Treatment of specific macrovascular beds in patients with diabetes mellitus

Background

A ubiquitous dilemma in medical education continues to be whether and how to integrate research competencies into the predoctoral curriculum. Understanding research concepts is imbedded in the six core competencies for physicians, but predoctoral medical education typically does not explicitly include research education. In an effort to quickly report academic research findings to the field, this is the second in a series of articles reporting the outcomes of a research education initiative at one college of osteopathic medicine. The first article described the competency model and reported baseline performance in applied understanding of targeted research concepts. This second article reports on the learning outcomes from the inaugural year of a course in basic biomedical research concepts.

Methods

This course consisted of 24 total hours of classroom lectures augmented with web-based materials using Blackboard Vista, faculty moderated student presentations of research articles, and quizzes. To measure changes in applied understanding of targeted research concepts in the inaugural year of the course, we administered a pretest and a posttest to second year students who took the course and to first year students who took an informatics course in the same academic year.

Results

We analyzed 154 matched pretests and posttests representing 56% of the 273 first and second year students. On average, the first year (53) and second year students (101) did not differ in their mean pretest scores. At posttest the second year students showed significant improvement in their applied understanding of the concepts, whereas the first year students' mean posttest score was lower than their mean pretest score.

Conclusions

This biomedical research course appears to have increased the second year students' applied understanding of the targeted biomedical research concepts. This assessment of learning outcomes has facilitated the quality improvement process for the course, and improved our understanding of how to measure the benefits of research education for medical students. Some of the course content and methods, and the outcome measures may need to be approached differently in the future to more effectively lay the foundation for osteopathic medical students to utilize these concepts in the clinical setting.     

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.     

Continuous and noninvasive recording of cardiovascular parameters with the Finapres finger cuff enhances undergraduate student understanding of physiology

The Finapres finger cuff recording system provides continuous calculations of beat-to-beat variations in cardiac output (CO), total peripheral resistance, heart rate (HR), and blood pressure (BP). This system is unique in that it allows experimental subjects to immediately, continuously, and noninvasively visualize changes in CO at rest and during exercise. This study provides evidence that using the Finapres system improves undergraduate student engagement, understanding, and learning of how the cardiovascular system responds to exercise. Second-year science students undertaking a physiology practical class in 2009 (n = 243) and 2010 (n = 263) used the Finapres system to record CO, BP, and HR during graded exercise on a cycle ergometer. Student experiences with the Finapres was evaluated with a survey (a 5-point scale from strongly disagree to strongly agree). This indicated that students appreciated the immediacy of the recordings (88% of students agreed or strongly agreed, average for 2009 and 2010), gained an understanding of how to record physiological data (84%), enjoyed the practical (81%), and would recommend the Finapres to other students (81%). To determine if the practical enhanced student learning of cardiovascular physiology, identical tests were given to the students at the beginning (pretest) and end (posttest) of the class. There was a significant improvement from the pretest to the posttest (4% in 2009 and 20% in 2010). In summary, the ability of the Finapres to continuously display CO, BP, and HR during experimental protocols provides students with immediate feedback and improves their understanding of cardiovascular physiology.     

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.     

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.     

On-line integration of computer controlled diagnostic devices and medical information systems in undergraduate medical physics education for physicians

We designed and evaluated an innovative computer-aided-learning environment based on the on-line integration of computer controlled medical diagnostic devices and a medical information system for use in the preclinical medical physics education of medical students. Our learning system simulates the actual clinical environment in a hospital or primary care unit. It uses a commercial medical information system for on-line storage and processing of clinical type data acquired during physics laboratory classes. Every student adopts two roles, the role of ‘patient’ and the role of ‘physician’. As a ‘physician’ the student operates the medical devices to clinically assess ‘patient’ colleagues and records all results in an electronic ‘patient’ record. We also introduced an innovative approach to the use of supportive education materials, based on the methods of adaptive e-learning. A survey of student feedback is included and statistically evaluated.The results from the student feedback confirm the positive response of the latter to this novel implementation of medical physics and informatics in preclinical education. This approach not only significantly improves learning of medical physics and informatics skills but has the added advantage that it facilitates students’ transition from preclinical to clinical subjects.     

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

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

Evolution and Medicine: An Inquiry-Based High School Curriculum Supplement

Evolution and Medicine is a curriculum supplement designed by the National Institutes of Health (NIH) and the Biological Sciences Curriculum Study (BSCS) for high school students. The supplement is freely available from NIH’s Office of Science Education (OSE) as a part of the NIH curriculum supplement series. Development of the supplement was a collaborative effort that included input from a panel of experts in medicine, evolution, education, and educational technology. In total, the curriculum supplement includes five inquiry-based lessons that are integrated into the BSCS 5E instructional model (based on constructivist learning theory). The goal was to develop a 2-week curriculum to help students understand major concepts of evolution using the dynamic, modern, and relevant context of medicine. A diverse group of students and teachers across the US participated in a formative evaluation of a field test version of the curriculum. High school students made significant learning gains from pretest to posttest, with a relatively large effect size for student understanding of common ancestry and a relatively small effect size for student understanding of natural selection. There was no statistically significant difference in achievement gains between white students and all other racial/ethnic categories. Overall, the evaluation suggests that a curriculum that emphasizes the role of evolution in medicine, uses a constructivist instructional model, and is grounded in inquiry is relatively well-received by teachers and students and shows promise for increasing student learning in evolution.     

Using the Genetics Concept Assessment to document persistent conceptual difficulties in undergraduate genetics courses

To help genetics instructors become aware of fundamental concepts that are persistently difficult for students, we have analyzed the evolution of student responses to multiple-choice questions from the Genetics Concept Assessment. In total, we examined pretest (before instruction) and posttest (after instruction) responses from 751 students enrolled in six genetics courses for either majors or nonmajors. Students improved on all 25 questions after instruction, but to varying degrees. Notably, there was a subgroup of nine questions for which a single incorrect answer, called the most common incorrect answer, was chosen by >20% of students on the posttest. To explore response patterns to these nine questions, we tracked individual student answers before and after instruction and found that particular conceptual difficulties about genetics are both more likely to persist and more likely to distract students than other incorrect ideas. Here we present an analysis of the evolution of these incorrect ideas to encourage instructor awareness of these genetics concepts and provide advice on how to address common conceptual difficulties in the classroom.     

Genethics: project accountability via evaluation of teacher and student growth.

Accountability through demonstrated learning is increasingly being demanded by agencies funding science education projects. For example, the National Science Foundation requires evidence of the educational impact of programs designed to increase the scientific understanding and competencies of teachers and their students. The purpose of this paper is to share our human genetics educational experiences and accountability model with colleagues interested in serving the genetics educational needs of in-service secondary school science teachers and their students. Our accountability model is facilitated through (1) identifying the educational needs of the population of teachers to be served, (2) articulating goals and measurable objectives to meet these needs, and (3) then designing and implementing pretest/posttest questions to measure whether the objectives have been achieved. Comparison of entry and exit levels of performance on a 50-item test showed that teacher-participants learned a statistically significant amount of genetics content in our NSF-funded workshops. Teachers, in turn, administered a 25-item pretest/posttest to their secondary school students, and collective data from 121 classrooms across the United States revealed statistically significant increases in student knowledge of genetics content. Methods describing our attempts to evaluate teachers' use of pedagogical techniques and bioethical decision-making skills are briefly addressed.     

Teaching cell biology in the large-enrollment classroom: methods to promote analytical thinking and assessment of their effectiveness

A large-enrollment, undergraduate cellular biology lecture course is described whose primary goal is to help students acquire skill in the interpretation of experimental data. The premise is that this kind of analytical reasoning is not intuitive for most people and, in the absence of hands-on laboratory experience, will not readily develop unless instructional methods and examinations specifically designed to foster it are employed. Promoting scientific thinking forces changes in the roles of both teacher and student. We describe didactic strategies that include directed practice of data analysis in a workshop format, active learning through verbal and written communication, visualization of abstractions diagrammatically, and the use of ancillary small-group mentoring sessions with faculty. The implications for a teacher in reducing the breadth and depth of coverage, becoming coach instead of lecturer, and helping students to diagnose cognitive weaknesses are discussed. In order to determine the efficacy of these strategies, we have carefully monitored student performance and have demonstrated a large gain in a pre- and posttest comparison of scores on identical problems, improved test scores on several successive midterm examinations when the statistical analysis accounts for the relative difficulty of the problems, and higher scores in comparison to students in a control course whose objective was information transfer, not acquisition of reasoning skills. A novel analytical index (student mobility profile) is described that demonstrates that this improvement was not random, but a systematic outcome of the teaching/learning strategies employed. An assessment of attitudes showed that, in spite of finding it difficult, students endorse this approach to learning, but also favor curricular changes that would introduce an analytical emphasis earlier in their training.     

Teaching tree thinking in an upper level organismal biology course: testing the effectiveness of a multifaceted curriculum

The ability to interpret and reason from Tree of Life diagrams is a key component of twenty-first century science literacy. This article reports on the authors’ continued development of a multifaceted research-based curriculum – including an instructional booklet, lectures, laboratories and a field activity – to teach such tree thinking to biology students. Results are presented from a study involving biology students enrolled in an upper level organismal biology class. All students received the multi-week tree-thinking curriculum, and learning was assessed by comparing pretest and posttest scores on the novel tree-thinking assessment instrument developed by the authors. Quantitatively, the authors found large gains in tree-thinking abilities due to their instruction. The results also provided qualitative evidence that the authors succeeded in their more general goal of helping students to appreciate the interconnectedness of Earth’s biodiversity through the utility of phylogenetic trees.     

探索医学研究生的《分子生物学》教学改革

培养具有创新思维和独立创新能力的高素质人才,是医学研究生教育的培养目标,也是新的历史时期对培养高等医学人才 的要求。《医学分子生物学》课程对于研究生教学至关重要,已成为医学研究生的重要基础课程。我们在多年教学经验的基础上, 通过调整理论教学模式、优化知识结构、合理设置教学内容、扩展前沿知识领域、改善考核方式等多个举措,着重培养研究生的独 立科研创新能力,使得研究生《医学分子生物学》教学改革取得一定成效。     

The use of multiple tools for teaching medical biochemistry

In this work, we describe the use of several strategies employing the philosophies of active learning and problem-based learning (PBL) that may be used to improve the teaching of metabolic biochemistry to medical and nutritional undergraduate students. The main activities are as follows: 1) a seminar/poster system in a mini-congress format (using topics of applied biochemistry); 2) a true/false applied biochemistry exam (written by peer tutors); 3) a 9-h exam on metabolism (based in real publications); 4) the Advanced Biochemistry course (directed to peer tutors, where students learn how to read and criticize real medical papers); 5) experiments about nutrition and metabolism, using students as volunteers, and about free radicals (real science for students); 6) the BioBio blog (taking advantage of the "web age," this enhances out of class exchanges of information between the professor, students, and peer tutors); 7) student lectures on public health issues and metabolic disorders directed to the community and lay people; and 8) the BioBio quiz show. The main objective of these activities is to provide students with a more practical and interesting approach to biochemistry, such as the application of theoretical knowledge to real situations (diseases, experiments, media information, and scientific discoveries). In addition, we emphasize the importance of peer tutor activities for optimized learning of both students and peer tutors, the importance of a closer interaction between students and teaching staff, and the necessity to initiate students precociously in two broad fields of medical activity: "real" basic science and contact with the public (also helping students--future doctors and nutritionists--to be able to communicate with lay people). Most activities were evaluated by the students through written questionnaires and informal conversations, along various semesters, indicating good acceptance and approval of these methods. Good student scores in the biochemistry exams and seminars indicated that these activities are also working as valid educational tools.     

Teaching human cardiovascular and respiratory physiology with the station method

We have developed a station method to offer combined cardiovascular and respiratory physiology exercises all in one laboratory period during our medical physiology course. This laboratory was designed for first-year medical students in order to minimize equipment costs, maximize efficient use of both student and faculty time, and facilitate integration of basic cardiovascular concepts with those in respiratory physiology. We designed six stations for the students to evaluate: cardiovascular and respiratory responses to dynamic exercise, cold pressor reflex, postural influences and respiratory modulation of cardiovascular functions, forced expiratory maneuvers with inverted bell spirometers, forced expiratory maneuvers and maximal inspiratory maneuvers with electronic spirometers with and without obstruction, and respiratory muscle strength. Students worked in groups of two to four and were assessed by individual laboratory reports. Although we neglected to formally assess the impact on students of changes in laboratory design, students appeared to respond enthusiastically to the laboratory and prepared knowledgeable laboratory reports.     

Teaching cardiovascular physiology with equivalent electronic circuits in a practically oriented teaching module

Here, we report on a new tool for teaching cardiovascular physiology and pathophysiology that promotes qualitative as well as quantitative thinking about time-dependent physiological phenomena. Quantification of steady and presteady-state (transient) cardiovascular phenomena is traditionally done by differential equations, but this is time consuming and unsuitable for most undergraduate medical students. As a result, quantitative thinking about time-dependent physiological phenomena is often not extensively dealt with in an undergraduate physiological course. However, basic concepts of steady and presteady state can be explained with relative simplicity, without the introduction of differential equation, with equivalent electronic circuits (EECs). We introduced undergraduate medical students to the concept of simulating cardiovascular phenomena with EECs. EEC simulations facilitate the understanding of simple or complex time-dependent cardiovascular physiological phenomena by stressing the analogies between EECs and physiological processes. Student perceptions on using EEC to simulate, study, and understand cardiovascular phenomena were documented over a 9-yr period, and the impact of the course on the students' knowledge of selected basic facts and concepts in cardiovascular physiology was evaluated over a 3-yr period. We conclude that EECs are a valuable tool for teaching cardiovascular physiology concepts and that EECs promote active learning.     

Can learning style predict student satisfaction with different instruction methods and academic achievement in medical education?

The curriculum of our medical school has a hybrid structure including both traditional training (lectures) and problem-based learning (PBL) applications. The purpose of this study was to determine the learning styles of our medical students and investigate the relation of learning styles with each of satisfaction with different instruction methods and academic achievement in them. This study was carried out with the participation of 170 first-year medical students (the participation rate was 91.4%). The researchers prepared sociodemographic and satisfaction questionnaires to determine the characteristics of the participants and their satisfaction levels with traditional training and PBL. The Kolb learning styles inventory was used to explore the learning styles of the study group. The participants completed all forms at the end of the first year of medical education. Indicators of academic achievement were scores of five theoretical block exams and five PBL exams performed throughout the academic year of 2008-2009. The majority of the participants took part in the "diverging" (n = 84, 47.7%) and "assimilating" (n = 73, 41.5%) groups. Numbers of students in the "converging" and "accommodating" groups were 11 (6.3%) and 8 (4.5%), respectively. In all learning style groups, PBL satisfaction scores were significantly higher than those of traditional training. Exam scores for "PBL and traditional training" did not differ among the four learning styles. In logistic regression analysis, learning style (assimilating) predicted student satisfaction with traditional training and success in theoretical block exams. Nothing predicted PBL satisfaction and success. This is the first study conducted among medical students evaluating the relation of learning style with student satisfaction and academic achievement. More research with larger groups is needed to generalize our results. Some learning styles may relate to satisfaction with and achievement in some instruction methods.     

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.     

Lord’s Paradox in a Continuous Setting and a Regression Artifact in Numerical Cognition Research

In this paper we review, and elaborate on, the literature on a regression artifact related to Lord’s paradox in a continuous setting. Specifically, the question is whether a continuous property of individuals predicts improvement from training between a pretest and a posttest. If the pretest score is included as a covariate, regression to the mean will lead to biased results if two critical conditions are satisfied: (1) the property is correlated with pretest scores and (2) pretest scores include random errors. We discuss how these conditions apply to the analysis in a published experimental study, the authors of which concluded that linearity of children’s estimations of numerical magnitudes predicts arithmetic learning from a training program. However, the two critical conditions were clearly met in that study. In a reanalysis we find that the bias in the method can fully account for the effect found in the original study. In other words, data are consistent with the null hypothesis that numerical magnitude estimations are unrelated to arithmetic learning.     

Developing a flexible learning activity on biodiversity and spatial scale concepts using open‐access vegetation datasets from the National Ecological Observatory Network

Biodiversity is a complex, yet essential, concept for undergraduate students in ecology and other natural sciences to grasp. As beginner scientists, students must learn to recognize, describe, and interpret patterns of biodiversity across various spatial scales and understand their relationships with ecological processes and human influences. It is also increasingly important for undergraduate programs in ecology and related disciplines to provide students with experiences working with large ecological datasets to develop students’ data science skills and their ability to consider how ecological processes that operate at broader spatial scales (macroscale) affect local ecosystems. To support the goals of improving student understanding of macroscale ecology and biodiversity at multiple spatial scales, we formed an interdisciplinary team that included grant personnel, scientists, and faculty from ecology and spatial sciences to design a flexible learning activity to teach macroscale biodiversity concepts using large datasets from the National Ecological Observatory Network (NEON). We piloted this learning activity in six courses enrolling a total of 109 students, ranging from midlevel ecology and GIS/remote sensing courses, to upper‐level conservation biology. Using our classroom experiences and a pre/postassessment framework, we evaluated whether our learning activity resulted in increased student understanding of macroscale ecology and biodiversity concepts and increased familiarity with analysis techniques, software programs, and large spatio‐ecological datasets. Overall, results suggest that our learning activity improved student understanding of biological diversity, biodiversity metrics, and patterns of biodiversity across several spatial scales. Participating faculty reflected on what went well and what would benefit from changes, and we offer suggestions for implementation of the learning activity based on this feedback. This learning activity introduced students to macroscale ecology and built student skills in working with big data (i.e., large datasets) and performing basic quantitative analyses, skills that are essential for the next generation of ecologists.