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ARCHIVE ADDITIONS
The APS Archive of Teaching Resources is a repository of case histories, simulations, figures, lectures and course syllabi, animations, and links to physiology teaching resources for use by APS members and other educators. The Archive is a searchable database that can be used by teachers at all levels (K-12, undergraduate, graduate, and medical school) to enhance and supplement their current teaching resources and is part of the National Science Digital Library Project and the BiosciEd Net collaborative (http://www.biosciednet.org). The APS Archive of Teaching Resources was established as an initiative of the APS Education Committee and APS Council with additional support from the National Science Foundation (DUE 0226185). Authors submitting materials to the Archive for review and inclusion have the option of developing an abstract for publication in Advances. The following abstracts are from items that have been accepted into the Archive following peer review.
Physiology of the Kidneys, Body Fluids and Acid-Base Balance (Learning Object #57) John R. Dietz PhD, Dept. of Physiology and Biophysics, University of South Florida, College of Medicine, Tampa, FL.
A set of 161 PowerPoint slides used by the author to teach the renal physiology, body fluids, and acid-base sections of a physiology course to first-year medical students is presented. These lectures constitute 12–13 hours of an approximately 100-hour physiology course with approximately 80 hours presented as in a large group lecture format. The lecture material and objectives closely mirror The American Physiological Society’s "Medical Objectives for Physiology Education" (http://www.the-aps.org/education/MedPhysObj/renal299.htm). Figures and drawings are original, or permission for their use was obtained. A handout of the material presented is available upon request (jdietz{at}hsc.usf.edu). These lectures have been consistently identified by students as a highlight of the Medical Physiology course.
Hyponatremia (Learning Object #58). John R. Dietz PhD and Cathleen G. Dietz MD, Dept. of Physiology and Biophysics, University of South Florida, College of Medicine, Tampa, FL.
This clinical case in pdf format describes a patient with syndrome of inappropriate ADH secretion (SIADH) and has been employed successfully in small-group conferences within a medical physiology course. This is an actual clinical case but does not contain protected health information. Normally, the students are given the first page of the case, which contains a brief patient history, laboratory results, and follow-up treatments. The first page also contains several self-study questions designed to emphasize how basic physiological principles are used in the understanding of clinical practice. The second page of the case, containing answers to the questions, is given only to the faculty/small-group facilitator and serves as a guide in probing the students for responses and directing their discussions. Medical students are required to research the questions by using various basic and clinical sources. The students meet with the facilitator in groups of 8–12 for approximately 90 minutes, during which time two or three such cases are discussed. In this particular case, the students begin with the patient’s primary symptom of hyponatremia. A successful diagnosis requires that the student understand the primary causes of hyponatremia. Other objectives include regulation of plasma and urine osmolality and control of ADH secretion as well as an emphasis on problem solving in a group setting. The facilitator summarizes the major principles at the end as a review and reinforcement, and relevant questions concerning the cases are included on examinations. These conferences are consistently identified by students as a highlight of the Medical Physiology course.
Work of the Heart (Learning Object #59). Kenneth J. Friedman PhD, Dept. of Pharmacology and Physiology, New Jersey Medical School, Newark, NJ.
"Work of the Heart" describes a procedure for demonstrating the work performed by the left ventricle of the human heart. It serves as a demonstration or a laboratory exercise for students ranging from upper-level elementary school through graduate school. (It was designed as a medical school human physiology demonstration and has been used by physicians to explain hypertension to their patients.) A sphygmomanometer (blood pressure cuff) is held in the hand of the demonstrator or student and is partially inflated until it can be squeezed comfortably by the hand. The student squeezes the cuff to generate pressures between 0 and 120 mmHg as monitored by the cuff’s pressure gauge (left-ventricular pressure cycles between 0 and 120 mmHg during each heartbeat). To simulate the heart’s normal beating, students either measure or are told their normal heart rate in beats per minute and attempt to squeeze the cuff at that frequency. Because normal resting heart rate can reach 100 beats/min and the exercised heart may reach rates in excess of 180 beats/min, the muscles of the hand are incapable of matching that performance, thereby instilling an appreciation of the work of the heart. In hypertension, left-ventricular pressures can exceed 220 mmHg. By squeezing the cuff to generate 220 mmHg while maintaining the same number of cycles per minute, the additional left-ventricular work necessitated by hypertension is appreciated.
PowerPoint for Pulmonary and Renal Pressure-Flow Relationships: What Should Be Taught? (Learning Object #62). Barbara E. Goodman PhD, Div. of Basic Biomedical Sciences, University of South Dakota School of Medicine, Vermillion, SD.
This PowerPoint presentation was designed for a symposium presentation on the module Gradients and Conductances: What Flows Where and Why? at the 2000 annual meeting of the Human Anatomy and Physiology Society. Articles based on the symposium can be found in Advances in Physiology Education 25: 8–28, 2001. The key concept of gradients and conductance in the respiratory and renal systems includes pressure-flow-resistance relationships for air during breathing (and transmural pressures), for the formation of tubular fluid in the kidneys, and for blood in the lungs and pressure-flow or concentration-flux relationships for diffusion of gases in the lungs and the movement of solutes and water across barriers in the lungs and kidneys. Simple slides are included that describe pulmonary pressures during breathing, airway pressure-flow-resistance changes in obstructive pulmonary disease, and gas exchange and its changes with alterations in pulmonary blood flow and lung fluid balance and how changes in renal blood flow affect the rate of glomerular filtration of tubule fluid in the kidneys. The purpose of the presentation is to use simple slides to give undergraduate students an understanding of how the physiology of the respiratory and renal systems depend on the basic concept of pressure-flow-resistance, described in many different ways and terms. When students realize that this key concept is found in multiple contexts throughout the body, they are more likely to understand physiology.
Simulations in Physiology: The Respiratory System (Learning Object #184). Harold Modell PhD, Physiology Educational Research Consortium, Seattle, WA.
"Simulations in Physiology: The Respiratory System" is a series of 11 simulated clinical and laboratory situations designed to provide students with thinking tools for examining their understanding of respiratory physiology. Each simulation deals with a limited number of concepts relevant to the physiology of the respiratory system. Each simulation requires the student to enter values defining an experiment or situation. Calculated values consistent with the problem definitions are then returned. It should be clear that these simulations are not intended as primary instruction tools. Four general areas of study are included. The simulations in each area of study build in complexity. Hence, models appearing later in an area assume some familiarity with the concepts covered in earlier models. The 11 simulations are divided into Mechanics Models (Static Relationships, Dynamic Relationships I and II, and Work of Breathing), General Gas Exchange Models (Alveolar Gas Exchange, O2 and CO2 Dissociation Curves, Exchange from Atmosphere to Tissues), Ventilation-Perfusion Relationships Models (Gas Exchange in a Single Alveolus, The Non-Uniform Lung, Overall Gas Exchange), and Acid-Base Balance Models (Acid-Base Balance).
Acidosis—Metabolic and Respiratory (Learning Object #192). John R. Dietz PhD and Cathleen G. Dietz MD, Dept. of Physiology and Biophysics, University of South Florida, College of Medicine, Tampa, FL.
This clinical case in pdf format describes a patient with, first, a metabolic acidosis and, later, a respiratory acidosis, and it has been employed successfully in small-group conferences within a medical physiology course. This actual clinical case does not contain protected health information. Students are given the first page of the case, which contains a brief patient history, laboratory results, and follow-up treatments. The first page also contains several self-study questions designed to emphasize how basic physiological principles are used in the understanding of clinical practice. The second page of the case, containing answers to the questions, is given only to the faculty/small-group facilitator and serves as a guide in probing the students for responses. Medical students are required to research the questions by using a variety of sources. Students meet with the facilitator in groups of 8–12 for approximately 90 minutes, during which time two or three such cases are discussed. In this particular case, the students begin with the patient’s primary complaint of cough, chills, and fever. A successful diagnosis requires that the student understand the primary causes of metabolic and respiratory acidosis. Other objectives include the anion gap, blood gas analysis, and review of the Davenport diagram, as well as an emphasis on problem solving in a group setting. The facilitator summarizes the major principles at the end as a review and reinforcement, and relevant questions concerning the cases are included on examinations. These conferences are consistently identified by students as a highlight of the Medical Physiology course.
Hypertension (Learning Object #193). John R. Dietz PhD and Cathleen G. Dietz MD, Dept. of Physiology and Biophysics, University of South Florida, College of Medicine, Tampa, FL.
This clinical case in pdf format describes a patient with renovascular hypertension and has been employed successfully in small-group conferences within a medical physiology course. This actual clinical case does not contain protected health information. Students are given the first page of the case, which contains a patient history, laboratory results, and follow-up treatments. The first page also contains several self-study questions designed to emphasize how basic physiological principles are used in the understanding of clinical practice. The second and third pages of the case, containing answers to the questions, are given only to the faculty/small-group facilitator and serve as a guide in probing the students for responses and directing their discussions. Medical students are required to research the questions by using a variety of sources. Students meet with the facilitator in groups of 8–12 for approximately 90 minutes, during which time two or three such cases are discussed. In this particular case, the students begin with the patient’s problem of uncontrollable hypertension. A successful diagnosis requires that the student understand regulation of the renin-angiotensin-aldosterone system and its effects on blood volume and pressure. Other objectives include measurement of renal function and a review of blood pressure regulation as well as an emphasis on problem solving in a group setting. The facilitator summarizes the major principles at the end as a review and reinforcement, and relevant questions concerning the cases are included on examinations. These conferences are consistently identified by students as a highlight of the Medical Physiology course.
Weakness and Hypotension (Learning Object #194). John R. Dietz PhD and Cathleen G. Dietz MD, Dept. of Physiology and Biophysics, University of South Florida, College of Medicine, Tampa, FL.
This clinical case in pdf format describes a patient with Addison’s disease and has been employed successfully in small-group conferences within a medical physiology course. This actual clinical case does not contain protected health information. Students are given the first page of the case, which contains a brief patient history, laboratory results, and follow-up treatments. The first page also contains several self-study questions designed to emphasize how basic physiological principles are used in the understanding of clinical practice. The second page of the case, containing answers to the questions, is given only to the faculty/small-group facilitator and serves as a guide in probing the students for responses and directing their discussions. Students are required to research the questions by using various basic and clinical sources. Students meet with the facilitator in groups of 8–12 for approximately 90 minutes, during which time two or three such cases are discussed. In this particular case, the students begin with the patient’s problem of weakness and hypotension. A successful diagnosis requires understanding of the regulation of the renin-angiotensin-aldosterone system and its effects on blood volume and pressure. Other objectives include regulation of electrolyte excretion and effects of aldosterone on hydrogen excretion as well as an emphasis on problem solving in a group setting. The facilitator summarizes the major principles at the end as a review and reinforcement, and relevant questions concerning the cases are included on examinations. These conferences are consistently identified by students as a highlight of the Medical Physiology course.
Polyuria and Polydipsia (Learning Object #195). John R. Dietz PhD and Cathleen G. Dietz MD, Dept. of Physiology and Biophysics, University of South Florida, College of Medicine, Tampa, FL.
This clinical case in pdf format describes a patient with nephrogenic diabetes insipidus and has been employed successfully in small-group conferences within a medical physiology course. This actual clinical case does not contain protected health information. Students are given the first page of the case, which contains a brief patient history, laboratory results, and follow-up treatments. The first page also contains several self-study questions designed to emphasize how basic physiological principles are used in the understanding of clinical practice. The second page of the case, containing answers to the questions, is given only to the faculty/small-group facilitator and serves as a guide in probing the students for responses and directing their discussions. Students are required to research the questions by using various basic and clinical sources. The students meet with the facilitator in groups of 8–12 for approximately 90 minutes, during which time two or three such cases are discussed. In this particular case, the students begin with the patient’s primary complaint of polyuria and polydipsia. A successful diagnosis requires that the student understand the primary causes of polyuria and polydipsia. Other objectives include regulation of plasma and urine osmolality, aquaporin channels, and ADH receptors and control of ADH secretion as well as an emphasis on problem solving in a group setting. The facilitator summarizes the major principles at the end as a review and reinforcement, and relevant questions concerning the cases are included on examinations. These conferences are consistently identified by students as a highlight of the Medical Physiology course.
Acidosis—Respiratory (Learning Object #197). John R. Dietz PhD and Cathleen G. Dietz MD, Dept. of Physiology and Biophysics, University of South Florida, College of Medicine, Tampa, FL.
This clinical case in pdf format describes a patient with a chronic respiratory acidosis and has been employed successfully in small-group conferences within a medical physiology course. This actual clinical case does not contain protected health information. Students are given the first page of the case, which contains a brief patient history, laboratory results, and follow-up treatments. The first page also contains several self-study questions designed to emphasize how basic physiological principles are used in the understanding of clinical practice. The second page of the case, containing answers to the questions, is given only to the faculty/small-group facilitator and serves as a guide in probing the students for responses and directing their discussions. Students are required to research the questions by using a variety of sources. Students meet with the facilitator in groups of 8–12 for approximately 90 minutes, during which time two or three such cases are discussed. In this particular case, the students begin with the patient’s primary complaint of tiredness and an inability to sleep soundly. A successful diagnosis requires that the student understand the primary causes of a respiratory acidosis. Other objectives include central and peripheral regulation of ventilation, blood gas analysis, and erythropoietin as well as an emphasis on problem solving in a group setting. The facilitator summarizes the major principles at the end as a review and reinforcement, and relevant questions concerning the cases are included on examinations. These conferences are consistently identified by students as a highlight of the Medical Physiology course.
Peer Feedback for Students Working in Small Groups (Learning Object #200). Ann P. McNeal PhD, Dept. of Natural Sciences, Hampshire College, Amherst, MA.
Students are an excellent source of information on the performance of other students within their groups. To get students to "buy into" the evaluation of their peers, they can help develop the criteria by writing out their own ideas of what makes for a good working group. These ideas can be pooled (with some of the instructor’s own) and given as a quick evaluation sheet. A sample peer evaluation sheet is given as a downloadable file.
Case Studies for Chapter Review and Integration (Learning Object #201). Ann P. McNeal PhD, Dept. of Natural Sciences, Hampshire College, Amherst, MA.
This learning object presents a method of using brief case studies to consolidate students’ learning of text material. Students read the chapter in advance. When they come to class on any day, they may be responsible for covering the material in small groups. The different small groups are assigned a range of case studies designed to cover the essentials of the material from a single chapter.
Tasks are defined on handouts.
Each group does a different problem.
Each group prepares a diagram/answer on a large chart paper.
Twenty to thirty minutes are allotted for the task; teacher does not give answers but checks accuracy.
Groups report to whole class.
"The loop is closed" by requiring each student to write the answers to questions on all problems.
The examples are from a sophomore/junior-level course keyed to Silverthorn’s Human Physiology text and are given as handout sheets.
Acid-Base Tutorial (Learning Object #225). Alan W. Grogono MD, FRCA, Dept. of Anesthesiology, Tulane University School of Medicine, New Orleans, LA.
This interactive website is hosted by Tulane University School of Medicine with the easily remembered address (www.acid-base.com). The site introduces acid-base balance to students in the health sciences. The tutorial was developed through experience obtained by teaching the subject to medical and nursing students. For some years now, this website has been ranked first by the major Internet search engines for the subject acid-base. The website generates worldwide appreciative and constructive feedback via e-mail from students and teachers in schools, universities, and graduate courses.
The subject is presented in a colorful and entertaining manner. Starting from a simplistic overview, basic concepts and terminology are introduced with definitions and explanations. The history of the subject is reviewed to explain how the current terminology, including pH and base excess, was introduced. Responsive graphics make the website interesting. Interactive acid-base diagrams enhance comprehension of the relationship between the various components of acid-base balance. Examples of typical acid-base disturbances are presented with detailed explanations of how the laboratory results are interpreted. The principal therapeutic options are explained. The website includes an alphabetical index and a bibliography.
The Nerve Impulse Seen from Outside (Learning Object #249). Dexter M. Easton PhD, Dept. of Biological Science, Florida State University, Tallahassee, FL.
This instructional module shows, with illustrations and text, some of the essential features of nerve impulse propagation, a phenomenon that many students find especially difficult to visualize. The lesson is based on observations made during external recording from the sciatic nerve of the frog Rana pipiens and consists of 30 short topics: Topics 1–12 provide background on the electrophysiology of nerve axon membrane and some relevant aspects of structure and transmembrane ("intracellular") events, helpful for understanding the external records. Topics 13–30 illustrate more than a dozen different propagation phenomena observable from external records. The figures are representative of those obtained by students during recording from frog nerve installed in a special student- and nerve-friendly bath. The lesson has supplemented laboratory exercises by advanced undergraduates using isolated sciatic nerve of frog. During an actual laboratory session, circumstances often conspire against the student’s acquiring good results, so these figures are intended to show what can be obtained. With or without laboratory, the lesson will be useful to readers at several levels, from advanced high school students to professionals requiring a first introduction to or a review of the marvels of the nerve impulse.
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