Best practices in active and student-centered learning in physiology classes

The use of instructional videos to compensate for flexible physiology learning during the pandemic of COVID 19

BACKGROUND

This study aimed at using instructional videos in physiology created by students to improve the process of learning Physiology especially during the COVID-19 Pandemic which enforced the lectures to be online. Additionally, it allowed students to visualize and understand clinical scenarios and the physiological reasons behind them while assessing how much they stand to gain from the experience.

METHODS

This study is a project to implement FAIMER, ASU MENA-FRI Institute, Cairo, Egypt. In a foundation course for first-year medical students, the instructor utilized a variety of instructional methods including lecture, small group discussion, individual assignments, and reflection. Students were randomly allocated into 18 groups, then a topic in their physiology curriculum was chosen and they formulated a related case scenario, thereafter a video was made by themselves. This intervention was rewarded by activity mark in their course. Post-project questionnaire was used, and an external reviewer evaluated the videos presented by students. This study obtained IRB approval from the Faculty of Medicine, Ain Shams Medical Ethics committee.

RESULTS

the project helped students to improve their skills in problem-solving, teamwork, active learning, communication, planning, and time management. In addition, it also increased their confidence in their abilities to learn, face unexpected challenges, and achieve goals, while considering new life opportunities, those which became an option when the students searched by themselves and learned more about the different angles of medicine.

CONCLUSION

Compared to the traditional lecture format that focuses on memorizing definitions and theoretical structures, instructional videos can be regarded as an innovative teaching tool and a unique medical education method that allowed students to participate more in the learning process even if their lectures were online. This article proposes an active learning method in undergraduate medical education which compensate for limited face-to-face attended during the pandemic.

Flipped classroom in neurophysiology: performance analysis of a system focusing on intrinsic students' motivation

Introduction: Teaching methodologies promoting active learning result in higher-order knowledge application, a desirable outcome in health disciplines like Physiology. Flipped-classroom (FC) promotes active learning and engagement in the classroom. Although specialized research keeps accumulating, the advantages of FC for improving academic outcome and ultimately patient care remain controversial and open to further analysis. Objective: This study evaluates the benefits of applying FC to the Neurophysiology module of a Human Physiology course. Methods:We compare final grades of students exposed to standard lecturing (five-years) vs. FC (six-years), and study the FC impact on student motivation, study time and rewards. Differing from conventional FC, we performed no pre-class/in-class assessments, relying on the students' internal motivation to experience our FC model. A printed student workbook was designed as pre-class material for each session. Reading times respect the expected daily study time of students in our system. Results and discussion: Concerning academic performance, our long-term study reports a significant increase in average scores for FC groups. Overall, students get better scores in multiple choice tests than in problem-solving questions. A more detailed analysis uncovers that our FC model helps students to obtain better scores, reducing variability in performance due to assessment methods. Based on our open-ended survey questions, most students rate the FC environment and in-class activities positively and perceive a positive effect of FC on teachers' performance. An objective automatic Sentiment analysis of open-ended answers reveals that FC is positively appreciated by students, associating positive perceptions to their understanding of physiological concepts, and negative evaluations to their time management.

Integrated laboratory classes to learn physiology in a psychology degree: impact on student learning and experience

Physiology is a fundamental discipline to be studied in most Health Science studies including Psychology. Physiology content is perceived by students as rather difficult, who may lack vision on how to relate it with their professional training. Therefore, identifying novel active and more engaging pedagogical strategies for teaching physiology to psychology students may help to fill this gap. In this pilot study, we used the PBL methodology developed around a clinical case to evaluate psychology students' experience and learning in two laboratory classes modalities. The aim of this study was to compare the undergraduates' preference for laboratory classes taught either independently (cohort 1, n = 87 students) or integrated into the PBL-oriented clinical case (cohort 2, n = 92 students) for which laboratory classes were transformed into Integrated Laboratory Classes (ILCs). The students' academic performance was also evaluated to look for quantitative differences between cohorts. We found similar overall academic scores for the Physiology course between cohorts. Interestingly, when we compared the academic scores obtained in the theoretical content from each cohort, we found a significant improvement (p < 0.05) in cohort 2 where the students achieved better results as compared to cohort 1. A subset of students was asked to fill a questionnaire assessment on their experience and found that 78.9% of them preferred integrated laboratory classes over laboratory classes alone. They consistently reported a better understanding of the theoretical content and the value they gave to ILCs for learning. In conclusion, our pilot study suggests that integrating laboratory classes into PBL-oriented clinical contexts help to retain core physiology contents and it can be considered as an engaging learning activity worth implementing in Psychology teaching.

A Phenomenological Exploration of Experiences Related to Learning Styles Among Undergraduate Medical Students in a Barbadian Medical School

Introduction

Learning style (LS) frameworks have been implemented by educators to promote participatory learning in order to strengthen learner engagement and to enhance learning outcomes. Self-efficacy has been shown to have an association with learning style and is a predictor of clinical performance and other qualities in medical students. This study examined the perspectives of second and final year medical students in a Caribbean-based medical school, relative to their learning approaches, teaching exposures and preparation for assessments.

Methods

An interpretivist qualitative approach was used to analyze data from two focus groups, conducted as part of a sequential mixed-methods study (November 2018-February 2019) with medical students in the second and final year of study. Discussions were audio-recorded, transcribed verbatim, and inductively coded with in-depth thematic analysis assisted by NVivo software.

Results

Six Year 2 (Female: Male = 5:1) and seven Year 5 (Female: Male = 5:2) participants, ranging between 18 and 34 years and with a range of LS were recruited into the study. Analysis and data reduction produced three organizing themes: "Dynamics of information delivery and acquisition", "Pivoting", and "LS identification, awareness and mutability", and the global construct "Individual and environmental factors modulate the influence of LS preference in triggering self-efficacy". In managing information received in class, students used textbooks, YouTube videos, and collaborative learning to augment perceived gaps in lectures and their personal notes. Learning style self-awareness is useful for facilitating self-efficacy throughout medical school, especially at points of transition within the programme of study.

Conclusion

LS theory and testing appear to be useful for student and teacher awareness. In practice, honing students' adaptability to varying learning settings may be more relevant in helping students achieve self-efficacy.

Unpacking the renal system component of the "structure and function" core concept of physiology by an Australian team

An Australia-wide consensus was reached on seven core concepts of physiology, one of which was "structure and function" with the descriptor "Structure and function are intrinsically related to all levels of the organism. In all physiological systems, the structure from a microscopic level to an organ level dictates its function." As a framework for the structure and function core concept, the renal system was unpacked by a team of 5 Australian Physiology educators from different universities with extensive teaching experience into hierarchical levels, with 5 themes and 25 subthemes up to 3 levels deep. Within theme 1, the structures that comprise the renal system were unpacked. Within theme 2, the physiological processes within the nephron such as filtration, reabsorption, and secretion were unpacked. Within theme 3, the processes involved in micturition were unpacked. In theme 4, the structures and processes involved in regulating renal blood flow and glomerular filtration were unpacked; and within theme 5, the role of the kidney in red blood cell production was unpacked. Twenty-one academics rated the difficulty and importance of each theme/subtheme, and results were analyzed using a one-way ANOVA. All identified themes were validated as "essential" to "important"/"moderately important" and rated between "difficult" to "not difficult." A similar framework consisting of structure, physiological processes, physical processes, and regulation can be used to unpack other body systems. Unpacking of the body systems will provide a list of what students should be taught in curricula across Australian universities and inform assessment and learning activities.NEW & NOTEWORTHY This is the first attempt to unpack and validate the "structure and function" core concept in physiology with all Australian educators. We unpacked the renal system into themes with hierarchical levels, which were validated by an experienced team of Australian physiology educators. Our unpacking of the "structure and function" core concept provides a specific framework for educators to apply this important concept in physiology education.

Learning and assessment strategies to develop specific and transversal competencies for a humanized medical education

Introduction: Medical education should promote the development of skills and abilities that can be applied to real-world work performance. The aim of this study is to evaluate technical and methodological knowledge, as well as physician-patient communication skills, as one of the most important transversal competencies that a good physician should acquire; all this in a reliable, accurate and objective way. Methods: We present a rubric specifically designed and implemented for the evaluation of specific and transversal competencies in the physiology practical sessions, during the second year of the medical degree. The assessment consists in two evaluation tests: 1) a theoretical test that consists of multiple-choice questions. Students must demonstrate that they have acquired adequate theoretical knowledge (specific competency "to know"); 2) a practical test, in which students are evaluated by the rubric through the simulation of a medical consultation. Thus, demonstrating their ability to execute/apply what they have learned in class (specific competency "to know how to do"). They are also evaluated on the transversal competencies that we call "communication with the patient" (transversal competency "to know how to be there") and "dealing with the patient" (transversal competency "to know how to be"). Results: We evaluated whether there were differences in the grades obtained by students when the transversal competencies were not assessed (academic years 2017-2018 and 2018-2019; n = 289), and when the transversal competencies were assessed by applying the rubric in the academic years 2019-2020, 2021-2022, and 2022-2023 (n = 526). Furthermore, we present a student perception that supports the use of clinical simulation and our rubric as a good method within the competency learning process. Discussion: The acquisition of these competencies, starting from the first courses of undergraduate education, helps to raise the students' awareness in the development of a more humanized medicine, allowing a better response to the patients' needs. Our rubric, which clearly indicate the performance criteria, have become an excellent method to carry out the assessment of competencies, both for students and teachers, since they allow to obtain clear evidence of the level of acquisition and application of knowledge.

LecturePlus: a learner-centered teaching method to promote deep learning

A new teaching format, the LecturePlus, was formulated as a lecture followed by small-group learning activities. This study assessed the effectiveness of LecturePlus in medical education. An interventional study was conducted among final-year medical students, with 74 students in the experimental group and 96 students in the control group. Each LecturePlus lasted ∼1 h and was conducted with 12-18 students. A LecturePlus session comprised of a lecture followed by small-group problem-solving exercises. The exercises were clinical cases with open-ended short-answer questions. Students were divided into groups of three (triads) for these exercises. A faculty tutor assisted the small groups as needed. Closure was achieved through a discussion moderated by the tutor. Learning outcomes were assessed via the National Board of Medical Examiners (NBME) subject scores and compared with those of the preceding academic year. An additional multiple-choice question (MCQ) test was administered before and after the clerkship. The MCQ test showed improvement in knowledge application (P < 0.001, partial eta squared = 0.42). There was a statistically significant improvement in adjusted NBME scores among female students (74.8 vs. 71.8; P = 0.017) but not among male students. An anonymous written questionnaire survey showed high ratings for LecturePlus (95% selecting yes or partly yes to overall satisfaction). LecturePlus is an instructional strategy that integrates a lecture with learning activities. It can be scaled to large class sizes facilitated by one teacher. By combining didactic teaching with problem-solving, this new instructional strategy may foster application of knowledge.NEW & NOTEWORTHY We developed a new structured teaching format, the LecturePlus, to promote deep learning. A LecturePlus session consists of a brief lecture, followed by small-group problem-solving exercises, ending with a closing discussion moderated by the teacher. During the small-group exercises, students were divided into groups of three (triads) and given case-based problems. One faculty tutor supervised the entire session. LecturePlus resulted in improved learning outcomes and was rated highly by medical students.

Real-life scenario blended teaching approach for nurturing inquisitive learning of central nervous system in medical students

Among the various systems taught in the preclinical phases, the nervous system is more challenging to learn than other systems. In this report, a novel teaching methodology, "real-life scenario (RLS) blended teaching," is described and its effectiveness in facilitating inquisitive learning in undergraduate medical students is evaluated. This mixed-method study was conducted among three groups (group 1, n = 83; group 2, n = 85; and group 3; n = 79) of undergraduate medical students (18-20 yr) in the neurology and behavioral sciences module. RLS was presented to students in the form of demonstrations, role-plays, videos, and group activities. Group 1 students underwent traditional teaching-learning sessions. Group 2 students underwent RLS blended sessions and were provided with multiple miniassignments in a vignette format. Group 3 students received RLS blended sessions, multiple miniassignments, peer discussions, multiple formative assessments, and facilitator feedback sessions. The student performances on different exams were compared in terms of their group, and their perceptions of RLS were documented. Students exposed to RLS sessions blended with multiple assignments, peer discussions, multiple formative assignments, and facilitator feedback sessions performed well in the final summative assessments (67.87%) compared with those exposed to RLS sessions and assignments (50.21%) or exposed to traditional teaching alone (50.34%). RLS sessions increased students' curiosity and motivated them to learn the subject well. RLS sessions stimulated student interest and facilitated their learning. RLS along with effective use of multiple assignments, formative assessments, and/or feedback sessions significantly improved student learning. This demonstrates the effectiveness of this active method in teaching various subjects with appropriate modifications.NEW & NOTEWORTHY In this report, a novel teaching methodology, "real-life scenario (RLS) blended teaching" is described and its effectiveness in facilitating inquisitive learning in undergraduate medical students is evaluated. Students exposed to RLS sessions blended with multiple miniassignments, peer discussions, multiple formative assignments, and facilitator feedback sessions performed well in the summative assessments compared with those exposed to RLS sessions and assignments or exposed to traditional teaching alone. Students preferred active teaching-learning techniques over the traditional method.

Ultrasound imaging in teaching cardiovascular physiology: disruption and challenge to foster learning

This work extends previously described applications of ultrasound technology in illustrating cardiovascular phenomena to investigation of learning effectiveness. To this end, learning in ultrasound-enhanced classes was assessed by quantifying the improvement in single best answer (SBA) exams conducted before and after an ultrasound practical class. This improvement was then compared to that seen in the same SBA exams conducted in matched groups that undertook similar classes conducted without ultrasound equipment. The SBA exams were designed to include questions that directly related to the phenomena being investigated in the practical classes as well as other "filler" questions to disguise the intent of the exam and ensure that standards of physiology knowledge were similar between the two groups. Any small statistically significant gains in performance observed between the two groups were confounded by differences in baseline (pretest) performance between the groups. These results contradict our previous work, which showed that self-reported measures of learning increased after ultrasound classes. It may be optimistic to expect improvements in deep learning and test performance immediately after even the most effective educational intervention. Direct measurement of the phenomena that bring about deep, long-term learning in classes remains problematic. Notwithstanding this, there is much evidence for the value of enhancing physiology learning by providing varying contexts in the physical, semantic, and cognitive domains. Ultrasound technology is a cheap and effective means of providing such context in physiology practical classes.NEW & NOTEWORTHY This work compares learning in cardiovascular physiology classes enhanced by using cheap ultrasound equipment with learning in comparable control classes without ultrasound. Performance improvement in single best answer tests between pre- and postclass tests were compared for the ultrasound and control classes, with little difference shown between the two classes. We question whether it is appropriate to measure deep learning after 2-h classes or whether other, phenomenological, qualitative measures of educational effectiveness would be better.

Nursing Students’ Perceived Learning Outcomes, Motivation to Learn and Grade Achieved in a Digital Blended Learning Course: A Norwegian Cross-Sectional Study

The COVID-19 pandemic forced educational institutions to move online, and it is important to understand how students perceive learning in a digital learning environment. We aimed to investigate students’ perceived learning outcomes in a digital learning environment and associations between perceived learning outcomes and grades achieved. An anonymous electronic survey was used (n = 230, response rate 34%). A significant linear relationship between overall perceived learning outcome and grade achieved was found (B 0.644, 95% CI 0.52 to 0.77). Of the different learning activities, attending digital seminars were positively associated with grades (B 0.163, 95% CI 0.002 to 0.32). In particular, participating in voluntary colloquium group (B 0.144, 95% CI 0.03 to 0.26) and motivation to learn (B 0.265, 95% CI 0.13 to 0.41) predicted the students’ grades. Intrinsic motivation was positively associated with grades (B 0.285, 95% CI 0.12 to 0.45), and extrinsic motivation was negatively associated with grades (B-0.213, 95% CI-0.35 to -0.07). Nursing students’ perceived learning outcomes and grades were positively associated. Of the different learning activities, attending digital seminars predicted higher grades. Additionally, attending colloquium groups and being motivated to learn predicted higher grades, while high extrinsic motivation was associated with lower grades.

The Perceived Utility of 3 Online Resources for Medical Student Neurosurgery Education

OBJECTIVE

Neurosurgery has a high barrier of educational access for medical students. The Medical Student Neurosurgery Training Center (MSNTC) is a novel online learning platform that provides on-site and virtual training opportunities and resources that aim to increase student access to neurosurgical education. The objective of this article was to describe student-reported utility of Medical Student Neurosurgery Training Center educational resources.

METHODS

A Qualtrics survey was sent to attendees after the 2020 Virtual Neurosurgery Training Camp. Ratings were quantified on modified 5-point Likert scales and compared using Wilcoxon rank sum tests, with a P value of 0.05.

RESULTS

Response was obtained from 119 (25.2%) of 473 Virtual Neurosurgery Training Camp registrants. Of respondents, 65 (54.6%) reported prior use of Brain & Spine Report (BSR), 68 (57.14%) reported use of the Video Library (VL), and 78 (65.5%) reported use of the Global Events Calendar (GEC). Among respondents who previously used the BSR, VL, or GEC, mean ratings of usefulness were 3.94 ± 1.01, 4.06 ± 0.91, and 4.10 ± 0.99, respectively. Medical students with a neurosurgery interest group at their home institution reported greater utility of the BSR (P = 0.0008), VL (P = 0.0018), and GEC (P = 0.0250). Medical students with a home program reported greater utility of the BSR (P = 0.0079), and international students reported greater utility of the VL (P = 0.0447).

CONCLUSIONS

Medical Student Neurosurgery Training Center resources appear to have promising preliminary benefits for students. Increasing medical student awareness, continued development of these resources, and objectively assessing outcomes in neurosurgery education are warranted.

Active Learning: A Shift from Passive Learning to Student Engagement Improves Understanding and Contextualization of Nutrition and Community Health

Challenging the notion of “teaching by telling,” active learning utilizes a student-oriented approach by emphasizing the concept of knowledge retention through peer interaction. To further examine the potential of active learning, we created a workshop based on didactic education and student collaboration. Participants included undergraduate students from traditionally underrepresented and disadvantaged backgrounds. The workshop was part of our summer academic enrichment program run in an urban, medically underserved community. The workshop focused on clinical and biochemical nutrition, wherein students synthesized information by discussing dietary choices and the socioeconomic aspects of nutrition. Student reception of the workshop was adjudged by anonymous surveys. The survey questions were designed to gauge how the workshop objectives were achieved. Cronbach alpha (0.276) confirmed that there was more than a single theme contained in the questions. The majority of students (97%) agreed that the workshop met the learning objectives: (1) acquire basic clinical knowledge, (2) gain a better understanding of nutrition, (3) formulate a linkage between clinical nutrition and disease, and (4) benefit from peer interaction. Students’ performance in the post-quiz (100% correct answers) had improved significantly compared to the pre-quiz (25% correct answers) suggesting acquisition, understanding and application of nutrition aspects taught in the workshop. Overall, the present study demonstrated the engagement and understanding of students with respect to learning about nutrition and community health in an active learning setting. These types of active-learning-based sessions may have broad applicability for any academic discipline to improve student engagement and knowledge retention.

Effect of shift to virtual teaching on active learning: A snapshot

PURPOSE

Active learning engages students via interaction for deeper understanding and retention. A global pandemic resulted in an abrupt mid-semester transition from in-person to virtual learning. This study examined student reporting on active learning before and after this transition.

METHODS

First-year DDS candidates took an anonymous survey, reflecting on three Spring (January-April) 2020 courses (lecture-style, small-group case-based, and pre-clinical). Survey questions included: (1) basic demographics, (2) reporting frequency (1-Never, 2-Rarely, 3-Sometimes, 4-Often, 5-Always) of active learning elements from a pre-set list before/after the shift to online learning, and (3) Likert-style questions regarding effects on active learning and learning environment preference.

RESULTS

The traditional lecture course manifested two active learning activities in the category Sometimes prior to the transition to virtual; one of those activities (question and answer) experienced the most significant difference (p < 0.0001) in frequency change. The small group, case-based course incorporated nine activities in-person in the category Sometimes; although small significant differences (p ≤ 0.05) in frequency were noted for five of those activities between virtual and in-person, these differences may have not have made a difference in practice. The pre-clinical course incorporated four activities in the category Sometimes pre-transition, with no significant differences detected in frequency. Students slightly leaned toward preferring in-person for the small-group and pre-clinical courses, but had no preference for the traditional lecture course.

CONCLUSIONS

Course structure may correlate more with student experience of the frequency of active learning activities and preference for in-person versus virtual environment than the environment itself.

The implementation of active learning practices in a South African physiology class: a follow-up study

Although there is increased uptake of active learning approaches in especially developed countries, this is still lagging within the African context. The current study therefore focused on the implementation of group learning at Stellenbosch University, with several modifications versus our earlier, pilot study. Students freely formed small groups at the start of a 5-wk cardiovascular physiology lecture series and were apportioned three separate assignments to complete over this period. This included three in-class group-learning sessions, while students also completed group work outside class times. The active learning element was embedded within a constructive alignment framework. Our data revealed that 75% of the students felt that the in-class sessions was a good use of their time and that they progressively improved their assignment scores, i.e., 67.5 ± 9.3%, 72.4 ± 9.8%, and 76.1 ± 9.5% for the first, second, and final ones, respectively (P < 0.0001). Moreover, the average class score for their final test (68 ± 15.1%) was higher when compared with the average class score (57.5 ± 19.4%) calculated for the previous 3 yr (P < 0.0001). This study revealed two major findings: i.e., 1) students displayed a strong positive response regarding the adoption of in-class collaborative group work, and 2) the introduction of such active learning elements correlated with improved student assignment and test scores. Based on these findings, we propose additional modifications (including a shift to more formative assessments) to ensure even greater success with the roll-out of such active learning elements within the African context.

Long-Term Impact of Living and Learning at High Altitude: An Altitude Physiology Class for Undergraduate Students

Alma College initiated an Altitude Physiology class in 1997 devoted to living and learning at high altitude (3440 m). The class incorporated several key elements of High-Impact Educational Practice including a strong student-research component and collaborative groups assignments. A retrospective survey was administered to alumni of the class to determine its long-term impact. Student responses ranged from “agree” to “strongly agree” with statements regarding the class’s impact on positive learning outcomes such as critical thinking, knowledge acquisition, synthesis of knowledge, and understanding of research. Students generally favored non-traditional formats such as living at altitude for gaining understanding of environmental physiology.

Virtual flipped teaching during the COVID-19 pandemic

The COVID-19 pandemic forced teaching to be shifted to an online platform. Since the flipped teaching (FT) model has been shown to engage students through active learning strategies and adapt both synchronous and asynchronous components, it was a convenient choice for educators familiar with this instructional method. This study tested the effectiveness of a virtual FT method during the pandemic in a graduate-level physiology course. Besides assessing knowledge gained in the virtual FT format, student surveys were used to measure student perception of their adjustment to the new FT format, their confidence in completing the course successfully, and the usefulness of assessments and assignments in the remote FT. Students reported that they adjusted well to the remote FT method (P < 0.001), and their confidence in completing the course in this teaching mode successfully improved from the beginning to the end of the semester (P < 0.05). Students expressed a positive response to the synchronous computerized exams (90.32%) and the formative group (93.51%) and individual (80.65%) assessments. Both collaborative activities (93.55%) and in-class discussions (96.77%) were found to be effective. The course evaluations and the overall semester scores were comparable to the previous semesters of face-to-face FT. Overall, students' perceptions and performance suggested that they embraced the virtual FT method and the tested teaching method maintained the same strong outcome as before. Thus, this study presents a promising new instructional method in the teaching of future physiology courses.

Core concepts in physiology: teaching homeostasis through pattern recognition

Homeostasis is a core concept in systems physiology that future clinicians and biomedical professionals will apply in their careers. Despite this, many students struggle to transfer the principles governing homeostasis to concrete examples. Precourse assessments conducted on 72 undergraduate biology students enrolled in an introductory systems physiology course at the University of Belgrade during the February-May semester of 2021 revealed that students had a vague, fragmentary understanding of homeostasis and its related concepts that was often conflated with topics touched on during their previous coursework. We formalized and implemented an approach to teaching homeostasis that focused heavily on consistent reinforcement of physiological reflex patterns throughout the course. To that end, we employed a variety of activities aimed at getting students to view organ system integration holistically. After the semester, postcourse assessment demonstrated that students were better able to provide concrete examples of organ system contributions to homeostasis and were more adept at applying basic principles to novel physiological scenarios. Comparison of final grades with previous semesters revealed that students outperformed their peers who had taken the course previously. In this article, we summarize the findings of pre- and postcourse assessments, describe the general approach we took to teaching homeostasis as well as the specific techniques used in the classroom, and compare student performance with previous semesters.

The Impact of the COVID-19 Global Pandemic on Undergraduate Nursing Students' Study of Anatomy and Physiology

The COVID-19 global pandemic caused major disruptions to the delivery of human Anatomy and Physiology courses to nursing students worldwide. The aim of the current study is to evaluate nursing students' experiences and perceptions of transitioning from a blended to a purely online study mode for first year Anatomy and Physiology courses during the global pandemic. Qualitative and quantitative methodologies were used with a sample of undergraduate nursing students enrolled at a regional Australian university across its three campuses. Descriptive statistical analysis was used to describe the study population. Content analysis was used to evaluate the participants' use of resources, experiences, and preferences in studying anatomy and physiology. There were 101 participants recruited in the study. Results indicated that face-to-face study mode (41.86%) was the preferred method of delivery during the global pandemic and participants were having a renewed appreciation for the blended study mode (38.37%). Online study mode was the least preferred (19.77%), with the participants' opinions of this mode of study not altered by the global pandemic. Although the COVID-19 global pandemic shifted the traditional teaching of anatomy and physiology in nursing programs to an online environment, the long-term impacts of this disruption have yet to be ascertained.

Faustino-Rocha A, A. Oliveira P, Mesquita J, Vala H. Virtual Physiology: A Tool for the 21st Century

Veterinary physiology is a basic curricular unit for every course within the veterinary field. It is mandatory to understand how the animal body works, and what to expect of a healthy body, in order to recognize any misfunction, and to be able to treat it. Classic physiology teaching involves wet labs, much equipment, many reagents, some animals, and a lot of time. But times are changing. In the 21st century, it is expected that the teaching and learning process can be more active and attractive, motivating students to learn better. It is necessary to understand what students like, and to introduce novelties into the school routine. The use of a game-based learning, using “new” technologies, creating virtual experiences and labs, reducing the costs of reagents, equipment, and especially reducing the use of animals, will be the future for physiology teaching.

Forcing a change: a learn-by-doing workshop on circadian rhythms to understand the complexities of human physiology

Physiology is an integrative science that requires an understanding of the organism as a whole to acquire a deep comprehension of its functions and avoid misconceptions that may impair further learning. Thus it is necessary to develop resources that promote the integrative vision that Physiology requires. Chronobiology is a challenging discipline and one of the least addressed concepts in Physiology curricula. The activity here presented proposes a workshop with a theoretical-practical perspective in the context of the Neuroscience Conferences held annually at our university. All conference presentations are neuroscience-related topics, in combination with practical activities, some of them analyzing variables of the students themselves. We chose to assess this informal teaching scenario to involve the students with a scientific perspective while learning and hoping to increase their appreciation for different topics related to neuroscience. Specifically for this activity on chronobiology, the evaluation was carried out via a survey study including quantitative and qualitative questions and semistructured personal interviews. In general, the results reveal a very positive opinion from students regarding aspects such as the teaching methodology, the organization before and during the activity or the added value of the experience for their future professional performance. Some of the students stated they were more aware of the importance of their circadian system and even changed some of their personal daily routines after the activity. Such positive feedback encourages us to continue working in this theoretical-practical format in the future, as it contributes to improving students' perception of their own learning.

Report on the online course "Basic Concepts in Neurophysiology": a course promoted during the COVID-19 pandemic quarantine

"Basic Concepts in Neurophysiology" was a 3-wk online course developed during six synchronous meetings combined with asynchronous activities. We proposed an active learning course that used free online platforms to teach physiology during a period in which undergraduates were not in classrooms or taking online classes due to the COVID-19 pandemic. Herein, we report the course organization and the students' involvement in, acceptance of, and evaluation of the course. To address the students' perceptions about these points, we sent a questionnaire to 49 participants who finished the course. We found that although most students (52.5%) had never taken a course with similar methods before, almost all of them (95%) liked the flipped class model. Additionally, a majority of the students (92.5%) said that the method increased their study frequency during the social distancing period, which is an important aspect to consider during this challenging time for both students and professors.

Appraisal of a novel pedagogical approach to demonstrating neuromuscular transmission to medical students

Although traditional didactic lecturing is the principal instructional approach used in numerous medical schools, this method has several limitations. Experiential learning approaches place students in the center of the learning process and creates a positive and supportive classroom learning environment. In this article, we propose an active pedagogical approach for teaching a basic physiology concept, namely, neuromuscular transmission (NMT), and we evaluate the effectiveness of this approach among undergraduate medical students. One-hundred forty-two undergraduate medical students were involved in this study (cohort A, n = 62; cohort B, n = 80). Cohort A received a didactic lecture on NMT and subsequently tested their knowledge of the topic via test 1, after which their perceptions of didactic lectures were recorded. The students were then asked to participate in a touch-and-go (TAG) active-learning session regarding NMT, after which their learning was subsequently tested by taking test 2. Their perceptions about the TAG game were also recorded. Students in cohort B were first administered test 1 regarding NMT. Then, they were asked to attend a didactic lecture blended with a TAG active-learning session, after which test 2 was administered, and their perceptions were recorded. Both the didactic lecture and active learning sessions facilitated student learning regarding the concepts involved in NMT. A comparison of the lecture followed by the game used in cohort A with the game blended lecture used in cohort B revealed no significant differences. However, both formats created a positive influence on students' interest in learning the concept, and the students preferred active learning over didactic sessions alone.

Realizing the actual magnitudes of aortic diameter and cardiac output: a multisensory learning approach

The conventional physiology courses consist of theoretical lectures, clinical application seminars, numerical exercises, simulations, and laboratory practices. However, in subjects that involve relevant physical quantities, even students who successfully pass exams may be unable to realize the actual quantities involved. For example, students may know what the values of the aortic diameter and cardiac output are, and they may be skilled at calculating changes in variables without being able to realize the actual physical magnitudes of the variables, resulting in limited understanding. To address this problem, here we describe and discuss simple practical exercises specifically designed to allow students to multisensory experience (touch, see, hear) the actual physical magnitudes of aortic diameter and cardiac output in adult humans at rest and exercise. The results obtained and the feedback from a student survey both clearly show that the described approach is a simple and interesting tool for motivating students and providing them with more realistic learning.

Not yet a dinosaur: the chalk talk

This article discusses the chalk talk's potential as an active learning method. Although chalk talks are a form of interactive lecture, they have received little attention in the medical education literature compared with other active learning methods such as team-based learning and simulation. One of the authors (C. K. L. Phoon) has used chalk talks to teach congenital heart defects to first- and third-year NYU medical students for many years. His chalk talks have consistently earned among the highest teaching scores, and students have noted their strengths of being more interesting, clear, and tangible than didactic lectures. Using the teacher and student perspectives, we examine the chalk talk's strengths and weaknesses compared with common passive and active learning methods. Chalk talks create a real-time, shared space that facilitates the active learning goals of helping students build, test, and revise mental models (conceptual frameworks). The limited amount of information that can be presented and the ability to solicit and arrange students' ideas on the board lead to the cocreation of valuable conceptual frameworks. Chalk talks require less restructuring of teaching sessions than other active learning methods and are best suited to topics that hinge on understanding of concepts. We advocate for the chalk talk to be reexamined as a promising educational tool given its strengths and the successes that other active learning methods have shown. Furthermore, we provide guidance to help educators deliver chalk talks and discuss future studies that would advance understanding of this powerful teaching tool.

The Physiological Court

Research has been important to prove that student achievement can improve when active methodologies are properly implemented, either in isolation or integrated with lectures. Here, active methodology was organized according to a student-centered collaborative design that involved group debate, described as a Physiological Court. The purpose of this work was to evaluate the performance and perception of medical students after integrating short lectures with collaborative work and debate. The activity was carried out with students (n = 50) from the 2nd year of medical school. The activity performed was related to the hypothalamus-pituitary-thyroid and hypothalamus-pituitary-adrenal axes. The students were instructed to prepare a study material on the proposed themes to be used on the day of the debate. At the activity day, the 2 students' groups (n = 25) were organized in the classroom so that they were face-to-face. Five days after, the students answered the cognitive monitoring test (CMT) which consists of 5 multiple choice questions (MCQ). Students also answered a question about their perception of the activities performed. Ninety-two percent of students showed a positive perception of the activities performed. After completion of the physiological court, 83 ± 4% of students achieved grades above 7.0 on CMT. The percentage of incorrect answers was 5 ± 1.3% in CMT. The association of 40-min lectures with active methodologies was positive for the perception and the performance of students in the second years of medical school related to the physiology of the endocrine systems.

Lectures and collaborative working improves the performance of medical students

The teaching-learning process is complex and requires continuous research and dedication. Research has been important to prove that student achievement can improve when active methodologies are properly implemented, either in isolation or integrated with a short lecture. The purpose of this work was to evaluate the performance and perception of first-year medical students subjected to a protocol involving the integration of a short lecture and collaborative compilation of portfolios on the topic of digestive physiology. After the lectures and elaboration of the portfolios, the students completed two tests: cognitive monitoring test (CMT) and integrative cognitive test (ICT), and then, they gave their opinions of the strategy. For CMT, the percentage of grade exceeding 7.0 was higher for the group who performed the portfolio activity, compared with the group who did not undertake the activity, and there was a lower percentage of incorrect answers among the portfolio group students, compared with the group that did not perform the activity. For ICT, the percentage of grades exceeding 7.0 was higher for the students who used the portfolio, compared with those who did not perform the activity, and there was also a reduction in incorrect answers among students who performed the portfolio activity, compared with those who did not perform the activity. The combination of short lectures and collaborative group work using a portfolio improved the grades obtained for digestive physiology. Most of the students believed that the collaborative work contributed to their learning about digestive physiology. In addition, most of them were comfortable working in their groups and did not feel dominated by other group members.

Lighting up the NMJ: developing an LED-based model of the neuromuscular junction for the undergraduate classroom

Many complex physiological processes can be introduced and explored using the framework of the neuromuscular junction (NMJ), including neurotransmitter release, membrane depolarization, and ion channel activity. While traditionally used instructional tools such as static complex drawings are useful, these images can be incomplete physiological representations due to the lack of physically moving parts. As a result, they often misrepresent the complexity of physiological phenomena to students. We describe an effort to create a more accurate, dynamic representation of the NMJ to enhance instruction in an undergraduate anatomy and physiology course. We sought to create a unique and memorable moving diagram that combines elements of static images with moving parts. To evaluate the impact of the dynamic model, students were asked about their understanding of the NMJ before and after exposure to the model. In addition, students were asked for attitudinal responses to the model and their preferred method of instruction. Analysis of student responses indicated that students enjoyed the model, although they also had concerns about the speed of the simulated ion movement being too fast. The model has also served as an informal science education art installation in presentations for prospective students, stakeholders in the broader community, including local and statewide politicians, the University president and board of trustees, donors, and other regional economic and educational leaders.

Student response to a cooperative learning element within a large physiology class setting: lessons learned

Physiology students grapple with large amounts of subject content and hence memorize facts to pass examinations. In parallel, students display limited critical-thinking and creative skills, integration abilities, and/or a deeper engagement with subject content. This study aimed to assess the feasibility of introducing active learning methods (cooperative learning) in a relatively large class to final-year undergraduate physiology students (Bachelor of Science stream) at Stellenbosch University in South Africa. An assignment designed to enhance active and engaged learning was made available to the students (n = 225) during the second week of a 5-wk cardiovascular physiology series of lectures. Students were instructed to freely form working groups (n = 3/group) and the assignment was due by the end of the module. Student groups were expected and encouraged to continuously work on the assignment (outside class time). Three cooperative learning slots were also created during class time, with the lecturer and postgraduate students acting as guides. After the module, students anonymously completed an electronic questionnaire. This study revealed three major findings in terms of implementing cooperative learning in large classes within a South African context, i.e., 1) relatively good reception by students with some indication of group work; 2) it is logistically feasible in relatively large classes, although adequate support is crucial; and 3) additional measures need to be adopted to ensure its success.

A new assessment to monitor student performance in introductory neurophysiology: Electrochemical Gradients Assessment Device

The basis for understanding neurophysiology is understanding ion movement across cell membranes. Students in introductory courses recognize ion concentration gradients as a driving force for ion movement but struggle to simultaneously account for electrical charge gradients. We developed a 17-multiple-choice item assessment of students' understanding of electrochemical gradients and resistance in neurophysiology, the Electrochemical Gradients Assessment Device (EGAD). We investigated the internal evidence validity of the assessment by analyzing item characteristic curves of score probability and student ability for each question, and a Wright map of student scores and ability. We used linear mixed-effect regression to test student performance and ability. Our assessment discriminated students with average ability (weighted likelihood estimate: -2 to 1.5 Θ); however, it was not as effective at discriminating students at the highest ability (weighted likelihood estimate: >2 Θ). We determined the assessment could capture changes in both assessment scores (model r² = 0.51, P < 0.001, n = 444) and ability estimates (model r² = 0.47, P < 0.001, n = 444) after a simulation-based laboratory and course instruction for 222 students. Differential item function analysis determined that each item on the assessment performed equitably for all students, regardless of gender, race/ethnicity, or economic status. Overall, we found that men scored higher (r² = 0.51, P = 0.014, n = 444) and had higher ability scores (P = 0.003) on the EGAD assessment. Caucasian students of both genders were positively correlated with score (r² = 0.51, P < 0.001, n = 444) and ability (r² = 0.47, P < 0.001, n = 444). Based on the evidence gathered through our analyses, the scores obtained from the EGAD can distinguish between levels of content knowledge on neurophysiology principles for students in introductory physiology courses.