Integrating an open-source course management system (Moodle) into the teaching of a first-year medical physiology course: a case study

Educators in medical schools around the world are presently experimenting with innovative ways of using web-based learning to supplement the existing teaching and learning process. We have recently used a popular open-source course management system (CMS) called the modular object-oriented dynamic learning environment (Moodle) to construct an online site (DPhysiol) to facilitate our face-to-face teaching of physiology to a group of first-year students in the Bachelor of Medicine and Bachelor of Surgery program. The integration of the Moodle site into our teaching was assessed using online log activity, student examination marks, and feedback from students. The freely available Moodle platform was simple to use, helped to effectively deliver course materials, and has features that allowed cooperative learning. Students who used the CMS throughout their academic year and commented favorably regarding its use as a complement to the face-to-face classroom sessions. The group of students used the CMS obtained significantly higher scores in the final examination compared with the previous class that did not use the CMS. In addition, there was a significant correlation between student participation and performance in online quizzes and their final examination marks. However, students' overall online usage of the CMS did not correlate with their examination marks. We recommend Moodle as a useful tool for physiology educators who are interested in integrating web-based learning into their existing teaching curriculum.     

Knowledge on HPV Vaccine and Cervical Cancer Facilitates Vaccine Acceptability among School Teachers in Kitui County,Kenya

Background

Vaccines against human papillomavirus (HPV) infection have the potential to reduce the burden of cervical cancer. School-based delivery of HPV vaccines is cost-effective and successful uptake depends on school teachers’ knowledge and acceptability of the vaccine. The aim of this study is to assess primary school teachers’ knowledge and acceptability of HPV vaccine and to explore facilitators and barriers of an ongoing Gavi Alliance-supported vaccination program in Kitui County, Kenya.

Methods

This was a cross-sectional, mixed methods study in Central Division of Kitui County where the Ministry of Health is offering the quadrivalent HPV vaccine to grade four girls. Data on primary school teachers’ awareness, knowledge and acceptability of HPV vaccine as well as facilitators and barriers to the project was collected through self-administered questionnaires and two focus group discussions.

Results

339 teachers (60% female) completed the survey (62% response rate) and 13 participated in 2 focus group discussions. Vaccine awareness among teachers was high (90%), the level of knowledge about HPV and cervical cancer among teachers was moderate (48%, SD = 10.9) and females scored higher than males (50% vs. 46%, p = 0.002). Most teachers (89%) would recommend the vaccine to their daughter or close relatives. Those who would recommend the vaccine had more knowledge than those who would not (p = <0.001). The main barriers were insufficient information about the vaccine, poor accessibility of schools, absenteeism of girls on vaccine days, and fear of side effects.

Conclusions

Despite low to moderate levels of knowledge about HPV vaccine among school teachers, vaccine acceptability is high. Teachers with little knowledge on HPV vaccine are less likely to accept the vaccine than those who know more; this may affect uptake if not addressed. Empowering teachers to be vaccine champions in their community may be a feasible way of disseminating information about HPV vaccine and cervical cancer.     

Active learning of respiratory physiology improves performance on respiratory physiology examinations

Active involvement in the learning process has been suggested to enhance creative thinking, judgement, interpretation, and problem-solving skills. Therefore, educators are encouraged to create an active-learning environment by incorporating active-learning strategies into the class. However, there is very little documentation of the effectiveness of active-learning strategies. Furthermore, faculty are often reluctant to incorporate new strategies without documentation of the effectiveness of these strategies. To address this concern, we compared the performance of two individual classes on an identical respiratory physiology examination. One class was taught respiratory physiology using active-learning strategies. The other class was taught respiratory physiology using the traditional lecture format. The results document that students who learned using active-learning strategies did significantly better (P < 0.05) on the respiratory physiology examination than students who learned by the traditional lecture format (61 +/- 2.2 vs. 86 +/- 1.0). Thus, by actively involving students in the learning process, academic performance is enhanced.     

Blending problem-based learning with Web technology positively impacts student learning outcomes in acid-base physiology

World Wide Web (Web)-based learning (WBL), problem-based learning (PBL), and collaborative learning are at present the most powerful educational options in higher education. A blended (hybrid) course combines traditional face-to-face and WBL approaches in an educational environment that is nonspecific as to time and place. To provide educational services for an undergraduate second-year elective course in acid-base physiology, a rich, student-centered educational Web-environment designed to support PBL was created by using Web Course Tools courseware. The course is designed to require students to work in small collaborative groups using problem solving activities to develop topic understanding. The aim of the study was to identify the impact of the blended WBL-PBL-collaborative learning environment on student learning outcomes. Student test scores and satisfaction survey results from a blended WBL-PBL-based test group (n = 37) were compared with a control group whose instructional opportunities were from a traditional in-class PBL model (n = 84). WBL students scored significantly (t = 3.3952; P = 0.0009) better on the final acid-base physiology examination and expressed a positive attitude to the new learning environment in the satisfaction survey. Expressed in terms of a difference effect, the mean of the treated group (WBL) is at the 76th percentile of the untreated (face-to-face) group, which stands for a "medium" effect size. Thus student progress in the blended WBL-PBL collaborative environment was positively affected by the use of technology.     

Near-Peer Teaching in a Required Third-Year Clerkship

Students who teach less experienced students within the same educational program are known as near-peer teachers. A number of studies have shown that near-peers are effective teachers in preclinical courses such as anatomy and physical examination. We hypothesized that near-peers could also be effective teachers in a clinical clerkship. We report on a pilot study in which near-peers participated in a training session and then taught a brief problem-focused skills curriculum to third-year students during a required ambulatory medicine rotation. The clerkship students assigned high ratings to the near-peer teachers, both on an absolute scale and relative to faculty. The results suggest that including near-peers as teachers in a clinical clerkship may be appropriate and that this concept deserves further investigation.     

Students’ Perceptions of Peer-Organized Extra-Curricular Research Course during Medical School: A Qualitative Study

Early integration of research education into medical curricula is crucial for evidence-based practice. Yet, many medical students are graduating with no research experience due to the lack of such integration in their medical school programs. The purpose of this study was to explore the impact of a peer-organized, extra-curricular research methodology course on the attitudes of medical students towards research and future academic careers. Twenty one medical students who participated in a peer-organized research course were enrolled in three focus group discussions to explore their experiences, perceptions and attitudes towards research after the course. Discussions were conducted using a semi-structured interview guide, and were transcribed and thematically analyzed for major and minor themes identification. Our findings indicate that students’ perceptions of research changed after the course from being difficult initially to becoming possible. Participants felt that their research skills and critical thinking were enhanced and that they would develop research proposals and abstracts successfully. Students praised the peer-assisted teaching approach as being successful in enhancing the learning environment and filling the curricular gap. In conclusion, peer-organized extra-curricular research courses may be a useful option to promote research interest and skills of medical students when gaps in research education in medical curricula exist.     

A Web-based course of lectures in respiratory physiology

A complete course of respiratory physiology suitable for first-year medical and graduate students has been placed on the Web for our own students and for other educational institutions. There are several reasons for doing this. The first is that the modern-day student uses a variety of options for acquiring knowledge. These include attending lectures, reading texts, iPod downloads, and surfing the internet. This Web-based course is another option that may be preferable for some students. A second reason is that it is becoming increasingly difficult for some medical schools to find faculty members who are willing and able to teach the principles of respiratory physiology. This is a potentially serious problem because a sound knowledge of respiratory physiology will always be necessary for the intelligent practice of medicine. Schools with limited faculty may find it useful to use these Web-based lectures followed by a discussion session with students. Another reason is that some schools have moved away from systematic lectures to case-based discussions, with the possibility that students will not be exposed to some of the principles of respiratory physiology. The hope is that this comprehensive course of lectures will help students to assimilate this important material as the medical school curriculum continues to expand at a rapid rate.     

Chewing over physiology integration

An important challenge for both students and teachers of physiology is to integrate the different areas in which physiological knowledge is didactically divided. In developing countries, such an issue is even more demanding, because budget restrictions often affect the physiology program with laboratory classes being the first on the list when it comes to cuts in expenses. With the aim of addressing this kind of problem, the graduate students of our department organized a physiology summer course offered to undergraduate students. The objective was to present the different physiological systems in an integrated fashion. The strategy pursued was to plan laboratory classes whose experimental results were the basis for the relevant theoretical discussions. The subject we developed to illustrate physiology integration was the study of factors influencing salivary secretion.     

Effects of different forms of physiology instruction on the development of students' conceptions of and approaches to science learning

The purpose of this study was to investigate students' conceptions of and approaches to learning science in two different forms: internet-assisted instruction and traditional (face-to-face only) instruction. The participants who took part in the study were 79 college students enrolled in a physiology class in north Taiwan. In all, 46 of the participants were from one class and 33 were from another class. Using a quasi-experimental research approach, the class of 46 students was assigned to be the "internet-assisted instruction group," whereas the class of 33 students was assigned to be the "traditional instruction group." The treatment consisted of a series of online inquiry activities. To explore the effects of different forms of instruction on students' conceptions of and approaches to learning science, two questionnaires were administered before and after the instruction: the Conceptions of Learning Science Questionnaire and the Approaches to Learning Science Questionnaire. Analysis of covariance results revealed that the students in the internet-assisted instruction group showed less agreement than the traditional instruction group in the less advanced conceptions of learning science (such as learning as memorizing and testing). In addition, the internet-assisted instruction group displayed significantly more agreement than the traditional instruction group in more sophisticated conceptions (such as learning as seeing in a new way). Moreover, the internet-assisted instruction group expressed more orientation toward the approaches of deep motive and deep strategy than the traditional instruction group. However, the students in the internet-assisted instruction group also showed more surface motive than the traditional instruction group did.     

Hybrid lecture-online format increases student grades in an undergraduate exercise physiology course at a large urban university

Hybrid courses allow students additional exposure to course content that is not possible in a traditional classroom environment. This exposure may lead to an improvement in academic performance. In this report, I describe the transition of a large undergraduate exercise physiology course from a traditional lecture format to a hybrid lecture-online format. A total of 658 final grades (traditional = 346, hybrid = 312) was used to evaluate the effect of course format on academic performance. The hybrid online portion was delivered using WebCT Vista, enhanced with various instructional technologies. The hybrid lecture portion was enhanced with an in-class response system. PowerPoint files were used to distribute in-class lectures in both formats of the course. Final student grades were 9.9% higher (83% of the increase due to an increase in the exam grade) when the course was administered in a hybrid format (P = 0.01), which translated to a one letter grade increase on a standard grading scale. Transition from a traditional lecture format to a hybrid format significantly enhanced student learning; presumably, this increase is due to the fact that students were able to increase their exposure to course content via access to material on WebCT.     

Desert Survivors: the design and implementation of a television program to enhance local scientific literacy

Outreach efforts by faculty members are oftentimes limited in scope due to hectic schedules. We developed a program to enhance science literacy in elementary school children that allows experts to reach a tremendous audience while minimizing their time commitment. The foundation of the program is a television series entitled "Desert Survivors." The episodes air on local cable access television and are available to teachers on DVD. Each episode features a guest expert who spotlights a particular organism and how that organism overcomes the myriad of hardships inherent to desert survival. Local classrooms are visited to solicit questions from students regarding the organism of interest. These videotaped questions are integrated into Desert Survivors television production and provide the guest expert with the basis to discuss the ecology, physiology, and evolutionary biology of the organism. The program is bolstered through the use of an interactive website. Assessment strategies are in place to ensure program efficacy. Herein, we describe the development of the program as a model for innovative outreach opportunities.     

Use of unsupervised online quizzes as formative assessment in a medical physiology course: effects of incentives on student participation and performance

Online quizzes were introduced into a large Medical Physiology class to provide students with formative assessment before midterm and final summative examinations. Use of unsupervised online quizzes was chosen to provide a flexible supplementary learning tool for students without overwhelming a small faculty. Several quiz models were applied, which varied in the availability of course credit points for participation and performance. The aims of the study were to investigate if participation in formative assessment was associated with improved course outcomes, if offering incentives for completing quizzes affected student participation, and if quiz performance was predictive of summative examination outcomes. Results showed that students who elected to use online quizzes performed better in summative examinations. Offering course credit of between 0.5% and 2% per quiz increased student participation. However, evidence was found for widespread inappropriate use of unsupervised online quizzes when incentives for participation were applied. Predictive validity of online quizzes could be demonstrated when comparing the first of several quiz attempts with subsequent summative examination scores.     

Online weight training

The purpose of this study was to determine how a traditional weight training class compared to nontraditional classes that were heavily laden with technology. Could students learn resistance exercises by watching video demonstrations over the Internet? Three university weight training classes, each lasting 16 weeks, were compared. Each class had the same curriculum and workout requirements but different attendance requirements. The online group made extensive use of the Internet and was allowed to complete the workouts on their own at any gym that was convenient for them. Seventy-nine college-aged students were randomized into 3 groups: traditional (n = 27), hybrid (n = 25), and online (n = 27). They completed pretest and posttest measures on upper-body strength (i.e., bench press), lower-body strength (i.e., back squat), and knowledge (i.e., written exam). The results indicated that all 3 groups showed significant improvement in knowledge (p < 0.05). The online group did not require the students to attend class and may have resulted in significantly lower scores on the bench press (p < 0.05) and squats (p < 0.05). This study indicates that an online weight training course may improve knowledge but not strength. Possible reasons for a lack of improvement in the online group included lack of motivation, low accountability, and the possibility that the self-reported workouts were not accurate. These results suggest that there is a limit to how much technology can be used in a weight training class. If this limit is exceeded, some type of monitoring system appears necessary to ensure that students are actually completing their workouts.     

Does sex (female versus male) influence the impact of class attendance on examination performance?

The "conventional wisdom" is that grades are related to class attendance, i.e., students who attend classes more frequently obtain better grades and class attendance dramatically contributes to enhanced learning. However, the influence of sex (female vs. male) on this relationship is understudied. Furthermore, there have been several studies examining the impact of attendance on course grades that challenge the conventional wisdom. To address these issues, we determined the effect of class attendance on examination scores for female and male students enrolled in our undergraduate exercise physiology class of 51 students (20 female students and 31 male students). The experiment was designed not to interfere with the normal conduct of the course. Attendance was recorded in each class, and, although regular attendance was encouraged, it was not required and did not factor into the final grades. The final grade reflected the average days of attendance for female students only. Specifically, female students earning a grade above the class average attended 89 ± 4% of the classes; however, female students earning a grade below the class average attended only 64 ± 6% of the classes. In sharp contrast, there was no difference in the number of classes attended for male students earning grades above or below the class average (84 ± 3% vs. 79 ± 5%). Accordingly, some male students were absent frequently but scored above the class average, whereas other male students attended many classes but scored below the class average. Thus, the influence of regular attendance on examination performance is more important for female students than male students.     

Clinical skills of medical residents: a review of physical examination.

Students are introduced to techniques of physical examination at medical school. However, their skills are deficient at the time of graduation, and with the increasing shift of clinical teaching away from the bedside and into the conference room it is expected that these skills will weaken in succeeding generations of physicians. A practical and satisfactory method of addressing this problem during internship and residency training has not been forthcoming because of the lack of a regular forum for the teaching of clinical skills in busy tertiary referral hospitals and the shortage of teachers with the necessary skills and commitment to teaching a large number of house staff. We describe a program whose unique hierarchical approach has permitted a detailed ongoing review of physical examination. One clinician was able to teach 24 residents by instructing a small group of senior residents, who in turn, after practising with clinical clerks, taught groups of junior residents.     

Analyzing the Practice of Life Cycle Assessment

Life cycle assessment (LCA) is a quantitative tool used to evaluate the environmental impacts of products or processes. With respect to buildings, LCA can be used to evaluate the environmental impacts of an entire building's life cycle. Currently LCA in the building area is used in a limited capacity, primarily to select building products. In order to determine the causality for the lack of whole‐building LCAs, focus groups with members of the architecture, engineering, and construction (AEC) communities were held. This article investigates the current level of knowledge of LCA in the AEC community and then discusses the benefits and barriers to the practice of LCA. In summary, the goal of the research was to identify why LCA is not used to its fullest potential in a whole‐building LCA. In an open forum and moderated setting, focus group participants were asked individually to self‐identify their experience with LCA, a brief education session on LCA was held, and then benefits and barriers to LCA were discussed. The focus group sessions were transcribed and systematically coded by social researchers in order to analyze the results. Hybrid flow and radar charts were developed. From the focus group results, the most important benefit to LCA was “provides information about environmental impacts.” The results did not identify a prominent barrier; however, building‐related metrics were ascertained to be one of the more crucial barriers. The benefits and barriers classified by this analysis will be utilized to develop a subsequent online survey to further understand the LCA and AEC community.     

概念图策略在生理学教学实践中的应用

目的:探讨概念图策略在高职护理专业生理学教学实践中的效果。方法:随机抽取57名学生作为实验组,54名学生作为对照组;实验组施行概念图策略教学法,对照组则采用传统教学法。分别比较两组学生的单元测验成绩和期末考试成绩,并于全部课程结束后进行问卷调查,分析调查结果。结果:实验组学生的单元测试成绩和期末考试成绩均明显高于对照组学生,差异具有统计学意义(P<0.05);实验组94.34%的学生认为教学能够提高学习主动性,而对照组为64.81%;实验组84.21%的学生认为教学有助于提升对课程内容的理解,而对照组为64.11%;实验组87.72%的学生认为教学促进师生互动,而对照组为38.89%;实验组84.21%的学生认为教学可增强团队合作精神,而对照组为57.41%。实验组的调查结果明显优于对照组,差异具有统计学意义(P<0.05)。结论:将概念图策略引入高职护理专业的生理学课程教学实践中,能够更好的帮助学生掌握生理学的理论体系,提升教学质量,提高学生的专业知识水平。     

Evaluation of a computer-based approach to teaching acid/base physiology

Because acid/base physiology is a difficult subject for most medical and veterinary students, the first author designed a software program, Acid/Base Primer, that would help students with this topic. The Acid/Base Primer was designed and evaluated within a conceptual framework of basic educational principles. Seventy-five first-year veterinary students (of 81; 93% response rate) participated in this study. Students took both a pre- and posttest of content understanding. After completing the Acid/Base Primer in pairs, each student filled out a survey evaluating the features of the program and describing his/her use and experience of it. Four pairs of students participated in interviews that elaborated on the surveys. Scores improved from 53 +/- 2% on the pretest to 74 +/- 1% on an immediate posttest. On surveys and in interviews, students reported that the program helped them construct their own understanding of acid/base physiology and prompted discussions in pairs of students when individual understandings differed. The case-based format provided anchors and a high degree of relevance. Repetition of concepts helped students develop a more complex network of understanding. Questions in the program served to scaffold the learning process by providing direction, accentuating the relevant features of the cases, and provoking discussion. Guidelines for software development were generated on the basis of the findings and relevant educational literature.     

The Physician and His Practice—1980 to 2000 Sixth Progress Report of the Committee on Role of Medicine in Society

Members of the Committee on the Role of Medicine in Society, together with medical student representatives of the medical schools in California worked for a period of close to two years preparing this Sixth Progress Report. Names of the committee members, ex-officio members, consultants and medical student members who served during the discussions and the drafting of the report are listed on the final page.