Learning approaches of undergraduate medical students to physiology in a non-PBL- and partially PBL-oriented curriculum

Melaka Manipal Medical College (Manipal Campus; Manipal, Karnataka, India) conducts the Bachelor of Medicine and Bachelor of Surgery program, for which the admission intakes are during the months of March and September. The present study was undertaken to study the differences in learning approaches to physiology of undergraduate medical students in a partially problem-based learning (PBL)- and non-PBL-oriented curriculum. PBL was introduced as a curricular reform for the September 2006 batch of students (partially PBL group), whereas it was not incorporated for the March 2006 batch of students (non-PBL group). Learning approaches to physiology of both groups of students were compared using the short inventory of approaches to learning. Mean scores for deep and strategic approaches were found to be significantly higher for the partially PBL group compared with the non-PBL group. The results of the present study support the earlier observation that PBL promotes a deep approach to learning.     

What does one mean by "arterial blood oxygenation?"

We used the following question in a large classroom session attended by undergraduate medical students and doctors with a Bachelor of Medicine and Bachelor of Surgery (MBBS) degree (240 in all) to test for conceptual understanding as to what constitutes arterial blood oxygenation. The question read as follows: Which one of the following physiological parameters taken alone tells you that arterial blood oxygenation in a critically ill patient is satisfactory? A. (Alveolar-arterial) O(2) gradient=10 mmHg. B. Partial pressure of O(2) in arterial blood=95 mmHg. C. O(2)saturation of hemoglobin>90%. D. Blood hemoglobin concentration=12 g/dl. Only 25 of 240 students correctly indicated that none of the above parameters taken alone could give us this information. Once students turned in their answers, we presented five examples illustrating how none of the above answers could be used alone to assess arterial blood oxygenation. Students were then asked to provide written feedback on their understanding of this topic. The majority of students indicated that they were satisfied that they got rid of a misconception.     

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.     

Combination of didactic lecture with problem-based learning sessions in physiology teaching in a developing medical college in Nepal

Physiology teaching as an essential part of medical education faces tremendous criticism regarding curriculum design, methods of implementation, and application of knowledge in clinical practice. In the traditional method of medical education, physiology is taught in the first year and involves little interdisciplinary interaction. The Manipal College of Medical Sciences, Pokhara, Nepal (affiliated with the Kathmandu Univ.) started in 1994 and adopted an integrated curriculum drawn along the lines of the student-centered, problem-based, integrated, community-based, elective-oriented, and systematic (SPICES) medical curriculum. Here, physiology is taught for the first 2 yr of the 4.5-yr Bachelor of Medicine, Bachelor of Surgery course. Methodology adopted is as follows. For a particular topic, objectives are clearly defined and priority content areas are identified. An overview is given in a didactic lecture class to the entire batch of 100 students. Tutorial classes are conducted thereafter with smaller groups of students (25/batch) divided further into five subgroups of five students each. In these sessions, a problem is presented to the students as a focus for learning or as an example of what has just been taught. Each problem was accompanied with relevant questions to streamline the students' thought processes. A tutor is present throughout the session not as an instructor but as a facilitator of the learning process. A questionnaire sought students' opinion on the usefulness of this approach, relevance of the combination of problem-based learning (PBL) sessions and didactic lectures in understanding a particular topic and relating clinical conditions to basic mechanisms, and improvement of performance on the university final examination. The majority of the students opined that the combination of didactic lectures and PBL sessions was definitely beneficial regarding all the above-mentioned aspects of learning. The university results corroborated their opinion. Thus it may be considered that a judicious mixture of didactic lectures and PBL sessions is beneficial as a teaching module of physiology in medical schools.     

Student perspectives of assessment by TEMM model in physiology

Assessment is the process by which the teacher and the student gain knowledge about student progress. Assessment systems should aim at evaluating the desired learning outcomes. In Melaka Manipal Medical College, (Manipal Campus), Manipal, India, the TEMM model (consisting of 4 assessment methods: Triple Jump Test, essay incorporating critical thinking questions, Multistation Integrated Practical Examination, and multiple choice questions) was introduced to 30 refresher students in the fourth block of the academic year. At the end of the block, a questionnaire was distributed to ask the students to rank the different assessments in the order of their preference with respect to seven items. Analysis of the results showed that not a single type of assessment was ranked highest for all the seven items, proving the earlier observation that a single assessment does not fulfill all aspects of assessment and that there is a need for an evaluating system with multiple ways of assessment.     

Language-trained chimpanzees (Pan troglodytes) delay gratification by choosing token exchange over immediate reward consumption

Token exchange inherently introduces an element of delay between behavior and reward and so token studies may help us better understand delay of gratification and self-control. To examine this possibility, we presented three language-trained chimpanzees with repeated choices involving different foods that could be eaten immediately or lexigram (graphic symbol) tokens that represented (and could be traded for) foods later. When both options were foods, chimpanzees always chose more preferred foods over less preferred foods. When both options were lexigram tokens representing those same foods, performance remained the same as chimpanzees selected the higher value token and then traded it for food. Then, when faced with choosing a token that could be traded later or choosing a food item that could be eaten immediately, most chimpanzees learned to make whatever response led to the more preferred food. They did this even when that meant selecting a high value lexigram token that could be traded only 2 to 3 min later instead of a medium value, but immediately available, food item. Thus, chimpanzees flexibly selected tokens even though such selections necessarily delayed gratification and required forgoing immediately available food. This finding illustrates the utility of symbolic token exchange for assessing self-control in nonhuman animals.     

Use of the web to provide learning support for a large metabolism and nutrition class

To support student learning in a large Metabolism and Nutrition class, we have introduced a web-based package, using a commercially available program, WebCT. The package was developed at a minimal cost and with limited resources. In addition to downloadable (PDF) versions of lecture Powerpoint presentations, tutorial outlines and a practical class exercise, web-based self-directed learning exercises were included to reinforce and extend lecture material in an active learning environment. The web-site also contained a variety of formative and summative assessment tasks that examined both factual recall and higher order thinking. Detailed course information, timetables and a bulletin board were also readily accessible. Student usage of the site was generally high, but varied widely between individual students. Students who achieved a high overall score for the course completed on average three times as many formative assessment items and achieved a higher score for all tests than students who did poorly. Student feedback about the site was very positive with the majority of students reporting that the course material and assessment items that were available were useful to their learning. Administration of the course was also facilitated.     

How much structuring is beneficial with regard to examination scores? A prospective study of three forms of active learning

Many studies have demonstrated a superiority of active learning forms compared with traditional lecture. However, there is still debate as to what degree structuring is necessary with regard to high exam outcomes. Seventy-five students from a premedical school were randomly attributed to an active lecture group, a cooperative group, or a collaborative learning group. The active lecture group received lectures with questions to resolve at the end of the lecture. At the same time, the cooperative group and the collaborative group had to work on a problem and prepare presentations for their answers. The collaborative group worked in a mostly self-directed manner; the cooperative group had to follow a time schedule. For the additional work of preparing the poster presentation, the collaborative and cooperative groups were allowed 50% more working time. In part 1, all groups worked on the citric acid cycle, and in part 2, all groups worked on molecular genetics. Collaborative groups had to work on tasks and prepare presentations for their answers. At the end of each part, all three groups were subjected to the same exam. Additionally, in the collaborative and cooperative groups, the presentations were marked. All evaluations were performed by two independent examiners. Exam results of the active lecture groups were highest. Results of the cooperative group were nonsignificantly lower than the active lecture group and significantly higher than the collaborative group. The presentation quality was nonsignificantly higher in the collaborative group compared with the cooperative group. This study shows that active lecturing produced the highest exam results, which significantly differed from collaborative learning results. The additional elaboration in the cooperative and collaborative learning setting yielded the high presentation quality but apparently could not contribute further to exam scores. Cooperative learning seems to be a good compromise if high exam and presentation scores are expected.     

Biofeedback,self-control,and self-management

A common goal of biofeedback is self-control of physiologic responses. The conceptions and paradigms of the literature on self-control of motoric and cognitive responses were surveyed to provide a basis for the self-control of physiologic responses. An operational definition of self-control was advanced, and self-control was placed in the framework of a general self-management strategy which included discrimination and maintenance components.     

Combination of didactic lectures and case-oriented problem-solving tutorials toward better learning: perceptions of students from a conventional medical curriculum

The Department of Physiology of Pramukhswami Medical College at Anand, Gujarat, India, started using problem-based learning in a modified way along with didactic lectures to improve students' understanding and motivate them toward self-directed study. After the didactic lectures were taken for a particular system, clearly defined short clinical problems related to that system were given to the students in the tutorial classes. Each tutor was assigned three to four groups of five to six students each. Problems were accompanied with relevant questions so as to streamline the thought processes of the first-year undergraduates. The tutor then facilitated the study process, and the students discussed among themselves to derive their solutions. At the end of the sessions, feedback was taken from the students through a planned questionnaire on a three-point scale. Of a total of 278 students over a span of 3 yr from 1999 to 2002, 74.4% of students favored a judicious mixture of didactic lectures and case-oriented problem solving in tutorial classes to be an efficient modality in understanding a system under study, and 84% of students stated the mixture of didactic lectures and case-oriented problem solving to be beneficial in relating a clinical condition to the basic mechanism; 82% of students believed that this module helped with better interactions among their batch mates, and 77.2% of students hoped to perform better in the university examination due to this new teaching/learning modality. They also expressed that this gave them ample motivation to do self-directed learning. It may therefore be concluded from the results of the present study that it is possible to have a problem-based learning module in the form of case-oriented problem-solving tutorials coexistent with the traditional didactic lecture module in the first year of medical education under a conventional curriculum.     

Science attitudes and knowledge among preclinical medical students in Pokhara, Nepal

Knowledge of science and the scientific method are important in learning about and using evidence-based medicine in practice. Courses in research methodology have been introduced for both medical students and practicing doctors. In Pokhara, the basic science subjects are taught in an integrated manner during the first four semesters of the undergraduate medical course. Studies on students' attitudes towards and knowledge of science are lacking in medical colleges in Nepal. Hence the study was carried out to obtain information on students' attitude towards and knowledge of science and scientific methodology among preclinical medical students and note the association, if any, of students' attitudes and their demographic characteristics. The study was carried out in March 2005 among the students of the first four semesters at the Manipal College of Medical Sciences, Pokhara, Nepal using a questionnaire developed by Hren and coworkers. Two hundred and twenty students (overall response rate 73.3%) successfully completed the questionnaire. Seventy-five respondents were Nepalese, 115 were Indians, 27 were Sri Lankans and 3 belonged to other nationalities. The X +/- SD total attitude score was 147.4 +/- 10.8 (neutral score 135). The X +/- SD scores on the subscales, value of science to humanity, value of scientific methodology and value of science to medicine were 51.3 +/- 5.4, 39.6 +/- 3.7 and 58.5 +/- 5.9 (neutral scores were 36, 51 and 48 respectively). The knowledge score measured using a set of 8 multiple choice questions was 3.3 +/- 1.4. The attitude scores were lower and the knowledge score was comparable to that reported previously in a study in Croatia but higher than that reported from Southeast Europe.     

关于在神经外科实习教学中采用Web-CPBL教学模式的探讨

在医学生临床实习带教过程中,神经外科实习教学由于其教学内容具有专业性强、信息量大、知识更新快的特点,与其它专业相比更具难度,教学效果往往难达到预期水平。Web-CPBL教学模式,是将传统的PBL教学理念与网络信息技术有机融合,延伸和发展出的一种新型教学模式。在神经外科实习教学中,巧妙得当的借力于网络资源平台,有助于打破临床师资缺乏、实操场地不足的局限,能更充分的发挥PBL教学的优势。此模式在培养和锻炼医学生临床思维能力的同时,也帮助他们尽早养成主动学习、善于协作、乐于共享的良好学习习惯,提高其医学人文素养。     

Computer simulation of introductory neurophysiology

A computer-assisted learning (CAL) package, NeuroLab, developed for use by first-year university students undertaking professional programs in the health area, is described and evaluated. NeuroLab is a simulation of a laboratory, in which students are able to impale neurons to measure resting membrane potentials and subsequently undertake experiments including measuring resting membrane potentials, determining threshold potentials, measuring refractory periods, and examining effects on membrane potential through altering the membrane permeability to sodium and potassium ions. Students find the package to be a worthwhile learning experience, with 81 +/- 2.2% reporting the package increased their understanding of neuron function, and 78 +/- 2.5% expressing a desire for more CAL packages. Exposure to the package resulted in significantly higher mean scores in a multiple-choice question test on measuring neuron membrane potentials compared with those who were not exposed (mean scores out of 4 of 2.42 and 2.02, respectively, P < 0.001).     

Differential negative air ion effects on learning disabled and normal-achieving children

Forty normal-achieving and 33 learning disabled (LD) children were assigned randomly to either a negative ion or placebo test condition. On a dichotic listening task using consonant-vowel (CV) combinations, both groups showed an ioninduced increase in the normal right ear advantage (REA). However, the mechanisms for this effect were different for each group. The LDs showed the effect at the right ear/left hemisphere (enhancement). The normal achievers showed the effect at the left ear/right hemisphere (inhibition). The results are consistent with an activation-inhibition model of cerebral function and suggest a functional relationship between arousal, interhemispheric activation-inhibition, and learning disabilities. The LDs may have an interhemispheric dysfunction. Both groups showed superior right ear report and the normal achiever showed overall superiority. Normal achievers showed higher consonant intrusion scores, probably due to a greater cognitive capacity. Age was a significant covariate reflecting developmental capacity changes. Negative air ions are seen to be a tool with potential theoretical and remedial applications.     

Medical Students’ Perceptions of Clinical Teachers as Role Model

Introduction

Role models facilitate student learning and assists in the development of professional identity. However, social organization and cultural values influence the choice of role models. Considering that the social organization and cultural values in South East Asia are different from other countries, it is important to know whether this affects the characteristics medical students look for in their role models in these societies.

Methods

A 32 item questionnaire was developed and self-administered to undergraduate medical students. Participants rated the characteristics on a three point scale (0 = not important, 1 = mildly important, 2 = very important). One way ANOVA and student''s t-test were used to compare the groups.

Results

A total of 349 (65.23%) distributed questionnaires were returned. The highest ranked themes were teaching and facilitating learning, patient care and continuing professional development followed by communication and professionalism. Safe environment and guiding personal and professional development was indicated least important. Differences were also observed between scores obtained by males and females.

Conclusion

Globally there are attributes which are perceived as essential for role models, while others are considered desirable. An understanding of the attributes which are essential and desirable for role models can help medical educators devise strategies which can reinforce those attributes within their institutions.     

Learning genetics through a scientific inquiry game

In this paper we discuss an activity through which students learn basic concepts in genetics by taking part in a police investigation game. The activity, which we have called Recal, immerses students in a scientific-based scenario in which they play a role of a scientific assessor. Players have to develop and use scientific reasoning and evidence-based decision-making to solve the given enigmas along the game. The activity aims to improve students’ knowledge of genetics and show them how genetic evidence can be applied in forensic science. The activity (known as ‘the Recal case’) uses a problem-based learning educational methodology. It is learner-centred and students play an active collaborative role. The methodology requires students to structure their knowledge, and develop their reasoning processes and self-directed learning skills. The activity has been developed for a range of audiences, including high school students, undergraduates engaged in pre-service teaching and adults of all ages. A case study has also been carried out with a group of 120 pre-service student teachers from the Universitat Rovira i Virgili (Tarragona, Spain) to check whether the coherence in the running of the game, whether its effectiveness as a learning activity and whether its dynamics and motivational aspects are acceptable.     

Efficacy of self-control and patience interventions in adolescents

Self-control and patience are character strengths predictive of positive developmental outcomes, but few interventions targeting their growth have been tested in adolescents. Moreover, interventions based on the limited-strength model of self-control have received considerable criticism, but few studies have tested moderation of interventions by motivational variables fundamental to computational and process models of self-control. To correct this deficiency, we tested the ability of three interventions—using one’s nondominant hand, engaging in cognitive reappraisal exercises, and tracking one’s schedule—to increase self-control and patience in 355 high school students (mean = 16.0 years; 59% female). The nondominant hand and schedule tracking conditions were found to increase self-control, patience, and well-being only when the perceived difficulty was low. Results suggest that the limited-strength model of self-control is insufficient and underscore the explanatory power of computational and process models that account for difficulty. Implications for constructing character interventions for adolescents are discussed.     

Making developmental biology relevant to undergraduates in an era of economic rationalism in Australia

This report describes the road map we followed at our university to accommodate three main factors: financial pressure within the university system; desire to enhance the learning experience of undergraduates; and motivation to increase the prominence of the discipline of developmental biology in our university. We engineered a novel, multi-year undergraduate developmental biology program which was "student-oriented," ensuring that students were continually exposed to the underlying principles and philosophy of this discipline throughout their undergraduate career. Among its key features are introductory lectures in core courses in the first year, which emphasize the relevance of developmental biology to tissue engineering, reproductive medicine, therapeutic approaches in medicine, agriculture and aquaculture. State-of-the-art animated computer graphics and images of high visual impact are also used. In addition, students are streamed into the developmental biology track in the second year, using courses like human embryology and courses shared with cell biology, which include practicals based on modern experimental approaches. Finally, fully dedicated third-year courses in developmental biology are undertaken in conjunction with stand-alone practical courses where students experiencefirst-hand work in a research laboratory. Our philosophy is a "cradle-to-grave" approach to the education of undergraduates so as to prepare highly motivated, enthusiastic and well-educated developmental biologists for entry into graduate programs and ultimately post-doctoral research.     

Ways of coping as predictors of satisfaction with curriculum and academic success in medical school

The purpose of the present study was to determine the coping strategies of medical students and to investigate the effects of coping strategies on student satisfaction and academic achievement with different instruction methods. A total of 152 medical students was followed throughout the first 2 yr of medical education between 2008 and 2010. Students completed a sociodemographic questionnaire and revised form of the Ways of Coping questionnaire both at the beginning of the first year and at the end of the second year. These forms provided data about the characteristics and main coping strategies (problem focused or emotion focused) of the students and revealed the change over time. At the end of the second year, participants also completed a satisfaction questionnaire asking their satisfaction with lectures, problem-based learning, and practicals. The authors used block, problem-based learning, and practical exam scores of the students attained in the past 2 yr as academic achievement indicators. No sociodemographic variable was related to coping strategy. The majority of students (80.9%) adopted problem-focused coping. A shift occurred in the main coping strategies of some students in both sides. Problem-focused coping scores decreased over time. Problem-focused coping positively correlated with satisfaction with practicals and practical exam scores, whereas emotion-focused coping showed the same correlation negatively. The main coping strategy also predicted satisfaction and exam success in practicals. In conclusion, a main coping strategy may be helpful to predict student satisfaction and academic achievement with some student-centered instruction methods. Determining undesired coping strategies may provide an opportunity for intervention to prevent relevant dissatisfaction and failure.