Charting a global future for education in physiology

Physiology education in China: the current situation and changes over the past 3 decades

OBJECTIVE

As an experimental biological science, physiology has been taught as an integral component of medical curricula for a long time in China. The teaching effectiveness of physiology courses will directly affect students' learning of other medical disciplines. The purpose of this study is to investigate the current situation and changes in physiology teaching over 30 years in Chinese medical schools.

METHODS

National survey was conducted online on the platform SoJump via WeChat and the web. The head of the physiology department in medical school was asked to indicate the information of physiology education from three periods: 1991-2000, 2001-2010, and 2011-2020. The responses of 80 leaders of the Department of Physiology from mainland Chinese medical schools were included in the study for analysis.

RESULTS

The survey showed that the class hours, both of theory and practice, had been decreased. During the past 20 years, the total number of physiology teachers, the number of physiology teachers who had been educated in medical schools, and the number of technicians had been reduced, whereas teachers with doctor's degrees had been increased. In addition to traditional didactic teaching, new teaching approaches, including problem-based learning/case-based learning/team-based learning, integrated curriculum and formative evaluation systems, had been employed, mostly for more than 5 years, in some medical schools.

CONCLUSION

The present study has provided historical data regarding the current status of physiology education in China and that in the past thirty years by showing that physiology education in China has developed quickly,even it faces many challenges.

Enhancing Medical Education through the "Distribute, Discuss, and Develop" Method: A Comparative Study of Small-Group Discussions

Background Small-group discussions (SGDs) are pivotal in medical education, facilitating the development of critical thinking, communication skills, and teamwork. However, traditional SGDs face challenges such as scalability and maintaining student engagement. This study aims to evaluate the "Distribute, Discuss, and Develop" (3D) method for enhancing learning outcomes in medical education. Methods A single-blinded interventional study was conducted with 125 first-year Bachelor of Medicine and Bachelor of Surgery students, who were divided into intervention and control groups through random assignment. The intervention group employed the 3D method across two thematic units: hematology and muscle nerve physiology. The study assessed learning outcomes using pre- and posttests, class-average normalized gain ("g"), and feedback questionnaires to capture student perceptions of interaction, communication enhancement, and session summarization. Results The intervention group showed significantly improved learning outcomes in both thematic units, with larger effect sizes (hematology: 1.55; muscle nerve physiology: 1.4) compared to the control group. The normalized gain "g" indicated a medium effectiveness level for the intervention group in both themes, suggesting enhanced learning. Feedback questionnaires revealed higher satisfaction levels within the intervention group regarding interaction, communication skills, and session summarization. Conclusions The 3D method addresses the challenges faced by traditional SGDs, providing a scalable and engaging approach to medical education. By fostering more effective student-centered learning, the method enhances the comprehension of complex physiological concepts and improves communication skills. The 3D method significantly improves learning outcomes, interaction, and communication skills in medical education. This innovative approach to SGDs offers a promising strategy for enhancing the educational experience in medical schools, supporting the development of more articulate and professionally competent medical graduates.

Integration of physiology in a curriculum on human structure: a snapshot of the cardiovascular block

With the gradual shift from discipline-based to competency-based medical education, the integrated curriculum has become a popular model for connecting basic science and clinical content in undergraduate medical education. Despite its popularity, there are concerns that important physiological concepts are not adequately addressed. We describe the spiral integration of physiology content in the 5-week Cardiovascular block of our Homeostasis course at the Zucker School of Medicine. We also describe our approach to incorporating physiology into an integrated, constructed response, short-answer assessment format. Our approach to spiral integration consists of rotating lab stations that highlight the distinction between normal and abnormal states, linked with appropriate clinical interventions. Physiology is at the core of integration in any curriculum and the basis of all applied fields of medicine, hence our approach is that teaching structural relationships would not be valuable without consideration of its functions, which can then be utilized in discussion of clinical presentations, imaging, and relevant pathologies. Likewise, our integrated assessments require the students to compose their answers to the questions from scratch, which creates a shift in mode of students' preparation from rote memorizations to more cognitive processing that enhances critical thinking.

Report on the online course "Basic Concepts in Neurophysiology": a course promoted during the COVID-19 pandemic quarantine

"Basic Concepts in Neurophysiology" was a 3-wk online course developed during six synchronous meetings combined with asynchronous activities. We proposed an active learning course that used free online platforms to teach physiology during a period in which undergraduates were not in classrooms or taking online classes due to the COVID-19 pandemic. Herein, we report the course organization and the students' involvement in, acceptance of, and evaluation of the course. To address the students' perceptions about these points, we sent a questionnaire to 49 participants who finished the course. We found that although most students (52.5%) had never taken a course with similar methods before, almost all of them (95%) liked the flipped class model. Additionally, a majority of the students (92.5%) said that the method increased their study frequency during the social distancing period, which is an important aspect to consider during this challenging time for both students and professors.

Physiology education for intensive care medicine residents: A 15-minute interactive peer-led flipped classroom session

Introduction

In acute care medicine, knowledge of the underlying (patho)-physiology is of paramount importance. This may be especially relevant in intensive care medicine, where individual competence and proficiency greatly depend on knowledge and understanding of critical care physiology. In settings with time constraints such as intensive care units (ICUs), time allotted to education is often limited. We evaluated whether introduction of a short, interactive, peer-led flipped classroom session is feasible and can provide ICU residents with a better understanding of critical care physiology.

Materials and methods

Using the flipped classroom concept, we developed a 15-minute peer-led interactive “physiology education” session to introduce a total of 44 residents to critical care physiology. Using a nine-item electronic survey with open questions and a five-point Likert scale, we analysed the overall concept with regard to feasibility, motivation, and subjective learning of critical care physiology.

Results

The overall rate of response to the survey was 70.5% (31/44). The residents reported that these sessions sparked their interest (p = 0.005, Chi square 10.52), and that discussion and interaction during these sessions had promoted their knowledge and understanding. Both novice and experienced residents reported that new knowledge was imparted (both p<0.0001, Chi-square 32.97 and 25.04, respectively).

Conclusions

In an environment with time constraints such as the ICU, a 15-minute, interactive, peer-led flipped classroom teaching session was considered feasible and generally appeared useful for teaching critical care physiology to ICU residents. Responses to questions on questionnaires indicated that teaching sessions sparked interest and increased motivation. This approach may theoretically induce a modification in professional behaviour and promote self-directed learning. We therefore support the use of peer-led flipped classroom training sessions in the ICU. Whether these sessions result in improved ICU care should be addressed in subsequent studies.

A flipped classroom method based on a small private online course in physiology

A small private online course (SPOC) supports blended learning on a small scale, enabling students to have a more comprehensive and deeper learning experience. It also provides instructors with a flexible and feasible model to better understand the students' learning needs and to supervise students' learning behaviors. In this study, we adopted SPOC flipped classroom blended teaching in the physiology course for clinical undergraduate students of Kunming Medical University. Compared with the control group [lecture-based learning (LBL)], the SPOC flipped classroom method significantly increased the scores of students in the preclass test (65.13 ± 12.45 vs. 53.46 ± 8.09, SPOC vs. LBL) and postclass test (80.43 ± 14.29 vs. 69.01 ± 12.81, SPOC vs. LBL), which is induced by students' increased interest in self-learning. More importantly, the significant difference between the preclass scores of the two groups suggested that the video lecture-based preview is more effective than the textbook-based preview. The study indicated that the SPOC flipped classroom was effective in enhancing the examination scores of students, reflecting an improved learning efficiency and a deeper understanding of the knowledge. In summary, the flipped classroom based on SPOC improves learning outcomes compared with LBL and has a wide application in the learning of basic medical courses.

Helping students to understand physiological aspects of regional distribution of ventilation in humans: a experience from the electrical impedance tomography

Undergraduate biomedical students often have difficulties in understanding basic concepts of respiratory physiology, particularly respiratory mechanics. In this study, we report the use of electrical impedance tomography (EIT) to improve and consolidate the knowledge about physiological aspects of normal regional distribution of ventilation in humans. Initially, we assessed the previous knowledge of a group of medical students ( n = 39) about regional differences in lung ventilation. Thereafter, we recorded the regional distribution of ventilation through surface electrodes on a healthy volunteer adopting four different decubitus positions: supine, prone, and right and left lateral. The recordings clearly showed greater pulmonary ventilation in the dependent lung, mainly in the lateral decubitus. Considering the differences in pulmonary ventilation between right and left lateral decubitus, only 33% of students were able to notice it correctly beforehand. This percentage increased to 84 and 100%, respectively ( P < 0.01), after the results of the ventilation measurements obtained with EIT were examined and discussed. A self-assessment questionnaire showed that students considered the practical activity as an important tool to assist in the understanding of the basic concepts of respiratory mechanics. Experimental demonstration of the physiological variations of regional lung ventilation in volunteers by using EIT is feasible, effective, and stimulating for undergraduate medical students. Therefore, this practical activity may help faculty and students to overcome the challenges in the field of respiratory physiology learning.

Recall of physiology knowledge among medical interns: an exploratory study in Riyadh, Saudi Arabia

The aim of the study was to explore the factors associated with the recall of basic medical physiology knowledge among medical interns and to determine the level of retained basic science knowledge. Two hundred and four interns, 114 women and 90 men, working in two major tertiary medical care centers, King Fahad Medical City (KFMC; 29 students) and King Khalid University Hospital (KKUH; 117 students), in Riyadh city, participated in the study. An anonymous knowledge test with 10 validated multiple-choice questions was developed specifically for this purpose. One hundred and forty-six interns (117 working at KKUH and 29 at KFMC) had graduated from medical schools adopting a conventional instructional system, whereas 58 (3 from KKUH and 55 from KFMC had graduated from schools adopting an integrated system (hybrid problem-based learning). Fifty-two students (26%) gained a score ≥60%, whereas 152 students (74%) obtained <60% of the score. Higher scores were associated with younger age ( P < 0.01), traditional curriculum ( P < 0.001), interns from KKUH ( P < 0.001), and candidates for postgraduate studies ( P < 0.02). There was no significant association between recall of physiology knowledge and all other variables studied, including sex. Multivariate analyses show that age and traditional curriculum are the only significant predictors of knowledge retention. Almost three-fourths of the interns scored <60%, and higher scores were significantly associated with younger interns, traditional curriculum, working in KKUH, and interns preparing for graduate studies. However, the difference between the two curricula disappears when the influence of hospital training is considered.

Status of research on physiology education in Brazil

Physiology education research aims to investigate teaching-learning aspects and methods specifically applied to physiology teaching and learning. In this paper exploring Brazilian research public data and information from the Brazilian Physiological Society Teaching Committee, we investigated the status of this research topic (physiology education) in Brazil. The data showed that physiology education research needs to be more recognized and supported in Brazil, and more physiologists may become interested in research in this field. Thus this field will become more developed during the physiologists' education.

Peer instruction in a physiology laboratory course in China

Peer instruction has been used extensively in lecture courses; however, there is little evidence of its use in laboratory courses. The purpose of the present study was to describe the implementation of the peer instruction method in a physiology laboratory course in China. Second-year medical students attended a 6-wk physiology laboratory course in the fall semester of the 2016-2017 school year. In the six new physiology laboratory classes, peer instruction strategies were used to substitute for the traditional short, didactic lectures. The effects of peer instruction were measured by in-class quizzes and confidence levels. The students' evaluations of peer instruction were measured by a Likert scale questionnaire. Peer instruction significantly improved the mean score on quizzes (0.53 ± 0.50 vs. 0.68 ± 0.47, P < 0.001) and confidence levels (2.36 ± 0.66 vs. 2.80 ± 0.45, P < 0.001). Furthermore, for individual incorrect answers, 39.07% changed to correct answers after peer instruction, whereas, for correct answers, 6.61% were changed to an incorrect response. Overall, significantly more students changed their answers from incorrect to correct than from correct to incorrect [χ²: 333.11; degrees of freedom (df): 1; P < 0.001]. Therefore, the positive effects of peer instruction were higher than the negative effects (χ²: 244.55; df: 1; P < 0.001). Moreover, student evaluations of peer instruction were highly positive. In conclusion, the implementation of peer instruction to the physiology laboratory course is an effective strategy to enhance students' performance on in-class quizzes and confidence levels. In addition, the attitude of students toward peer instruction was favorable.

Teaching medical undergraduates: the psychiatrist as medical teacher

This article is a brief review of the teaching role of psychiatrists and is directed at psychiatrists in the UK National Health Service who teach medical undergraduates. It reviews the responsibility of delivering teaching, the delineation of teaching duties, and the teaching roles of the psychiatrist in the changing environment of medical education. Application of good principles of clinical teaching and delivery of tomorrow's doctors in line with the General Medical Council's recommendations are discussed. The article also describes a recommended core curriculum in psychiatry for undergraduates, which lays out what should be taught.

Status of physiology education in US Doctor of Pharmacy programs

The purpose of the present study was to assess the current status of physiology education in US Doctor of Pharmacy (PharmD) programs. A survey instrument was developed and distributed through SurveyMonkey to American Association of Colleges of Pharmacy (AACP) Biological Sciences section members of 132 PharmD programs. Survey items focused on soliciting qualitative and quantitative information on the delivery of physiology curricular contents and faculty perceptions of physiology education. A total of 114 programs responded to the survey, resulting in a response rate of 86%. Out of 114 schools/colleges, 61 programs (54%) offered standalone physiology courses, and 53 programs (46%) offered physiology integrated with other courses. When integrated, the average contact hours for physiology contents were significantly reduced compared with standalone courses (30 vs. 84 h, P < 0.0001). Survey respondents identified diverse strategies in the delivery and assessment of physiology contents. Eighty percent of the responding faculty (n = 204) agree/strongly agree that physiology is underemphasized in PharmD curriculum. Moreover, 67% of the respondents agree/strongly agree that physiology should be taught as a standalone foundational course. A wide variation in the depth and breadth of physiology course offerings in US PharmD programs remains. The reduction of physiology contents is evident when physiology is taught as a component of integrated courses. Given current trends that favor integrated curricula, these data suggest that additional collaboration among basic and clinical science faculty is required to ensure that physiology contents are balanced and not underemphasized in a PharmD curriculum.

Radiology in the Study of Bone Physiology

RATIONALE AND OBJECTIVES

In this article, we review the core principles of bone physiology alongside imaging examples that demonstrate such principles.

MATERIALS AND METHODS

The core principles of bone physiology are reviewed and further solidified with a corresponding abnormal pathophysiologic example. The key principles of bone physiology to be reviewed include the following: (1) formation and growth, (2) maintenance and repair, (3) metabolism and regulation, and (4) neoplastic disease. Lastly, a collection of secondary bone diseases is presented to demonstrate the skeletal manifestations of numerous systemic diseases. With this integrative method, we hope to emphasize the value of using radiology to teach physiology within a clinical context. This is especially relevant now, as many US medical schools undergo curricular reform with more emphasis on integrative interdisciplinary learning. Ultimately, we intend to provide a paradigm for incorporating radiology into the pre-clinical medical curriculum through a review of basic science physiology that underlies key radiographic findings of the skeletal system.

RESULTS

Radiology is known for its role in helping make diagnoses and clinical decisions. However, radiology is also well suited to enhance medical education by offering the ability to visualize physiology in action. This is especially true in skeletal radiology, where radiographic osseous changes represent a wide range of physiological processes. Therefore, skeletal radiology can be a useful tool for illustrating concepts of physiology that underlie the normal and abnormal radiologic appearances of bone.

CONCLUSION

Radiology is an important but underutilized tool for demonstrating concepts in bone physiology.

Peer-instructed seminar attendance is associated with improved preparation, deeper learning and higher exam scores: a survey study

BACKGROUND

Active engagement in education improves learning outcomes. To enhance active participation in seminars, a student-centered course design was implemented and evaluated in terms of self-reported preparation, student motivation and exam scores. We hypothesized that small group learning with intensive peer interaction, using buzz-groups followed by plenary discussion, would motivate students to prepare seminar assignments at home and to actively engage in the seminars. Active engagement involved discussion of the preparatory assignments until consensus was reached.

METHODS

In total seven seminars were scheduled in a 10-week physiology course of an undergraduate Biomedical Sciences program. After each seminar, students were asked to fill out their perceptions of preparation and quality of the seminar (deepening of knowledge and confidence in answers) on a five-point scale using electronic questionnaires. Student motives were first collected using open questions. In the final questionnaire students were asked to indicate on a five-point scale how each motive was perceived. Students overall explanations why they had learned from seminars were collected via open questions in the final questionnaire. One hundred and twenty-four students of the cohort from November 2012 to February 2013 (82.6 %) voluntarily participated. Students' motives to prepare and attend seminars were analyzed by inspection of descriptive statistics. Linear regression analysis was conducted to relate student preparation to the quality of seminars, seminar attendance to exam scores, and exam scores to the quality of seminars. Answers to open questions were deductively clustered.

RESULTS

Studying the material, training for exams and comparing answers with peers motivated students to prepare the seminars. Students were motivated to participate actively because they wanted to keep track of correct answers themselves, to better understand the content and to be able to present their findings in plenary discussions. Perceived preparation of peers was positively associated with the perceived quality of seminars. Also, seminar attendance was positively associated with exam scores. Students' overall explanations suggest that discussing with peers and applying knowledge in pathophysiology cases underlies this association.

CONCLUSION

Discussion with well-prepared peers during seminars improves student perceptions of deeper learning and peer-instructed seminar attendance was associated with higher exam scores.

Active physiology learning in a diverse class: an analysis of medical student responses in terms of sex, home language, and self-reported test performance

The student body at the Nelson R. Mandela School of Medicine (NRMSM) is very diverse, representing many cultures, religions, and languages. Research has shown that weakness in English can impact student performance. Recent studies have also highlighted sex-based differences in students' learning and listening styles. These factors pose both challenges and opportunities for teachers of physiology. Student presentations were incorporated for a number of years into the traditional didactic second-year medical physiology curriculum at the NRMSM. Feedback obtained about the perceived benefits of these presentations for the learning of gastrointestinal and endocrine physiology included demographic data pertaining to students' sex, home language, and self-reported performance in tests. Analysis of the 50-item questionnaire responses, obtained over a 2-yr period, provided some interesting insights. Student responses to the items differed significantly in 27 of the 50 items in the questionnaire, based on sex alone (22%), sex and home language (7%), home language alone (37%), performance alone (26%), and performance and home language (7%). Our analyses of student perceptions support the findings of other studies and show that factors such as sex, home language, and student performance can play an important role in the way students are motivated to learn. In designing active learning strategies, academics need to take into account the potential influences that might affect student learning in diverse, multicultural, and multilingual classes.

Medical students' evaluation of physiology learning environments in two Nigerian medical schools

The expansion of biomedical knowledge and the pursuit of more meaningful learning have led to world-wide evidence-based innovative changes in medical education and curricula. The recent emphasis on problem-based learning (PBL) and student-centred learning environments are, however, not being implemented in Nigerian medical schools. Traditional didactic lectures thus predominate, and learning is further constrained by funding gaps, poor infrastructure, and increasing class sizes. We reviewed medical students' perceptions of their exposed learning environment to determine preferences, shortcomings, and prescriptions for improvements. The results confirm declining interest in didactic lectures and practical sessions with preferences for peer-tutored discussion classes, which were considered more interactive and interesting. This study recommends more emphasis on student-centered learning with alternatives to passive lecture formats and repetitive cookbook practical sessions. The institutionalization of student feedback processes in Nigerian medical schools is also highly recommended.

Student perceptions of the use of presentations as a method of learning endocrine and gastrointestinal pathophysiology

Second-year medical students at the Nelson R. Mandela School of Medicine (Durban, South Africa) were given a brief to prepare oral presentations on topics related to disorders of the gastrointestinal tract and endocrine system in the form of "patient-doctor" role play and to submit written documents about their topics. This initiative was introduced to assist medical students in their application and understanding of physiology to clinical situations. The aims of the student presentations were to improve the understanding of the physiological basis of diseases; promote independent research, active, and group-based learning; encourage social interactions; and develop presentation and peer review skills. Students rose to the challenge, producing a variety of presentations reflecting a wealth of creativity, humour, sensitivity to local cultural issues, and analytic thinking skills. The quality of the supporting posters and computer-generated slides was outstanding. Numerous "fun" prizes for specific individual and group performances were given based on peer and staff evaluations. This exercise ran over a 5-yr period before the introduction of a problem-based learning medical curriculum. Student feedback obtained over these years is reported here. Students were asked to complete semistructured questionnaires, which elicited feedback on various aspects of the learning exercise, including whether it should be continued and how it could be improved upon, especially if they were in groups that did not function well. The feedback obtained revealed that most students perceived the presentations to be fun, informative, creative/innovative, and, most importantly, beneficial to their learning. The majority of students felt that this exercise improved their understanding of pathophysiology, taught them to research independently, and encouraged better class interactions and group learning. The inclusion of such initiatives is beneficial not only to students' understanding and their experience in studying physiology but also for the development of skills useful in their future careers.

What makes the learning of physiology in a PBL medical curriculum challenging? Student perceptions

Physiology is an integral component of any medical curriculum. Traditionally, the learning of physiology has relied heavily on systems-based didactic lectures. In 2001, the Nelson R. Mandela School of Medicine (NRMSM; Durban, South Africa) embarked on a problem-based curriculum in which the learning of physiology was integrated with relevant clinical scenarios. Students are expected to gain an understanding of physiology through self-directed research with only certain aspects being covered in large-group resource sessions (LGRSs). It has gradually become evident that this approach has resulted in significant gaps in students' understanding of basic physiological concepts. A survey of student perceptions of needs for physiology was undertaken to gain a better understanding of their perceived problems and also to inform them of proposed curricular changes. Students were asked to what extent they thought physiology was essential for their understanding of pathology, interpretation of patients' clinical signs and presentation of symptoms, and analysis of laboratory results. Students were also invited to detail the difficulties they experienced in understanding in LGRSs on clinical and physiological topics. The results of the survey indicate that greater interaction of students with experts is needed. In particular, students felt that they lacked the basic conceptual foundations essential for the learning and understanding of physiology, since the difficulties that the students identified are mainly terminological and conceptual in nature.

An overview of undergraduate physiology education in Turkish medical faculties

Physiology education, which occupies an important place in undergraduate medical education, exhibits diversities across the world. Since there was no specific source of information about physiology education in Turkish medical faculties, the authors aimed to evaluate the general status of undergraduate physiology teaching of medical students in Turkey. A questionnaire designed for the program used for medical students was sent to the physiology departments of 38 faculties that had academic personnel and had carried out medical education for at least 3 years. It questioned the educational load, content, and duration of the lectures, written materials, techniques, assessment methods, basic equipments, and subjects used in practical sessions. All 38 departments answered the questionnaire. This study investigating 38 faculties showed that the content and time devoted to lectures and practical sessions (169 and 35 h) differed, as it does throughout the world, and teaching laboratories constituting 17% of total physiology education were performed and assessed by all of the departments. The practical hours correlated with the number of teaching staff. Our results indicated an insufficient number of teaching staff with a heavy educational load. This survey showed that the number of teaching staff is critical for practical sessions. Considering that the actual number of medical schools is 61 schools, with some established but not yet admitting students and educating with their own staff, if the requirements for teaching staff are not met, physiology education in Turkey will face important problems in the coming years.

Assessing core manipulative skills in a large, first-year laboratory

Responding to the concern from our faculty that undergraduate students do not have robust laboratory skills, we designed and implemented a strategy to individually teach and assess the manipulative skills of students in first-year laboratories. Five core laboratory skills were selected for the course entitled Human Biology, a large, first-year class of students, most of whom were enrolled in Bachelor of Pharmacy and Human Movement Studies. Here, we report details for the 365 students enrolled primarily in Pharmacy and Human Movement Studies bachelor degree programs in semester 1 of 2006. We designed a specific strategy to assess five core laboratory skills: 1) accurate and precise use of a micropipette, 2) calculation of dilutions and preparation of diluted samples of saline, 3) accurate representation of data using a graph, 4) use of a light microscope, and 5) acquisition of digital data by measuring the latent period for the Achilles reflex. Graduate tutors were trained to teach and assess each student on each skill. The development of competency was tracked for all students across all five skills. Most students demonstrated proficiency on their first attempt. The development of proficiency across the core skills depended on both the skill and degree program. In semester 2 of 2006, 854 students mostly enrolled in the Bachelor of Science degree program and were similarly taught and assessed on the same five core skills. This approach was an effective teaching and assessment strategy that, when applied beyond first year, should increase the level of laboratory skills across undergraduate programs in physiology.