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Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858
Abstract
In 1998, the American Physiological Society (APS) and the Association of Chairs of Departments of Physiology (ACDP) began collaboration on a project to develop a set of physiology learning objectives for medical students. Over the next 2 years, more than 50 physiologists collaborated in the development a comprehensive draft containing its 695 learning objectives. Faculty in 31 medical schools in the United States, Canada, and Puerto Rico evaluated these objectives. On the basis of this evaluation, the ACDP recommended deleting 13 of them. The final project, containing 682 objectives, was approved in December 2000 by the ACDP and published on the APS website http://www.the-aps.org/education/MedPhysObj/medcor.htm. The identification of the "content" of medical physiology instruction provides the APS and the ACDP with a tool to introduce emerging topics, such as the physiology of aging and gender differences, at a national level. The medical physiology learning objectives project provides a guide for directing current and future medical physiology instruction in the United States.
Key words: teaching; assessment; exit standards
As medical and other professional schools in the health sciences continue to modify their curricula, a variety of approaches is being used to teach the students. These widely diversified approaches range from the traditional and systematic course in physiology and neuroscience to those in which there is not an identifiable course in physiology (1). Whereas a systematic presentation of physiological concepts under the direction of physiology faculty continues to be the most efficient way to ensure appropriate depth and breadth, physiologically related topics are often spread out over several courses. It is, nevertheless, essential that all medical and health professional students receive sufficient exposure to the physiological concepts that provide the foundations needed for further studies in pharmacology, pathology, pathophysiology, and medicine. The mechanisms of deranged function cannot be appreciated without an in-depth understanding of basic biophysical and physiological mechanisms.
One approach to insure adequate coverage of a topic is to establish explicit exit expectations. In the 1950s, Bloom (2) and Mager (5) popularized a pedagogical approach that relied heavily on learning objectives. By establishing explicit learning objectives, student mastery of a topic can be assessed and evaluated, independently of the instructional mode used.
In 1998, the president of the American Physiological Society (APS; L. Gabriel Navar), the president of the Association of Chairs of Departments of Physiology (ACDP; Mordecai P. Blaustein) and the chair of the APS Teaching Section (Robert G. Carroll) met to discuss ways in which to assist faculty who teach medical physiology. This group initiated a project that would develop a set of learning objectives for medical physiology instruction. The learning objectives were organized around nine physiology disciplines. For each discipline, an objective writing committee was recruited and cochaired by a member of the relevant APS section and a member of the ACDP. The APS teaching section coordinated the project, managed the time line, and provided a template and pedagogical support for constructing the objectives.
This paper describes the design and evaluation of the medical physiology learning objectives project. Key aspects in the design of the project include early involvement of the decision makers, soliciting broad input from content experts, providing opportunities for feedback and revision, and a broad-based evaluation. The result of this project is available on the APS web page at http://www.the-aps.org/education/MedPhysObj/medcor.htm.
METHODS
Constructing the learning objectives.
Two groups within the physiology community were approached to provide leadership for this project, the APS Section Advisory Committee and the ACDP. The discipline of physiology was divided into nine sections: cell, cardiovascular, neurophysiology, endocrinology and metabolism, respiration, gastrointestinal, renal, muscle, and exercise and integration. An objective writing group was recruited for each of the areas, with the representative of the ACDP and the representative from the APS section serving as cocoordinators (see Table 1).
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The January 2000 draft had a total of 695 individual objectives. Of those, 48 objectives addressed cellular physiology, 128 objectives cardiovascular physiology, 144 objectives neurophysiology, 102 objectives endocrine physiology, 58 objectives pulmonary physiology, 86 objectives gastrointestinal physiology, 77 objectives renal and acid-base physiology, 39 objectives muscle physiology, and 13 objectives exercise and integration physiology.
Evaluating the learning objectives.
The January 2000 draft of the medical physiology learning objectives project was distributed to 150 medical schools in the United States, Puerto Rico, and Canada. Contact individuals were either members of the ACDP or, for those schools in which an ACDP member was not identified, through the individual responsible for curriculum/medical education as listed in the Association of American Medical Colleges (AAMC) guide.
In each school, appropriate faculty were asked to review the objectives and to rank them on five-point scale, with 5 = essential, 4 = important, 3 = appropriate, 2 = of questionable value, and 1 = inappropriate. Faculty were asked to consider the objectives only in light of the medical physiology instruction. Suggested reasons for rating an objective as inappropriate included too detailed for medical students, not related to medical practice, or more appropriate for another basic science discipline such as pathology or anatomy. Scantron grading sheets, coded to identify the institution and the physiology topics, were included in each packet; faculty were asked to return the rating sheets by November 2000.
RESULTS
Responses were obtained from 31 different medical schools (20.7% response rate), and in some schools, multiple faculty evaluated each section. One exception was neurophysiology, where only 22 schools responded. This is likely because neurophysiology is not always a component of medical physiology courses. Responses were obtained both from schools using a lecture curriculum as well as schools using a problem-based curriculum.
For each section, average ranking of the objectives ranged from 3.6 for neurophysiology to 4.5 for endocrine physiology. All other sections had average rankings between 4.1 and 4.2. (Fig. 1).
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DISCUSSION
The Medical Physiology Learning Objectives Project lasted over 2 yr and resulted in the construction and national endorsement of 682 individual physiology learning objectives. Over 60 faculty helped construct and revise the objectives, and 31 medical schools participated in the evaluation of the final draft (see Table 2).
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Although not formalized, national expectations for mastery of physiology have already been set. The United States Medical Licensing Examination, as a single pathway for licensure to practice medicine, identifies the physiology that the item writers deem as appropriate. Textbook authors and publishers similarly identify the physiology content when writing and revising textbooks. Other basic science and clinical science disciplines identify the physiology that they feel is an important prerequisite for student mastery of their material.
These expectations are more appropriately set by a national organization of physiologists. In doing so, the APS and the ACDP gain the opportunity to review and revise expectations, and provide input into the material that will be taught and tested under the guise of physiology.
Structuring the learning expectations as objectives is a common approach to managing instruction (4). The Association of American Medical Colleges has initiated a Medical School Objectives Project: http://www.aamc.org/meded/msop/report1.htm.
Under the knowledge objectives (4), the guidelines indicate that "For its part, the medical school must ensure that before graduation, a student will have demonstrated, to the satisfaction of the faculty, the following:
The process of compiling the learning objectives was facilitated by the fact that many physiology departments had already adopted learning objectives in their courses. In 1978, APS published a translation of a set of learning objectives used at the Institute of Physiology, University of Aarhus, Denmark (6). The effort of these Danish physiologists underscores the importance of using the objectives as a "living document." The translation into English was the fifth edition of the Aarhus physiology objectives, and Christain Olsen at Aarhus indicates that the objectives are now in their 14th edition (Christian Olsen, personal communication). For this project, the ACDP has agreed to manage a cycle for contnuing revision and modification of the objectives.
The Human Anatomy and Physiology Society (HAPS) has also established a set of curriculum objectives for undergraduate instruction (3), available at http://www.hapsweb.org/corecurr.htm. These objectives include course guidelines as well as aspects of course prerequisites and structure in addition to the content expectations. Again, HAPS has in place the system for review and revision of these objectives.
By necessity, the objectives define the content to be taught. Not addressed in this project are issues related to the format in which this content should be presented. This will be dictated by factors and constraints (i.e., class size, number of faculty) unique to each institution. Nevertheless, all of the objectives can be attained using multiple teaching formats, and faculty need to determine the optimum teaching/learning format for their students.
The curricular objectives are focused primarily on normal body function. However, it is recognized that this material must be presented in a context that will prepare students for their roles as physicians. Accordingly, it is suggested that, wherever possible, clinical examples can and should be used to illustrate the underlying physiological principles.
FUTURE DIRECTIONS
One advantage in defining the content of medical physiology is that it becomes clear what is currently missing in physiology courses. At the 2000 ACPD meeting, participants noted the absence of objectives related to gender-specific health issues and also to physiological changes across the life span. For example, the physiology of development and aging is likely to become an important part of medical education in the very near future. These and other items can be introduced as recommended curriculum components by introducing objectives dealing with these topics.
The APS hopes to use the framework of these objectives to organize materials for inclusion in the archive of teaching resources. Linking the learning objective, identifying tools for accomplishing the objective, and providing options for assessment of student learning will allow physiology instructors to implement an objective-driven approach in their teaching.
Additional information about the objectives is available at the APS web page, http://www.the-aps.org/education/MedPhysObj/medcor.htm or from the author.
APPENDIX
Deleted Learning Objectives
Footnotes
Address for reprint requests and other correspondence: R. G. Carroll, Dept. of Physiology, East Carolina Univ. School of Medicine, 600 Moye Blvd., Greenville, NC 27858–4354 (E-mail: Carrollr{at}mail.ecu.edu ).
Received for publication March 8, 2001. Accepted for publication March 21, 2001.
References
This article has been cited by other articles:
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  A. W. Ra'anan The evolving role of animal laboratories in physiology instruction Advan Physiol Educ, September 1, 2005; 29(3): 144 - 150. [Abstract] [Full Text] [PDF]
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