Performance in physiology evaluation: possible improvement by active learning strategies

Microlearning activities improve student comprehension of difficult concepts and performance in a biochemistry course

INTRODUCTION

Students must rapidly learn and retain fundamental basic science knowledge in a doctor of pharmacy curriculum. Active learning stimulates engagement, reinforces concept understanding, and promotes retention of knowledge. The purpose this study was to determine if introducing game-based active recall and critical thinking microlearning activities improved student comprehension of challenging concepts, exam performance, and successful completion of a biochemistry course.

METHODS

Microlearning activities were generated using Articulate Storyline software. Questions and problems were embedded in gamification-type activities to reinforce challenging biochemistry concepts and improve critical thinking. Activities were published on Blackboard and student performance was recorded. Students were divided into performance groups using their first exam scores. Student's exam scores were related to results from corresponding microlearning. Statistical analysis of results was performed to compare exam results with outcomes of microlearning activities.

RESULTS

Student performance on exams and final scores positively correlated with successful completion of microlearning activities. Students who successfully completed more microlearning activities performed significantly better on all exams in comparison with students who completed few microlearning activities. Students who initially struggled with the material but completed more microlearning improved their performance on exams and passed the course with a higher score. In contrast, students who struggled and completed fewer activities failed to improve their exam and course performance.

CONCLUSIONS

Active recall and critical thinking microlearning activities enhanced knowledge retention and comprehension of challenging biochemical concepts. Microlearning scores positively correlated with student exam performance in a biochemistry course, especially amongst students struggling with the material.

Teaching bioelectricity and neurophysiology to medical students using LabAXON simulations

Patch-clamp electrophysiological recordings of neuronal activity require a large amount of space and equipment. The technique is difficult to master and not conducive to demonstration to more than a few medical students. Therefore, neurophysiological education is mostly limited to classroom-based pedagogies such as lectures. However, the demonstration of concepts such as changes in membrane potential and ion channel activity is best achieved with hands-on approaches. This article details an in silico activity suitable for large groups of medical students that demonstrates the key concepts in neurophysiology using the LabAXON simulation software. Learning activities in our practical include 1) measurements of voltage and time parameters of the neuronal action potential and its relationship to the Nernst potentials of Na⁺ and K⁺; 2) determination of the stimulus threshold to evoke action potentials; 3) demonstration of the refractory period of an action potential; and 4) voltage-clamp experiments to determine the current-voltage relationship of voltage-gated Na⁺ and K⁺ channels and the voltage dependence of, and recovery from, inactivation of voltage-gated Na⁺ channels. We emphasized the accuracy of quantitative measurements as well as the correct use of units. The level of difficulty of the activity can be altered through different multiple choice questions relating to material introduced in the associated lectures. This practical activity is suitable for different class sizes and is adaptable for delivery with online platforms. Student feedback showed that the students felt the activity helped them consolidate their understanding of the lecture material.

Computer-based virtual laboratory simulations: LabHEART cardiac physiology practical

Practical demonstration of cardiomyocyte function requires substantial preparation, a source of freshly isolated animal hearts, and specialized equipment. Even where such resources are available, it is not conducive for demonstration to any more than a few students at a time. These approaches are also not consistent with the 3R principle (replacement, reduction, and refinement) of ethical use of animals. We present an implementation of the LabHEART software, developed by Donald Bers and Jose Puglisi, for medical students. Prior to the activity, students had lectures covering the physiological and pharmacological aspects of cardiac excitation-contraction (EC) coupling. We used this problem-based activity to help students consolidate their knowledge and to allow a hands-on approach to explore the key features of EC coupling. Students simulate and measure action potentials, intracellular calcium changes, and cardiomyocyte contraction. They also apply drugs that target ion channels (e.g., nifedipine or tetrodotoxin) or sympathetic input (using isoproterenol) and explore changes to EC coupling. Furthermore, by modifying the biophysical parameters of key ion channels involved in the electrical activity of the heart, students also explore the effect of channelopathies such as long QT syndromes. We describe approaches to implement this activity in a flipped classroom format, with recorded lecture materials provided ahead of the practical to facilitate active learning. We also describe our experiences implementing this activity online. The content and difficulty of the activity can be altered to suit individual courses and is also amenable to promote peer-driven learning.

Method 300: a complementary teaching methodology in Dentistry

This study evaluated Method 300, a complementary teaching methodology in Dentistry. Thirty participants were divided into 6 groups according to the scores obtained in a placement test ranging from 0 to 10. Students with scores lower than 6 were classified as having poor academic performance; students with scores equal to or greater than 6 were considered as having good academic performance. Each group included at least one student with good performance. Our methodology consisted of two application cycles, each including one different test; however, only students with low performance could undergo the second testing. Students held meetings twice a week for one hour and thirty minutes. Of the 54 students initially enrolled in the subject, 24 dropped out, leaving 30 students who completed all the proposed activities. In cycle 1, 24 (80%) students showed poor academic performance and 6 (20%) good. Students with poor performance in P1 significantly improved after P1 300 test application (P < 0.001). After cycle 1 activities, all 30 participants showed significant improvement. In cycle 2, the number of students with good performance tripled when compared to cycle 1, resulting in a decrease in the number of students with poor performance (P = 0.205). Results show that the Method 300 is an important teaching-learning resource in Dentistry, to be used as a complementary methodology to lectures.

Appraisal of a novel pedagogical approach to demonstrating neuromuscular transmission to medical students

Although traditional didactic lecturing is the principal instructional approach used in numerous medical schools, this method has several limitations. Experiential learning approaches place students in the center of the learning process and creates a positive and supportive classroom learning environment. In this article, we propose an active pedagogical approach for teaching a basic physiology concept, namely, neuromuscular transmission (NMT), and we evaluate the effectiveness of this approach among undergraduate medical students. One-hundred forty-two undergraduate medical students were involved in this study (cohort A, n = 62; cohort B, n = 80). Cohort A received a didactic lecture on NMT and subsequently tested their knowledge of the topic via test 1, after which their perceptions of didactic lectures were recorded. The students were then asked to participate in a touch-and-go (TAG) active-learning session regarding NMT, after which their learning was subsequently tested by taking test 2. Their perceptions about the TAG game were also recorded. Students in cohort B were first administered test 1 regarding NMT. Then, they were asked to attend a didactic lecture blended with a TAG active-learning session, after which test 2 was administered, and their perceptions were recorded. Both the didactic lecture and active learning sessions facilitated student learning regarding the concepts involved in NMT. A comparison of the lecture followed by the game used in cohort A with the game blended lecture used in cohort B revealed no significant differences. However, both formats created a positive influence on students' interest in learning the concept, and the students preferred active learning over didactic sessions alone.

Gamification of health professions education: a systematic review

Gamification refers to using game attributes in a non-gaming context. Health professions educators increasingly turn to gamification to optimize students' learning outcomes. However, little is known about the concept of gamification and its possible working mechanisms. This review focused on empirical evidence for the effectiveness of gamification approaches and theoretical rationales for applying the chosen game attributes. We systematically searched multiple databases, and included all empirical studies evaluating the use of game attributes in health professions education. Of 5044 articles initially identified, 44 met the inclusion criteria. Negative outcomes for using gamification were not reported. Almost all studies included assessment attributes (n = 40), mostly in combination with conflict/challenge attributes (n = 27). Eight studies revealed that this specific combination had increased the use of the learning material, sometimes leading to improved learning outcomes. A relatively small number of studies was performed to explain mechanisms underlying the use of game attributes (n = 7). Our findings suggest that it is possible to improve learning outcomes in health professions education by using gamification, especially when employing game attributes that improve learning behaviours and attitudes towards learning. However, most studies lacked well-defined control groups and did not apply and/or report theory to understand underlying processes. Future research should clarify mechanisms underlying gamified educational interventions and explore theories that could explain the effects of these interventions on learning outcomes, using well-defined control groups, in a longitudinal way. In doing so, we can build on existing theories and gain a practical and comprehensive understanding of how to select the right game elements for the right educational context and the right type of student.

Gamification and flipped learning and their influence on aspects related to the teaching-learning process

Nowadays, education is going through a moment of methodological transformation. Two of the active methodologies with excellent projection within the educational field are gamification and flipped learning. This study analyzed the methodological contrast between gamification and flipped learning in the subject of Physical Education in three different educational stages to determine the most influential methodology in the training process. Research design was a quasi-experimental research with a sample of 356 students in Spain. Data collection took place with a questionnaire. The results show that gamification as a teaching and learning methodology is better valued at an early stage, while the more aged participants better value the flipped learning methodology. Both methodologies have shown great potential in the development of educational processes in Physical Education. Gamification indeed seems to have positive effects on students from the lower stages. On the other hand, flipped learning produces positive effects on the group stages, pre-university students.

The Physiological Court

Research has been important to prove that student achievement can improve when active methodologies are properly implemented, either in isolation or integrated with lectures. Here, active methodology was organized according to a student-centered collaborative design that involved group debate, described as a Physiological Court. The purpose of this work was to evaluate the performance and perception of medical students after integrating short lectures with collaborative work and debate. The activity was carried out with students (n = 50) from the 2nd year of medical school. The activity performed was related to the hypothalamus-pituitary-thyroid and hypothalamus-pituitary-adrenal axes. The students were instructed to prepare a study material on the proposed themes to be used on the day of the debate. At the activity day, the 2 students' groups (n = 25) were organized in the classroom so that they were face-to-face. Five days after, the students answered the cognitive monitoring test (CMT) which consists of 5 multiple choice questions (MCQ). Students also answered a question about their perception of the activities performed. Ninety-two percent of students showed a positive perception of the activities performed. After completion of the physiological court, 83 ± 4% of students achieved grades above 7.0 on CMT. The percentage of incorrect answers was 5 ± 1.3% in CMT. The association of 40-min lectures with active methodologies was positive for the perception and the performance of students in the second years of medical school related to the physiology of the endocrine systems.

Lectures and collaborative working improves the performance of medical students

The teaching-learning process is complex and requires continuous research and dedication. Research has been important to prove that student achievement can improve when active methodologies are properly implemented, either in isolation or integrated with a short lecture. The purpose of this work was to evaluate the performance and perception of first-year medical students subjected to a protocol involving the integration of a short lecture and collaborative compilation of portfolios on the topic of digestive physiology. After the lectures and elaboration of the portfolios, the students completed two tests: cognitive monitoring test (CMT) and integrative cognitive test (ICT), and then, they gave their opinions of the strategy. For CMT, the percentage of grade exceeding 7.0 was higher for the group who performed the portfolio activity, compared with the group who did not undertake the activity, and there was a lower percentage of incorrect answers among the portfolio group students, compared with the group that did not perform the activity. For ICT, the percentage of grades exceeding 7.0 was higher for the students who used the portfolio, compared with those who did not perform the activity, and there was also a reduction in incorrect answers among students who performed the portfolio activity, compared with those who did not perform the activity. The combination of short lectures and collaborative group work using a portfolio improved the grades obtained for digestive physiology. Most of the students believed that the collaborative work contributed to their learning about digestive physiology. In addition, most of them were comfortable working in their groups and did not feel dominated by other group members.

Effect of flipped classroom methodology on the student performance of gastrointestinal and renal physiology entrants and repeaters

BACKGROUND

Physiology is a subject that is considered difficult; it is associated with academic failure and causes high levels of stress and anxiety in students.

METHODS

This study compared the effectiveness of a traditional lecture-based methodology with that of a flipped classroom scheme focusing on cooperative ludic learning among gastrointestinal and renal physiology students. Two groups were subjected to these two different methods to teach gastrointestinal and renal physiology content divided into 14 topics. Additionally, two subgroups were identified in each group: entrants and repeaters. There were no differences in age or gender between the subgroups.

RESULTS

Levels of self-perceived stress (measured by the SISCO scale), biological stress (measured by awakening salivary cortisol levels), and anxiety (measured by the Zung scale) were high in all of the students; the cortisol levels increased in the entrants and some of the scores in SISCO scale increased in the repeaters, throughout the study. The self-reported study time was longer in the students subjected to the flipped classroom-based method. The final exam results were better only in the new students facing the flipped methodology, but not in the repeaters, who scored lower on the final evaluation. The quantitative and qualitative assessments completed by the participants regarding the different aspects of the flipped-classroom-based methodology were favorable; however, the participants believed that traditional lectures should be maintained for specific topics.

CONCLUSIONS

A methodology based on flipped teaching was an effective strategy to improve academic performance ingastrointestinal and renal physiology, but only in new students.

A hydraulic model of cardiovascular physiology and pathophysiology embedded into a computer-based teaching system for student training in laboratory courses

Functional understanding of the different parts of the cardiovascular system is essential for an insight into pathomechanisms of numerous diseases. During training cardiovascular physiology, students and early-stage medical personnel should understand the role of different functional parameters for systolic and diastolic blood pressure, as well as for blood flow. The impact of isolated parameters can only be studied in models. Here physical hydraulic models are an advantage in which the students have a direct contact to the mechanical properties of the circulatory system. But these models are often difficult to handle. The aim of the present study was to develop a comprehensive model of the cardiovascular system, including a mechanical heart with valves, an elastic aorta, a more rigid peripheral artery system, a total peripheral resistance, and a venous reservoir representing the variable cardiac preload. This model allows one to vary systematically several functional parameters and to continuously record their impact on pressure and flow. This model is embedded into a computer-based teaching system (LabTutor) in which the students are guided through the handling of the model (as well as the systematic variation of parameters), and the measured data can be analyzed. This hybrid teaching system, which is routinely integrated in physiology laboratory courses of medical students, allows students to work with a complex hydraulic model of the cardiovascular system and to analyze systematically the impact of influencing variables (e.g., increased peripheral resistance or changed cardiac preload) as well as pathophysiological dysfunctions (e.g., reduced aortic compliance).

Increased learning by using board game on muscular system physiology compared with guided study

The aim of this work is to describe the "Muscular System Game," created to assist in the teaching-learning process concerning the physiology of the muscular system, and to evaluate its effect on the learning of university students. Participating in this study were first-year undergraduate students of the pharmacy course (game group, n = 21, 5 men and 16 women, age 23.57 ± 4.92 yr) and the nursing course (control group, n = 22, 2 men and 20 women, age 22.90 ± 4.93 yr), who had the same level of preparation. After theoretical classes concerning the physiology of the muscular system, all students were instructed to study the topic. In the next week, the students of the game group performed the activity with the board game, and the students of the control group undertook a guided study activity, which contained a list of exercises with the same questions used in the game, to be answered by groups. In the week following these activities, all of the students answered evaluation questions about the topic. The scores obtained for the two groups in the evaluation were compared using Student's t-test for unpaired samples, considering a significance level of 0.05. The score obtained for the control group (5.78 ± 0.38) was significantly lower than the score for the game group (7.50 ± 0.47; P < 0.05). The results obtained indicating that the use of an educational board game about the physiology of muscle contraction resulted in significantly improved learning, compared with the use of guided study.

Medical student perceptions about active methodologies in the study of physiology in medical schools in Salvador, Brazil

In the field of medical education, it is possible to consider that the acquisition of professional competences can gain new contours when considering the use of active methodologies. It is important to analyze the perception of the students about the use of them in medical courses, as well as to reflect on their challenges and potentials. In the present study, a semistructured questionnaire of student perception was applied immediately after the execution of different types of active methodologies in the discipline of physiology in two medical courses. The results suggest a highly positive evaluation of the use of active methodologies by the student body of the two institutions. The students evaluated positively the application of the method (94.6%) and the perception about the learning (84.1%). On the other hand, when questioned about the substitution of the traditional expository method by the active methodologies, there was a tendency to the centrality of the answers, with 84.0% of the responses concentrated at positions 2, 3, and 4 on a scale of 1 (minimum) to 5 (maximum) on the Likert scale. There were no statistically significant differences when comparing variables of age, sex, and previous graduation. Although there was no consensus regarding the full replacement of traditional for active methodologies, one can conclude that the students' perception about the introduction of said methodologies in the teaching of physiology in medical courses is positive, regardless of the subgroups evaluated. These results encourage the insertion of these and other methodologies into medical courses.

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.

The trilayer approach of teaching physiology, pathophysiology, and pharmacology concepts in a first-year pharmacy course: the TLAT model

This paper describes the development, implementation, and students' perceptions of a new trilayer approach of teaching (TLAT). The TLAT model involved blending lecture, in-class group activities, and out-of-class assignments on selected content areas and was implemented initially in a first-year integrated pharmacy course. Course contents were either delivered by traditional lectures or by the TLAT. A survey instrument was distributed by SurveyMonkey to determine students' perceptions of the TLAT model. Descriptive statistics were used for data analysis. Students' performance in a total of 225 examination and quiz questions was analyzed to evaluate whether the TLAT model improved students' learning. Students' (n = 98) performance scores for TLAT-based and lecture-based questions were 83.3 ± 10.2 and 79.5 ± 14.0, respectively (P < 0.05). Ninety-three percent of students believed that in-class group activities enhanced conceptual understanding of course materials, helped them take responsibility of their own learning, and enhanced their overall learning experiences. More than 80% of respondents felt that solving cases and developing concept maps helped them sharpen creative and critical thinking skills. In addition, 90% of the respondents indicated that the homework throughout the semester helped them stay up to date and focused with the progress of the course. The use of the TLAT model led to an improvement in student learning of complex concepts. Moreover, the results suggest that this model improves students' self-reliance and attitudes toward learning. Our findings should serve as an impetus for inclusion of diverse active learning strategies in pharmacy education.

Using whiteboards to support college students' learning of complex physiological concepts

Research underscores the importance of retrieval-based practice and application of knowledge for meaningful learning. However, the didactic lecture format continues to persist in traditional university physiology courses. A strategy called whiteboarding, where students use handheld dry erase boards and work in small groups to actively retrieve, discuss, and apply concepts presented in the lecture, has the potential to address challenges associated with actively engaging students in science courses for greater learning. The purpose of this study was to empirically examine the potential benefits of whiteboarding for increasing students' understanding of animal physiology concepts. Student performance on physiology questions assessing concepts taught using lecture only vs. concepts taught using lecture and whiteboarding were compared within the term that whiteboarding was used, as well as across whiteboard and lecture-only terms taught by the same instructor. Results showed that when whiteboarding was incorporated in the course, student performance on items that assessed concepts corresponding to the whiteboarding activities were significantly higher compared with performance on items that assessed concepts taught through lecture only. These patterns in student performance were found within and across terms. Taken together, findings point to whiteboarding as an effective tool that can be integrated in traditional lecture courses to promote students' understanding of physiology.

Novel use of a noninvasive hemodynamic monitor in a personalized, active learning simulation

The present study furthered the concept of simulation-based medical education by applying a personalized active learning component. We tested this novel approach utilizing a noninvasive hemodynamic monitor with the capability to measure and display in real time numerous hemodynamic parameters in the exercising participant. Changes in medical knowledge concerning physiology were examined with a pre-and posttest. Simply by observation of one's own hemodynamic variables, the understanding of complex physiological concepts was significantly enhanced.