|Year : 2016 | Volume
| Issue : 1 | Page : 4-9
Students' perception of quality of medical education in a medical college in west Bengal, India
Dipta Kanti Mukhopadhyay
Associate Professor, Department of Community Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
|Date of Web Publication||23-Feb-2016|
Dipta Kanti Mukhopadhyay
Lokepur, Near NCC Office, Bankura - 722 102, West Bengal
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Students' perceived quality of educational service is an important field of educational research. Objectives: To identify the gaps in the quality of educational services as perceived by students in a medical college in West Bengal, India. Materials and Methods: In a cross-sectional study, educational quality was measured using validated SERVQUAL instrument between two randomly selected groups of undergraduate medical students (n = 179). This five-point Likert scale questionnaire measured the expectation and perception of students on 26 items under five dimensions of quality of educational services, viz., tangible (physical facilities, equipment, and appearance of personnel), reliability (accuracy and consistency of a department in providing educational services), responsiveness (eagerness to help and commitment), assurance (ability of teaching departments to earn students' confidence), and empathy (ability to communicate care and understanding). Dimension-wise difference in the mean scores for expectation and perception was calculated and was considered as quality gaps in educational services. Results: Significant negative quality gaps were noted in all five dimensions. The highest gap was found in tangible (-1.67) followed by empathy (-1.64) although the mean score of perceived quality in the dimension of empathy was the lowest (2.53). This indicates the need for improvement in physical facilities as well as behavior of teachers and staff toward students. The smallest gap was noted in the dimension of assurance (-1.29), which indicates the students' overall confidence in teaching departments regarding their management or content expertise. Conclusion: These findings underscore students' aspiration for the overall improvement of educational services that can be taken into consideration during development planning.
Keywords: Medical education, quality, SERVQUAL, students′ perception
|How to cite this article:|
Mukhopadhyay DK. Students' perception of quality of medical education in a medical college in west Bengal, India. Indian J Public Health 2016;60:4-9
|How to cite this URL:|
Mukhopadhyay DK. Students' perception of quality of medical education in a medical college in west Bengal, India. Indian J Public Health [serial online] 2016 [cited 2020 Feb 24];60:4-9. Available from: http://www.ijph.in/text.asp?2016/60/1/4/177256
| Introduction|| |
Medical education is primarily meant to serve medical students although the ultimate goal is to ensure quality health care to the community. The Medical Council of India, universities, colleges, teachers, students, and the community are the stakeholders of medical education in India. Collaboration of these stakeholders is necessary for improvement of the quality of medical education, particularly in a country, which produces around 50,000 qualified doctors per year.  The perception and expectation of stakeholders are crucial for collaboration. However, in India, there is little opportunity to consider the views of students and the community during planning and implementation of medical education. Educational service quality emphasizing the students' view is an important field of educational research. It is not only related to students' performance but also can be a useful basis for improving the quality of the educational service itself. ,
Perceived quality is the judgment about excellence of a service from the point of view of the expectations of people using that service.  SERVQUAL, a multiple item scale with established validity and reliability, has been used to measure the service quality as a gap between consumer perception and expectation of services in different settings including higher education although students cannot be seen as "consumers" in the same way as a person who buys a commodity in a shop. ,,
Studies highlighting the issue of students' perceived quality gaps in medical education, which might sensitize policy makers and administrators to their needs, are reported from other countries but are scarce in India. ,,
The objective of this study was to determine the quality gaps within educational services as perceived by the medical students using an instrument based on the SERVQUAL model in a Medical College in West Bengal, India.
| Materials and Methods|| |
Study design and duration
A cross-sectional descriptive study was conducted in Bankura Sammilani (B.S.) Medical College, Bankura in West Bengal from May 2010 to April 2011.
Development and validation of questionnaire
The instrument (SERVQUAL) was modified for adaptation in the present setting to measure the students' perceptions and expectations of the service quality of medical education along five dimensions: Tangible (physical facilities, equipment, and appearance of personnel), reliability (accuracy and consistency of a department in educational service provision), responsiveness (eagerness to help and commitment), assurance (ability of teaching departments to earn students' confidence in a professional manner), and empathy (ability to communicate care and understanding).  Based on the theoretical construct of the instrument, four focus group discussions were conducted with students who were not selected in the study to identify items of educational quality under the abovementioned constructs. Similarly, in-depth interviews with 15 medical teachers having a formal training in medical education technology were conducted to identify items on essential quality of medical education. The items proposed by the students and teachers were reviewed and a harmonized version of the questionnaire was developed with 41 items. Through the Delphi technique, with the help of seven medical education specialists, a final version of the questionnaire with 26 items was prepared. Using the instrument, the students were asked to rate their perception about the quality of educational services in a five-point Likert scale (very good, good, moderate, poor, and very poor). They were also asked to rate their level of expectation on each item in a five-point Likert scale (very important, important, moderate, less important, and least important). Each item was scored from 1 to 5 with very poor/least important as 1 and very good/very important as 5 and others in between. In each dimension, the score of individual items was added up and the sum was divided by the number of items in that dimension to get a mean score. The mean score of each dimension of the study population was calculated in both the perceived and expected services of education.
Expectation and perception questionnaires in the five-point Likert scale were pilot tested among 100 students outside the study population representing two year groups. Five principal constructs, similar to theoretical constructs were yielded on principal component analysis with varimax (variance maximization) rotation in both the expectation and perception scales having a minimum loading of 0.34 [Table 1] and [Table 2]. The extraction method used based on eigenvalue greater than 1. All the items except item no. 9 showed maximum loading in the concerned theoretical dimensions. Item no. 9, though theoretically considered in the reliability dimension, showed higher factor loading in the responsiveness dimension.
|Table 1: Rotated factor structure and domain-wise Cronbach's alpha for expectation scale|
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|Table 2: Rotated factor structure and domain-wise Cronbach's alpha of perception scale|
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After redistribution of items based on principal component analysis, dimension-wise internal reliability were examined with Cronbach's alpha. In the expectation scale, values of Cronbach's α were 0.78, 0.76, 0.78, 0.82, and 0.86 for tangible, reliability, responsiveness, assurance, and empathy, respectively [Table 1]. Similarly, as noted in [Table 2], all five dimensions of the perception questionnaire were found to be internally reliable (Cronbach's α was 0.75, 0.83, 0.85, 0.69, and 0.74 for tangible, reliability, responsiveness, assurance, and empathy, respectively).
Test-retest validity was examined in a small group of students (n = 25) with a washout period of 2 weeks and weighted kappa value for each item was above 0.8.
The validation of questionnaire establishes that the questionnaire was internally consistent, reliable, and valid in the present sociocultural setting.
Study subjects and method of data collection
In this study, two year groups with 199 enrolled undergraduate medical students were selected randomly out of five year groups. In small group teaching classes, after taking written informed consent, the anonymous self-administered questionnaires were distributed among students. They were requested to submit the filled up questionnaires in a box kept in the classroom. Absentees were recorded from the attendance register and they were retrieved in three consecutive visits.
Medical teachers attached to the institution with an experience of 5 years and above were also requested to express their expectation and perception of the quality of medical education in the same questionnaire.
In both the expectation and perception scales, dimension-wise mean score was calculated. The difference between the mean score in the expectation and perception scales in each dimension was considered as "quality gap" and Wilcoxon signed-rank test was applied to check whether the differences were significant or not.
Ethics: The study obtained clearance from the Institutional Ethics Committee of the concerned medical education institute.
| Results|| |
The total number of enrolled students in the selected classes was 199. In the present study, 179 (89.9%) students participated, out of whom 33.3% were females. Among the study subjects, 50.5% were 3rd Professional Part I students and the rest were from the 2nd Professional Bachelor of Medicine, Bachelor of Surgery (MBBS).
Provision of handouts after class (item no. 9 under "reliability"), out-of-class consultation (item no. 18 under "responsiveness"), and of giving anonymous suggestion to departments (item no. 23 under Empathy) were considered as of moderate importance by the students with score less than 4 [annexure 1[Additional file 1]]. The remaining 23 items having scored more than 4 indicated that they were considered as important by the students. All five dimensions of quality as per SERVQUAL concept were regarded as important (score ≥4) by the students. There was no significant difference in expectation by gender or class.
In eight items such as neat and professional appearance of teachers, clarity of teaching materials, developing clear concept by attending class, regular classes, timeliness in teachers, easy accessibility of teachers as well academic heads and adequate preparedness of the teacher for the class (item no. 1, 7, 8, 10, 12, 13, 14, and 21 as shown in Annexure 1), the quality of existing services was perceived as moderate (score 3-4) by the students, whereas in the remaining 18 items the services were perceived as of poor (score 2-3) or very poor quality (score <2). Assurance was the only dimension where the perceived quality of services was moderate. In the remaining four dimensions, the mean scores were less than 3 and more than 2, which indicated that those services were perceived as poor. Significant difference by gender or class was also not found in perception.
In all five dimensions, expectation of students exceeded their perceived quality of existing educational services [Table 3]. Highest gap was found in the dimension of tangible (−1.67) indicative of physical facilities, equipment, and appearance of the personnel followed by the dimension of "empathy" (−1.64), the ability to communicate care and understanding of students. The lowest gap was found in Assurance dimension (−1.28), which means the ability to earn students' confidence. Highest quality gaps (two or more) were found in four items (No. 23, 4, 3, and 2) out of which three items were from the "tangible" dimension.
|Table 3: Domain-wise quality gap in educational services as perceived by study participants|
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Twenty teachers filled up the questionnaire. They considered all items (item no. 5, 16, and 22) and all dimensions in the expectation scale as important (average score ≥4). In 11 items of the perception scale, the existing services were considered as moderate to poor (average score 2-3) and in rest items the services were considered as good to moderate (average score 3-4). According to the teachers, significant negative quality gap persisted in all SERVQUAL dimensions (P < 0.001), the highest being in tangible (−1.64) followed by empathy (−1.53).
| Discussion|| |
The study showed that the students felt quality gaps in all 26 items under five SERVQUAL dimensions. It was evident from the study that students' perceptions of existing services lagged behind their expectations. Similar findings were noted by Aghamolaei et al., Kebriaei et al., and Mosahab et al. among medical students and students in higher education institutes in Iran, and Chopra et al. and Chua C in higher education institutes in India and Canada, respectively. ,,,, Negative quality gap in SERVQUAL domains except tangible was reported by Ruby CA while Abili et al. noted negative quality gaps in only three dimensions, namely, tangible, reliability, and empathy. , Ramakrishnan et al. in India found positive quality gap in the responsiveness dimension and negative quality gaps in the rest of the four dimensions.  Gholami et al. in Iran found negative quality gaps in all dimensions and all but one item. 
Tangible was the domain where students perceived the highest quality gap. It was revealed that students were not happy with the physical facilities, availability of educational aids, audiovisual tools, and appearance of their faculty members. The issue of physical facilities is a matter of real concern in medical teaching institutes in India and other countries. , However, this finding differs depending on the setting. In contrast to the present study, Ruby noted positive quality gap in tangible, which means that the perception of students about physical facilities exceeded their expectations.  The highest quality gap was reported in the dimension of "responsiveness" in two Iranian studies and "assurance" in a Canadian study. ,,
The present study also noted the high negative quality gap in empathy that was in corroboration with Chopra et al. and Ramakrishnan et al. in India. , In the present setting, students perceived that the lowest quality of services was provided in the dimension of empathy even despite their low expectation in this dimension. The lowest perceived quality of service was recorded for the item under this dimension concerning the provision of anonymous suggestions to the department. This perhaps suggests a lack of capacity among college teachers and staff to communicate care and understanding. Awareness of teachers and staff regarding this issue followed by capacity-building can address this dimension of educational services.
Earlier studies in India and Canada noted the lowest negative quality gap in assurance dimension that was similar to the present study. ,, It means that the college and teachers are close to the students' expectations in enjoying their confidence. However, Chua, Aghamolaei et al., Kebriaei et al., and Mosahab et al. reported the lowest quality gap in the dimension of reliability. ,,,
It was encouraging that all the senior teachers including administrators recognized all five SEVQUAL dimension as important in maintaining the quality of educational services.
Negative quality gap in educational service dimensions can be used as a referendum for future planning and allocation of resources at the institutional level.  Although in the present study, negative quality gaps were found in all five dimensions, a focused approach may be appropriate in our resource-constrained setting to prioritize the issue(s), which are relatively considered to be most important or where the quality gap is maximum. It was encouraging that the quality gaps regarding consistency of and commitment to educational services as well as in earning students' confidence were somewhat smaller than in the other dimensions in the current study. Students were mostly dissatisfied with the physical facilities and the ways they are treated by the teachers and staff of the college.
This finding is specific to the study institute and the situation would be different in different institutes. The students' aspiration and perception may differ depending on the background, exposure of the students, and the institutes they were in. Situation in government and private institutes may be perceived differently.
An analysis of the reasons for the observed gaps is the cornerstone of the improvement process and may be considered as a priority issue for further research. It could be suggested that the SERVQUAL model of service quality is applicable in medical education in the Indian sociocultural setting and could provide a useful input in emphasizing the areas of concern in medical teaching institutions, as perceived by students.
The author acknowledges the intellectual inputs of Prof. Janet Grant, Director, Centre for Medical Education in Context (CenMEDIC) and FAIMER Centre for Distance Learning, London, England, Professor Tejinder Singh and Professor Jugesh Chhatwal of CMCL-FAIMER Regional Institute at Christian Medical College, Ludhiana, Punjab, India during different phases of the study and during preparation of the draft.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]