Student engagement and higher order skill proficiency: a comparison of traditional didactic and renewed integrated active learning curricula.

A large, multicampus, public medical school underwent curricular renewal, emphasizing a student-centered approach with 50% of all course contact time devoted to active learning. Determining the impact of active learning on student engagement and higher order skill (HOS) proficiency was the primary aim of this study. Following Institutional Review Board approval, two cohort groups of first-year medical students were enrolled. The first cohort ( n = 54) included students before curriculum reform in the legacy curriculum (LC). The second cohort ( n = 73) included students completing studies in the renewed curriculum (RC). Near the end of the first year of medical school, both cohorts completed a validated survey of student engagement, and a proctored problem-based assessment of HOS proficiency [Collegiate Learning Assessment (CLA+)]. Results indicated RC students perceived greater levels of engagement than LC (39.5+5.8 vs. 33.3+5.6), and greater reliance on HOS, including analysis, synthesis, and application. However, there were no significant differences between cohorts in proficiency of HOS when assessed by the CLA+ (LC = 1,878 ± 161 vs. RC = 1,900 ± 157). Additionally, poor correlation between engagement and HOS for both LC and RC indicated more engaged students do not necessarily possess greater HOS proficiency. Ceiling effect may explain results as medical students enter medical school as highly skilled learners with potentially little room for improvement. It will be informative to continue to track engagement and HOS of both cohort groups as they continue their medical studies.

Engagement and higher order skill proficiency of students completing a medical physiology course in three diverse learning environments.

The primary aim of this study was to determine whether levels of student engagement, higher order skill proficiency, and knowledge acquisition demonstrated by medical students would differ when completing the same course in three diverse learning environments. Following Institutional Review Board approval, 56 first-year medical students, registered at the same medical school but attending class at three different campus centers, were enrolled in the study. All participants were completing a medical physiology course that utilized the same learning objectives but relied on different faculty incorporating diverse methodologies (percentage of class devoted to active learning strategies), course format (6-wk block vs. 17-wk semester), and student attendance. Students completed a validated survey of student engagement (SSE), a proctored online problem-based assessment of higher order skill proficiency [Collegiate Learning Assessment (CLA+); http://cae.org ], and the National Board of Medical Examiners (NBME) Physiology subject exam. In this limited sample, results indicate no significant differences between campus sites for any of the variables assessed. Levels of engagement were lower than expected compared with published values for graduate students. Higher order skill proficiency assessed by CLA+ was significantly higher than values reported for college seniors nationally. Surprisingly, SSE offered no prediction of performance on CLA+ or NBME, as there were no significant correlations between variables. These data indicate that, although first-year medical students may not perceive themselves as highly engaged, they are adept in using higher order skills and excel in meeting course learning objectives, regardless of learning environment.

Promoting the APS Chapter Program by sharing its history, best practices, and how-to guide for establishing new chapters.

Early establishment of physiological societies in Oklahoma and Ohio demonstrated the benefits of networking physiologists and paved the way for establishing the APS Chapter Program. Designed to promote the general objectives of the APS, the Chapter Program was officially launched in 1995, with Ohio being the first recognized chapter. There are 13 active chapters regularly engaged in numerous activities designed to advance physiology education and research. In the hopes that others will recognize the important offerings of state chapters and consider organizing one, the aims for this paper are to 1) share a brief history, 2) provide rationale for chapter initiation, and 3) describe the process involved in establishing a chapter. In light of current changes in American Medical Association and Liaison Committee on Medical Education guidelines, the present time may be critical in promoting chapters, as they play a vital role in sustaining recognition and support for the discipline.

Mapping the Nephron Exercise Incorporates Multiple Learning Strategies.

Introduction: Understanding the location and action of nephron transporters and channels is important to the understanding of renal function. As each region of the nephron is unique in its inclusion of specific transporters and channels, mapping of the nephron is an effective first step in understanding overall nephron processing. We describe a small-group, active-learning exercise that facilitates students' ability to understand renal processing within each region of the nephron. Methods: Following an overview lecture on renal transporters and channels, small groups of students worked cooperatively to map the nephron. This 2-hour, collaborative exercise was developed to reinforce key concepts in renal processing of ions and nutrients and, at the same time, utilize effective learning strategies. Learning strategies incorporated in this exercise include small-group collaboration, peer teaching, retrieval practice using an audience response system, and elaboration through discussion. Results: Written examination was used to assess student understanding. Students demonstrated higher performance on a subset of questions related to this learning activity compared to the overall exam. Highly positive feedback was provided by a convenience sample of students completing an anonymous survey. Discussion: This nephron-mapping exercise was an effective means to promote synthesis and analysis of lecture content and engage students in methods that enhance learning.

Tracking weight change, insulin resistance, stress, and aerobic fitness over 4 years of college.

OBJECTIVE: To determine if weight gain is accompanied by development of insulin resistance (IR) during 4 years in college. PARTICIPANTS: Two cohorts of college students were enrolled in fall semesters 2009 and 2010 and tracked for 4 years. METHODS: Following a 12-hour fast, subjects reported for measurement of body mass index (BMI), perceived stress (PSS), aerobic fitness, and blood glucose, insulin, and lipids. RESULTS: In the first year, 33% of subjects were overweight or obese, and 20% were hyperinsulinemic. Year 4 had 29 remaining subjects with disproportionate attrition of overweight and obese individuals. Just over half the subjects gained weight (WI), whereas nearly 30% lost considerable amounts (WD). WD showed significant decline in fasting insulin, low-density lipoprotein (LDL) cholesterol, and PSS from year 1. WI was primarily highly fit men who did not demonstrate increased IR. CONCLUSION: WI was not associated with IR over 4 years of college.

Assessment and comparison of student engagement in a variety of physiology courses.

Calls for reform in science education have promoted active learning as a means to improve student engagement (SENG). SENG is generally acknowledged to have a positive effect on student learning, satisfaction, and retention. A validated 14-question survey was used to assess SENG in a variety of upper- and lower-level physiology courses, including 100-level Anatomy and Physiology 1, 300-level Animal Physiology, 400-level Advanced Physiology, and 500-level Medical Physiology courses. The results indicated that SENG did not vary consistently by course level, format, or curriculum. The highest levels of SENG were found in the Advanced Physiology course, which included SENG as a primary objective of the course. Physiology student SENG scores were compared with National Survey of Student Engagement (NSSE) scores. The results demonstrated that physiology students enrolled in the Anatomy and Physiology 1 course reported lower levels of SENG than first-year students that completed the NSSE. Students enrolled in the Advanced Physiology course reported higher levels of SENG than fourth-year students that completed the NSSE. Assessment of SENG offers insights as to how engaged students are, identifies where efforts may best be applied to enhance SENG, and provides a baseline measure for future comparisons after targeted course modifications.

Laboratory exercise: study of digestive and regulatory processes through the exploration of fasted and postprandial blood glucose.

Digestive physiology laboratory exercises often explore the regulation of enzyme action rather than systems physiology. This laboratory exercise provides a systems approach to digestive and regulatory processes through the exploration of postprandial blood glucose levels. In the present exercise, students enrolled in an undergraduate animal physiology course select to participate in either an oral glucose tolerance test (OGTT) or one of the following three meal treatments based on typical student breakfasts: 1) high glycemic load (HGL), 2) moderate glycemic load (MGL), and 3) low glycemic load (LGL). The caloric value of the meals is 540 kcal. An Accucheck glucometer is used to determine fasted and 30-, 60-, and 120-min postprandial blood glucose levels. Students discover that postprandial glucose levels peak similarly for the OGTT and HGL group (137 ± 7.1 and 145 ± 4.7mg/dl) and remain higher than MGL and LGL groups over the 2-h period. Between sampling, vibrant discussion covering such topics as glucose and cognitive function, insulin resistance, epigenetics, and fad diets occurs. The postlaboratory assignment requires students to discuss the importance of glucose homeostasis, graphically summarize their findings, review the literature to describe results in light of published data, and describe relationships between hyperglycemia and hyperinsulinemia and disease processes. Students evaluated this laboratory as highly effective and one of the top three experiences of the course.

A preliminary study on the variability of blood glucose following meal consumption as it relates to differences in oral glucose tolerance in young adults.

Insulin resistance (IR) affects the ability to maintain normal glycemia and places one at greater risk of the development of disease. The aim of this study was to assess IR via the administration of an oral glucose tolerance test (OGTT) and then determine the relationship between IR and postprandial blood glucose levels in young adults 19-24 years of age. Following a 10 hour fast, 10 men and 10 women completed an OGTT and in three subsequent weeks consumed high, medium, and low glycemic load (GL) meals in random order. Fasted and two-hour (2 h) blood glucose levels were determined. Height, weight, and waist circumference were measured and subjects completed a questionnaire recording recent weight gain, family history of diabetes, and physical fitness. Although all fasted blood glucose levels were normal, two subjects classified as impaired glucose tolerant based on 2 h OGTT values >140 mg/dL. OGTT and high glycemic load meal 2 h blood glucose levels were highly significantly correlated (p = 0.0012). Significantly higher blood glucose levels were also found in women, high BMI, low fitness, and rapid weight gain groups. Although limited by a small sample, these preliminary data suggest that glycemic response to meal ingestion is based on both the GL of the meal and the individual's level of IR.

Prevalence of hyperinsulinemia associated with body mass index, genetic predisposition, and lifestyle in college freshmen students.

OBJECTIVE: College lifestyle places an individual at greater risk for the development of insulin resistance (IR) and disease. The aim of this study was to establish a baseline measurement of insulin, and other variables influencing IR in college freshmen. PARTICIPANTS: Twenty-two men and women, 18 to 19 years of age, during first month of college. METHODS: Following 12-hour fast, subjects reported to the laboratory for determination of body mass index (BMI) and completion of questionnaire determining ethnicity, family history, and patterns of diet, exercise, and stress. Blood samples were obtained and analyzed for glucose and insulin. RESULTS: Mean insulin value for men (14.9 ± 1.86 µU/mL) was normal, and that for women (17.3 ± 1.74 µU/mL) was slightly elevated. When subjects were grouped by BMI, genetic predisposition, and summated lifestyle risk, fasting insulin values were significantly different. Eight of 22 subjects were hyperinsulinemic (insulin >19 µU/mL). CONCLUSION: Hyperinsulinemia is prevalent in this population and merits further investigation and intervention.