Tackling the threshold concepts in physiology: what is the role of the laboratory class?

Online Physiology Practice with Team-Based Learning During the COVID-19 Pandemic

Background

The spread of the coronavirus disease (COVID-19) has significantly affected medical education. In particular, conducting practical training in a face-to-face format has become difficult.

Purpose

To address this problem, online physiology practice combined with team-based learning (TBL) for deep learning of renal physiology was conducted among second-year medical students.

Participants and Methods

The experiment was performed by a group of students, while other students watched online. After the experiment, all students were grouped using breakout rooms. Following a discussion of the data, a clinical case study related to the experiment was conducted using TBL. To examine the effect of online practice in a case study under TBL, the participants completed an anonymous, open-ended, web-based questionnaire after the program, enabling us to compare their expectations and satisfaction. The questionnaire consisted of questions examining students' opinions on the appropriateness of online practice, degree of understanding, ease of asking questions, time efficiency, and the usefulness of case studies using TBL.

Results

There was no change in the number of students who participated in the online practice before and after class. After class, more students considered the level of understanding easier and displayed better on-time efficiency than with regular face-to-face training. However, these questions are difficult to answer.

Conclusion

Online-based physiology practice combined with clinical case studies under TBL helped maintain students' expectations and satisfaction with the training.

The increasing relevance of immunobiology within a connected animal science curriculum

Modern technological agriculture emerged in the 20th century and has expanded into a global enterprise occupying approximately 38% of the Earth's land area and accounting for over 40% of the world's workforce. The United Nations Food and Agriculture Organization estimates that to feed a world population of 9-billion people in 2050 will require an almost doubling of overall food production, including meat, dairy, and egg production over 2010 levels. However, our collective ability to meet this demand cannot be taken for granted. Despite many successes, global agricultural systems now face multiple unprecedented challenges including a dearth of new treatments for livestock diseases. The discovery of antibiotics led to a complacency now reflected in a dependency on exogenous antimicrobials and a growing threat of antimicrobial resistance. Developments within the field of immunobiology had led to significant breakthroughs in understanding of human health and disease. However, despite over 60% of infectious diseases being zoonotic in nature and nonhuman animals acting as an important disease reservoir, research in livestock immunobiology has not been as resourced. As a direct result, recalcitrant animal diseases continue to threaten sustainability of animal production systems, security of the food chain and human health. It is within the context of collective One Health action that ambitious innovation in the connectivity of animal science undergraduate curricula is urgently required, specifically to include threshold concepts in immunobiology. Fostering transformative learning is critical to equip future generations of animal scientists with the knowledge and interdisciplinary skills to counter these existential challenges of our time.

The baroreceptor reflex brought to life outside the classroom - an e-learning based asynchronous laboratory class using a non-supervised modified Active Standing Test

BACKGROUND

E-learning based laboratory classes can replace or enhance in-classroom laboratories. They typically offer temporal flexibility, self-determined learning speed, repeatability and do not require supervision or face-to-face contact. The aim of this feasibility study was to investigate whether the established in-classroom laboratory class on the baroreceptor reflex (BRR) can be transformed into a new e-learning based asynchronous laboratory class for untrained, non-supervised students without medical equipment. The BRR is a fundamental cardiovascular process which is regularly visualized in physiology during in-classroom laboratories by a student-performed Active Standing Test (AST). During this voluntary provocation of orthostatic stress, the BRR reliably causes a solid rise in heart rate (HR) and a stabilization or even increase in blood pressure (BP).

METHODS

The conventional AST was modified by omission of BP measurements which would require medical devices and was embedded into a framework of interactive digital material allowing independent student performance. With specific adaptions, this instrument was implemented to 1st and 2nd year curricula of human medicine, dental medicine, midwifery and pharmacy. An audience response system was used to collect the students' data on HR, epidemiology, technical problems, satisfaction and orthostatic symptoms. As primary outcome, we investigated the students' correct performance of the modified AST regarding textbook conformity of the HR data. Secondary outcomes included technical feasibility, the students' satisfaction and consistency of HR data within predefined subgroups (e.g., gender, curricula). Descriptive statistics are reported.

RESULTS

The class was completed by 217 students (mean age: 23 ± 8 [SD], 81% female, 19% male). Mean reported rise of HR during standing was ~ 20 bpm (~ 30%) which is highly concordant to textbooks. Reported feasibility (~ 80% negated any technical issues) and students' satisfaction (4.4 on 5-point Likert-scale) were high. The HR data were consistent within the subgroups.

CONCLUSION

This study demonstrates that the highly relevant BRR can be successfully addressed in an e-learning based asynchronous laboratory class implementing a non-supervised AST restricted to HR measurements embedded in digital material. The robust HR response and the adjustable complexity allow an application to different healthcare-related curricula. This class, therefore, provides a broad audience access to a fundamental concept of cardiovascular physiology.

The effectiveness of combining e-learning, peer teaching, and flipped classroom for delivering a physiology laboratory course to nursing students

The Internet and 5G era makes e-learning a vital part of modern education, and extensive evidence has shown that peer teaching and flipped classroom contribute to increased success in medical teaching. However, the applicability of these pedagogies in laboratory courses remains largely unexplored. This study aimed to evaluate the academic performance, proficiency in procedural skills, and perception of nursing students in physiology laboratory classes delivered with nontraditional classroom (NTC) pedagogies comprising the combination of e-learning, peer teaching, and flipped classroom. Each class was subdivided into two equal halves by successive student identification (ID) number and randomly assigned to the control or NTC group. Compared to the control class, NTC teaching significantly enhanced mean score of six preclass tests (67.77 ± 9.83 vs. 62.94 ± 9.70), with "B" graders increased obviously, suggesting that preclass e-learning was more effective than textbook-based preview, especially for general grasp of the topic. Similarly, average scores on postclass quizzes in the NTC group were improved (79.40 ± 9.12 vs. 74.43 ± 8.88). Lesser time cost and higher success rates were observed in trachea, artery, and heart catheterizations in the NTC group, although no disparities were found in ureteral intubation. The majority (∼74%) of students supported the reform and shared positive experiences with NTC methodology. They reported that virtual experiments and self-paced procedural skill videos affected pre- and in-class learning outcomes most, respectively. These findings indicated that NTC pedagogy was workable to improve students' subject scores and proficiency in complicated and direct-viewing procedural skills and was favorable to students.

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.

Exploration of simulated urine sample biochemistry for the diagnosis of diseases: A laboratory practical exercise

The practical work described here is designed for third-year bachelor students in Life Sciences attending a kidney physiology course. It illustrates how urinary biochemistry can be used for a medical diagnosis. Students have to measure glucose, proteins, and creatinine concentrations in three simulated urine samples. First, they independently elaborate detailed protocols from the biochemical kit's technical sheets. Second, after correction of the protocols by the teacher, they perform the biochemical assays. Finally, students write a report in which they interpret the biochemical data and use them in the context of histological images assigned to each urine sample. With their results, their theoretical background and scientific articles supplied by the teacher, they establish the diagnosis indicating which patients are diseased and from which disease they are suffering (diabetes without nephropathy, diabetic nephropathy or hypertensive nephropathy). The originality of this practical work is to give student autonomy from the start of the project by requiring them to write the protocols, and determine the diagnosis by themselves. Simple and inexpensive, this practical forces students to mobilize their knowledge in renal physiology and pathophysiology as well as those acquired in other disciplines such as biochemistry or cellular biology. A survey conducted on two classes of students confirmed that this type of training helps students to better understand renal physiology, to realize the importance of interdisciplinarity (biochemistry, histology, and physiology) and to develop confidence in their ability to work independently.

Staff-student interactions in a physiology laboratory class: What do they involve and are they important?

Although considerable staff resources are often allocated to the teaching of undergraduate laboratory classes, there is a paucity of discussion regarding the extent and substance of the staff-student interactions that occur within classes and also whether these interactions benefit student learning in any way. Performed across four undergraduate laboratory sessions, this exploratory study aimed to quantify the interactions in terms of frequency, duration, and initiation of interactions, as well as gathering staff and student perceptions of the impact of the interactions. Staff gathered descriptive data by completing an observation checklist after each interaction and also provided their own perceptions of the interaction focus and outcome. Student perceptions were collected using an online survey after each class. Staff perceived that the most frequent achievement of the interactions was to enable students to progress with work. However, students' perceptions suggested that staff may underestimate the impact of staff-student interactions on conceptual learning. The most striking findings were the students' perceptions of the impact of interactions on their affective domain. On average, 93% of students agreed that when staff take an interest in their work, it motivates them to work hard, and 78% agreed that interactions with staff made the classes more enjoyable. With evidence that positive affect such as enjoyment is positively associated with aspects of learning, this is a salient finding. The study underscores the value of staff availability within the laboratory class and provides impetus to reevaluate how we perceive these interactions and their impact on student learning.

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.

A student practical to conceptualize the importance of Poiseuille's law and flow control in the cardiovascular system

The laboratory practical reported here is based in Poiseuille's law and utilizes low-cost laboratory consumable items, thereby making it easy to deploy in any teaching laboratory. In the practical, students take an experimental approach of individually changing physical variables and measuring fluid flow rates. Plotting these results allows them to discuss the effect each variable has on flow. Furthermore, students enhance their appreciation of experimental errors and variability by making repeat measurements. In the follow-up teaching session, the students are encouraged to apply their experimental findings to the cardiovascular system and the control of blood flow both at rest and under conditions of altered cardiac output, such as during exercise. By tackling the topic of flow control as a core concept, it allows the students to then apply their understanding in wider physiological contexts, such as airflow in the respiratory system.

Structured oral examination as an effective assessment tool in lab-based physiology learning sessions

Traditional oral examination (TOE) is criticized for the shortage of objectivity, standardization, and reliability. These perceived limitations can be mitigated by the introduction of structured oral examination (SOE). There is little evidence of the implementation of SOE in physiology laboratory courses. The purpose of this study was to investigate the effect of SOE in laboratory-based learning sessions. Second-year medical students (n = 114) attended a 16-wk physiology laboratory course. They were initially assessed by TOE in the middle of the academic term. The students' perspectives on this assessment were measured by a modified three-point Likert-type scale questionnaire. Following this, faculty members prepared topics for SOE; nine topics were included from each laboratory course. The correct answers and scoring criteria were discussed among the faculty before the SOE event. One week after the last laboratory course, SOE was carried out for each student. As with the TOE process, student feedback was collected via a modified three-point Likert-type scale questionnaire. The mean laboratory homework score from the first four and last four laboratory courses was also calculated. Paper exams were also conducted after TOE and SOE. The results show that SOE is more acceptable to students than TOE. Significant differences (P < 0.05) were observed in terms of uniformity of questions asked, syllabus coverage, and anxiety levels. In addition, SOE improved students' performance in the laboratory course explored here. We contend that SOE shows promise as an effective assessment tool in laboratory-based physiology learning sessions.

Blended learning in basic medical laboratory courses improves medical students' abilities in self-learning, understanding, and problem solving

Blended learning, is a teaching approach that integrates online self-learning and classroom teaching. When designed well, blended learning courses in medicine can facilitate students to improve themselves in self-learning, understanding, and problem solving, ultimately enhancing their learning efficiency. However, blended teaching methods are usually used in only a single course, so it is unclear whether these methods can work well in a variety of basic medical courses. The goal of this study is to explore students' perceptions of whether blended laboratory courses are helpful for them in overcoming the difficulties they experience. Blended laboratory courses were taken by medical students at Guilin Medical University. Approximately 71.1% of the students agreed that online lecture courses improved their understanding of threshold concepts and the underlying theories. The majority of the students (63.01%) held the opinion that the blended laboratory courses were more effective than other types of courses in achieving the knowledge goals. The majority of the teachers believed that students' interest in experimentation operations, hands-on abilities, confidence, and other factors were greatly improved compared with those of students taught using the traditional teaching model (face to face). In addition, the average scores for the quizzes of laboratory courses were significantly improved in the blended learning method compared with the traditional learning method. Blended laboratory courses are successful and welcomed by both students and teachers in undergraduate laboratory courses.