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

Integration of respiratory physiology and clinical reasoning in the early years of a medical curriculum: engaging with students in a large classroom setting

Medical graduates are expected to apply scientific principles and explain the processes underlying common and important diseases. Evidence shows that integrated medical curricula, which deliver biomedical science within the context of clinical cases, facilitate student learning in preparation for practice. However, research has also shown that the student's perception of their knowledge can be lower in integrated compared to traditional courses. Thus the development of teaching methods to support both integrated learning and build student confidence in clinical reasoning is a priority. In this study, we describe the use of an audience response system to support active learning in large classes. Sessions, delivered by medical faculty from both academic and clinical backgrounds, were designed to build on the knowledge of the respiratory system in both health and disease through the interpretation of clinical cases. Results showed that student engagement was high throughout the session and students strongly agreed that the application of knowledge to real-life cases was a better way to understand clinical reasoning. Qualitative free text comments revealed that students liked the link between theory and practice and the active, integrated method of learning. In summary, this study describes a relatively simple but highly effective way of delivering integrated medical science teaching, in this case respiratory medicine, to improve student confidence in clinical reasoning. This educational approach was applied within the early years of the curriculum in preparation for teaching within a hospital setting, but the format could be applied across many different settings.NEW & NOTEWORTHY The development of teaching methods that support integrated learning and build student confidence is a priority. An audience response system was used to engage early year medical students in large classes in preparation for teaching within a hospital setting. Results showed high levels of student engagement and a greater appreciation for the link between theory and practice. This study describes a simple, active, and integrated method of learning that improves student confidence in clinical reasoning.

Physiology education in the medical program at Mandume Ya Ndemufayo University: content description and critical overview

The Faculty of Medicine at Mandume Ya Ndemufayo University began teaching in 2009, taking on the challenge of outcomes-based education and aiming to train qualified professionals according to the needs of the community. This article aims to describe and analyze how the teaching of physiology is organized in the medical program at this university. This is a descriptive study of the course pedagogical plan from 2009 to 2020. The results revealed that there is a correspondence between learning outcomes of the Physiology course, the competencies set out in the Profile of the Angolan Doctor, and internationally established sets of competencies. Some weaknesses were identified in relation to the development of skills, pedagogical methodology, and the evaluation process. The recent educational context of this medical school poses great challenges, which require the contextualization and periodic adjustment of its pedagogical plans.NEW & NOTEWORTHY An Angolan faculty of medicine has taken on the challenge of outcomes-based education, aiming to train qualified professionals according to the needs of the community. This article aims to describe and analyze how the teaching of physiology is organized. The results revealed a correspondence between learning outcomes, the competencies set out in the Profile of the Angolan Doctor, and internationally established sets of competencies. The educational context requires contextualization and periodic adjustment of pedagogical plans.

Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review

BACKGROUND

Problem-based learning (PBL) is a pedagogical approach that shifts the role of the teacher to the student (student-centered) and is based on self-directed learning. Although PBL has been adopted in undergraduate and postgraduate medical education, the effectiveness of the method is still under discussion. The author's purpose was to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs.

METHODS

The authors applied the Arksey and O'Malley framework to undertake a scoping review. The search was carried out in February 2021 in PubMed and Web of Science including all publications in English and Spanish with no limits on publication date, study design or country of origin.

RESULTS

The literature search identified one hundred and twenty-four publications eligible for this review. Despite the fact that this review included many studies, their design was heterogeneous and only a few provided a high scientific evidence methodology (randomized design and/or systematic reviews with meta-analysis). Furthermore, most were single-center experiences with small sample size and there were no large multi-center studies. PBL methodology obtained a high level of satisfaction, especially among students. It was more effective than other more traditional (or lecture-based methods) at improving social and communication skills, problem-solving and self-learning skills. Knowledge retention and academic performance weren't worse (and in many studies were better) than with traditional methods. PBL was not universally widespread, probably because requires greater human resources and continuous training for its implementation.

CONCLUSION

PBL is an effective and satisfactory methodology for medical education. It is likely that through PBL medical students will not only acquire knowledge but also other competencies that are needed in medical professionalism.

What happens to misunderstandings of biomedical concepts across a medical curriculum?

Research on the extent and nature of commonly misunderstood fundamental biomedical concepts across a medical curriculum is scarce. These misunderstandings could point toward robust misconceptions. We examined first whether common misunderstandings persist throughout a medical curriculum, followed by a fine-grained analysis to identify their nature. We designed and administered a 2-tier test to 987 medical students across our curriculum, with 8 questions covering the respiratory and cardiovascular systems, cell division, and homeostatic processes. Proportions of incorrect responses were computed. Four questions where misunderstandings persisted were further qualitatively analyzed. A one-way ANOVA showed the proportion of incorrect responses decreased significantly by students' academic year [F(6, 986) = 96.05, P < 0.001]. While novices and end-of -first-year students showed similar proportion of incorrect responses (P > 0.05), incorrect responses decreased significantly between first years and second years (P < 0.001). Thereafter, the proportion of incorrect responses remained stable from second to final year (P > 0.05), with ∼35% of incorrect responses. Five questions showed no decrease of incorrect responses between second and final years, with two questions where final year students performed marginally better than novices. A Chi-square analysis, with Bonferroni post hoc test, showed certain misunderstandings appeared frequently across the curriculum. The qualitative analysis of the open-ended questions yielded 15 categories of common misunderstandings of fundamental biomedical concepts in all years of training. If educators become aware of commonly misunderstood biomedical concepts, preventative measures could be taken to prevent robust misconceptions.

An innovative pharmacology curriculum for medical students: promoting higher order cognition, learner-centered coaching, and constructive feedback through a social pedagogy framework

BACKGROUND

Ongoing developments in medical education recognize the move to curricula that support self-regulated learning processes, skills of thinking, and the ability to adapt and navigate uncertain situations as much as the knowledge base of learners. Difficulties encountered in pursuing this reform, especially for pharmacology, include the tendency of beginner learners not to ask higher-order questions and the potential incongruency between creating authentic spaces for self-directed learning and providing external expert guidance. We tested the feasibility of developing, implementing, and sustaining an innovative model of social pedagogy as a strategy to address these challenges.

METHODS

Constructivism, communities of practice, and networked learning theory were selected as lenses for development of the model. Three hundred sixty-five first-year medical students participated between 2014 and 2018; they were introduced to pharmacodynamics and pharmacokinetics via 15 online modules that each included: learning objectives, a clinical vignette, teaching video, cumulative concept map, and small group wiki assignment. Five-person communities organized around the 15 wiki assignments were a key component where learners answered asynchronous, case-based questions that touched iteratively on Bloom's cognitive taxonomy levels. The social pedagogy model's wiki assignments were explored using abductive qualitative data analysis.

RESULTS

Qualitative analysis revealed that learners acquired and applied a conceptual framework for approaching pharmacology as a discipline, and demonstrated adaptive mastery by evaluating and interacting competently with unfamiliar drug information. Learners and faculty acquired habits of self-directed assessment seeking and learner-centered coaching, respectively; specifically, the model taught learners to look outward to peers, faculty, and external sources of information for credible and constructive feedback, and that this feedback could be trusted as a basis to direct performance improvement. 82-94% of learners rated the social pedagogy-based curriculum valuable.

CONCLUSIONS

This social pedagogy model is agnostic with regard to pharmacology and type of health professional learner; therefore, we anticipate its benefits to be transferable to other disciplines.

Selected omissions and capstone presentations: a new approach to student-centered integrative physiology education

Here, we describe a pedagogical approach that combines didactics with active learning to facilitate integration across physiological systems in a team-taught, graduate-level physiology course. We covered the major physiological systems, with each system preceded by an overview of its evolution/ontogeny to provide a broader perspective. Lectures provided a framework for integration by giving examples of how each system interacted with systems that preceded and followed. In lieu of a final exam, the course culminated in capstone presentations by small groups to promote student-centered learning of integrative physiology. At the beginning of the semester, students were assigned to groups; each group chose from predetermined topics. This allowed them to accumulate information throughout the semester and required them to attend to lecture content to assess how the material applied to their topic, thereby facilitating learning and retention. Faculty were deliberate in choosing material that was presented in each system, and material that was strategically omitted, establishing "gaps" that students filled in their capstone presentations. The final week was dedicated to student preparation for their presentations, which promoted peer-to-peer teaching and problem solving by the group, assisted by faculty as necessary. Capstone presentations demonstrated students' mastery of basic physiological principles and their ability to integrate among physiological systems, and they rated capstone presentations highly in helping with integration and critical thinking. Thus students showed a better understanding of systems physiology and the importance of integration across systems in normal function and in responding to homeostatic challenges.

Using lectures to identify student misconceptions: a study on the paradoxical effects of hyperkalemia on vascular smooth muscle

Medical students have difficulty understanding the mechanisms underlying hyperkalemia-mediated local control of blood flow. Such control mechanisms are crucial in the brain, kidney, and skeletal muscle vasculature. We aimed to identify medical students' misconceptions via assessment of students' in-class knowledge and, subsequently, improve future teaching of this concept. In-class polling was performed with the TurningPoint clicker response system (n = 860) to gauge students' understanding of three physiological concepts related to hyperkalemia: membrane potential (V_m), conductance, and smooth muscle response. V_m includes the concepts of equilibrium potential (V_eq) for specific ions, as well as driving force (DF = V_m - V_eq). Students understood the concept of DF (~70% answered correctly), suggesting their understanding of V_m. However, students misunderstood that hyperkalemia results in depolarization (~52% answered correctly) and leads to an increase in potassium conductance (~31% answered correctly). Clarification of the type of smooth muscle as vascular increased the percentage of correct responses (~51 to 73%). The data indicate that students lacked knowledge of specific potassium conductance in various muscle types, resulting in divergent responses, such as the canonical depolarization in skeletal muscle versus hyperpolarization in smooth muscle cells during hyperkalemia. Misunderstanding of this crucial concept of conductance is directly related to the students' performance. Furthermore, we connected the paradoxical effect of hyperkalemia to pathological acute and chronic hyperkalemia clinical scenarios.

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.

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.

Update on research and application of problem-based learning in medical science education

Problem-based learning (PBL) is a unique form of pedagogy dedicated to developing students' self-learning and clinical practice skills. After several decades of development, although applications vary, PBL has been recognized all over the world and implemented by many medical schools. This review summarizes and updates the application and study of PBL in medical education through the literature published between 1993 and early 2017. It focuses on understanding real medical PBL courses and ways to improve PBL to achieve better learning outcomes. PBL aims to develop lifelong skills to solve practical problems rather than limiting learning to theoretical knowledge. To achieve this goal, strict and reasonable procedures need to be designed and implemented. Rigorous monitoring and timely feedback and evaluation are indispensable to constant improvements and perfecting of the process. © 2017 by The International Union of Biochemistry and Molecular Biology, 46(2):186-194, 2018.

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.

ClueConnect: a word array game to promote student comprehension of key terminology in an introductory anatomy and physiology course

The sheer amount of terminology and conceptual knowledge required for anatomy and physiology can be overwhelming for students. Educational games are one approach to reinforce such knowledge. In this activity, students worked collaboratively to review anatomy and physiology concepts by creating arrays of descriptive tiles to define a term. Once guessed, students located the structure or process within diagrams of the body. The game challenged students to think about course vocabulary in novel ways and to use their collective knowledge to get their classmates to guess the terms. Comparison of pretest/posttest/delayed posttest data revealed that students achieved statistically significant learning gains for each unit after playing the game, and a survey of student perceptions demonstrated that the game was helpful for learning vocabulary as well as fun to play. The game is easily adaptable for a variety of lower- and upper-division courses.

Exploring lecturers' views of first-year health science students' misconceptions in biomedical domains

Research has indicated that misconceptions hamper the process of knowledge construction. Misconceptions are defined as persistent ideas not supported by current scientific views. Few studies have explored how misconceptions develop when first year health students conceptually move between anatomy and physiology to construct coherent knowledge about the human body. This explorative study analysed lecturers' perceptions of first-year health science students' misconceptions in anatomy and physiology to gain a deeper understanding of how and why misconceptions could potentially arise, by attempting to link sources of misconceptions with four schools of thought, namely theories on concept formation, complexity, constructivism and conceptual change. This was a qualitative study where ten lecturers involved in teaching anatomy and physiology in the health science curricula at the University of Cape Town were interviewed to explore perceptions of students' misconceptions. Analytical induction was used to uncover categories within the interview data by using a coding system. A deeper analysis was done to identify emerging themes that begins to explore a theoretical understanding of why and how misconceptions arise. Nine sources of misconceptions were identified, including misconceptions related to language, perception, three dimensional thinking, causal reasoning, curricula design, learning styles and moving between macro and micro levels. The sources of misconceptions were then grouped together to assist educators with finding educational interventions to overcome potential misconceptions. This explorative study is an attempt in theory building to understand what is at the core of biomedical misconceptions. Misconceptions identified in this study hold implications for educators as not all students have the required building blocks and cognitive skills to successfully navigate their way through biomedical courses. Theoretical insight into the sources of misconceptions can assist educators in addressing potential hampering factors in the construction of coherent scientific knowledge.

Performance of first-year health sciences students in a large, diverse, multidisciplinary, first-semester, physiology service module

Health Science students at the University of KwaZulu-Natal perform better in their professional modules compared with their physiology modules. The pass rates of physiology service modules have steadily declined over the years. While a system is in place to identify "at-risk" students, it is only activated after the first semester. As a result, it is only from the second semester of their first year studies onward that at-risk students can be formally assisted. The challenge is thus to devise an appropriate strategy to identify struggling students earlier in the semester. Using questionnaires, students were asked about attendance, financing of their studies, and relevance of physiology. After the first class test, failing students were invited to complete a second questionnaire. In addition, demographic data were also collected and analyzed. Correlation analyses were undertaken of performance indicators based on the demographical data collected. The 2011 class comprised mainly sport science students (57%). The pass rate of sport science students was lower than the pass rates of other students (42% vs. 70%, P < 0.001). Most students were positive about physiology and recognized its relevance. Key issues identified were problems understanding concepts and terminology, poor study environment and skills, and lack of matriculation biology. The results of the first class test and final module marks correlated well. It is clear from this study that student performance in the first class test is a valuable tool to identify struggling students and that appropriate testing should be held as early as possible.

Motivational component profiles in university students learning histology: a comparative study between genders and different health science curricula

BACKGROUND

The students' motivation to learn basic sciences in health science curricula is poorly understood. The purpose of this study was to investigate the influence of different components of motivation (intrinsic motivation, self-determination, self-efficacy and extrinsic -career and grade- motivation) on learning human histology in health science curricula and their relationship with the final performance of the students in histology.

METHODS

Glynn Science Motivation Questionnaire II was used to compare students' motivation components to learn histology in 367 first-year male and female undergraduate students enrolled in medical, dentistry and pharmacy degree programs.

RESULTS

For intrinsic motivation, career motivation and self-efficacy, the highest values corresponded to medical students, whereas dentistry students showed the highest values for self-determination and grade motivation. Genders differences were found for career motivation in medicine, self-efficacy in dentistry, and intrinsic motivation, self-determination and grade motivation in pharmacy. Career motivation and self-efficacy components correlated with final performance in histology of the students corresponding to the three curricula.

CONCLUSIONS

Our results show that the overall motivational profile for learning histology differs among medical, dentistry and pharmacy students. This finding is potentially useful to foster their learning process, because if they are metacognitively aware of their motivation they will be better equipped to self-regulate their science-learning behavior in histology. This information could be useful for instructors and education policy makers to enhance curricula not only on the cognitive component of learning but also to integrate students' levels and types of motivation into the processes of planning, delivery and evaluation of medical education.

Showercap Mindmap: a spatial activity for learning physiology terminology and location

Students struggle with the volume and complexity of physiology terminology. We compared first-year undergraduate psychology students' learning of physiological terms using two teaching methods: one verbal (control group; n = 16) and one spatial and multisensory (experimental group; n = 19). The experimental group used clear plastic shower caps to mark brain regions and affix labels to another participant's head. The control group learned the material verbally through a game. When tested verbally, both the control and experimental groups recalled more of the 10 terms immediately after the activity (+106% and +83%, respectively) and 2 wk later (+53% and +31%, respectively) than at the pretest (P < 0.0005). When participants' knowledge was tested spatially (labeling a brain diagram), the experimental group recalled more terms at the posttest (+76%) and followup (+73%) than at the pretest (P < 0.0005), but the control group who showed no improvement at either time point (+12% and +14%, respectively). These findings support the notion that spatial and multisensory learning produces improved spatial recall over time while also supporting the notion of transfer-appropriate processing.

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.