Identifying and Exploring the Cognitive Nature of Threshold Concepts in Pharmacology to Improve Medical Students' Learning.

Phenomenon: Pharmacology is a fundamental healthcare discipline, but it can be difficult and counterintuitive for learners to learn. Navigation toward understanding pharmacology can be troublesome, but once the threshold to comprehension is crossed, learners can experience a transformative shift in their ways of thinking and practicing. We conducted an in-depth examination of threshold concepts within pharmacology, aiming to identify and prioritize their learning to improve the medical curriculum and enhance medical treatment and patient safety. Approach: We carried out a consensus generation process using the Nominal Group Technique (NGT) to identify potential threshold concepts in pharmacology. Participant groups of pharmacology experts and medical students considered, identified, reviewed, and ranked potential pharmacology threshold concepts within their own group. Then, using a logical, step-by-step approach, we combined the final ranked data from these multiple NGT sessions. We further analyzed these data using an abductive analysis approach; data were coded, categorized, reorganized, and conceptually mapped after critical evaluation. Conceptual themes were established corresponding to different phases of cognitive schema development. Findings: Six comprehensive conceptual themes were identified: Drug Mechanism of Action; Pharmacotherapeutics; Pharmacokinetics; Drug Receptor Interactions; Drug Terminology and Nomenclature; and Signaling Pathways. These concepts align with many of the key attributes of threshold concepts (e.g., troublesome, integrative and transformative). The cognitive schematic themes generated were (i) acquisition-troublesome; (ii) acquisition-transformative; (iii) automation-troublesome; (iv) automation-transformative. Insights: Transformative learning involves different stages of cognitive schema evolution, including acquisition, elaboration, and automation, and is influenced by both the inherent challenges of the concepts and limitations of human cognition. The high interactivity of these troublesome concepts challenge schema acquisition and automation. Troublesome concepts underpinning procedures or skills, while not easily explained by cognitive rules, can lead to slow, awkward, error-prone performance, creating additional barriers for practice. Integrating concepts into a coherent structure leads to the irreversible assimilation of knowledge and the transferability of both knowledge and skills, influencing learners' epistemological transitions and ontological transformations at theoretical and professional levels. Further work on designing instructional models around assisting and automating schemas around identified troublesome knowledge, while addressing the impact of cognitive load, has the potential to promote transformational learning.

Twelve tips for adopting the virtual Nominal Group Technique (vNGT) in medical education research.

Nominal Group Technique (NGT) is a structured approach to consensus development and data collection driven by problem-solving, idea inception and prioritisation. Challenges of the coronavirus disease 2019 (COVID-19) pandemic necessitated the development of a virtual (vNGT) model to recruit participants from diverse locations and time zones. Our reflections reveal the opportunities and challenges of using Zoom © for NGT sessions, resulting in more effective engagement and focus with fewer distractions compared to in-person meetings. The 12 tips provide practical suggestions for expanding the versatility of NGT in a virtual environment. These recommendations cover every aspect of the process, including the person, place, and object, from planning the sessions, and utilising technology resources effectively, to ensuring a seamless implementation to desirable outcomes. The paper strives to assist individuals in effectively using the online NGT as a substitute for in-person events, promoting effective management of remote participants even during unprecedented times of quarantine and physical distancing.

Blended learning mediated fostering of students' engagement in an undergraduate medical education module.

This article was migrated. The article was marked as recommended. Introduction The study investigated students' perception of introducing blended learning strategies to engage and motivate them towards lecture halls and Problem Based Learning (PBL) sessions for improving the quality of the overall students' learning experience. Methods A prospective study was conducted at the Aga Khan University Medical College involving a total of one hundred four (104) year II medical students for the Endocrine and Reproduction module in the academic year 2018. This module ran for six weeks. Modifications in teaching methods were made for this module introduced after approval from Endocrine & Reproduction module, year II and curriculum committees. Written informed consent was obtained from facilitators and students. To assess the effectiveness of modifications introduced, students' feedback was taken on a Likert's scale of 1-5, at the end of the module. Data were analyzed by SPSS version 20. Results Total 94 (90%) students participated in the written feedback. Forty percent medical students (n=38) responded that videos were useful, 54% (n=51) acknowledged that post-PBL activities like crossword puzzles and Kahoot games, created significant discussions amongst students in a fun yet intellectual manner. Seventy percent of students (n=66) agreed that access to Kahoot was easy and no connectivity issues were faced. Twenty percent students (n=20) endorsed that flipped lectures enhanced understanding of topics, 87% students (n=82) felt that recorded lecture was very helpful and flash cards were found helpful by 14% students (n=12). Conclusion Student engagement is an important issue in medical schools in this era. Results showed that blended learning and educational activities enhanced students' learning motivation and interest.

Concept Animation - a potential instructional scaffolding.

This article was migrated. The article was marked as recommended. Concept animation - the graphical array of pictures accompanied by text as speech balloons, can help to improve learner's comprehension from basic to advanced levels concepts. When the process of concept comprehension is not facilitated, the learner may come in a transitional state of misperception and understanding, that can restrain their learning to a surface approach. The basic science concepts learned at the inception of a Health Sciences program play a vital role towards the development of higher-order thinking and problem-solving aptitude in the subsequent years. Hence, it is important to facilitate meaningful learning of core concepts and principles in difficult basic science disciplines, like Pharmacology. This work reports our experiences of employing concept animations as a 'visual aid' instructional strategy to simplify pharmacology concepts to undergraduate Optometry students. The fundamental ideas of drug pharmacokinetics, pharmacodynamics and side effects were transformed into concept animations. The effects of these concept animations are explained by using Vygotsky's 'zone of proximal development, Mayer's cognitive theory of multimedia learning and cognitive load theory.

Frequency of FMR1 gene mutation and CGG repeat polymorphism in intellectually disabled children in Pakistan.

Fragile X syndrome is considered the most common heritable form of X-linked intellectual disability (ID). The syndrome is caused by silencing of the fragile X mental retardation 1 gene (Xq27.3) due to hypermethylation. This mutation results in absence or deficit of its protein product, the fragile X mental retardation protein (FMRP) that affects synaptic plasticity in neurons, hence leads to brain dysfunction. The syndrome is widely distributed throughout the world. This study reported for the first time the frequency of the fragile X mental retardation 1 gene mutations in intellectually disabled children in Pakistan. We recruited 333 intellectually disabled children and 250 normal children with age ranging from 5 to 18 years for this study. Genomic DNA was extracted from peripheral blood and full mutations were identified by methylation sensitive PCR using primers corresponding to modified methylated and unmethylated DNA. Southern blot was used for confirmation of the results. The frequency of fragile X syndrome with full mutation was found as 4.8%. It was 6.5% in males as opposed to 0.9% in females; 29 CGG repeats were found as the most common allele; 31.5% in the intellectually disabled and 34% in control subjects. In Pakistan intellectual disability is considered as a social stigma for the individuals and their families. Due to lack of knowledge and cultural background people make such patients and families isolated. This study will increase public awareness about the intellectual disability and importance of prenatal screening and genetic counseling for vulnerable families.