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APS REFRESHER COURSE REPORT
Department of Physiology, University of Kentucky, Lexington, Kentucky 40536
Abstract
The University of Kentucky medical curriculum was revised in 1994 to implement a more interactive approach. The Endocrine Physiology section of the new physiology course, Human Function, was modified from its former daily lecture and weekly laboratory format to eight daily 3
-h sessions. Each session is composed of four components: a didactic lecture, a whole class discussion session, a quiz, and a patient presentation. These components are presented in a staggered format over the course of 2 days, i.e., the lecture is presented on the first day, and the remaining three components take place on the second day. This allows students to assimilate the new lecture material before participating in the discussion session, quiz, and patient presentation, which are more interactive. This format has been received favorably by the students because of its variety, and it is easier to keep up with the material.
Key words: interactive learning; problem solving; clinical correlation; physiology education
HISTORY
In 1993, the University of Kentucky College of Medicine was awarded a Robert Wood Johnson grant to totally revise its curriculum toward a more integrative and active learning approach. In the "old" medical curriculum, before the Robert Wood Johnson initiative, the Medical Physiology course format was rather typical; a 14-wk semester in the spring of the first year consisted of five daily 1-h lectures, a 4-h laboratory, and a 2-h recitation session each week. The Endocrine Physiology block contained anywhere from 9 to 12 lectures and was taught by one lecturer.In the new medical curriculum, the course is entitled "Human Function." The new format consists of a 3-h daily session that can include any combination of didactic and interactive activities and lasts 9 wk at the end of the first year. Afternoons remain relatively unscheduled so that students can use the time to study and complete assignments.
The Endocrine Physiology block is taught at the beginning of the course. This enables us to make a smooth transition from the preceding course, Neuroscience. The Neuroscience course combines the old Neuroanatomy course with the old Neurophysiology block, and the latter material is taught at the end of the course. Thus, when Human Function begins, the Endocrine block is first and can build on some of the material presented in Neurophysiology, because it constitutes another major regulatory system, and it starts out with general neuroendocrine concepts. Presently, two endocrine physiologists and six endocrine clinicians, including the deans of the Dental and Medical Schools, teach this block to 
100 medical and 50 dental students (the dental students were added in 1999).
FORMAT
At the time of restructuring, all block coordinators in the Human Function course were given complete autonomy in redesigning their respective portions of the course. Thus, although each of the six blocks (Endocrine, Gastrointestinal, Muscle, Cardiovascular, Respiratory, and Renal) has a different format, any given format fits the personalities, teaching styles, and philosophies of the faculty that teach each block.
A subcommittee of endocrine faculty designed the new Endocrine Physiology block. The format is based on the key concept that learning requires repetition. A second goal was to emphasize interactive learning as much as possible. Last but not least, each session utilizes a variety of approaches that maximize the students’ interest throughout the 4 h of class and emphasize different perspectives during each repeat of the material. Thus each session consists of four components. First, a didactic lecture, during which students listen to the new material; second, a daily quiz that mandates that students read the assigned material and their lecture notes; third, a whole class discussion session offers the opportunity to discuss and review the material; and fourth, a clinically oriented patient presentation requires the students to use the material in a novel problem-solving fashion to determine each patient’s disease and to understand the underlying physiology and pathophysiology.
SUPPORT
Throughout the conversion of the curriculum and the subsequent conduct of the course, support from several subdivisions of the Office of Academic Affairs has proved invaluable to the success of our efforts. The director of the Kentucky medical curriculum provides resources and assistance with any problems that arise. The Office for Testing and Evaluation assists with all aspects of testing, providing feedback on exams and course evaluation. The Curriculum Office helps with recording grades. The Academic Computing Office assists in all aspects of the use of computers in class-related activities, including development and presentation of computer-based presentations, quizzes, and maintenance of a class website.
SCHEDULE
Class begins at 8:30 AM and lasts until 12:00 PM daily. The Endocrine Physiology block consists of eight class sessions out of a total of 44 for the course, the topics for which are listed in Table 1. Each 3-h class session is divided into four components. For each topic, a lecture is given first, followed by a discussion session, a quiz, and a patient presentation. Although we originally designed each class session to incorporate all four components on the same day, we soon learned that the best results are obtained when this format is presented over 2 days. With a 2-day format, students have time to assimilate the new lecture material and to complete the reading assignment before participating in the discussion session, quiz, and patient presentation. Therefore, we soon adopted a staggered format for each topic; thus the lecture is given on the first day, and the other three components take place on the second day of class, as shown in Table 2.
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10 min each, one after the quiz and the other after the lecture.
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COMPONENTS
The lecture lasts between 50 and 60 min and has a traditional didactic format. On each day, there is enough time to allow for interactive interludes, such as directing questions to students while presenting certain concepts. In this regard, it is very helpful that the students have been exposed to a number of problem-based learning and interactive class sessions throughout the preceding 8 mo, so that by the time our course begins, they are very used to answering questions aloud in a lecture setting.
The design of our block limits us to eight lectures in which to present all of Endocrine Physiology. There was initially some concern that we would not be able to present all the material that had formerly been covered in 9–12 lectures. Interestingly, this problem never arose for at least two reasons: the extra 10–15 min of lecture time and the ability to add to and expand on the lecture material where appropriate in the next day’s discussion session and patient presentation. On the first day of class, the lecture follows the Introduction to the course and can be expanded, as described earlier. On all the remaining days of the block, the lecture is the third component of the day and follows the discussion session and quiz, as indicated in Table 2.
The discussion session is the first component of every class (after the first day). The discussion involves the entire class and is based on a set of 7–10 questions that are based on the previous day’s lecture material and are included in the handout. Depending on the questions, students either call out the answer individually, in groups, or the lecturer selects someone to answer. Because students answer from their seats, the lecturer must reiterate many of the answers for the class because the students have no microphones. This enables the lecturer to summarize the answer, in the course of which new questions can be raised and additional points can be made. Thus this session serves as a review of the previous day’s lecture material in preparation for the quiz that follows and offers students an opportunity to clarify any concepts from the lecture or the reading material. It also affords the lecturer an opportunity to clarify points from the lecture that may have been forgotten or to expand on lecture material that is pertinent to or provides background for the patient presentation. This session usually lasts 45 min, however, this is highly flexible. In most cases, we finish all the questions in the handout, but it is not necessary to do so.
The quiz takes place at the end of the discussion session. Students are instructed to put all their notes away, and a 5- or 10-question multiple-choice quiz is handed out along with a separate answer sheet. The students complete the quiz, hand in the answer sheet only, and leave the lecture hall for a 10- to 15-min break. The time when they must return to class is posted on the board and announced once the quiz begins. This is often 30 min after the beginning of the quiz.
The quiz questions are designed to be easy, and most students score 80% or above. The goal of this exercise is to encourage the students to review the lecture material and do the readings each day. Most students finish the quiz within 10–20 min. When class resumes, the quiz is reviewed with the whole class, enabling the students to determine their grade immediately and clear up any questions or ambiguities. This review of the quiz eliminates the need to notify the students of their scores every day. However, they can request their scores from the block director at any time. During the entire block, there are seven quizzes, but only the top four scores are included in a student’s final grade.
Student responses to the daily quizzes, to our surprise, were very favorable, because they help students keep up with the course. On the basis of this response, we have added quizzes to other courses, and they have also been received favorably.
As described earlier, on days 2–8 of the block, a lecture on new material follows the review of the quiz. Depending on how long the discussion session and quiz take, the lecture can extend beyond 50 min. In any case, it ends no later than 10:50 AM so that there is always a 10-min break before the patient presentation. The patient presentation always begins at 11:00 AM. This time is fixed to maximize the efficient use of time for the clinicians, patients, and students. It is important, for the success of this session, to recruit clinicians who enjoy teaching and are good teachers and to recruit outgoing patients. The patients volunteer for these sessions and receive no remuneration. Patients are selected whose disease and history lend themselves to emphasis of basic physiological concepts and principles. Examples of cases we have presented for specific class topics are listed in Table 4. The clinicians are reminded to emphasize aspects of the disease that relate to endocrine physiology and to minimize clinical issues and details that will be learned in later years. This session is very interactive because the physician assists the patient in establishing the history, and the students are required to interact with them to determine the patient’s disease.
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Students are given three exams throughout the course. The first exam is based on material presented in both the Endocrine and Gastrointestinal Physiology blocks. The questions are true or false, multiple choice, matching, or any other format that has a single best answer and can be graded by computer. The students take the exam between 8:00 and 11:00 AM. At 11:00, the answer key is posted, and there is a review session in the lecture hall, in which the answers are read aloud, and the students have an opportunity to grade their exams, review the answers, and clarify any problems. This session provides immediate feedback to the students and, at the same time, alerts us to any ambiguous or flawed questions, for which the answer key can be adjusted before submitting the exams for computer grading.
The three exams are collectively worth 85% of the final course grade, and the quiz scores constitute the remaining 15%. There are 80 total points in quizzes throughout the course, only 20 of which derive from the top four grades among the seven quizzes given in the Endocrine block. Average scores for our medical students in the Endocrine Physiology portion of the National Boards, Part I, are similar to those observed before conversion to the new curriculum.
In summary, since 1994, the Endocrine Physiology block of the Human Function course in the University of Kentucky’s new medical curriculum has converted from a 1-h daily lecture format to a more interactive approach that utilizes a variety of formats during a 3-h period every day. Endocrine Physiology is currently taught in eight sessions, and each 3-h class period includes a lecture, discussion session, quiz, and patient presentation. For each of the eight endocrine systems, these four components are staggered and take place during 2 days. Thus the lecture is given on the first day, and the discussion session, quiz, and patient presentation for a given endocrine system are presented on the second day. This format enables students to familiarize themselves with the lecture material and complete the reading assignments before participating in the more interactive components. On a given day, class begins with a discussion session based on material presented in the previous day’s lecture. This is followed by a quiz on the same material. Next, there is a lecture on new material, and finally there is a patient presentation based on the endocrine system presented in the previous day’s lecture. This more interactive approach, with its variety of formats, allows for repetition of the material in several different ways, which facilitates learning. In addition, it provides students with the opportunity to not only listen and read about, but also to discuss and solve problems for each endocrine system in a large-group format. A tribute to the success of this multi-format approach is its consistently favorable reviews by the students.
Acknowledgments
Address for reprint requests and other correspondence: S. J. Legan, Dept. of Physiology, Univ. of Kentucky, Lexington, KY 40536-0298 (E-mail: sjlegan{at}uky.edu).
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