| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
ILLUMINATIONS
Department of Biology
University of Dayton
300 College Park
Dayton, OH 45469-2320
E-mail: Carissa.Krane{at}notes.udayton.edu
doi:10.1152/advan.00035.2005
"Why do I need to know this?" A question that is thought, if not spoken, by students that challenges both instructors and students in a physiology laboratory course to bring relevance and context to the information presented. In an attempt to address this question, instructors challenge students to bring perspective and meaning to the experiments performed in a formal laboratory course by encouraging them to apply the knowledge they have gained through problem-solving exercises that involve real-life situations. Yet, for some students, there is a disconnect between what information is retained in the physiology laboratory exercise and its application in a practical setting. This failure to synthesize the principle material, its meaning and application, is at times expressed by the student in terms of the relevance of the exercise: "Why do I need to know this?" or "When am I ever going to use this information?" In the absence of meaning, many students tend to factually memorize information in a static pattern rather than process information and formulate strategies for truly understanding the dynamism that is physiology. Faced with this teaching/learning obstacle, we attempted to provide undergraduate students enrolled in a one-semester upper-level physiology laboratory course with a learning opportunity designed to extend the individual lessons performed in the laboratory course with self-directed learning through the contextual application of information in a clinical setting. To accomplish this task, we implemented a "Special Topics: Experiential Learning" exercise as part of the University of Dayton physiology course curriculum. The purpose of the exercise was to "bring to life" the experiments students conducted during the semester.
Throughout the semester, students performed a panorama of experiments in human physiology, including sensory physiology, nervous reflexes, electromyography, electrocardiogram, blood pressure, hematological assays, spirometry, urinalysis, and digestion laboratory exercises. The Special Topics: Experiential Learning exercise served as the capstone for the course. It involved one 3- to 4-h learning activity outside of the classroom setting, where students observed a physician, veterinarian, nurse practitioner, physical therapist, podiatrist, speech pathologist, scientist, or any other health practitioner as approved by the instructor. The goal of the exercise was to view the interactions of the health professional with patient or the experiments performed by the scientist in terms of the physiology involved. Because many students with an academic major in the areas of Biology, Biochemistry, Chemistry, Pre-Medicine, Pre-Dentistry, Pre-Veterinary, Pre-Physical Therapy, and Pre-Health Profession are already involved in outside volunteer or job shadow activities in a healthcare setting or undergraduate research in a research laboratory, we emphasize that this is NOT a job shadow but, rather, an opportunity to view "physiology in action." The learning objectives were threefold:
To coordinate this experience, students were given a selection form where they ranked their top three choices for the specific area(s) of interest for this exercise within medical subdisciplines (obstetrics-gynecology, cardiology, nephrology, geriatrics, pediatrics, orthopedics, or internal medicine) or in one of the fields listed above. The instructor then worked with professionals in the area to accommodate student requests for the active learning opportunity by initiating contacts and making arrangements. We found that many local hospitals in the Dayton, OH area have medical education directors who will coordinate shadow opportunities for students with volunteer mentors in the field of the student's choice. Students may also elect to arrange their own experience with instructor approval. Before the day of the visit, students were trained on patient confidentiality rules and were expected to comply with Health Insurance Portability and Accountability Act of 1996 standards as implemented at the location at which they shadowed. Students were advised of the professional requirements of the workplace, including appropriate dress and conduct. The 3- to 4-h block of time dedicated for this exercise was scheduled as part of the normal class meeting time, usually during the penultimate class of the semester. Pending their assigned mentor, students may or may not have had an opportunity for hands-on participation. Students were encouraged to talk with and ask questions of their mentor and to bring along a notepad to take notes.
Accountability for participation was twofold: students were required to prepare a written summary and presented an oral case study of their experiential learning activity. Students were given the following instruction as a guide for their case study before their participation in the activity:
"At the conclusion of this activity, you will be asked to generate and present a ‘case study’ that provides a detailed analysis of one aspect of your experiential learning activity. Use the following as a guideline for your report:
- State the physiological ‘problem(s)’ or situation(s) that you encountered. Provide detailed information obtained from your observation and conversations with the professional you observed.
- Describe in detail the techniques/methods/tools etc. that the professional that you observed employed in dealing with the situation. Did the professional use any of the physiological assessment tools that you are now familiar with after this course? Ask questions and take notes with regard to the techniques/methods/tools used during your experiential learning activity. Supplement the information gained from your conversations with primary and review literature, textbook, and other appropriate sources to provide a comprehensive picture of ‘what,’ ‘how,’ and ‘why’ the methods you observed were used in the situation you describe.
- Provide an in-depth discussion of one aspect of your observation and relate the experience as it pertains to relevant physiological processes. For this section, because you are likely to see a number of different patients/situations, the topic of discussion is your choice and is based on your individual and unique observational experience in which you participated (clinical or research). If you chose a clinical observation, provide a detailed description of the physiological system(s) or process(es) examined in a clinical setting in relation to the pathophysiological condition(s) you observed. If you chose to observe a scientist, provide an overview of the hypotheses tested in the investigator's laboratory and potential implications of their research. You must provide four to five outside references other than your textbook in your discussion.
- Evaluate the value of this exercise and its relevance to learning physiology. Did you find it a useful tool in learning physiology? What did you learn through this activity?
Reports should be two to three single-spaced pages in length, although you are encouraged to write as much as you wish. Reports are due the final day of class. The oral presentations take place on the last day of class and should be 5–10 minutes in length. You are encouraged to bring visual aids, although such aids are not required."
The following is an abbreviated example of a case report written as a result of this Experiential Learning exercise:
"I observed an emergency room physician in the Miami Valley Emergency and Trauma Center. When I first arrived a patient had been in the emergency room because she had not been feeling well. The patient has regularly scheduled dialysis, three times each week. The patient had missed her previous dialysis appointment due to not feeling well and as a result was feeling worse. She presented with a general ill feeling and some difficulty breathing as well as hypertension, a chronic problem. She was evaluated initially by a physical exam where the symptom of fluid buildup in the lungs was discovered as well as shortness of breath. The patient was placed on oxygen to help with the shortness of breath. Blood was drawn for lab work and hyperkalemia was discovered by the results of these tests. Her blood work came back with a potassium level of 7.5 mEq/L while normal levels are in the range of 3.5–5.0 mEq/L (citation). Her lungs, when auscultated, had rales or crackles (citation). Rales are a sign of fluid buildup in the lungs. Both of these symptoms were determined to be due to the missed dialysis appointment two days prior to her presentation in the ER. The physician was concerned about possible arrhythmias and other cardiac problems due to the dangerously high potassium concentration (citation). Severe hyperkalemia was treated with the administration of calcium gluconate which helps to re-establish the normal membrane potential difference between threshold potential and resting membrane potential in an attempt to prevent any cardiac compromise (citation). An amp of D50 (glucose) was administered as well as insulin. The glucose and insulin were given to stimulate glucose coupled cellular uptake of K+ (citation). The patient was also given bicarbonate to increase blood pH (citation). To combat the pulmonary edema the patient was suffering from the physician gave the patient Lasix. The Lasix (active ingredient is furosemide) works as a loop diuretic to block the Na+-K+-2Cl– co-transporter present in the thick ascending limb of the loop of Henle, and would help to increase the amount of urine excreted and decrease the absorption of Na+ and K+ ions, thereby driving down blood pressure, driving fluid out of the lungs, and also combating the hyperkalemia (citation). This overall increase in the excretion of ions will help to decrease the potassium levels. In addition to these emergency treatments for hyperkalemia the physician wanted to have the patient dialyzed as soon as possible. The physician consulted with a nephrologist who agreed emergency dialysis was necessary for this patient. The patient was going to be admitted for monitoring and was scheduled for dialysis immediately. This experience was a good opportunity to see the application of the laboratory experiments we conducted throughout the semester (osmolarity/tonicity, ion/fluid balance, dialysis, auscultation, blood pressure, urinalysis, kidney function, hematology) in practical situations. The opportunity to discuss the rationale for each of the tests preformed and then the treatment in response to those test results was the most beneficial. I have had previous experiences in the healthcare setting and specifically in the emergency room but have not previously had the opportunity to discuss in detail with the physicians reasoning behind treatment with an understanding of physiology myself. Applying the concepts learned in lecture and lab to real clinical settings and seeing how physiological function can be changed by treatments which I understood was really neat. Seeing physiological changes in a person over short periods of time, while at the same time understanding the mechanism of the treatments administered, is amazing. I felt knowing what effect a certain treatment was going to have on the body by understanding the way the human body works prior to the administration of a treatment was an excellent way to gain a greater understanding of physiology. Through this experience I have also come to realize the best way to truly understand the way the human body functions is to understand pathophysiological conditions and how they can be treated. Knowing how to fix a subject when it is broken is the best way to truly understand the subject it self. The experiential learning helped me to begin to understand physiology in this way."
Approximately 270 students over the course of 4 years have participated in this exercise, and the response has been overwhelmingly positive. The following is a sampling of comments made by students evaluating this exercise:
A small minority of students (1–2 students/semester) have expressed disappointment with their experiential learning activity. Because this exercise occurs in the "real world," a few students have experienced scheduling conflicts associated with the clinical/research setting. A few students have reported that the physicians to which they were assigned were unavailable at the scheduled time or were running late. A small number of students have been disappointed when surgeries that they have been scheduled to watch were canceled or the patients scheduled to be seen canceled unexpectedly. A few students reported that their mentor experienced a very busy day and spent little time explaining what was happening, while a few others reported following their mentor on "rounds" where physician-patient interaction was limited, and, therefore, what the student experienced was "uneventful." In these cases, students were given the option to repeat the activity with a different mentor or to research and report on a topic of interest to them. The students who experienced such conflicts expressed diminished enthusiasm for the exercise and reported that the exercise did not facilitate their learning of physiology. This type of negative response, although rare, suggests a qualitative advantage to those who participated in the exercise versus those who did not and a willingness by the students to objectively evaluate the exercise. Student colleagues were eager to share their stories, and, therefore, all students were informed of the types of observations that other students participated in.
In conclusion, we found this exercise to be an excellent supplement to classroom experimentation, which allows student learning to extend past classroom walls and into real world settings. This Special Topics: Experiential Learning activity could be adapted as part of any physiology course (majors/nonmajors), because the learning objectives and expectations for the rigor of the oral and written reports is determined by the instructor. It is relatively easy to implement into an existing course and does not impose additional cost or equipment. Moreover, students are given the opportunity to witness the use of state-of-the-art technology and equipment not commonly used in a formal physiology laboratory course. Finally, student interactions and conversations with professionals outside of the classroom further inspire student interest in physiology as well as enhance integrated student learning from the perspective of the student.
 |
Acknowledgments |
|---|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Visit Other APS Journals Online |
