-ended questions. This survey was conducted during the cardiovascular module of the third-year class in 2011 and 2012. Ninety-eight students in the 2011 group were surveyed three times each, at the beginning, midpoint, and end of the cardiovascular module, whereas 99 students in the 2012 group were surveyed at the beginning of the cardiovascular module. Quantitative data was analyzed with SPSS version 17 (SPSS Inc., Chicago, IL, USA). Homogeneity test for questions dealing with the importance of attendance were performed. Goodness of fit test for students’ responses to questions dealing with teaching strategies and for students’ perception of instructional practices were done. P-values less than 0.05 were considered to indicate statistical significance. Qualitative data were analyzed in terms of the percentage of the students who gave the same response.

The total number of participants was 314, including three sets of responses from the 2011 group and one set of responses from the 2012 group. Of the participants, 55% were female and 45% were male. Their parents belonged to the middle class, with average monthly incomes of PIKR 100,000-500,000 (USD 1,000-5,000). A total of 188 students (69.1%) said that class attendance is important, whereas 32 students (11.8%) said that class attendance is not important since it reduces motivation and that attendance should be optional; uncertain, 52 students (19.1%) (Table 1). The students who were aware that attendance was important for learning believed that it lead to improved learning, improved performance, and higher grades; while, the students who thought that attendance was not important believes that it did not lead to improved learning, improved performance, and higher grades (Table 1). The attitudes of students towards attendance did not depend on instructor, topic, or type of delivery. Moreover, the students indicated that they are willing to attend class even if the teaching material is available online (Table 2). A majority of students said that small group discussions are the most informative (63.7%, P=0.000) and that they found this method of teaching to be the most interesting (56.5%, P=0.000), as compared to reviews, lectures, and large-group interactive sessions. All knowledge delivery techniques were assessed positively, including large-group interactive sessions, problem-based learning, reviews, lectures, objective structured clinical examinations, skill- based lab sessions, outpatient department learning, and inpatient observation. Students had a negative opinion about student presentations in class and journal club. They indicated that they would like to utilize most of their time for self-directed study, study in the classroom, studying online, studying from textbooks, evidence-based study, lab work, operational theater observation, inpatient department learning, and outpatient department learning (Table 3).

Corresponding to the results of previous studies, students perceived active learning through case- based group activities more positively than traditional lectures [1]. Most students in this study also preferred case-based learning and stated that it enhances their learning. A high rate of regular attendance and consistently good test results indicated that the team-based learning concept was widely accepted among this group. Large-group interactive sessions were also perceived as very useful by the surveyed students, as shown in Table 3. Therefore, a correct mixture of instructional practices and tools is essential for the optimal achievement of learning objectives. The answers to the open-ended questions in our study expressed positive attitudes, and there were no inappropriate or particularly negative remarks. Students also suggested that appropriate leave policies should be developed for students who have genuine problems in order to compensate for possible missed attendance. In conclusion, the students had a positive perception of a variety of instructional practices, and small-group activities received a particularly positive assessment. Programmatic improvement in the implementation of instructional practices might incentivize better attendance.