The synaptic challenge

Music in medical education: A critical interpretive synthesis

INTRODUCTION

While many have championed the value of music in medical education, research specific to how and why music has been offered in medical education is sparse and there have been few attempts to synthesise the literature.

METHODS

A Critical Interpretive Synthesis (CIS) of 56 texts including published articles, correspondence, abstracts and one thesis published between 1977 and 2022 was undertaken to explore the evidence basis for offering music in medical education.

RESULTS

A total of 52 music-focused programmes/activities were described, encompassing both curricular and extra-curricular, receptive and participatory music activities and a wide range of musical genres. Inductive analysis of data extracted from texts revealed a variety of rationales for the use of music in medical education, which could be grouped within seven interrelated themes: well-being; supportive learning environment; affective engagement; teaching and learning; developing skills for clinical practice; humanism in medicine; and creative expression (identity).

DISCUSSION

The results of this synthesis demonstrate that there remains a gap between what is claimed about the affordances of music and what has been explicitly addressed in medical education research. Despite a paucity of research in this area, the available data support that the affordances of music are 'multiple' and may not be well represented by linear models. Evidence that engagement with music is beneficial for medical students is strongest in relation to the affordances of music for well-being, facilitating a supportive learning environment, affective engagement, memorisation and creative expression (identity). That engagement with music might enhance humanism, including developing skills for clinical practice, requires further investigation. Accounting for student agency and the 'multiple' affordances of music will ensure that future teaching and research are best positioned to benefit medical students' well-being and personal and professional development.

A 3-D-printed synaptic puzzle contributes to students' synaptic transmission comprehension

We created the "3-dimensional synaptic puzzle" (3Dsp) as an educational resource for the physiology teaching of synaptic transmission (ST). In this study, we aimed to apply and evaluate the use of 3Dsp. For this, we divided 175 university students from public and private universities into two groups: 1) control (CT; students that were only exposed to traditional class or video lessons about ST), and; 2) test (3Dsp; students that were exposed to the 3Dsp practical class in addition to the traditional theoretical class). ST knowledge of students was evaluated before, immediately after, and 15 days after interventions. Additionally, students completed a questionnaire about their perception of teaching-learning methods used in physiology classes and their self-perception of engagement in the physiology content. The CT groups improved their ST knowledge score from pretest to immediate (P < 0.0001 for all groups) and late posttest (P < 0.0001 for all groups). 3Dsp groups also enhanced their score from pretest to immediate (P = 0.029 for public university students; P < 0.0001 for private university students) and late posttest (P < 0.0001 for all groups). We also observed improvement from the immediate to late posttest in the 3Dsp group from private universities (P < 0.001). Both private groups performed better in general ST and specific electrical synapse questions in the pretest and immediate posttest compared to the public CT group (P < 0.05 for all comparisons). More than 90% of the students from both universities affirmed that the 3Dsp contributed to their physiology comprehension and that they would recommend the use of the 3-D models to other teachers in their classes.NEW & NOTEWORTHY We included a 3-dimensional puzzle (3Dsp) of electrical and chemical synapses in the physiology of synaptic transmission (ST) teaching. After a traditional or video lesson class, students from private and public universities were oriented to use the educational resource. More than 90% of the students affirmed that the 3Dsp improved their comprehension of ST content.

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.

Integrating synapse, muscle contraction, and autonomic nervous system game: effect on learning and evaluation of students' opinions

This work describes the educational game "Integrating Synapse, Muscle Contraction, and Autonomic Nervous System," which was developed to assist students in understanding and integrating concepts related to the physiology of synapses, muscle contraction, and the autonomic nervous system. Analysis was made of the effect of the game on learning and the students' opinions about it. Dentistry students were divided into control and game groups. They attended lectures about the topics, after which the control group students were submitted to a test, whereas the game group performed the game activity before undertaking the test. The mean score was significantly higher for the game group, compared with the control group (P < 0.05). Pharmacy students also attended lectures about these topics; in the next class, the students performed a pretest and the activity with the educational game. After the game, a posttest was applied. The mean scores were significantly higher for the posttest than for the pretest (P < 0.05). Students of medicine attended the lectures and performed the activity with the educational game, without the learning assessment. All of the students answered a question, using a 5-point Likert-type scale, concerning whether they thought the activity with the game was useful for learning. The mean scores obtained by the dentistry, pharmacy, and medicine students were 4.7 ± 0.6, 4.9 ± 0.3, and 4.3 ± 0.1, respectively. The educational game increased the learning of the undergraduate students, in agreement with their opinions of the strategy.

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.

Performance in physiology evaluation: possible improvement by active learning strategies

The evaluation process is complex and extremely important in the teaching/learning process. Evaluations are constantly employed in the classroom to assist students in the learning process and to help teachers improve the teaching process. The use of active methodologies encourages students to participate in the learning process, encourages interaction with their peers, and stimulates thinking about physiological mechanisms. This study examined the performance of medical students on physiology over four semesters with and without active engagement methodologies. Four activities were used: a puzzle, a board game, a debate, and a video. The results show that engaging in activities with active methodologies before a physiology cognitive monitoring test significantly improved student performance compared with not performing the activities. We integrate the use of these methodologies with classic lectures, and this integration appears to improve the teaching/learning process in the discipline of physiology and improves the integration of physiology with cardiology and neurology. In addition, students enjoy the activities and perform better on their evaluations when they use them.

A puzzle used to teach the cardiac cycle

The aim of the present article is to describe a puzzle developed for use in teaching cardiac physiology classes. The puzzle presents figures of phases of the cardiac cycle and a table with five columns: phases of cardiac cycle, atrial state, ventricular state, state of atrioventricular valves, and pulmonary and aortic valves. Chips are provided for use to complete the table. Students are requested to discuss which is the correct sequence of figures indicating the phases of cardiac cycle. Afterward, they should complete the table with the chips. Students of biology, dentistry, medicine, pharmacy, and nursing graduation courses from seven institutions performed the puzzle evaluation. They were invited to indicate whether the puzzle had been useful for learning about the subject by filling one of four alternatives. Of the students, 4.6% answered that it was not necessary but helped them to confirm what they had learned, 64.5% reported that although they had previously understood the cardiac cycle, the puzzle helped them to solve doubts and promoted a better understanding of it, and 30.9% said that they needed the puzzle to understand the cardiac cycle, without differences among courses, institutions, and course semesters. The results of the present study suggest that a simple and inexpensive puzzle may be useful as an active learning methodology applied after the theoretical lecture, as a complementary tool for studying cardiac cycle physiology.