the students were assured that scores obtained by them in this study would not be counted for internal assessment of university .
a sample size analysis was done at the initiation of the study . as per our pilot study
, the standard deviation of marks was estimated to be approximately two . based on a two tailed a of 0.05 and power of 80%
, it was determined that 64 students were required to detect 1 of difference in the outcome variable . on the assumption of an overall rate of loss to follow up of about 10%
the topic for the tutorial was  chemotherapy .  as per institute timetable and distribution of students , of total students ( n = 171 ) , roll numbers 170 were in group a and 71 onward were in group b. after the completion of series of lecture classes on chemotherapy , a preintervention test on the topic was taken for all the students .
the groups were allotted either slot intervention or cts controls , following toss of a coin .
students from interventional group ( slot ) were divided into small teams , each team having five or six students .
each team selected a team leader who was to collect the subtopic(s ) of the preceding lecture topic ( chemotherapy ) for their team .
each team was given instructions to study the given subtopic(s ) and prepare five multiple choice questions ( mcqs ) in powerpoint format so that they could be presented in the slot session .
the students were to contact the lecturers ( who had a prior training in preparing mcqs ) for any clarification regarding the preparation of mcqs for slot .
a flowchart depicting division of group to teams and allocation of subtopic for the first slot session is shown in figure 1 .
a format of mcq slides given as a guide to the teams who were preparing for their slot session is illustrated in figure 2 .
model flowchart depicting division of interventional group into teams and allocation of respective subtopics for the first session of student - led objective tutorial format of multiple choice question slides for student - led objective tutorial session on the allotted day of the tutorial , students of all the teams of interventional group ( slot ) assembled in the department lecture hall .
session for team 14 was conducted on the 1 day of tutorials ( teams 512 represented audience ) .
session for team 58 was conducted on the 2 day of tutorials ( teams 912 and 14 represented audience ) .
session for team 912 was conducted on the 3 day of tutorials ( teams 18 represented audience ) .
the teams were invited to take their seats as per their number got through lots .
the students of group a were communicated in advance that individual and team winners would be appreciated at the end of slot session so that they would come prepared for the topic of that day .
the first mcq was posed by the leader of team 1 directly to team 2 .
the other teams , namely , 3 and 4 observed . the time given for direct question was 1 min and indirect question was 10 s. the marks given were 15 for direct correct answer .
if the question was unanswered by team 2 , the question was passed on to subsequent teams in pursuit of getting correct answer .
it passed to team 3 , and if team 3 answered it right , 10 marks were given .
if team 3 did not answer it correctly , it passed to team 4 , and if they answered it right , they got 5 marks .
the next slide displayed the correct answer even if team 4 gave the wrong answer .
there was a decrease in the award of marks as question passed because the subsequent teams could exclude the previous distractors .
team 1 continued the second question starting from team 3 and the third question from team 4 so that each team had a chance to get direct question .
the slot session went on for 6080 min . at the end of slot session for that particular day
, the individual and team winners were called on the dais and appreciated with a round of applause .
similar sessions went on for three consecutive tutorial classes and all the seventy students of group a got a chance to be in groups who prepared and presented mcqs .
the scores achieved by teams in slot were only to enhance learning and develop competitive spirit .
they were neither counted in the analysis of this study nor for internal assessment of university . at the end of the third slot session ,
a prevalidated and pretested anonymous questionnaire was distributed to the students to know their perceptions on slot .
the responses were obtained on a 5 point likert scale ( 1 for strongly disagree to 5 for strongly agree ) .
open ended questions , for example , the best aspects and areas for improvement of slot were also included in the questionnaire .
the students were divided into 5 teams with 14 or 15 students in each team .
there was a teacher ( cum facilitator ) for each team who divided each team further into 3 subteams containing 4 or 5 students in each subteam .
the teacher posed short questions on the allotted topic which the subteams had to answer in turns .
they were mainly teacher centric . at the end of all tutorial sessions ( both slot and ct ) for chemotherapy ,
a postintervention test was taken for both a and b group students . the pattern and questions
in all , our study went on for five tutorial classes which included a preintervention test , three slot sessions ( or three ct for controls ) , and a postintervention test .
whitney test was used for comparing differences between groups a and b , and wilcoxon matched pairs signed ranks test was used to compare pre and post intervention scores .
hence , for ethical reasons , slot was conducted for control group also , after the completion of our study .
students from interventional group ( slot ) were divided into small teams , each team having five or six students .
each team selected a team leader who was to collect the subtopic(s ) of the preceding lecture topic ( chemotherapy ) for their team .
each team was given instructions to study the given subtopic(s ) and prepare five multiple choice questions ( mcqs ) in powerpoint format so that they could be presented in the slot session .
the students were to contact the lecturers ( who had a prior training in preparing mcqs ) for any clarification regarding the preparation of mcqs for slot .
a flowchart depicting division of group to teams and allocation of subtopic for the first slot session is shown in figure 1 .
a format of mcq slides given as a guide to the teams who were preparing for their slot session is illustrated in figure 2 .
model flowchart depicting division of interventional group into teams and allocation of respective subtopics for the first session of student - led objective tutorial format of multiple choice question slides for student - led objective tutorial session on the allotted day of the tutorial , students of all the teams of interventional group ( slot ) assembled in the department lecture hall .
session for team 14 was conducted on the 1 day of tutorials ( teams 512 represented audience ) .
session for team 58 was conducted on the 2 day of tutorials ( teams 912 and 14 represented audience ) .
session for team 912 was conducted on the 3 day of tutorials ( teams 18 represented audience ) .
the teams were invited to take their seats as per their number got through lots .
the students of group a were communicated in advance that individual and team winners would be appreciated at the end of slot session so that they would come prepared for the topic of that day .
the first mcq was posed by the leader of team 1 directly to team 2 .
the other teams , namely , 3 and 4 observed . the time given for direct question was 1 min and indirect question was 10 s. the marks given were 15 for direct correct answer .
if the question was unanswered by team 2 , the question was passed on to subsequent teams in pursuit of getting correct answer .
it passed to team 3 , and if team 3 answered it right , 10 marks were given .
if team 3 did not answer it correctly , it passed to team 4 , and if they answered it right , they got 5 marks .
the next slide displayed the correct answer even if team 4 gave the wrong answer .
there was a decrease in the award of marks as question passed because the subsequent teams could exclude the previous distractors .
team 1 continued the second question starting from team 3 and the third question from team 4 so that each team had a chance to get direct question .
the slot session went on for 6080 min . at the end of slot session for that particular day
, the individual and team winners were called on the dais and appreciated with a round of applause .
similar sessions went on for three consecutive tutorial classes and all the seventy students of group a got a chance to be in groups who prepared and presented mcqs .
the scores achieved by teams in slot were only to enhance learning and develop competitive spirit .
they were neither counted in the analysis of this study nor for internal assessment of university . at the end of the third slot session ,
a prevalidated and pretested anonymous questionnaire was distributed to the students to know their perceptions on slot .
the responses were obtained on a 5 point likert scale ( 1 for strongly disagree to 5 for strongly agree ) .
open ended questions , for example , the best aspects and areas for improvement of slot were also included in the questionnaire .
the students were divided into 5 teams with 14 or 15 students in each team .
there was a teacher ( cum facilitator ) for each team who divided each team further into 3 subteams containing 4 or 5 students in each subteam .
the teacher posed short questions on the allotted topic which the subteams had to answer in turns .
they were mainly teacher centric . at the end of all tutorial sessions ( both slot and ct ) for chemotherapy ,
the pattern and questions were same as preintervention test . in all , our study went on for five tutorial classes which included a preintervention test , three slot sessions ( or three ct for controls ) , and a postintervention test .
whitney test was used for comparing differences between groups a and b , and wilcoxon matched pairs signed ranks test was used to compare pre and post intervention scores .
students should not be deprived of the benefits of a successful intervention . hence , for ethical reasons
, slot was conducted for control group also , after the completion of our study .
all the 2 year undergraduates ( n = 141 ) consented for participating in the study . the interventional group slot ( n = 70 ) was group a while control group ct was group b ( n = 71 ) .
there was no difference in preintervention marks of both groups ( 5.1  2 vs. 5  2 , p = 0.97 ) .
there were some students who were absent in preintervention test and some in postintervention test . on pairing , it was found that 65 students of group a ( interventional group ) were present in both tests while 66 from group b ( control group ) were in both tests .
the mean marks of students in group a improved considerably ( from 5.1  2 to 11.2  1.8 , p < 0.0001 ) . in group
b , they improved only to some extent ( from 5  2 to 7.2  2 , p <
mean marks obtained by students in pre- and post - intervention tests the total faculty requirement for ct was five , while for slot , it was three ( one tutor and two lecturers ) .
feedback was taken from students ( n = 67 ) who were present in the third session of slot [ table 2 ] .
students ( 78% ) agreed that they learned better in slot when compared to ct and that it involved active learning in groups .
the opinion of teachers ( n = 12 ) on slot is presented in table 3 .
feedback on slot was also positive from teachers , but they opined that preparation for slot is time consuming and needs costly equipment .
students feedback ( positive)$ on student - led objective tutorial ( n=67 ) opinions of teachers on student - led objective tutorial ( n=12 )
it was compared with ct in terms of improving the academic performance of students . in our pilot study , we had randomized all the students of interventional group to various teams .
hence , in the present study , students of group a ( n = 70 ) were divided into teams in line with their roll numbers . the seating arrangement ( on seats i 
iv ) of four teams who presented mcqs for that particular slot session in the lecture hall was randomized . in our study , the mean marks of students in group a improved by 31% ( from 5.1 to 11.2 ) . in group b ,
our study is similar to a study which also states that knowledge retention improves with interactive teaching learning .
it is also similar to a study , in which group activity was strongly correlated with students grades in exams .
however , it differs from another study that shows no differences in outcomes for directed and self directed learning .
our study also differs from another study which states that small group tutorials can lead to more satisfaction but may not give better exam results . in our study
, there was an improvement in control group ( ct ) also , probably , because of self learning skills of students and possibly because of some motivated students who had prepared the topic that was given a week in advance . in our study , student learning occurred not only during slot preparation ( intragroup ) but also during the presentation ( intergroup ) . as there were teams and audience , the content reached all of them uniformly
the students ( 61% ) enjoyed working with a team and contributed to teams success . in another study ,
the physicians in small group session performed better than the lecture or in large groups .
another study mentions that students self directedness was more in small and medium size groups but not in large groups . in yet another study , learning accounted for 80% of the interactions in group tutorials
this shows that group learning improves academic performance . in our study , during slot sessions , the lecturers guided the discussions and intervened if there was a need for clarification .
a majority of students ( 60% ) agreed that guidance by lecturers during slot sessions was useful . in another study in australia , students had an intragroup discussion and the tutor facilitated discussions and clarified their queries but did not lead it or take it over . in another study in sri lanka
, scenarios were used for subject discussion while faculty only moderated and guided the discussion .
a study mentions that a good tutor needs to have qualities such as establishing rapport with students , allowing adequate time for discussion , has content expertise to guide the students well . in our study , in their feedback on slot , students mentioned of such qualities in teachers and were satisfied with their guidance . whenever a new teaching method is introduced
our students also faced a few difficulties in the first slot session , for example , in preparing mcqs , preparing powerpoint slides , etc . some students ( 39% ) complained that all the team members did not actively contribute to mcq preparation or cooperate out of the classroom .
difficult personalities , lack of cooperation or interaction can inhibit group function . a study shows that about 96% of graduates , who were student tutors previously , were active participants of academic programs .
this could help the groups analyze and learn from their behaviors . in our study , students ( 78% ) agreed that they learned better in slot when compared to ct . in yet another study , students ( 79% ) perceived that modified tutorials improved understanding as compared to traditional teaching methods which is similar to our study . in our study
, 63% students wanted to have more slot sessions which is less than another study , in which most of the students ( 79% ) wanted similar sessions in future . looking at the enthusiasm of students , we conducted slot sessions for subsequent batches in our department , whenever it was feasible . in open ended questions , slot induced active participation by the students .
the best aspects of slot , as mentioned by students ( 76% ) , were that it improved learning skills .
the areas where slot can be improved , as mentioned by students , were either to reduce the time allotted for slot or to have them when there was at least a month for their terminal exams .
the academic benefit of slot sessions was that the teams prepared mcqs related to their subtopic , and to score more , they also prepared other subtopics .
intergroup interactions and competitive spirit were also distinctly observed in yet another study at wardha . in ct , if group size is large , they become mini lecture sessions . in such situations , the students hardly get a chance to reply to questions posed and improve communication skills .
some students who do not come prepared for the tutorial and could easily go unnoticed . in ct , tutors with different experience and knowledge , conduct tutorials on the same topic , so students are subjected to some amount of bias .
in contrast , in slot , there is uniformity in sharing of information by the entire class .
slot also helps students in improving skills for answering mcqs which could help them in future competitive exams .
short video and audio clips can be hyperlinked to make slot , a multimedia tutorial .
the strength of the study is that intervention ( slot ) has been compared with control ( ct ) prospectively .
slot is student centric and an active learning method involving group work , while in ct , learning is mainly passive and teacher centric .
slot is an interesting method of conducting tutorials that promote active learning through group work .
 objectives : students learn in a better way if they are involved in active learning . 
 hence , the study was designed to introduce student - led objective tutorials ( slots ) as an alternative to conventional tutorials ( cts ) in pharmacology and to compare slot and ct on outcomes such as improved score in tests , active involvement of students , and faculty requirement of each.materials and methods : didactic lectures taken on a topic in pharmacology were followed by a preintervention test for a batch of the 2nd year medical undergraduates . 
 they were allotted either in slot or ct group . for a slot session , 
 students of group a ( interventional group ) were divided into teams and each team prepared five multiple choice questions on the given topic in powerpoint format , which were presented to other teams and audience . 
 the proceedings were facilitated by two lecturers . 
 group b undertook ct ( controls ) . 
 a postintervention test was then taken for both groups . 
 feedback was sought from students and teachers on slot.results:the total marks for the test were 20 . 
 the mean marks in group a improved by 31% ( from 5.1 to 11.2 ) . in group 
 b , they improved by 11% ( from 5 to 7.2 ) . 
 academic performance following slot was better than ct . 
 students ( 63% ) favored slot as it stimulated their interest in the topic , improved self - learning skills , and teamwork . 
 the teachers also favored slot for similar reasons.conclusion:slot leads to greater satisfaction and better performance in tests . 
 slot is an effective alternative to ct to promote active learning among students through group work . 
 it helps overcome the logistic difficulties due to faculty shortage . 
Materials and Methods
Intervention
Controls
Ethical Aspects
Results
Discussion
Conclusion
Financial Support and Sponsorship
Conflicts of Interest