Beyond the printed page: physiology education without a textbook?

Pedagogical innovations, ideas, and outcomes designed to enhance student learning in physiology courses are encouraged by our professional organizations and are actively discussed at conferences and in Advance in Physiological Education. Here, we report our experiment with freely available internet-based material as a substitute for the textbook for a single chapter on muscle physiology in a sophomore-level Human Physiology course. Student reactions to the textbookless curriculum were registered with the use of a questionnaire. Their responses indicated that they enjoyed the online material (animations, images, reviews, etc.), the emphasis on important concepts, and the variety of resources. Furthermore, students were almost unanimous in their praise for such pedagogical approaches to science education. Yet, students were reluctant to part with their textbooks. We believe that with subsequent iterations of this course we will be more successful at further separating the learning experience from the textbook. Reliance on freely available material may eventually relieve students from the burden of purchasing a costly textbook.     

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.     

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.     

Evaluating the impact of physical renovation, computerization, and use of an inquiry approach in an undergraduate, allied health human anatomy and physiology lab

This paper describes and evaluates a major renovation of a human anatomy and physiology lab for allied health students. A Howard Hughes Medical Institute award funded an extensive collaboration between faculty involved in teaching the course and faculty with expertise in industrial and furniture design. The resulting physical lab has unique features designed to improve work in groups, student movement, and integration of computers with wet laboratories. The anatomy curriculum was switched from fetal pig dissections to the use of human cadavers, computer animations, and plastic models. An inquiry approach was integrated into the physiology curriculum. Student attitude surveys suggest that the physical and curricular changes resulted in a significant increase in student learning. An experiment designed to specifically test the effect of new vs. old equipment did not support a benefit to new equipment independent of changes in the lab physical environment and curriculum. Because the improvements in student attitude surveys occurred in the physiology but not the anatomy labs, we suggest that at least a portion of the increase is due to the institution of the inquiry approach.     

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 the teaching strategy of cardiovascular system in a problem-based curriculum: student perception

It is generally acknowledged that an integrated approach to teaching cardiovascular system (CVS) is clinically relevant. However, very little attention has been paid with respect to student perception of teaching CVS in an integrated problem-based curriculum. A questionnaire on the feedback and perception of medical students (n = 60) to their learning experience of CVS exposed early in the problem-based integrated curriculum at the Arabian Gulf University (AGU) was used. The average percentage scores of positive student responses to items related to knowledge was 62.7%, to integration was 87.3%, and to skills was 77.1%. A significant positive correlation was observed among skills and knowledge (r = 0.408, P = 0.002), skills and integration (r = 0.506, P < 0.000), and integration and knowledge (r = 0.294, P = 0.028). The lowest individual percentage score related to knowledge items was given to the role of resource sessions in understanding difficult concepts (32.7%). Interestingly, 90.7% of the students were aware of the presence of gaps in their knowledge. On the other hand, 92.7% of students expressed their satisfaction with the study experience of CVS in the integrated problem-based approach. These results indicate that students overall achieved satisfactory learning outcome during the study of CVS in the problem-based integrated curriculum at AGU. The study also points out issues where improvement and fine tuning of the educational system can take place.     

The positive impact of team-based virtual microscopy on student learning in physiology and histology

Team-based virtual microscopy and on-line learning were used to transform the first-year Physiology/Histology course at The Johns Hopkins School of Medicine into a student-centered learning environment. Prior to each laboratory session, students were required to view prelaboratory virtual lectures and examine digital slides that had been enhanced with annotations and 2-min microlectures. The laboratory classroom was then used for team-based learning exercises including student presentations and small-group discussions designed to integrate histology and physiology. The results of quantitative assessments indicated an 8- to 14-point increase over the identical final exams given over the past 5 yr. Means (+/-SD) of percent correct answers on the final exam were found to be 75.2% (11.1%), 72.5% (12.6%), 70.5% (12.6%), 73.6% (11.3%), 73.1% (12.2%), and 84.1% (9.1%) for years 2001-2006, respectively. The mean test scores for all other years were statistically lower compared with 2006, as determined by the Bonferroni post hoc multiple-comparison test (P < 0.001 for all years).     

Video laboratories for the teaching and learning of professional ethics in exercise physiology curricula

Student researchers in physiology courses often interact with human subjects in classroom research but may be unfamiliar with the professional ethics of experimenter-subject interactions. This communication describes experiences related to an interactive video used in exercise science and general biology courses to help students become aware of, sensitive to, and comfortable with implementing professional ethics into their own thinking and behavior as researchers before entering the laboratory. The activity consisted of a filmed exercise physiology experiment complemented with interactive question sheets followed by small- and large-group discussion and culminating with individual student reflections. Student written responses from multiple courses indicated that students were able to 1) identify and consider the ethics of experimenter-subject interactions from the movie, 2) generalize broader ideas of professional ethics from those observations, and 3) consider their observations in terms of future experiments they would be conducting personally and how they should interact with human subjects. A majority of students indicated a positive reaction to the video and identified specific aspects they appreciated. It is hoped that this report will encourage other instructors to consider the use of interactive videos in the teaching and learning of professional ethics related to their courses.     

Blending problem-based learning with Web technology positively impacts student learning outcomes in acid-base physiology

World Wide Web (Web)-based learning (WBL), problem-based learning (PBL), and collaborative learning are at present the most powerful educational options in higher education. A blended (hybrid) course combines traditional face-to-face and WBL approaches in an educational environment that is nonspecific as to time and place. To provide educational services for an undergraduate second-year elective course in acid-base physiology, a rich, student-centered educational Web-environment designed to support PBL was created by using Web Course Tools courseware. The course is designed to require students to work in small collaborative groups using problem solving activities to develop topic understanding. The aim of the study was to identify the impact of the blended WBL-PBL-collaborative learning environment on student learning outcomes. Student test scores and satisfaction survey results from a blended WBL-PBL-based test group (n = 37) were compared with a control group whose instructional opportunities were from a traditional in-class PBL model (n = 84). WBL students scored significantly (t = 3.3952; P = 0.0009) better on the final acid-base physiology examination and expressed a positive attitude to the new learning environment in the satisfaction survey. Expressed in terms of a difference effect, the mean of the treated group (WBL) is at the 76th percentile of the untreated (face-to-face) group, which stands for a "medium" effect size. Thus student progress in the blended WBL-PBL collaborative environment was positively affected by the use of technology.     

Gender differences in learning style preferences among undergraduate physiology students

Students have individual learning style preferences including visual (V; learning from graphs, charts, and flow diagrams), auditory (A; learning from speech), read-write (R; learning from reading and writing), and kinesthetic (K; learning from touch, hearing, smell, taste, and sight). These preferences can be assessed using the VARK questionnaire. We administered the VARK questionnaire to undergraduate physiology majors enrolled in a capstone physiology laboratory at Michigan State University; 48 of the 86 students (55.8%) who returned the completed questionnaire voluntarily offered gender information. The responses were tallied and assessed for gender difference in learning style preference; 54.2% of females and only 12.5% of males preferred a single mode of information presentation. Among the female students, 4.2% of the students preferred V, 0% of the students preferred A, 16.7% of the students preferred printed words (R), and 33.3% of the students preferred using all their senses (K). In contrast, male students were evenly distributed in preference, with 4.2% of the students preferring A, R, or K, respectively, while 0% of the students preferred V. Furthermore, 45.8% of female and 87.5% of male respondents preferred multiple modes [female: 2 modes (12.5%), 3 modes (12.5%), and 4 modes (20.8%); males: 2 modes (16.7%), 3 modes (12.5%), and 4 modes (58.3%)] of presentation. In summary, a majority of male students preferred multimodal instruction, specifically, four modes (VARK), whereas a majority of female students preferred single-mode instruction with a preference toward K. Thus, male and female students have significantly different learning styles. It is the responsibility of the instructor to address this diversity of learning styles and develop appropriate learning approaches.     

Quantitative concept mapping in pulmonary physiology: comparison of student and faculty knowledge structures

Quantitative concept mapping, in contrast with qualitative approaches, is rigorous scientifically and permits statistical analyses of data about concept learning. This study extends past quantitative research on the structure of student concept learning in pulmonary physiology. Pathfinder scaling is used to derive concept maps for medical and veterinary students and their physiology instructors at Northwestern University and the University of Wisconsin, respectively. The concept maps are evaluated for coherence (internal consistency), student-instructor similarity, and correlation of similarity with final examination scores. Results show that student and instructor concept maps are coherent and that student concept maps become increasingly similar to instructors' concept maps from pre- to postinstruction, but that student-instructor concept map similarity does not correlate with examination performance. Research outcomes are discussed concerning possible sources of variation in student and faculty knowledge structures.     

A computer-assisted personalized approach in an undergraduate plant physiology class

We used Computer-Assisted Personalized Approach (CAPA), a networked teaching and learning tool that generates computer individualized homework problem sets, in our large-enrollment introductory plant physiology course. We saw significant improvement in student examination performance with regular homework assignments, with CAPA being an effective and efficient substitute for hand-graded homework. Using CAPA, each student received a printed set of similar but individualized problems of a conceptual (qualitative) and/or quantitative nature with quality graphics. Because each set of problems is unique, students were encouraged to work together to clarify concepts but were required to do their own work for credit. Students could enter answers multiple times without penalty, and they were able to obtain immediate feedback and hints until the due date. These features increased student time on task, allowing higher course standards and student achievement in a diverse student population. CAPA handles routine tasks such as grading, recording, summarizing, and posting grades. In anonymous surveys, students indicated an overwhelming preference for homework in CAPA format, citing several features such as immediate feedback, multiple tries, and on-line accessibility as reasons for their preference. We wrote and used more than 170 problems on 17 topics in introductory plant physiology, cataloging them in a computer library for general access. Representative problems are compared and discussed.     

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.     

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.     

Using a high-fidelity patient simulator with first-year medical students to facilitate learning of cardiovascular function curves

Students are relying on technology for learning more than ever, and educators need to adapt to facilitate student learning. High-fidelity patient simulators (HFPS) are usually reserved for the clinical years of medical education and are geared to improve clinical decision skills, teamwork, and patient safety. Finding ways to incorporate HFPS into preclinical medical education represents more of a challenge, and there is limited literature regarding its implementation. The main objective of this study was to implement a HFPS activity into a problem-based curriculum to enhance the learning of basic sciences. More specifically, the focus was to aid in student learning of cardiovascular function curves and help students develop heart failure treatment strategies based on basic cardiovascular physiology concepts. Pretests and posttests, along with student surveys, were used to determine student knowledge and perception of learning in two first-year medical school classes. There was an increase of 21% and 22% in the percentage of students achieving correct answers on a posttest compared with their pretest score. The median number of correct questions increased from pretest scores of 2 and 2.5 to posttest scores of 4 and 5 of a possible total of 6 in each respective year. Student survey data showed agreement that the activity aided in learning. This study suggests that a HFPS activity can be implemented during the preclinical years of medical education to address basic science concepts. Additionally, it suggests that student learning of cardiovascular function curves and heart failure strategies are facilitated.     

Conceptual assessment in the biological sciences: a National Science Foundation-sponsored workshop

Twenty-one biology teachers from a variety of disciplines (genetics, ecology, physiology, biochemistry, etc.) met at the University of Colorado to begin discussions about approaches to assessing students' conceptual understanding of biology. We considered what is meant by a "concept" in biology, what the important biological concepts might be, and how to go about developing assessment items about these concepts. We also began the task of creating a community of biologists interested in facilitating meaningful learning in biology. Input from the physiology education community is essential in the process of developing conceptual assessments for physiology.     

A comparison between learning style preferences and sex, status, and course performance

Students have learning style preferences that are often classified according to their visual (V), aural (A), read-write (R), and/or kinesthetic (K) sensory modality preferences (SMP). The purposes of this investigation were to compare student perceived and assessed SMPs and examine the associations between those SMPs and status (i.e., undergraduates vs. graduates), sex, and course performance. Students from the fall 2009 APK 3110 and APK 6116 Exercise Physiology courses were asked to indicate their perceived SMPs and complete the standard VARK SMP assessment. There were 64 student respondents: 50 undergraduates and 14 graduates (40 women and 24 men). According to the perceived SMP results, the largest number of respondents chose V (36%), followed by R (28%), K (19%), and A (17%). In terms of assessed SMPs, the largest number of respondents were classified as VARK (37%), followed by R (14%), AK (11%), K (8%), VK (6%), ARK (6%), A (5%), VAK (3%), RK (3%), V (2%), AR (2%), and VRK (2%). Nearly two-thirds of the respondents correctly matched their perceived and dominant assessed SMP. There was no statistical association between SMP and status. There was a very nearly significant relationship between sex and both perceived (χ(2) = 7.18, P = 0.06) and assessed (χ(2) = 17.36, P = 0.09) SMP. Finally, there was a significant relationship between perceived SMP and course scores (P = 0.01 by ANOVA). Post hoc tests revealed that the K group scored significantly lower than the other three modality groups.     

Undergraduates' understanding of cardiovascular phenomena

Undergraduates students in 12 courses at 8 different institutions were surveyed to determine the prevalence of 13 different misconceptions (conceptual difficulties) about cardiovascular function. The prevalence of these misconceptions ranged from 20 to 81% and, for each misconception, was consistent across the different student populations. We also obtained explanations for the students' answers either as free responses or with follow-up multiple-choice questions. These results suggest that students have a number of underlying conceptual difficulties about cardiovascular phenomena. One possible source of some misconceptions is the students' inability to apply simple general models to specific cardiovascular phenomena. Some implications of these results for teachers of physiology are discussed.     

An inquiry-based learning model for an exercise physiology laboratory course

We developed an inquiry-based learning model to better stimulate undergraduate students' cognitive development of exercise physiology laboratory concepts. The course core is the two independent research projects that students, working in small groups, complete during the last 9 wk of the semester. Student groups develop their own research question and hypothesis, design the experiment, collect and analyze the data, and report their findings to the rest of the class using presentation software. To help with success of the research projects, students are taken through a series of guided-inquiry laboratory activities during the initial 6 wk of the semester to develop laboratory skills and an understanding of the scientific process. Observations of student behaviors reflected a high level of enthusiasm and engagement in laboratory activities. Surveys, journal entries, and interviews indicated that students felt empowered by having ownership in their projects, which may be the key reason for the success of this model.