Showing papers in "Advances in Physiology Education in 2013"

Flipped Classroom Model Improves Graduate Student Performance in Cardiovascular, Respiratory, and Renal Physiology.

Abstract: The purpose of this study was to assess the effectiveness of a traditional lecture-based curriculum versus a modified "flipped classroom" curriculum of cardiovascular, respiratory, and renal physiology delivered to first-year graduate students. Students in both courses were provided the same notes and recorded lectures. Students in the modified flipped classroom were required to watch the prerecorded lectures before class and then attend class, where they received a quiz or homework covering material in each lecture (valued at 25% of the final grade) followed by a question and answer/problem-solving period. In the traditional curriculum, attending lectures was optional and there were no quizzes. Evaluation of effectiveness and student performance was achieved by having students in both courses take the same multiple-choice exams. Within a comparable group of graduate students, participants in the flipped course scored significantly higher (P ≤ 0.05) on the cardiovascular, respiratory, and weighted cumulative sections by an average of >12 percentage points. Exam averages for students in the flipped course also tended to be higher on the renal section by ∼11 percentage points (P = 0.06). Based on our experience and responses obtained in blinded student surveys, we propose that the use of homework and in-class quizzes were critical motivating factors that likely contributed to the increase in student exam performance. Taken together, our findings support that the flipped classroom model is a highly effective means in which to disseminate key physiological concepts to graduate students.

T cell responses: naïve to memory and everything in between

Abstract: THE MAMMALIAN IMMUNE SYSTEM can be broadly divided into two main arms: innate and adaptive immunity. As its name implies, the cells and receptors of the innate immune system are critical for the rapid recognition of the infectious agent and initiating a proinflammatory response. While the inflammation generated by innate immune cells [neutrophils, macrophages, monocytes, natural killer (NK) cells, dendritic cells (DCs), etc.] is important in the initial containment of the infection, it also informs and directs the expansion and differentiation of adaptive immune cells. Responding to the inflammatory environment created by the innate response, cells of the adaptive arm of the immune response (B cells, T cells, and T cells) are stimulated to expand in number (proliferate) and to differentiate into cells with a range of functions appropriate for the immunological challenge. Upon elimination of the invading pathogen, the majority of adaptive cells die and leave behind an (evergrowing) array of memory cell subsets. These memory cells offer a diversity of migratory properties and functions, collectively mediating a rapid and protective immune response upon reinfection. Thus, the major advantages of an adaptive response to the host are twofold. First, it allows the host to form an immune response that is specifically tailored to the invading pathogen. Second, it forms a pool of memory cells from these specific effectors that can last for many years, capable of protecting the host against reinfection by their rapid response. This combination of specificity and memory are the mechanistic underpinnings for the clinical success of vaccination. Critical to almost all functions of the adaptive immune response is the activation and programming of T cells from their naive/resting state. Although there is much more to be learned, we now have a good basic understanding of the signals and cell types involved in the various stages of the T cell response initiated within the secondary lymphoid organs (SLOs). To provide a comprehensive overview, this review will summarize the T cell response broken down into three major stages: activation, differentiation, and memory formation. We will then assemble these components into a description of the anatomy of an immune response and its relationship to productive immune protection.

Pattern recognition receptors in innate immunity, host defense, and immunopathology.

Abstract: Infection by pathogenic microbes initiates a set of complex interactions between the pathogen and the host mediated by pattern recognition receptors. Innate immune responses play direct roles in host defense during the early stages of infection, and they also exert a profound influence on the generation of the adaptive immune responses that ensue. An improved understanding of the pattern recognition receptors that mediate innate responses and their downstream effects after receptor ligation has the potential to lead to new ways to improve vaccines and prevent autoimmunity. This review focuses on the control of innate immune activation and the role that innate immune receptors play in helping to maintain tissue homeostasis.

Explorations in statistics: the analysis of ratios and normalized data

Abstract: Learning about statistics is a lot like learning about science: the learning is more meaningful if you can actively explore. This ninth installment of Explorations in Statistics explores the analysis of ratios and normalized–or standardized–data. As researchers, we compute a ratio–a numerator divided by a denominator–to compute a proportion for some biological response or to derive some standardized variable. In each situation, we want to control for differences in the denominator when the thing we really care about is the numerator. But there is peril lurking in a ratio: only if the relationship between numerator and denominator is a straight line through the origin will the ratio be meaningful. If not, the ratio will misrepresent the true relationship between numerator and denominator. In contrast, regression techniques–these include analysis of covariance–are versatile: they can accommodate an analysis of the relationship between numerator and denominator when a ratio is useless.

A comparison of traditional and engaging lecture methods in a large, professional-level course

Abstract: In engaging lectures, also referred to as broken or interactive lectures, students are given short periods of lecture followed by “breaks” that can consist of 1-min papers, problem sets, brainstorm...

A writing-intensive course improves biology undergraduates' perception and confidence of their abilities to read scientific literature and communicate science

Abstract: Most scientists agree that comprehension of primary scientific papers and communication of scientific concepts are two of the most important skills that we can teach, but few undergraduate biology ...

Case-based learning in endocrine physiology: an approach toward self-directed learning and the development of soft skills in medical students

Abstract: The Medical Council of India, in the recent Vision 2015 document, recommended curricular reforms for undergraduates. Case-based learning (CBL) is one method where students are motivated toward self...

Rationale and Resources for Teaching the Mathematical Modeling of Athletic Training and Performance.

Abstract: A number of professions rely on exercise prescription to improve health or athletic performance, including coaching, fitness/personal training, rehabilitation, and exercise physiology. It is theref...

Cold Stress and the Cold Pressor Test.

Abstract: Temperature and other environmental stressors are known to affect blood pressure and heart rate. In this activity, students perform the cold pressor test, demonstrating increased blood pressure during a 1- to 2-min immersion of one hand in ice water. The cold pressor test is used clinically to evaluate autonomic and left ventricular function. This activity is easily adapted to an inquiry format that asks students to go to the scientific literature to learn about the test and then design a protocol for carrying out the test in classmates. The data collected are ideal for teaching graphical presentation of data and statistical analysis.

Interactions between the central nervous system and pancreatic islet secretions: a historical perspective.

Abstract: The endocrine pancreas is richly innervated with sympathetic and parasympathetic projections from the brain. In the mid-20th century, it was established that α-adrenergic activation inhibits, whereas cholinergic stimulation promotes, insulin secretion; this demonstrated the importance of the sympathetic and parasympathetic systems in pancreatic endocrine function. It was later established that insulin injected peripherally could act within the brain, leading to the discovery of insulin and insulin receptors within the brain and the receptor-mediated transport of insulin into the central nervous system from endothelial cells. The insulin receptor within the central nervous system is widely distributed, reflecting insulin's diverse range of actions, including acting as an adiposity signal to reduce food intake and increase energy expenditure, regulation of systemic glucose responses, altering sympathetic activity, and involvement in cognitive function. As observed with central insulin administration, the pancreatic hormones glucagon, somatostatin, pancreatic polypeptide, and amylin can each also reduce food intake. Pancreatic and also gut hormones are released cephalically, in what is an important mechanism to prepare the body for a meal and prevent excessive postprandial hyperglycemia.

Online feedback assessments in physiology: effects on students' learning experiences and outcomes.

Abstract: Online formative assessments have become increasingly popular; however, formal evidence supporting their educational benefits is limited. This study investigated the impact of online feedback quizzes on the learning experiences and outcomes of undergraduate students enrolled in an introductory physiology course. Four quiz models were tested, which differed in the amount of credit available, the number of attempts permitted, and whether the quizzes were invigilated or unsupervised, timed or untimed, or open or closed book. All quizzes were composed of multiple-choice questions and provided immediate individualized feedback. Summative end-of-course examination marks were analyzed with respect to performance in quizzes and were also compared with examination performance in the year before the quizzes were introduced. Online surveys were conducted to gather students' perceptions regarding the quizzes. The vast majority of students perceived online quizzes as a valuable learning tool. For all quiz models tested, there was a significant relationship between performance in quizzes and end-of-course examination scores. Importantly, students who performed poorly in quizzes were more likely to fail the examination, suggesting that formative online quizzes may be a useful tool to identify students in need of assistance. Of the four quiz models, only one quiz model was associated with a significant increase in mean examination performance. This model had the strongest formative focus, allowing multiple unsupervised and untimed attempts. This study suggests that the format of online formative assessments is critical in achieving the desired impact on student learning. Specifically, such assessments are most effective when they are low stakes.

Do Learning Approaches of Medical Students Affect Their Satisfaction with Problem-Based Learning?.

Abstract: The aim of this research was to determine the satisfaction of medical students with problem-based learning (PBL) and their approaches to learning to investigate the effect of learning approaches on their levels of satisfaction. The study group was composed of medical students from three different universities, which apply PBL at different levels in their curricula. The revised two-factor study process survey was applied to the study group to determine their approaches to learning as “deep” or “surface” learning. In addition, another survey of 20 questions was used to determine satisfaction levels of students with PBL and other variables. Of the study group, 64.6% were found to adopt a deep approach to learning, and we confirmed that these students were reasonably more satisfied with PBL.

Evaluating Learning among Undergraduate Medical Students in Schools with Traditional and Problem-Based Curricula.

Abstract: This study aimed to assess knowledge and skills in a respiratory physiology course in traditional versus problem-based learning (PBL) groups in two different medical schools. Two different undergra...

Process-oriented guided-inquiry learning improves long-term retention of information

Abstract: Many chemistry educators have adopted the process-oriented guided instructional learning (POGIL) pedagogy. However, it is not clear which aspects of POGIL are the most important in terms of actual ...

An efficient approach to improve the usability of e-learning resources: the role of heuristic evaluation

Abstract: Optimizing the usability of e-learning materials is necessary to maximize their potential educational impact, but this is often neglected when time and other resources are limited, leading to the release of materials that cannot deliver the desired learning outcomes. As clinician-teachers in a resource-constrained environment, we investigated whether heuristic evaluation of our multimedia e-learning resource by a panel of experts would be an effective and efficient alternative to testing with end users. We engaged six inspectors, whose expertise included usability, e-learning, instructional design, medical informatics, and the content area of nephrology. They applied a set of commonly used heuristics to identify usability problems, assigning severity scores to each problem. The identification of serious problems was compared with problems previously found by user testing. The panel completed their evaluations within 1 wk and identified a total of 22 distinct usability problems, 11 of which were considered serious. The problems violated the heuristics of visibility of system status, user control and freedom, match with the real world, intuitive visual layout, consistency and conformity to standards, aesthetic and minimalist design, error prevention and tolerance, and help and documentation. Compared with user testing, heuristic evaluation found most, but not all, of the serious problems. Combining heuristic evaluation and user testing, with each involving a small number of participants, may be an effective and efficient way of improving the usability of e-learning materials. Heuristic evaluation should ideally be used first to identify the most obvious problems and, once these are fixed, should be followed by testing with typical end users.

Higher levels of intrinsic motivation are related to higher levels of class performance for male but not female students.

Abstract: Our students are naturally curious, with powerful intrinsic motives to understand their world. Accordingly, we, as teachers, must capitalize on this inherently active and curious nature so that learning becomes a lifelong activity where students take initiative for learning, are skilled in learning, and want to learn new things. Achieving this goal requires an understanding of student attitudes, beliefs, characteristics, and motivations. To achieve this goal, we administered the intrinsic motivation inventory (IMI) to assess our students' interest and enjoyment, perceived choice, and perceived competence while taking our undergraduate exercise physiology class (46 students; 20 female students and 26 male students). The interest and enjoyment subscale is considered the self-reported measure of intrinsic motivation. The perceived choice and perceived competence concepts are theorized to be positive predictors of both self-reported and behavioral measures of intrinsic motivation. Our results documented a significant increase in course grade with an increase in survey score for the interest and enjoyment subscale of the IMI when female and male students were combined. Specifically, each increase in survey score for the interest and enjoyment subscale of the IMI was associated with a significant (P < 0.05) increase of 3.9% in course grade. However, the increase in survey score was associated with a significantly greater (P < 0.05) increase in course grade for male (6.1%) compared with female (0.3%) students. These results have implications for both classroom practice and educational reform policies.

Glucose transport into everted sacs of the small intestine of mice

Abstract: The Na+-glucose cotransporter is a key transport protein that is responsible for absorbing Na+ and glucose from the luminal contents of the small intestine and reabsorption by the proximal straight...

Evaluation of a Peer Mentoring Program for a Mature Cohort of First-Year Undergraduate Paramedic Students.

Abstract: The purpose of this study was to evaluate the effectiveness of a peer-assisted study session (PASS) program for a large class of Bachelor of Health Science (Paramedic) students. This cohort was made up predominantly of mature aged students who have not undertaken any study for many years. Within a bioscience first-year core subject, student mentees attended PASS sessions on a voluntary basis, with second-year Bachelor of Health Science (Paramedic) students acting as mentors. Mentors were recruited based on their outstanding academic performance in bioscience the previous year and selected based on group and individual interviews. Successful candidates participated in a compulsory 2 days of student mentor training and were supported throughout the program to develop their mentoring skills in both face-to-face workshops and online. Mentee students were allocated to a PASS session with a maximum size of 25 students/group that was facilitated by 2 student mentors. In general, the program was viewed favorably by both mentors and mentees. There was an increase in academic performance and a decrease in the fail rate of the mentee group compared with the cohort of students that did not participate in the PASS program. Importantly, mentees believed that the program improved their study skills and gave them confidence in their approach to studying. This is a significant consideration for the improvement of student transition and retention in a mature aged student cohort.

Retrieval practice is an efficient method of enhancing the retention of anatomy and physiology information

Abstract: Although a great deal of empirical evidence has indicated that retrieval practice is an effective means of promoting learning and memory, very few studies have investigated the strategy in the cont...

Using a classic paper by Robin Fåhraeus and Torsten Lindqvist to teach basic hemorheology

Abstract: “The viscosity of the blood in narrow capillary tubes” by Robin Fahraeus and Torsten Lindqvist (Am J Physiol 96: 562–568, 1931) can be a valuable opportunity for teaching basic hemorheological prin...

Effect of an Individual Readiness Assurance Test on a Team Readiness Assurance Test in the Team-Based Learning of Physiology.

Abstract: We examined whether requiring an individual readiness assurance test (iRAT) before a team readiness assurance test (tRAT) would benefit students in becoming better problem solvers in physiology. It was tested in the form of tRAT scores, the time required to complete the tRAT assignment, and individual performance on the unit examinations. Students in one section were given the iRAT at the beginning of the team-based learning session. The same set of questions was given to students as their tRAT immediately after their iRAT. Students in the second section were not given the iRAT before the tRAT. This pattern was reversed for the next scheduled team-based learning activity between the two sections. We found that the section having both the iRAT and tRAT scored higher on the tRAT and completed their assignments in less time than the section with the tRAT alone. This suggests that the tRAT combined with the iRAT is an effective team-based approach to the teaching of physiology compared with the tRAT alone.

An active learning mammalian skeletal muscle lab demonstrating contractile and kinetic properties of fast- and slow-twitch muscle

Abstract: The fact that humans possess fast- and slow-twitch muscle in the ratio of ∼50% has profound implications for designing exercise training strategies for power and endurance activities. With the growth of exercise and sport science courses, we have seen the need to develop an undergraduate student laboratory that demonstrates the basic properties of fast- and slow-twitch mammalian skeletal muscle. This laboratory illustrates the major differences in contractile properties and fatigue profiles exhibited by the two muscle types. Students compare and contrast twitch kinetics, fused tetanus characteristics, force-frequency relationships, and fatigue properties of fast- and slow-twitch muscles. Examples of results collected by students during class are used to illustrate the type of data collected and analysis performed. During the laboratory, students are encouraged to connect factual information from their skeletal muscle lectures to their laboratory findings. This enables student learning in an active fashion; in particular, the isolated muscle preparation demonstrates that much of what makes muscle fast or slow is myogenic and not the product of the nervous or circulatory systems. This has far-reaching implications for motor control and exercise behavior and therefore is a crucial element in exercise science, with its focus on power and endurance sport activities. To measure student satisfaction with this active learning technique, a questionnaire was administered after the laboratory; 96% of the comments were positive in their support of active versus passive learning strategies.

A Set of Vertically Integrated Inquiry-Based Practical Curricula that Develop Scientific Thinking Skills for Large Cohorts of Undergraduate Students.

Abstract: Science graduates require critical thinking skills to deal with the complex problems they will face in their 21st century workplaces. Inquiry-based curricula can provide students with the opportunities to develop such critical thinking skills; however, evidence suggests that an inappropriate level of autonomy provided to underprepared students may not only be daunting to students but also detrimental to their learning. After a major review of the Bachelor of Science, we developed, implemented, and evaluated a series of three vertically integrated courses with inquiry-style laboratory practicals for early-stage undergraduate students in biomedical science. These practical curricula were designed so that students would work with increasing autonomy and ownership of their research projects to develop increasingly advanced scientific thinking and communication skills. Students undertaking the first iteration of these three vertically integrated courses reported learning gains in course content as well as skills in scientific writing, hypothesis construction, experimental design, data analysis, and interpreting results. Students also demonstrated increasing skills in both hypothesis formulation and communication of findings as a result of participating in the inquiry-based curricula and completing the associated practical assessment tasks. Here, we report the specific aspects of the curricula that students reported as having the greatest impact on their learning and the particular elements of hypothesis formulation and communication of findings that were more challenging for students to master. These findings provide important implications for science educators concerned with designing curricula to promote scientific thinking and communication skills alongside content acquisition.

Interactive mobile learning: a pilot study of a new approach for sport science and medical undergraduate students

Abstract: Mobile learning has increasingly become interwoven into the fabric of learning and teaching in the United Kingdom higher education sector, and as technological issues become addressed, this phenome...

A comparison of student performance on discipline-specific versus integrated exams in a medical school course

Abstract: Curricular reform is a widespread trend among medical schools. Assessing the impact that pedagogical changes have on students is a vital step in review process. This study examined how a shift from discipline-focused instruction and assessment to integrated instruction and assessment affected student performance in a second-year medical school pathology course. We investigated this by comparing pathology exam scores between students exposed to traditional discipline-specific instruction and exams (DSE) versus integrated instruction and exams (IE). Exam content was controlled, and individual questions were evaluated using a modified version of Bloom's taxonomy. Additionally, we compared United States Medical Licensing Examination (USMLE) step 1 scores between DSE and IE groups. Our findings indicate that DSE students performed better than IE students on complete pathology exams. However, when exam content was controlled, exam scores were equivalent between groups. We also discovered that the integrated exams were composed of a significantly greater proportion of questions classified on the higher levels of Bloom's taxonomy and that IE students performed better on these questions overall. USMLE step 1 exam scores were similar between groups. The finding of a significant difference in content complexity between discipline-specific and integrated exams adds to recent literature indicating that there are a number of potential biases related to curricular comparison studies that must be considered. Future investigation involving larger sample sizes and multiple disciplines should be performed to explore this matter further.

Teaching physiology online: successful use of case studies in a graduate course

Abstract: To address the need for greater flexibility in access to higher education, an online graduate course in physiology using case studies was developed and offered in summer 2012. Topics in both animal and human physiology were organized as modules that contained a case study with questions, a prerecorded online lecture, and three research journal articles. We followed best practices for teaching and learning in distance education, including the preparation of materials before the course starting date, a discussion board for responding to pre- and postcase discussion questions, and prompt reply to student queries. For exams, students generated their own questions based on new cases and developed their own case study for the final project. Although only 20% of students had previously taken an online course, all students stated that they would recommend this course to others. Postcase assessment indicated that students found the cases interesting, informative, and presented at the appropriate level. Most students said that the online course took them more time but that they learned more content and used the primary literature more than in a traditional class. Our results indicate that a well-organized physiology course using a case study format is a very effective model for online learning.

Introducing e-learning/teaching in a physiology course for medical students: acceptance by students and subjective effect on learning

Abstract: Retrieval of information has substantially changed within the last two decades. Naturally, this has also affected learning/teaching techniques, and methods that are commonly referred to as “e-learn...

The force-frequency relationship: insights from mathematical modeling.

Abstract: The force-frequency relationship has intrigued researchers since its discovery by Bowditch in 1871. Many attempts have been made to construct mathematical descriptions of this phenomenon, beginning with the simple formulation of Koch-Wesser and Blinks in 1963 to the most sophisticated ones of today. This property of cardiac muscle is amplified by β-adrenergic stimulation, and, in a coordinated way, the neurohumoral state alters both frequency (acting on the sinoatrial node) as well as force generation (modifying ventricular myocytes). This synchronized tuning is needed to meet new metabolic demands. Cardiac modelers have already linked mechanical and electrical activity in their formulations and showed how those activities feedback on each other. However, now it is necessary to include neurological control to have a complete description of heart performance, especially when changes in frequency are involved. Study of arrhythmias (or antiarrhythmic drugs) based on mathematical models should incorporate this effect to make useful predictions or point out potential pharmaceutical targets.

Medical students' participation in and perception of unprofessional behaviors: comparison of preclinical and clinical phases.

Abstract: We aimed to compare reported observations, participation in, and perceptions of unprofessional behaviors across preclinical and clinical medical students using a 23-item questionnaire that asked pa...

A novel laboratory approach for the demonstration of hemodynamic principles: the arterial blood flow reflection

Abstract: In the frame of a laboratory training course for medicine students, a new approach for laboratory exercises has been applied to teach the phenomena of circulation. The exercise program included measurements of radial artery blood flow waveform for different age groups using a noninvasive optical sensor. Arterial wave reflection was identified by measurements of blood flow waveforms before and after arterial branching. Students were able to distinguish between different waveforms of blood flow within different age groups. Furthermore, students were given the opportunity to explore the effect of aging on the elasticity of blood vessels. This exercise is an introduction to the fundamental physical laws of hemodynamics that can facilitate the learning and understanding of cardiovascular physiology to students of medicine.