International student exchange and the medical curriculum: evaluation of a medical sciences translational physiology course in Brazil

The objective of the present study was to conduct a short-term international course on translational physiology for medical students from Wright State University and the University of Iowa. The goals were to 1) provide students with an exposure to the academic, cultural, and medical environments in Brazil; 2) promote awareness of the global medical community; and 3) provide an academic course focused on translational physiology. An evaluation of the students was conducted to determine whether such a short-term course might be useful in the medical curriculum. The 2-wk course was held in the summer of 2005 at the University of S?o Paulo School of Medicine in Ribeir?o Preto, Brazil, for 23 American students. The program included presentations of basic and clinical topics, meetings with medical students, and clinical presentations. The program finished with student attendance at a scientific meeting sponsored by the Brazilian Society of Hypertension. Student surveys evaluated issues related to perceived treatment, Brazilian medical school environment, culture and personal attributes, and career aspirations. The international Medical Sciences Translational Physiology course for medical students provided a brief, but intense, experience. It gave students a picture of the medical environment in Brazil and an appreciation for the differences and similarities in cultures. Most students reported that it was a positive experience that would be beneficial to their careers. In conclusion, a short-term international course provides an efficient means for medical students to experience aspects of global medical science.     

Enhancing learning objectives by use of simple virtual microscopic slides in cellular physiology and histology: impact and attitudes

The impact and perception of students on the use of a simple, low technology-driven version of a virtual microscope in teaching and assessments in cellular physiology and histology were studied. Its impact on the time and resources of the faculty were also assessed. Simple virtual slides and conventional microscopes were used to conduct the same examinations for the same students. Students performed significantly better in the examination with the virtual slide and also showed a significantly higher preference for virtual slides. The time and cost implications of conducting examinations using the simple virtual slides were reduced by >1,400%. The results reemphasize the need for the design and adoption of simple sustainable technological innovations in developing countries to bridge gaps in purposeful learning environments.     

The STAR project: context, objectives and approaches

STAR is a European Commission Framework V project (EVK1-CT-2001-00089). The project aim is to provide practical advice and solutions with regard to many of the issues associated with the Water Framework Directive. This paper provides a context for the STAR research programme through a review of the requirements of the directive and the Common Implementation Strategy responsible for guiding its implementation. The scientific and strategic objectives of STAR are set out in the form of a series of research questions and the reader is referred to the papers in this volume that address those objectives, which include: (a) Which methods or biological quality elements are best able to indicate certain stressors? (b) Which method can be used on which scale? (c) Which method is suited for early and late warnings? (d) How are different assessment methods affected by errors and uncertainty? (e) How can data from different assessment methods be intercalibrated? (f) How can the cost-effectiveness of field and laboratory protocols be optimised? (g) How can boundaries of the five classes of Ecological Status be best set? (h) What contribution can STAR make to the development of European standards? The methodological approaches adopted to meet these objectives are described. These include the selection of the 22 stream-types and 263 sites sampled in 11 countries, the sampling protocols used to sample and survey phytobenthos, macrophytes, macroinvertebrates, fish and hydromorphology, the quality control and uncertainty analyses that were applied, including training, replicate sampling and audit of performance, the development of bespoke software and the project outputs. This paper provides the detailed background information to be referred to in conjunction with most of the other papers in this volume. These papers are divided into seven sections: (1) typology, (2) organism groups, (3) macrophytes and diatoms, (4) hydromorphology, (5) tools for assessing European streams with macroinvertebrates, (6) intercalibration and comparison and (7) errors and uncertainty. The principal findings of the papers in each section and their relevance to the Water Framework Directive are synthesised in short summary papers at the beginning of each section. Additional outputs, including all sampling and laboratory protocols and project deliverables, together with a range of freely downloadable software are available from the project website at www.eu_star.at.     

Comparative and medical physiology: a theme with three variations

The aim of this essay is to show how a comparative approach, by adding new variables, might shed unexpected light on some well-known problems of general physiology. In my first example I describe how a classic study of the energetics of Na reabsorption in canine kidneys leads to new insights if kidney size is introduced as a co-variable. The second example demonstrates that if the maximum rate of ATP production does not suffice to meet the ATP-demand of a particular physiological function, the deficit metabolic fuel could be supplied by the ATP spared by the suppression of another function. In evidence I draw attention to the high metabolic cost of growth in larval fish, although any mammalian organ with high energy requirements could run into the same problem under energy limiting conditions. In the third example, I suggest that the experimentally determined degree of sensitivity of cellular functions to hypoxia could be used to make predictions about the ecology of the biological system studied. This inference would be valid irrespective of whether the term "ecology" refers to the external environment of different species or to the internal environment of different organs in the human body.     

The UNSIN project: exploring the molecular physiology of sins

Although active learning works, promoting it in large undergraduate science classes is difficult. Here, three students (F. Naji, L. Salci, and G. Hoit) join their teacher (P. K. Rangachari) in describing one such attempt. Two cohorts in a first-year undergraduate biology course explored the molecular underpinnings of human misbehavior. Students were divided into 18 groups and randomly allotted to deal with one of the four deadly sins: sloth, gluttony, lust, and wrath. Students were expected to read primary sources to devise molecular ways to counter these sins. Group progress was monitored over the 12-wk period by the preceptor (P. K. Rangachari) at scheduled intervals. A single randomly selected student was questioned about the work done, and future directions were provided by the preceptor. At the end of the term, randomly selected students defended their group's approaches to the entire class. A final written report was graded. The following multiple target molecules were considered for each sin: gluttony (cholecystokinin, ghrelin, GABA, leptin, peptide YY, neuropeptide Y, and the melanocortin 4 receptor); sloth (dopamine, glutamate, GABA, and orexin); wrath (serotonin, GABA, glutamate, and corticotropin-releasing hormone receptor 2); and lust (prolactin, testosterone, oxytocin, dopamine, and estrogen). Students noted that the project provided a valuable learning experience, and the random selection approach gave students a greater sense of responsibility to their group. The project helped students hone their skills at searching, synthesizing, sharing, and presenting information, fostered group interactions, and provided a solid knowledge base for subsequent courses.     

Comparative evaluation of active learning and the traditional lectures in physiology: A case study of 200 level medical laboratory students of Imo State Unversity, Owerri.

Currently, understanding of Physiology and disease patterns is undergoing a fundamental paradigm shift with attendant shift in education of health professionals worldwide towards active learning to encourage exploration of connections and their relationships. We introduced problem-based learning to Physiology teaching of medial laboratory students to confirm worldwide reports that active learning environments offer better learning opportunities over the traditional methods which is the predominant teaching method in Nigerian universities. Our findings indicate that Problem-based learning increases students' attendance/participation in classes and performance in examination. We recommend the integration of active learning into physiology curriculum of Nigerian Universities.     

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.     

Sex and gender in medical education: a national student survey

Background

Gender- and sex-specific medicine is defined as the practice of medicine based on the understanding that biology (dictated by sex chromosomes) and social roles (gender) are important in and have implications for prevention, screening, diagnosis, and treatment in men and women. In light of the many ways that sex and gender influence disease presentation and patient management, there have been various initiatives to improve the integration of these topics into medical education curriculum. Although certain schools may include the topics, their impact on the student body’s knowledge has not been as fully studied. By studying the opinions of US allopathic and osteopathic-enrolled students on the extent to which their schools address these topics and their understanding of these topics, this study examined the role of gender specific medicine in the US medical school curriculum.

Methods

An email solicitation with link to an anonymous survey was sent to approximately 35,876 student members of five US medical student organizations. The survey instrument consisted of yes/no, multiple choice, and attitude awareness questions. Data was analyzed as a complete data set to evaluate national trends and via subset analysis using chi-square, paired t test, and one-way anova.

Results

A total of 1097 students responded. The majority of respondents strongly agreed that sex and gender medicine (SGBM) improves patient management (96.0 %) and should be included as a part of the medical school curriculum (94.4 %). Only 2.4 % of participants agreed that SGBM is the same as Women’s Health. When asked specifically about inclusion of an identified sex and gender-based medicine curriculum at their institution, students answered not sure at 40.8, 25.1, 19.1, and 20.3 % from first year to fourth year, respectively. Males reported a higher rate of exposure to SGBM content areas (in medical history taking, domestic violence) than women.

Conclusions

Medical students recognize the differentiation between SGBM principles and women’s health, and understand the translational value of sex and gender-specific principles in the clinical setting. However, current curricular offerings fall short of providing students with adequate coverage of specific evidence-based health differences.

     

Enhancing learning through optimal sequencing of web-based and manikin simulators to teach shock physiology in the medical curriculum

The Association of American Medical Colleges has encouraged educators to investigate proper linkage of simulation experiences with medical curricula. The authors aimed to determine if student knowledge and satisfaction differ between participation in web-based and manikin simulations for learning shock physiology and treatment and to determine if a specific training sequencing had a differential effect on learning. All 40 second-year medical students participated in a randomized, counterbalanced study with two interventions: group 1 (n = 20) participated in a web-based simulation followed by a manikin simulation and group 2 (n = 20) participated in reverse order. Knowledge and attitudes were documented. Mixed-model ANOVA indicated a significant main effect of time (F(1,38) = 18.6, P < 0.001, η(p)(2) = 0.33). Group 1 scored significantly higher on quiz 2 (81.5%) than on quiz 1 (74.3%, t(19) = 3.9, P = 0.001), for an observed difference of 7.2% (95% confidence interval: 3.3, 11.0). Mean quiz scores of group 2 did not differ significantly (quiz 1: 77.0% and quiz 2: 79.7%). There was no significant main effect of group or a group by time interaction effect. Students rated the simulations as equally effective in teaching shock physiology (P = 0.88); however, the manikin simulation was regarded as more effective in teaching shock treatment (P < 0.001). Most students (73.7%) preferred the manikin simulation. The two simulations may be of similar efficacy for educating students on the physiology of shock; however, the data suggest improved learning when web-based simulation precedes manikin use. This finding warrants further study.     

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.