The effect of active learning on student characteristics in a human physiology course for nonmajors

This study investigated the effect of active-learning strategies on college students' achievement, motivation, and self-efficacy in a human physiology course for nonmajors. Variables were studied via a quasi-experimental, Solomon four-group design on 141 students at a small west-Texas university. Treatment groups were taught using a continuum-based, active-learning model implemented over the course of a semester. Control groups were taught using traditional didactic lecture methods. To assess the effects of the continuum-based active learning strategies, students were administered a comprehensive physiology content exam, the Motivated Strategies for Learning Questionnaire, and attitude surveys. Factorial analyses indicated that the treatment groups acquired significantly more content knowledge and were significantly more self-efficacious than students in the control groups. There were no significant differences in motivation. Attitude surveys indicated that students in both the treatment and control groups demonstrated a positive attitude toward active learning, believed it helped (or would help) them to learn the material, and would choose an active learning course in the future.     

Effects of an applied supplemental course on student performance in elementary physiology

The objective of this study was to determine whether students within a large (100-160 students) didactic lecture-based course, "Elementary Physiology" (EP), who were given an active-learning opportunity would perform better on objective examinations over EP material compared with their classroom peers who did not have the same active-learning experience. This was achieved by offering the EP students the option of taking a supplemental one credit hour discussion-based course, "Case Studies in Physiology" (CSP). Approximately 14% of the EP students opted for the CSP course. The format of CSP consisted of a one-hour-per-week discussion of applied problems based on the factual information presented in EP. On a subjective scale of 1 to 4, the CSP students felt that the course helped them to understand the EP material (3.5). This was reflected in the EP examination results for which the CSP students scored significantly higher compared with their non-CSP peers (81.1% vs. 75.7%; P < 0.05). These results indicate that when active-learning methods, such as discussion of applied problems, are used as a supplement to didactic lectures in physiology, performance on objective examinations of lecture material is improved.     

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.     

Comparing biology majors from large lecture classes with TA-facilitated laboratories to those from small lecture classes with faculty-facilitated laboratories

The teaching faculty for this course sought to address their own concerns about the quality of student learning in an impersonal large lecture biology class for majors, the difficulties in getting to know each student by name, and difficulties in soliciting answers and reactions from the students during the lecture. Questions addressed by this study were, Do active-learning activities in a small and personal lecture setting enhance student learning more than active-learning activities in large impersonal lectures? and Are students more satisfied with an educational experience in a small and personal lecture setting? Based on faculty perceptions of how they best relate to their students, the prediction was that the students in the experimental group with small lecture classes and increased direct contact with the teaching faculty would learn physiological principles better than the students in the control group in the large impersonal lecture portion of the course. One of the laboratory sections of this large enrollment biology course was randomly selected to be taught with separate small lectures by the teaching faculty. In addition, the teaching faculty participated in the laboratory with these students during their experiments correlated with the lecture material. The students in both groups were compared by pre- and posttests of physiological principles, final course grades, and class satisfaction surveys.     

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.     

Adaptation to altitude as a vehicle for experiential learning of physiology by university undergraduates

In this article, an experiential learning activity is described in which 19 university undergraduates made experimental observations on each other to explore physiological adaptations to high altitude. Following 2 wk of didactic sessions and baseline data collection at sea level, the group ascended to a research station at 12,500-ft elevation. Here, teams of three to four students measured the maximal rate of oxygen uptake, cognitive function, hand and foot volume changes, reticulocyte count and hematocrit, urinary pH and 24-h urine volume, athletic performance, and nocturnal blood oxygen saturation. Their data allowed the students to quantify the effect of altitude on the oxygen cascade and to demonstrate the following altitude-related changes: 1) impaired performance on selected cognitive function tests, 2) mild peripheral edema, 3) rapid reticulocytosis, 4) urinary alkalinization and diuresis, 5) impaired aerobic but not anaerobic exercise performance, 6) inverse relationship between blood oxygen saturation and resting heart rate, and 7) regular periodic nocturnal oxygen desaturation events accompanied by heart rate accelerations. The students learned and applied basic statistical techniques to analyze their data, and each team summarized its results in the format of a scientific paper. The students were uniformly enthusiastic about the use of self-directed experimentation to explore the physiology of altitude adaptation and felt that they learned more from this course format than a control group of students felt that they learned from a physiology course taught by the same instructor in the standard classroom/laboratory format.     

Endocrine physiology in a patient-centered learning curriculum

The medical curriculum at the University of North Dakota School of Medicine and Health Sciences has recently been redesigned into a problem-based/traditional hybrid model that utilizes an integrated organ systems-based approach to teach basic and clinical sciences. The number of lecture hours in general has been greatly reduced, and, in particular, lecture hours in physiology have been reduced by 65%. Students learn basic science in small groups led by a faculty facilitator, and students are responsible for a great deal of their own teaching and learning. The curriculum is centered around patient cases and is called patient-centered learning (PCL). The curriculum includes traditional lectures and laboratories supporting faculty-generated learning objectives. Endocrine physiology is taught in year one, utilizing four weeks of patient cases that emphasize normal structure and function of endocrine systems. Endocrine physiology is revisited in year two, which is primarily focused on pathobiology. The PCL curriculum, with emphasis on the endocrine component, is described in detail along with key portions of an endocrine case.     

Problem-based writing with peer review improves academic performance in physiology

The aim of this study was to determine whether problem-based writing with peer review (PW-PR) improves undergraduate student performance on physiology exams. Didactic lectures were replaced with assignments to give students practice explaining their reasoning while solving qualitative problems, thus transferring the responsibility for abstraction and generalization to the students. Performance on exam items about concepts taught using PW-PR was compared with performance on concepts taught using didactic lectures followed by group work. Calibrated Peer Review, a Web-delivered program, was used to collect student essays and to manage anonymous peer review after students "passed" three calibration peer reviews. Results show that the students had difficulty relating concepts. Relationship errors were categorized as (1) problems recognizing levels of organization, (2) problems with cause/effect, and (3) overgeneralizations. For example, some described cells as molecules; others thought that vesicles transport materials through the extracellular fluid. With PW-PR, class discussion was used to confront and resolve such difficulties. Both multiple-choice and essay exam results were better with PW-PR instead of lecture.     

Multiple-format sessions for teaching endocrine physiology

The University of Kentucky medical curriculum was revised in 1994 to implement a more interactive approach. The Endocrine Physiology section of the new physiology course, Human Function, was modified from its former daily lecture and weekly laboratory format to eight daily 3 1/2-h sessions. Each session is composed of four components: a didactic lecture, a whole class discussion session, a quiz, and a patient presentation. These components are presented in a staggered format over the course of 2 days, i.e., the lecture is presented on the first day, and the remaining three components take place on the second day. This allows students to assimilate the new lecture material before participating in the discussion session, quiz, and patient presentation, which are more interactive. This format has been received favorably by the students because of its variety, and it is easier to keep up with the material.     

Sleep as a teaching tool for integrating respiratory physiology and motor control

Sleep exerts major effects on most fundamental homeostatic mechanisms. Current data suggest, however, that students of physiology and medicine typically receive little or no formal teaching in sleep. Because sleep takes up a significant component of our life span, it is proposed that current teaching in systems and integrative physiology is not representative if it is confined to functions describing wakefulness only. We propose that sleep can be readily integrated into various components of physiology and medical curricula simply by emphasizing how commonly taught physiological processes are importantly affected by sleep mechanisms. In our experience, this approach can be used to reinforce basic physiological principles while simultaneously introducing sleep physiology into the students' training. We find that students have a general and inherent interest in sleep and related clinical disorders, and this proves useful as an effective means to teach the material. In this paper, examples of how sleep influences motor control and the respiratory system will illustrate these points. These considerations also highlight some important gaps in traditional teaching of respiratory physiology.     

Case study analysis and the remediation of misconceptions about respiratory physiology

Most students enter the physiology classroom with one or more fundamental misconceptions about respiratory physiology. This study examined the prevalence of four respiratory misconceptions and determined the role of case analysis in the remediation of one of them. A case study was used to help students learn about oxygen transport in the blood and a conceptual diagnostic test was used to assess student understanding of the relation between Po(2) and hemoglobin saturation by probing for the corresponding (Sa/Po(2)) misconception. A 36% remediation of the Sa/Po(2) misconception was found to be associated with case analysis. This repair was selective since the frequency of three other respiratory misconceptions was found to be unchanged after classroom instruction about respiratory physiology in lectures and laboratories. Remediation of the Sa/Po(2) misconception before an instructor-led, in-class case review was superficial and temporary. Explanations provided by students who correctly answered the Sa/Po(2) conceptual diagnostic test showed improved conceptual understanding following case analysis. These results suggest that a learning strategy where students actively confront their faulty notions about respiratory physiology is useful in helping them overcome their misconceptions.     

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.     

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.     

Teaching more by lecturing less

We carried out an experiment to determine whether student learning gains in a large, traditionally taught, upper-division lecture course in developmental biology could be increased by partially changing to a more interactive classroom format. In two successive semesters, we presented the same course syllabus using different teaching styles: in fall 2003, the traditional lecture format; and in spring 2004, decreased lecturing and addition of student participation and cooperative problem solving during class time, including frequent in-class assessment of understanding. We used performance on pretests and posttests, and on homework problems to estimate and compare student learning gains between the two semesters. Our results indicated significantly higher learning gains and better conceptual understanding in the more interactive course. To assess reproducibility of these effects, we repeated the interactive course in spring 2005 with similar results. Our findings parallel results of similar teaching-style comparisons made in other disciplines. On the basis of this evidence, we propose a general model for teaching large biology courses that incorporates interactive engagement and cooperative work in place of some lecturing, while retaining course content by demanding greater student responsibility for learning outside of class.     

Clinically oriented physiology teaching: strategy for developing critical-thinking skills in undergraduate medical students

Medicine is an applied science, interpreting evidence and applying it to real life by using clinical reasoning skills and experience. COPT (clinically oriented physiology teaching) was incorporated in physiology instruction aiming to relate the study of physiology to real-life problems, to generate enthusiasm and motivation for learning, and to demonstrate the vocational relevance of physiology among students by integrating clinical experience with teaching. COPT consisted of two elements: 1) critical-thinking questions (CTQ) and 2) clinical case studies. After a few topics were taught, CTQ and case studies were given as an assignment. Answers were discussed in the next class. Two exams, each of which contained CTQ and recall questions, were conducted, one before (exam 1) and one after (exam 2) the implementation of COPT. Analysis of student performance in the examinations revealed that the students did better in exam 2 (P < 0.0001). Feedback from students indicated that this method was useful and challenging.     

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.     

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.     

Formative assessment in physiology teaching using a wireless classroom communication system

Systems physiology, studied by biomedical engineers, is an analytical way to approach the homeostatic foundations of basic physiology. In many systems physiology courses, students attend lectures and are given homework and reading assignments to complete outside of class. The effectiveness of this traditional approach was compared with an approach in which a wireless classroom communication system was used to provide instant feedback on in-class learning activities and reading assignment quizzes. Homework was eliminated in this approach. The feedback system used stimulated 100% participation in class and facilitated rapid formative assessment. The results of this study indicate that learning of systems physiology concepts including physiology is at least, as if not more, effective when in-class quizzes and activities with instant feedback are used in place of traditional learning activities including homework. When results of this study are interpreted in light of possible effects of the September 11, 2001 terrorist attacks on student learning in the test group, it appears that the modified instruction may be more effective than the traditional instruction.     

Student responses to a hands-on kinesthetic lecture activity for learning about the oxygen carrying capacity of blood

This article describes a new hands-on, or "kinesthetic," activity for use in a physiology lecture hall to help students comprehend an important concept in cardiopulmonary physiology known as oxygen carrying capacity. One impetus for designing this activity was to address the needs of students who have a preference for kinesthetic learning and to help increase their understanding and engagement during lecture. This activity uses simple inexpensive materials, provides an effective model for demonstrating related pathophysiology, and helps promote active learning. The activity protocol and its implementation are described here in detail. We also report data obtained from student surveys and assessment tools to determine the effectiveness of the activity on student conceptual learning and perceptions. A brief multiple-choice pretest showed that although students had already been introduced to the relevant concepts in lecture, they had not yet mastered these concepts before performing the activity. Two postactivity assessments showed that student performance was significantly improved on the posttest compared with the pretest and that information was largely retained at the end of the course. Survey data showed that one-half of the students stated kinesthetic learning as among their learning preferences, yet nearly all students enjoyed and were engaged in this hands-on kinesthetic activity regardless of their preferences. Most students would recommend it to their peers and expressed a desire for more kinesthetic learning opportunities in the lecture curriculum.     

Pulmonary and renal pressure-flow relationships: what should be taught?

This article is from a symposium presented at the annual meeting of the Human Anatomy and Physiology Society (HAPS) on June 11, 2000. The presentation was funded under the auspices of a National Science Foundation Course, Curriculum, and Laboratory Improvement Program entitled "Development of Active Learning Materials for Physiology and Functional Anatomy: A Cooperative HAPS-APS Initiative." This symposium was part of the first module to be developed on "gradients and conductances: what flows where and why?" This presentation was designed to model the usefulness of the general model of gradients and conductances in the physiology and pathophysiology of the respiratory and renal systems. Thirteen different examples of pressure-flow-resistance and concentration-flux relationships are introduced; several ideas for active-learning activities and simple figures appropriate for undergraduate physiology classes are included. The symposium assumes that undergraduate students have already learned about diffusion, osmosis, and the basic principles of cardiovascular physiology. The presentation was designed to follow a symposium entitled: "Cardiovascular pressure-flow relationships: what should be taught?"