| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
HOW WE TEACH
Department of Biology, Earlham College, Richmond, Indiana 47374
Address for reprint requests and other correspondence: N. A. Trueblood, 801 National Rd. W., Richmond, IN 47374 (E-mail: truebna{at}earlham.edu)
 |
Abstract |
|---|
 TOP Abstract IntroductionMETHODSDISCUSSIONGRANTSREFERENCES |
|---|
Key words: undergraduate student; general education; diagnosis; clinical research; lifelong learning
|
Introduction |
|---|
|
TOPAbstractIntroductionMETHODSDISCUSSIONGRANTSREFERENCES |
|---|
In our non-majors general education course, Human Biology, we have been capitalizing on a student’s interest in human disease and disease treatments for over 20 years with a project called the "Responsible Patienthood Project" (RPP). The RPP has evolved over the years from the use of abstracts of medical articles in lieu of whole articles to the use of CD-ROMs of Medline to access the latest research (12). This study describes the most recent evolution of the RPP at Earlham College, in which students focus their attention on accessing, reading, assessing, and presenting original clinical trials to be well-informed "hypothetical patients."
|
METHODS |
|---|
|
TOPAbstractIntroductionMETHODSDISCUSSIONGRANTSREFERENCES |
|---|
The assignment.
In RPP, students evaluate the efficacy and safety of a treatment regimen based on medical evidence. The final product of the RPP assignment is a poster presentation. A brief description of the assignment and its requirements is given in Fig. 1.
|
biol/nathan/humanbio/humanassign.html).
|
Acclimation to information resources.
After the introduction to the assignment, the choice of a disease/treatment combination and a group, and the introduction to the assignment web page, the class receives instruction on the paper and electronic information resources in the library. As part of the library instruction, there is an initial hands-on "information scavenger hunt" exercise in which students gain some guided experience with a variety of library tools. Students are then given class time to get started on their group’s disease/treatment combination. Beyond this initial structured class time, the students are "on their own" for completion of the assignment.
The poster presentation.
The final product of the RPP assignment is a poster presentation. Each student, or pair of students, gives a formal poster presentation to the rest of the class, followed by a period for questions and answers and open discussion. More information about the requirements for the poster can be found in Fig. 1.
The assessment tool(s).
To determine whether the RPP moved students closer to our goal of becoming "responsible patients," and by extension lifelong learners, we designed and implemented a pre- and post-RPP assessment tool (Fig. 3). As can be seen in the questionnaire, the goal of this assessment strategy was to determine whether the student’s responses to a "real-world-like" situation might be altered by the RPP. The situation or scenario used in the questionnaire was taken partly from the real-life experiences of a family member of one of the authors of this paper but was written from the perspective of the individual student completing the questionnaire to put the student "into the situation."
|
In addition to this pre- and post-assessment tool, students were encouraged to provide further comments or suggestions after completion of the RPP. Some selected comments have been provided in Fig. 5.
|
RESULTS
Survey/questionnaire.
On the basis of the pre- and post-RPP assessment, students were 32% less likely to "agree without question" to the treatment suggested by the physician in the scenario after completing the RPP. Furthermore, the students’ post-RPP were 40% more likely to use a combination of primary and other literature sources to become more knowledgeable about the condition and treatment (Fig. 4, A and B). None of the other survey questions revealed significant differences between pre- and post-assessments.
|
The only negative comments about the RPP were in the organization of the Oral Poster Presentation. Specifically, we opted to devote 2.5 lecture meetings to running through all of the poster presentations back to back. Students perceived this as too much concentrated time on the RPP, and too little on lecture. Students suggested instead spreading the oral poster presentations over the semester, so that there might only be one or two presentations per day.
Student performance.
As an indication of the capability of non-science majors to access and interpret primary scientific literature, grades earned for this assignment were generally quite high, with an average grade of 86 ± 10% (range: 51–99%). The average RPP grade was 10% higher than the average exam grade for the class, a finding consistent with a generally strong performance on the RPP. There was no relationship between exam performance and RPP performance (R2 = 0.10), suggesting that some students who do not perform well on examinations were able to excel at the RPP (and also the corollary). Indeed, the student with the greatest RPP grade-exam grade difference (31%) had an exam average of 65%, yet earned top marks for the RPP. This suggests that the RPP may be able to capture the interests of some students who otherwise do not fully apply themselves in traditional, exam-based courses. The lack of correlation between exam scores and RPP grades also reflects the inability of some students who normally excel at examinations to transfer their skills to the RPP.
Number of primary sources used.
One of the requirements of the RPP was to use at least nine information sources, of which four needed to be primary literature (see METHODS). Other acceptable sources included web pages, review articles, reference texts, books, brochures, etc. Most of the students (80%) used more than the required number of primary journal articles, and web sources were only 38% of the five "other sources."
|
DISCUSSION |
|---|
|
TOPAbstractIntroductionMETHODSDISCUSSIONGRANTSREFERENCES |
|---|
The RPP assignment capitalizes on the general interest in health–one’s own health and the health of loved ones are topics of great interest. A 1995 survey by Miller (8) indicated that 70% of Americans found medical news interesting, while a survey at a liberal arts institution not unlike Earlham (2), indicated 68% of non-science majors had a high level of interest in health and human disease. Although we have not conducted such a survey of our own students, our experience with the RPP and other projects suggests that Earlham students are similarly intrigued. Perhaps students are motivated by the near certainty that they or people they know and love will fall out of health, be diagnosed with an ailment, and be prescribed a treatment, and will thus want to lay a foundation of understanding with which to meet this occasion, or perhaps act as advocates by asking, "is this the only/best treatment available," or simply, are curious.
Regardless of the reason(s) for interest in the topic of human health, it is unlikely that students are prepared to meet the challenge of gathering and critically analyzing health information. Only one in nine Americans, and only 20% of college graduates (8), consider themselves to be well informed about science and technology. If the desire is to be a health advocate the picture is dim as well. About one-half of college graduates in the Miller survey (8) said they felt they could make sound decisions about scientific results reported in the media. Curiously, the Drury undergraduate survey (2) showed that though only 48% of non-science majors feel they have a grasp of the process of making discoveries in science, more than 80% feel they can grasp the scientific findings and supporting statistical data reported by the media. This may hint at the differing abilities required to comprehend a popular account versus a primary literature account of a scientific discovery.
The current trends in both the information gathering practices of young adults (7) and direct-to-consumer drug advertising (6), add their own layers of difficulty for anyone trying to be a smart health consumer and/or advocate. Students are increasingly comfortable with web sources of information, and, given the option, might choose to use web pages exclusively rather than blending the web with other possible sources of medical information including primary sources (7). Interestingly, the Pew Internet and American Life Project has found that more than half of those who recently conducted health searches online did so on behalf of someone else, reinforcing the "caregiver" training of the RPP (13). This Pew Internet and American Life Project further found that the percent of Internet users seeking medical/health information online has been increasing recently (an increase from 62% to 80% last year) and that the most common task is researching specific diseases or medical problems, followed by researching specific treatments or procedures (13). Since the RPP trains students to use primary literature, in addition to other sources, for these same and increasingly common tasks, it follows that the RPP may be enabling our students to move "beyond" the summaries, interpretations and distillations of web page information, and into the original evidence found in the primary scientific literature.
Without the type of guided experience that projects like the RPP offer in accessing scientific literature, students might not know (beyond web sources) what information tools are available. More importantly, they likely would not know how to evaluate the safety and efficacy of the information espoused in any of these sources. Given the number of pharmaceutical, surgical, and nontraditional options for most afflictions, and the aggressive marketing campaigns associated with some of them, it is not always clear which treatment regimen is most effective, or safest, or simply the most current and well funded. Along these lines, students are encouraged to compare the efficacy and safety of the treatment studied in their in-focus article with other treatment choices for their RPP poster presentation.
With this library-based research project, we hoped to facilitate student use of medical evidence in their current course and, perhaps more importantly, in their future personal health decisions. Indeed, our results indicate that the RPP enabled our students to find, assess, and base health decisions on medical evidence, including that in primary literature. Moreover, the RPP was pertinent to the course in terms of the biology content encountered, and it engaged students in the activities of scientists in terms of learning how to interpret graphs and in critically evaluating the literature.
One of the successes of the RPP was the verification that primary literature can serve as a valuable learning resource for non-science majors. The value of using primary literature in undergraduate science programs has been convincingly shown (5). But this experience is often reserved for upper-level classes within science majors. With only rare exceptions (11) are non-majors exposed to scientific literature, experimental design, or clinical trials, let alone expected to use them. But, from our course and its evaluation, we conclude that non-science majors are capable of finding, interpreting, and critiquing primary scientific literature. The basis for this conclusion is that the students were generally able to speak clearly and with accuracy about the experimental design and details of the results in their in-focus paper. In fact, through their oral presentation of the research and ensuing discussions, students generally performed well in answering questions about the adequacy of control/placebo groups, and were able to give reasoned, justified conclusions on the quality of the research in their in-focus paper. Finally, as described in RESULTS, the grades earned on the assignment were generally high, relative to other assignments, and were consistent with strong performance.
From the standpoint of reforming science education, the RPP works as well. By now many reports (9, 10) have been issued suggesting that students learn more if they feel connected to the material and understand that science is not a set of distilled facts, but is instead a process that is still in process and which is meaningful and relevant in their lives. Even if students realize that science can deliver good things (8), they likely do not grasp the process leading up to that delivery, thus making it even harder to see any possible way they might intercede, manipulate, or otherwise apply the product of science. With the RPP, because we are giving students the chance to shift their subject position from student (or later from patient), to researcher and presenter, they engage with science on a different level and even engage in a "teaching to learn" position (1). Such techniques are often used to increase interest in a topic but here it can help shift the learning to the student and also to shield them from emotional overinvolvement (i.e., if they were actually making health decisions). Prior research has shown that, besides helping students to master a topic, teaching the topic to others and engaging it in a "real world" sort of way increases student competence and confidence (1).
Moreover, the RPP is surely an active form of learning, because students are responsible for choosing a disease/treatment, collecting and analyzing appropriate literature, culling that literature down to one piece they find to be exemplary (for the in-focus paper), and using that piece as the basis of their poster, in which they communicate to an audience their sense of this disease and its treatment options. In an article outlining five principles of making science teaching relevant, Art Hobson said, "Nonscientists have little need for scientific techniques, but an urgent need to integrate science into their lives" (4). To this end, Hobson lists "make it modern" and "make it social" as two of the five key principles (4). We feel that the RPP is successful in these two principles. In fact, during their oral poster presentations, many students divulged information from their personal lives about loved ones with the diseases they chose to work on in their RPPs. This helped to make the process and the information more meaningful to themselves and to the student audience and demonstrated that learning tied to experience can have added power (4). Furthermore, almost all of the oral poster presentations were followed by numerous follow-up questions and an exchange of personal stories from the student audience, making for a lively social interaction, which added a "common community" feel to the experience.
It is possible that a non-RPP class activity may have influenced the success of the RPP. Specifically, the same class that did the RPP had a regular laboratory activity at a local retirement center. For this lab activity, students were paired up with an elderly individual for whom they performed some basic health measures (peak expiratory flow rate, systolic and diastolic blood pressure, heart rate, and percentage of body fat). They also socialized and did aerobic exercises with them. It is possible that some of the students gained a heightened awareness of the fragility of health, and therefore became more personally involved in the RPP. Interestingly, very few of the disease/treatment combinations chosen by the students were specifically related to the aging process or affected the individuals with whom they were paired.
In summary, we have found that the RPP, which asks students to act as "hypothetical patients" and focus their attention on reading, assessing, and presenting original clinical trials, brings about positive changes in our human biology students. These non-science majors were able to successfully access and assess primary scientific literature for evidence of treatment efficacy and safety, and, as a result, felt empowered by the RPP. The instruction in library resources that underpins this project may serve as the basis for important lifelong learning.
|
GRANTS |
|---|
|
TOPAbstractIntroductionMETHODSDISCUSSIONGRANTSREFERENCES |
|---|
|
Acknowledgments |
|---|
Received for publication August 13, 2003. Accepted for publication June 18, 2004.
|
REFERENCES |
|---|
|
TOPAbstractIntroductionMETHODSDISCUSSIONGRANTSREFERENCES |
|---|
This article has been cited by other articles:
|
|
 |
|
  B. Buckner, J. Beck, K. Browning, A. Fritz, L. Grantham, E. Hoxha, Z. Kamvar, A. Lough, O. Nikolova, P. S. Schnable, et al. Involving Undergraduates in the Annotation and Analysis of Global Gene Expression Studies: Creation of a Maize Shoot Apical Meristem Expression Database Genetics, June 1, 2007; 176(2): 741 - 747. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Gillen Criticism and Interpretation: Teaching the Persuasive Aspects of Research Articles CBE Life Sci Educ, March 1, 2006; 5(1): 34 - 38. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Visit Other APS Journals Online |
