Collaborative testing enhances student learning

Examinations and quizzes should be used as learning as well as assessment tools. To achieve this goal, an assessment procedure was developed to enhance as well as assess student learning. Students were tested on four different topics of cardiovascular physiology. Each topic was tested by a different type of quiz (fill in the blanks, single best response multiple choice, short essay, or true/false). The students first completed a quiz individually. Once the quiz was completed individually, the students completed the same quiz in groups. Eighty percent of the score on the quiz was based on the individual results, and 20% of the score on the quiz was based on the group results. The performance on the quizzes was significantly higher (P < 0.001) when students completed the quizzes in groups than when they completed the quizzes individually. Results document that completing the quizzes in groups enhances the understanding of the material. In addition, students rated this format superior to the traditional method.     

Voluntary participation in an active learning exercise leads to a better understanding of physiology

Students learn best when they are focused and thinking about the subject at hand. To teach physiology, we must offer opportunities for students to actively participate in class. This approach aids in focusing their attention on the topic and thus generating genuine interest in the mechanisms involved. This study was conducted to determine if offering voluntary active learning exercises would improve student understanding and application of the material covered. To compare performance, an anonymous cardiorespiratory evaluation was distributed to two groups of students during the fall (control, n = 168) and spring (treatment, n = 176) semesters. Students in both groups were taught by traditional methods, and students in the treatment group had the option to voluntary participate in two additional active learning exercises: 1) a small group discussion, where students would discuss a physiology topic with their Teaching Assistant before running BIOPAC software for the laboratory exercise and 2) a free response question, where students anonymously responded to one short essay question after the laboratory exercise. In these formative assessments, students received feedback about their present state of learning from the discussion with their peers and also from the instructor comments regarding perceived misconceptions. As a result of the participation in these activities, students in the treatment group had a better overall performance [χ(2) (degree of freedom = 1) = 31.2, P < 0.001] on the evaluation (treatment group: 62% of responses correct and control group: 49%) with an observed difference of 13% (95% confidence interval: 8, 17). In conclusion, this study presents sufficient evidence that when the opportunity presents itself, students become active participants in the learning process, which translates into an improvement in their understanding and application of physiological concepts.     

Expanding the traditional physiology class with asynchronous online discussions and collaborative projects

Discussion and writing are very powerful ways to support learning. This article describes the use of a free, asynchronous online forum to expand student-teacher discussions beyond the time/place constraints of the physical physiology classroom. The main participants were medical students enrolled in physiology class at the University of Zagreb Medical School and their teachers. The assessment data were collected by the electronic administration of the software, by anonymous paper questionnaires, and by the results of the final examination in physiology. During one academic year, 25% (n = 55) of 220 students enrolled in a traditional physiology course participated in online discussions. Physiology teachers and other faculty also joined the forum. All forum members (n = 99) posted 395 messages. Nine documents were published by six students who participated in two online collaborative projects. The difference in the mean grade of the final examination in physiology between student members and nonmembers was statistically significant (P = 0.0328, t = 2.1526). Students who participated in Web discussions were self-selected. Likely, they are the most motivated students, who would perform better on the final examination with or without this resource. Nevertheless, using an online forum could be very successful in teaching critical thinking in physiology because the Internet removes traditional time/place barriers. However, new barriers related to technology and behavioral changes are created. For most teachers and students, the main obstacles to information technology implementation are lack of motivation and lack of professional incentives. To overcome these barriers, institutional support is needed for both students and teachers.     

Assessment outcome is weakly correlated with lecture attendance: influence of learning style and use of alternative materials

The relation between lecture attendance and learning is surprisingly weak, and the role of learning styles in this is poorly understood. We hypothesized that 1) academic performance is related to lecture attendance and 2) learning style influences lecture attendance and, consequently, affects performance. We also speculated that the availability of alternative resources would affect this relationship. Second-year Bachelor of Science physiology students (n = 120) self-reported their lecture attendance in a block of 21 lectures (attendance not compulsory) and use of alternative resources. Overall self-reported lecture attendance was 73 ± 2%. Female students (n = 71) attended more lectures (16.4 ± 0.6) than male students (14.3 ± 0.08, n = 49) and achieved a higher composite mark in all assessments (73.6% vs. 69.3%, P < 0.02). Marks in the final exam were not statistically different between the sexes and correlated only weakly with lecture attendance (r = 0.29, n = 49, P < 0.04 for male students; r = 0.10, n = 71, P = not significant for female students; and r =0.21, n = 120, P < 0.02 for the whole class). Of the students who passed the exam, poor attenders (<11 lectures) reported significantly more use of lecture recordings (37 ± 8%, n = 15, vs. 10 ± 1%, n = 85, P < 0.001). In a VARK learning style assessment (where V is visual, A is auditory, R is reading/writing, and K is kinesthetic), students were multimodal, although female students had a slightly higher average percentage of the R learning style (preferred read/write) compared with male students (28.9 ± 0.9%, n = 63, vs. 25.3 ± 1.3%, n = 32, P < 0.03). Lecture attendance was not correlated with measured learning style. We concluded that lecture attendance is only weakly correlated with academic performance and is not related to learning style. The substitution of alternative materials for lecture attendance appears to have a greater role than learning style in determining academic outcomes.     

Small-group learning in an upper-level university biology class enhances academic performance and student attitudes toward group work

To improve science learning, science educators' teaching tools need to address two major criteria: teaching practice should mirror our current understanding of the learning process; and science teaching should reflect scientific practice. We designed a small-group learning (SGL) model for a fourth year university neurobiology course using these criteria and studied student achievement and attitude in five course sections encompassing the transition from individual work-based to SGL course design. All students completed daily quizzes/assignments involving analysis of scientific data and the development of scientific models. Students in individual work-based (Individualistic) sections usually worked independently on these assignments, whereas SGL students completed assignments in permanent groups of six. SGL students had significantly higher final exam grades than Individualistic students. The transition to the SGL model was marked by a notable increase in 10th percentile exam grade (Individualistic: 47.5%; Initial SGL: 60%; Refined SGL: 65%), suggesting SGL enhanced achievement among the least prepared students. We also studied student achievement on paired quizzes: quizzes were first completed individually and submitted, and then completed as a group and submitted. The group quiz grade was higher than the individual quiz grade of the highest achiever in each group over the term. All students--even term high achievers--could benefit from the SGL environment. Additionally, entrance and exit surveys demonstrated student attitudes toward SGL were more positive at the end of the Refined SGL course. We assert that SGL is uniquely-positioned to promote effective learning in the science classroom.     

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.     

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.     

Improving Education in Medical Statistics: Implementing a Blended Learning Model in the Existing Curriculum

Background

Although recent studies report on the benefits of blended learning in improving medical student education, there is still no empirical evidence on the relative effectiveness of blended over traditional learning approaches in medical statistics. We implemented blended along with on-site (i.e. face-to-face) learning to further assess the potential value of web-based learning in medical statistics.

Methods

This was a prospective study conducted with third year medical undergraduate students attending the Faculty of Medicine, University of Belgrade, who passed (440 of 545) the final exam of the obligatory introductory statistics course during 2013–14. Student statistics achievements were stratified based on the two methods of education delivery: blended learning and on-site learning. Blended learning included a combination of face-to-face and distance learning methodologies integrated into a single course.

Results

Mean exam scores for the blended learning student group were higher than for the on-site student group for both final statistics score (89.36±6.60 vs. 86.06±8.48; p = 0.001) and knowledge test score (7.88±1.30 vs. 7.51±1.36; p = 0.023) with a medium effect size. There were no differences in sex or study duration between the groups. Current grade point average (GPA) was higher in the blended group. In a multivariable regression model, current GPA and knowledge test scores were associated with the final statistics score after adjusting for study duration and learning modality (p<0.001).

Conclusion

This study provides empirical evidence to support educator decisions to implement different learning environments for teaching medical statistics to undergraduate medical students. Blended and on-site training formats led to similar knowledge acquisition; however, students with higher GPA preferred the technology assisted learning format. Implementation of blended learning approaches can be considered an attractive, cost-effective, and efficient alternative to traditional classroom training in medical statistics.     

Evaluation of a Brief Personalised Intervention for Alcohol Consumption in College Students

In the current study we investigated the effect of a brief personalised feedback intervention (BPI), compared to an active control intervention, on outcome measures of (i) alcohol consumption (ii) frequency of binge drinking and (iii) readiness to change (RTC). A sample of 103 college students (mean age=23.85) who consumed alcohol regularly provided baseline measures of drinking behaviour and readiness to change before completing an alcohol-related quiz on the UK Department of Health’s Change4Life website (active control). The study was a between subjects design and half the participants were randomly allocated to the BPI group (N=52), who received 10 minutes personalised feedback on their drinking in addition to the alcohol-related quiz. At a two-week follow-up, participants (N=103) repeated the questionnaire battery, and attempted to recall the answers to the alcohol quiz. Results indicated that both groups significantly reduced their alcohol consumption and frequency of binge drinking but there were no significant group differences in either of these measures. We conclude that the provision of generalised information can be as efficient as a BPI for the reduction of alcohol consumption in students.     

Comparison of naive and experienced students of elementary physiology on performance in an advanced course

The purpose of this study was to determine whether, in comparison with naive students, experienced students who have completed an elementary physiology course 1) have a greater knowledge level of physiology and 2) perform better in an upper division physiology course. The educational setting for this study was the cardiovascular block of an advanced undergraduate level course entitled Principles of Human Physiology (PGY 412). The study employed students who had completed elementary physiology (PGY 206) at the University of Kentucky (group 1), students who had completed elementary physiology in another academic program (group 2), and naive students with no prior physiology experience (group 3). A cardiovascular pretest was presented during the opening session of the cardiovascular block in PGY 412. Respective scores for the three groups were 29.4%, 31.7%, and 24.1%, and there were no significant between-group differences. Respective scores on the same pretest items given as a posttest at the end of the cardiovascular block were 90.4%, 91.4%, and 90.4%, and, again, there were no significant between-group differences. Respective scores on other cardiovascular test items given at the end of the block were 78.9%, 78.7%, and 81.1%. Interestingly, the highest score here was achieved by the naive students (group 3), but, once again, between-group differences were not significant. In summary, on the basis of pretest/posttest examination of cardiovascular physiology between naive and experienced students, the results of this study indicate 1) that the common assumption that students entering advanced level physiology courses have a significant retention of knowledge from elementary physiology is not valid and 2) that completion of an elementary physiology course does not offer an advantage in learning advanced material.     

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.     

Using manipulatives to improve learning in the undergraduate neurophysiology curriculum

Educational research has demonstrated that the use of concrete objects or manipulatives in the classroom enhances problem-solving skills and conceptual learning. This project examines the use of manipulatives in a neurophysiology curriculum and assesses their effectiveness on student comprehension. Three activities, building an ion channel, building a nerve cell, and passive membrane properties, were developed using modeling clay and beads as manipulatives. Their effect on learning was assessed in a neurobiology class that had been divided into an experimental group that worked with manipulative-based activities and a control group that did not. After the experimental group had completed the manipulative activity, both groups were given a quiz. Students who had used manipulatives scored significantly better than those who had not. In a second study, students were given a quiz before and after completing a manipulative activity. Students who had used manipulatives showed the greatest grade improvement. These studies suggest that manipulative activities can be used to enhance learning in the neurophysiology curriculum.     

Pizza and pasta help students learn metabolism

In this article, we report on an experiment designed to improve the learning of metabolic biochemistry by nutrition and medical undergraduate students. Twelve students participated in a monitored lunch and had their blood extracted for analysis 1) before lunch, 2) 30 min after lunch, and 3) 3 h after lunch. The subjects were divided in two groups. One group had a hyperglicidic meal [pasta plus orange juice: 80% carbohydrate, 10% protein, and 10% lipid (estimated values)] and the other group had a hyperlipidic meal (calabresi pizza plus diet soda: 36% carbohydrate, 18% protein, and 46% lipid). Individual quantities of food were based on body mass index, age, and sex. The blood parameters analyzed were glucose, triglycerides (TG), and urea. Glucose remained constant in the three measurements in both groups. The TG concentration in the pasta group was constant before and after lunch but increased significantly during the evening. In the pizza group, TG increased after lunch and remained constant in the evening. Levels of urea increased only in the evening, specially in the pizza group. These results were used for the final biochemistry exam. With the maximum score set as 10, the average score was 6.0 +/- 2.4 (n = 102). We considered this activity a unique way of evaluating important issues on metabolism, because students had several hours to work on the final exam (with free access to a bibliography). It was also a good didactic experience (problem-based learning like) for the subject students, because they had to work in all phases of the experiment (idealization, realization, and analysis) and participated actively in the elaboration and correction of the exam.     

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.     

Helping undergraduates repair faulty mental models in the student laboratory

Over half of the undergraduate students entering physiology hold a misconception concerning how breathing pattern changes when minute ventilation increases. Repair of this misconception was used as a measure to compare the impact of three student laboratory protocols on learning by 696 undergraduate students at 5 institutions. Students were tested for the presence of the misconception before and after performing a laboratory activity in which they measured the effect of exercise on tidal volume and breathing frequency. The first protocol followed a traditional written "observe and record" ("cookbook") format. In the second treatment group, a written protocol asked students to complete a prediction table before running the experiment ("predictor" protocol). Students in the third treatment group were given the written "predictor" protocol but were also required to verbalize their predictions before running the experiment ("instructor intervention" protocol). In each of the three groups, the number of students whose performance improved on the posttest was greater than the number of students who performed less well on the posttest (P < 0.001). Thus the laboratory protocols helped students correct the misconception. However, the remediation rate for students in the "instructor intervention" group was more than twice that observed for the other treatment groups (P < 0.001). The results indicate that laboratory instruction is more effective when students verbalize predictions from their mental models than when they only "discover" the outcome of the experiment.     

A Comprehensive,Simulation-Based Approach to Teaching Clinical Skills: The Medical Students’ Perspective

The purpose of this study was to determine if third-year medical students participating in a mandatory 12-week simulation course perceived improvement in decision-making, communication, and teamwork skills. Students participated in or observed 24 acute emergency scenarios. At 4-week intervals, students completed 0-10 point Likert scale questionnaires evaluating the curriculum and role of team leader. Linear contrasts were used to examine changes in outcomes. P-values were Bonferroni-corrected for multiple pairwise comparisons. Student evaluations (n = 96) demonstrated increases from week 4 to 12 in educational value (p = 0.006), decision-making (p < 0.001), communication (p = 0.02), teamwork (p = 0.01), confidence in management (p < 0.001), and translation to clinical experience (p < 0.001). Regarding the team leader role, students reported a decrease in stress (p = 0.001) and increase in ability to facilitate team function (p < 0.001) and awareness of team building (p = <0.001). Ratings demonstrate a positive impact of simulation on both clinical management skills and team leadership skills. A simulation curriculum can enhance the ability to manage acute clinical problems and translates well to the clinical experience. These positive perceptions increase as the exposure to simulation increases.     

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 effects of an exercise physiology program on physical fitness variables, body satisfaction, and physiology knowledge

This study was performed to determine the effects of an exercise physiology program on physical fitness, body satisfaction, and knowledge. A total of 161 students (mean age = 16.5 +/- 0.89 years) of the Coral Gables Senior High School served as the experimental group volunteers, whereas 33 students enrolled in a standard biology course served as the control group (mean age = 15.61 +/- 0.84 years). The experimental group received exercise physiology theory coupled with active aerobic and resistance exercise. Age (p = 0.0001) and lean body mass (p = 0.023) were the only physical characteristics significantly greater in the experimental group at pretesting. An analysis of covariance controlling for pretest values showed better results in the experimental compared with the control group for sit and reach (p = 0.008), step test, recovery heart rate (p = 0.0002), overhead press (p = 0.002), bench press (p = 0.017), leg press (p = 0.012), sit-ups (p = 0.001), body satisfaction (p = 0.0009), and physiology knowledge (p = 0.0001) at posttesting. Findings indicated that a biology curriculum integrated with exercise physiology theory and exercise activities may result in significant improvements in physical fitness, body size satisfaction, and physiology knowledge in high school adolescents.