Effect of personal response systems on student perception and academic performance in courses in a health sciences curriculum

To increase student engagement, active participation, and performance, personal response systems (clickers) were incorporated into six lecture-based sections of four required courses within the Health Sciences Department major curriculum: freshman-level Anatomy and Physiology I and II, junior-level Exercise Physiology, and senior-level Human Pathophysiology. Clickers were used to gather anonymous student responses to questions posed within the class period after individual thought and peer discussion. Students (n = 293, 88% of students completing the courses) completed a perceptual survey on clicker effectiveness inserted into the Student Assessment of Learning Gains online instrument. Across courses and years, students uniformly rated several dimensions of clicker use as providing good to great gain in engaging them in active learning, increasing participation and involvement during class, maintaining attention, applying material immediately, providing feedback concerning their understanding, and offering an anonymous format for participation. Within these four sections, quiz grades were compared between clicker and nonclicker years. Significant increases in pre- and posttest scores were seen in Exercise Physiology in clicker years and on some, but not all material, in Anatomy and Physiology I and II based on content quizzes. Human Pathophysiology results were unexpected, with higher quiz scores in the nonclicker year. The results support the hypothesis of increased engagement with clicker use. The hypothesis of increased student performance was not consistently supported. Increased performance was seen in Exercise Physiology. In Anatomy and Physiology I and II, performance improved on some content quizzes. In Human Pathophysiology, performance did not improve with clickers.     

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.     

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.     

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.     

A blended approach to active learning in a physiology laboratory-based subject facilitated by an e-learning component

Learning via online activities (e-learning) was introduced to facilitate existing face-to-face teaching to encourage more effective student preparation and then informed participation in an undergraduate physiology laboratory-based course. Active learning was encouraged by hypothesis formation and predictions prior to classes, with opportunities for students to amend their e-learning submissions after classes. Automatic or tutor feedback was provided on student submissions. Evaluation of the course was conducted via student questionnaires, individual student interviews, and analysis of student marks in examinations and of the e-learning component. Student feedback on this entire subject in the university-wide quality of teaching survey was very high by University of Melbourne standards and most encouraging for the first implementation of such a curriculum modification. Results from further detailed surveys of student interactions and engagement and correlation analysis between student responses were also very supportive of the effectiveness of the course. There were no significant differences between examination marks in the new course with e-learning and the previous year without e-learning. However, there was a significant correlation between assessment of student e-learning work and their final examination mark. Correlation analysis between various survey responses helped interpret results and strengthened arguments for e-learning and suggested future improvements for student use of e-learning. This mode of e-learning used to support face-to-face learning activities in the laboratory can be adapted for other disciplines and may assist students in developing a greater appreciation and a deeper approach for learning from their practical class experiences.     

Formative Assessment and Increased Student Involvement Increase Grades in an Upper Secondary School Biology Course

This study shows that formative methods and increased student participation has a positive influence on learning measured as grades. The study was conducted during the course Biology A in a Swedish Upper Secondary School. The students constructed grade criteria and defined working methods and type of examination within a given topic, Gene technology. The procedure resulted in variation within teaching and examination carried out as an oral test in small groups. In the analysis, students’ grades on Gene technology were analysed in comparison with grades on other topics within the course, and the results show that mean grade is significantly higher on Gene technology. Based on the results and student course evaluations, I discuss the reasons behind the good results and the relation to participation, student interest, teacher and type of examination.     

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.     

The efficacy of interactive lecturing for students with diverse science backgrounds

Learning is an active process, and, as such, interactive lectures are considered as the educational best practice. This study investigated the efficacy of interactive lecturing in a module of eight respiratory physiology lectures in a second-year Physiology course with two distinct subcohorts: students with strong science backgrounds and those without. The comparison of student performance in the summative examinations of respiratory physiology allowed us to evaluate the efficacy of interactive lecturing for each subcohort. Formal teaching evaluations were used to gauge the students' perception of interactive lectures. To further validate our findings, we repeated the study in the following year. The introduction of interactive lecturing significantly improved learning outcomes, with this improvement being maintained for the period of this study. Furthermore, students with limited prior knowledge, who had typically performed very poorly in this module, achieved a similar learning outcome to those students with a good science background. From these summative results and the students' perceptions, we concluded that students that are alert, motivated and interested in the subject, and engaged in learning activities and that are being encouraged to think and receive constant feedback on their progress will become confident in their learning abilities and have improved learning outcomes.     

Student retention of course content is improved by collaborative-group testing

We recently reported that collaborative testing (i.e., group test taking) increased student performance on quizzes. It is unknown, however, whether collaborative testing improves student retention of course content. Therefore, this study was designed to test the hypotheses that collaborative-group testing improves student retention of course content. To test this hypothesis, our undergraduate exercise physiology class of 38 students was randomly divided into two groups: group A (n = 19) and group B (n = 19). During exam 1, students from both groups answered questions in the traditional format as individuals. Immediately after completing the exam as individuals, students from group A answered a randomly selected subset of questions from exam 1 in groups of two (1 group had 3 students) to test the effectiveness of collaborative-group testing on test performance and level of student retention. On the next exam (exam 2, 4 wk later), students from both groups answered questions in the traditional format as individuals and responded to the same subset of questions from exam 1. The subset of questions was analyzed to determine the level of retention of the original test material. In addition, immediately after completing the exam as individuals, students from group B answered a randomly selected subset of questions from exam 2 in groups of two (1 group had 3 students). Finally, on the next exam (exam 3, 4 wk later), students from both groups answered questions in the traditional format as individuals and responded to the same subset of questions from exam 2. This protocol followed a randomized crossover design to control for time and order effects. Student retention of course content was reduced when students completed the original examinations individually. In sharp contrast, student retention was improved (P < 0.05) when students completed the original examinations in groups. Results suggest that collaborative testing is an effective strategy to enhance learning and increase student retention of course content.     

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.     

Greek Students Research the Effects of Fire on the Soil System through Project-based Learning

This study is focused on the development, implementation and evaluation of an environmental education programme for secondary education students. The programme was entitled ‘Τhe effects of fire on the soil system’ and it was implemented during the school period of 2008. Twenty-four (24) students (aged from 15 to 20) coming from Lidoriki Secondary School (Central Greece) participated in the programme, which was based on Project Method. The programme consisted of one theoretical part (achievement of cognitive and affective goals) and one experimental part (achievement of cognitive and psychomotor goals). Initial, formative and summative assessments were implemented during the course of the programme, by means of questionnaires, observation of students’ teamwork and examination of their work sheets. The questionnaire analysis highlighted students’ misconceptions regarding the subject, revealed positive changes in students’ attitudes as a result of their participation in the programme, as well as satisfactory results concerning the acquired knowledge and skills. The experimental results were of significant scientific and educational value.     

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.     

Shaking up biology – our experiences teaching cell biology and biochemistry to a first year undergraduate class through the Canterbury (New Zealand) earthquakes

While most studies concerning how Universities respond to crises are based on simulations, we describe how the University of Canterbury responded to a real crisis, a series of major seismic events that caused significant disruption in 2010/2011. We focus on a single, first-year undergraduate biology course in which we modified our teaching strategies at short notice, introduced tutorials in tents, recorded podcasts, and set online quizzes. The University’s policy on special consideration applications for performance impairment (aegrotats) required us to develop new ways of estimating student grades. Course surveys indicate few changes in student appreciation of the course for earthquake-affected students, and there were no measurable changes in outcomes for these students in the remainder of their studies. We learned many lessons including the advantages of a good working relationship with learning resource providers, having progressive assessment through the term and also having online course delivery. The positive attitude and availability of staff is also important, along with quick decision-making that reduces uncertainty. We suggest that these lessons are pertinent for any crisis situation where weather, health or political incidents prevent a class and its teachers gathering over an extended period of time.     

Probabilities and predictions: modeling the development of scientific problem-solving skills

The IMMEX (Interactive Multi-Media Exercises) Web-based problem set platform enables the online delivery of complex, multimedia simulations, the rapid collection of student performance data, and has already been used in several genetic simulations. The next step is the use of these data to understand and improve student learning in a formative manner. This article describes the development of probabilistic models of undergraduate student problem solving in molecular genetics that detailed the spectrum of strategies students used when problem solving, and how the strategic approaches evolved with experience. The actions of 776 university sophomore biology majors from three molecular biology lecture courses were recorded and analyzed. Each of six simulations were first grouped by artificial neural network clustering to provide individual performance measures, and then sequences of these performances were probabilistically modeled by hidden Markov modeling to provide measures of progress. The models showed that students with different initial problem-solving abilities choose different strategies. Initial and final strategies varied across different sections of the same course and were not strongly correlated with other achievement measures. In contrast to previous studies, we observed no significant gender differences. We suggest that instructor interventions based on early student performances with these simulations may assist students to recognize effective and efficient problem-solving strategies and enhance learning.     

Introduction and evaluation of case-based learning in the first foundational course of an undergraduate medical curriculum

Case-based learning (CBL) has been proposed as an effective method to promote student knowledge and motivation. The timing and methods for implementation have varied among schools, and data regarding the effectiveness of this pedagogy compared to other learning modalities are inconclusive. We introduced five different cases in the first course of our medical school as part of small-group CBL, and monitored student satisfaction and performance in summative evaluations. We observed that (1) students were very satisfied with the CBL sessions; (2) performance in essay examinations was significantly higher in CBL topics, compared to non-CBL topics, as evaluated at the end of the course, and three months after course conclusion; and (3) there was a trend of higher performance in multiple-choice questions about CBL topics, but this was not statistically significant. Our results indicate that CBL is an acceptable pedagogy to be incorporated from the beginning of undergraduate medical education to promote acquisition and retention of knowledge, students’ interest in foundational sciences, and integration of basic science disciplines and clinical medicine. When evaluating knowledge acquired using the CBL method, integrative essays represent a valuable tool to assess the depth of comprehension and application of information.     

Performance of Physical Examination Skills in Medical Students during Diagnostic Medicine Course in a University Hospital of Northwest China

This study was conducted to evaluate the performance of physical examination (PE) skills during our diagnostic medicine course and analyze the characteristics of the data collected to provide information for practical guidance to improve the quality of teaching. Seventy-two fourth-year medical students were enrolled in the study. All received an assessment of PE skills after receiving a 17-week formal training course and systematic teaching. Their performance was evaluated and recorded in detail using a checklist, which included 5 aspects of PE skills: examination techniques, communication and care skills, content items, appropriateness of examination sequence, and time taken. Error frequency and type were designated as the assessment parameters in the survey. The results showed that the distribution and the percentage in examination errors between male and female students and among the different body parts examined were significantly different (p<0.001). The average error frequency per student in females (0.875) was lower than in males (1.375) although the difference was not statistically significant (p = 0.167). The average error frequency per student in cardiac (1.267) and pulmonary (1.389) examinations was higher than in abdominal (0.867) and head, neck and nervous system examinations (0.917). Female students had a lower average error frequency than males in cardiac examinations (p = 0.041). Additionally, error in examination techniques was the highest type of error among the 5 aspects of PE skills irrespective of participant gender and assessment content (p<0.001). These data suggest that PE skills in cardiac and pulmonary examinations and examination techniques may be included in the main focus of improving the teaching of diagnostics in these medical students.     

Peer instruction enhanced student performance on qualitative problem-solving questions

We tested the hypothesis that peer instruction enhances student performance on qualitative problem-solving questions. To test this hypothesis, qualitative problems were included in a peer instruction format during our Physiology course. Each class of 90 min was divided into four to six short segments of 15 to 20 min each. Each short segment was followed by a qualitative problem-solving scenario that could be answered with a multiple-choice quiz. All students were allowed 1 min to think and to record their answers. Subsequently, students were allowed 1 min to discuss their answers with classmates. Students were then allowed to change their first answer if desired, and both answers were recorded. Finally, the instructor and students discussed the answer. Peer instruction significantly improved student performance on qualitative problem-solving questions (59.3 +/- 0.5% vs. 80.3 +/- 0.4%). Furthermore, after peer instruction, only 6.5% of the students changed their correct response to an incorrect response; however, 56.8% of students changed their incorrect response to a correct response. Therefore, students with incorrect responses changed their answers more often than students with correct responses. In conclusion, pausing four to six times during a 90-min class to allow peer instruction enhanced student performance on qualitative problem-solving questions.     

A partial flip classroom exercise in a large introductory general biology course increases performance at multiple levels

Incorporation of active learning into large lecture classes is gaining popularity as a pedagogical method due to its known benefits in helping learning outcomes. A more recent active learning technique that has emerged is the flipped classroom. In this study, we investigated the effects of incorporating a ‘partial-flip’ into an introductory general biology course, where only a portion of the class time was spent in a flipped classroom format. This partial flip presented the classic biology experiment of Meselson and Stahl that discovered the mechanism of DNA replication. Performance on in-class formative assessments and subsequent summative assessments (eg out-of-class assignments and exams relating to this material) was compared between a class that had the partial flip and a control class that had a traditional lecture. The partial flip students scored higher on in-class formative questions, specific exam questions and final exam essay questions. We found that the partial flip had different effects in males versus females depending on the assessment. The partial flip manipulation appeared equally effective in aiding both below and above average students in formative assessments. Overall, this study shows that the partial flip classroom can be an effective technique to incorporate into existing courses and that it does provide some benefits compared to traditional lecture.     

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.     

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.