Advan. Physiol. Edu. 32: 152-156, 2008;
doi:10.1152/advan.00103.2007
1043-4046/08 $8.00
ADV PHYSIOL EDUC 32:152-156, 2008
© 2008 American Physiological Society
HOW WE TEACH
Using truncated lectures, conceptual exercises, and manipulatives to improve learning in the neuroanatomy classroom
Johanna Krontiris-Litowitz
Department of Biological Sciences, Youngstown State University, Youngstown, Ohio
Address for reprint requests and other correspondence: J. Krontiris-Litowitz, Dept. of Biological Sciences, One University Plaza, Youngstown State Univ., Youngstown, OH 44555 (e-mail: jkrontirislitowitz{at}ysu.edu)
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Abstract
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Functional Neuroanatomy is a course designed to help students learn the function and anatomy of the human nervous system. Historically, students have had difficulty with the spinal tract curricular unit and frequently resorted to memorization to "learn" the material. They performed poorly on exams and failed to demonstrate competence in the functional application of their knowledge. In an effort to improve learning and promote critical thinking in this course, the instructor revised the curriculum to include 1) shorter, less detailed lectures; 2) a set of practice problems that presented the spinal tracts in an applied context; and 3) a manipulative, which was composed of a magnetic bulletin board and a kit of magnets representing structures of the nervous system. Student learning, as assessed by summative exams, improved under the revised curriculum. Scores on knowledge, analytical, and synthesis questions were significantly higher than scores from previous classes using the traditional lecture curriculum (P < 0.05). This curricular protocol could potentially be applied to other topics where students resort to memorization and fail to comprehend concepts and processes.
Key words: active learning; critical thinking; formative assessment; neuroscience; problem-based learning; student-centered learning
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Introduction
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PHYSIOLOGY is an discipline where concepts, terms, and structures are not readily visualized. In some cases, laboratory activities can be used to demonstrate concepts, but this approach has limited application as students advance in the discipline. Concepts associated with advanced classes often require complex experiments, protocols, or technology that is too sophisticated, too expensive, or too time consuming to realistically address in a laboratory. Without these experiences, students have difficulty understanding the physiology and may resort to memorization to pass a course. Little real comprehension has occurred in this situation, and frequently students cannot apply their learning to problem solving.
Some educators have suggested that the key to improving student learning is to remodel the lecture presentation (22). While the educational literature presents many models and approaches to changing the lecture presentation, most focus on a common goal: reducing student dependence on the instructor for learning and understanding (12, 18, 19, 25). Studies have indicated that if instructors reduce information transfer at lectures, students must assume more responsibility for learning. Thus, by refocusing lectures such that they no longer provide students with an extensive and detailed picture of the topic but rather present a global perspective with seminal concepts guiding the topic, the instructor can encourage student to acquire knowledge and understanding through their own efforts.
A key component of learning in any context is formative assessment, a valued method for testing personal understanding in the classroom (2, 13, 24). With formative classroom assessment, the student is given an activity such a quiz or discussion question in which they can test their knowledge, reflect upon their understanding, and correct their deficiencies. It is particularly important in student-centered learning because it encourages the student to investigate the extent of his/her knowledge and supplement it as necessary. In this way, it helps the student take an active role in learning, not only by evaluating what they know but also by practicing it and possibly by acquiring missing knowledge.
Another issue, student learning style, plays a key role in cognition and should be integrated into any curricular project aimed at enhancing learning. Researchers have identified four learning styles prevalent in the classroom, and studies have demonstrated that effective curricula need to accommodate some combination of them (7, 16, 20, 21). Unfortunately, the traditional lecture format falls short in this area and preferentially addresses one learning style: auditory learning. On those occasions that the lecture includes images, diagrams, etc. in the presentation, a second learning style, visual learning, might also be incorporated. Realistically, the value of either can be diminished in a classroom where the bulk of the information is transmitted so rapidly that the student is unable to synthesize what they see and hear.
This project addresses student learning problems observed in Functional Neuroantomy, a course serving junior- and senior-level undergraduate biology majors as well as graduate students in biology and physical therapy at Youngstown State University (YSU). In this course, students learn the function and anatomy of the central nervous system. This demands that students acquire an extensive topic vocabulary while learning processes and concepts. Prior to this study, students had difficulty with the spinal tract curricular unit, which taught the anatomy and function of the spinal tract. They performed poorly on exam questions assessing the topic and failed to demonstrate thorough comprehension of the functional application and practical understanding of lesions and injuries to these tracts. Initial attempts to resolve these problems involved revising class lectures, emphasizing the many excellent diagrams available in the textbook, and encouraging students to use text-associated study aids. While this improved student performance on content and recall questions, it did not improve higher-order thinking and problem solving associated with the functional physiology of the tracts.
In an effort to improve learning in the spinal tract unit, the curriculum was revised so that it shifted the responsibility of learning to the student and incorporated collaborative learning, formative assessment, and the use of a manipulative. The first key change in the revised curriculum was in the lecture presentation. The new lectures were shorter, less detailed than in the past, and presented a global view of the topic rather than a detailed presentation of anatomic facts. The second key change involved formative assessment and student practice. A set of problems/case studies were developed to present the spinal tracts in a clinical context and to challenge the students' understanding in escalating steps. Finally, the instructor developed a manipulative: the Spine Board, which was composed of a magnetic bulletin board and a kit of magnets that represented structures and components of the nervous system. The Spine Board was used by students to solve questions as well as represent the solutions.
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METHODS
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Protocol.
Students attended an initial lecture and then proceeded to the laboratory. In the laboratory, they answered questions, discussed case studies, and solved problems about the spinal tracts using the Spine Board manipulative. Student learning was assessed via performance on laboratory quizzes and selected exam questions. Nineteen students participated in this study. The protocol for this study was reviewed and approved by the YSU Human Subjects Committee.
Lecture presentations.
Two 1-h lectures presented a brief overview of the spinal cord, identified the spinal tracts and major anatomic components, and provided a short discussion of function. Presentations were shorter than in the past and focused upon two specific learning objectives. First, by the end of the class, it was expected that students would understand how the topic integrated with previous course material. Second, it was expected that students would understand how the topic contributed to one of the major course objectives, neural control of motor activity. Lectures were presented in a PowerPoint slide format using diagrams and figures from the textbook and the World Wide Web. Students could access the PowerPoint files prior to class at the course website.
Laboratory sessions.
Students worked in teams of two or three during laboratory sessions to answer a set of practice questions (Table 1) in which they were asked to reproduce pathways of identified spinal tracts, create neural circuits for identified motor function, or analyze motor activity for lesions or injury. They were encouraged to use their lecture notes and textbook as resources. Half of the class used the magnetic Spine Board to answer questions (Spine Board group), and the other half of the class used pencil and paper to answer questions (pencil-and-paper group). Baseline understanding of the topic was assessed in both groups before the activity with an initial quiz (QU1). After each team of students finished their activity, they took a second quiz (QU2) to assess postactivity understanding. The efficacy of each learning activity was evaluated as a value-added measure where the difference between QU1 and QU2 was calculated and analyzed. Learning was defined as a significant difference in the value-added means between the groups. After students completed QU2, they worked on a second set of problems using the questions and protocol they had not tried initially so that by the end of the laboratory, all students had used both the Spine Board and pencil-and-paper protocol.
Spine Board manipulative.
The Spine Board (Fig. 1) was composed of a magnetic bulletin board and a kit of magnets shaped and labeled to represent structures of the central nervous system. The tool kit contained magnets of brain regions, spinal regions, spinal tracts, brain pathways, axons, somas, synapses nerves, and lesions. Students used the Spine Board to recreate the neural circuit or schema that represented the solution to the practice questions.
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Fig. 1. A photo of the Spine Board and magnets. The solid line diagram represents the spinal cord and brain regions. Black magnetic strands show ascending tracts; red magnetic strands show descending tracts; red circle magnets show somas; black squares show axon terminals; yellow magnets show brain regions; and "X" magnets show lesions.
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Assessment.
The function of the assessment was threefold. First, QU1 and QU2 served as a formative assessment, informing students about the extent of their learning and understanding. Second, the contribution of the Spine Board to learning was assessed by comparing student learning with and without use of the Spine Board. This was accomplished by comparing the value-added scores between the Spine Board and pencil-and-paper groups. The third function of the assessment was to determine whether or not the revised Spinal Tracts curriculum promoted learning more effectively than the curriculum used in previous years. This was evaluated by comparing current student performance on final exam questions with previous student performance.
Each exam and quiz was composed of questions that assessed three levels of cognitive function: 1) knowledge and comprehension, 2) application and analysis, and 3) integration and synthesis (3, 4, 10). Exam questions classified as knowledge-based questions tested student command of topic vocabulary, neural pathways, and nervous system anatomy. Analysis questions tested the students' ability to analyze underlying neural control of specific components of motor activity using content knowledge of pathways. Integration questions, which tested the students' ability to analyze the underlying neural control of motor activity in real-life situations, required that students integrate knowledge of the spinal tract with prior and subsequent knowledge (sample questions; Table 2).
Student surveys.
Student opinions of the Spine Boards and laboratory activities were collected using a self-reporting survey that was scored using a Likert scale (Table 3).
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RESULTS
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Evaluation of student learning.
The effect of the Spine Board on student learning was evaluated in the laboratory using pre- and postactivity assessment. The mean score for the class on the preactivity assessment (QU1) was not significantly different from the mean score of the Spine Board group or the pencil-and-paper group (P > 0.05; Table 4). The mean score on the postactivity assessment (QU2) was also not significantly different among the groups (Table 4).
There was, however, a trend observed in the value-added scores among the groups (Table 4). The value-added score of the Spine Board group was greater than that of the pencil-and-pencil group; but, again, these results were not significant (P = 0.061). All but one student scored better on QU2 than QU1. There was a significant difference in scores when critical thinking questions were compared (P = 0.014). Paired analysis showed that the value-added scores for analytical and application questions increased by 29.4% (±7%, n = 8) in the Spine Board group versus 17.9% (±0.2%, n = 9) in the pencil-and-paper group. No significant differences in value-added scores of knowledge-based recall questions were observed (P = 0.49).
Summative student learning was assessed on exams where mean normalized scores of knowledge-based questions, analysis questions, and integration/synthesis questions were evaluated separately (Table 2). These scores were compared with exam scores from a previous class that used a traditional lecture curriculum. The traditional curriculum class was similar in enrollment and composition to the class using the revised curriculum. Both classes were composed of two student populations: graduate students in biology and physical therapy and baccalaureate students in biology. Students in physical therapy made up 50–60% of each class, and the remaining enrollment was distributed among biology graduate and undergraduate students. Student preparation was similar in both classes. All students had satisfactorily completed the prerequisite physiology course before entering the class. Also, all biology and physical therapy graduate students met the entrance requirements of their respective programs. and, consequently, the preparation of this student population did not differ between traditional and revised curriculum classes. A comparison of summative exam performances showed that students using the revised curriculum scored significantly higher on all categories of questions (P < 0.05; Table 5).
Student evaluation of the Spine Board.
When surveyed about the Spine Board, the majority of students thought that it was easy to use and helped them learn the anatomy of the spinal tracts (Table 3). They also reported that the Spine Board helped them clarify function, recognize misconceptions, and gain a global understanding of the spinal tracts. Eighty-five percent of the class reported that the Spine Board helped them clarify the function and sidedness of the tracts. More than half of the class (62%) reported that the Spine Board pointed out misconceptions that they had about structure or function of the tracts. Finally, 82% of the class agreed that the Spine Board helped them understand how the spinal tracts coordinated with brain regions. Students recognized, however, that the Spine Board alone was not responsible for successful learning, and 89% of the students reported that working with classmates helped them clarify their understanding of the spinal tracts.
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DISCUSSION
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This study demonstrates how truncating lectures, integrating student practice problem sets, and providing an image-based manipulative in a Functional Neuroanatomy course enhanced learning. Results of summative examinations showed that the revised curriculum promoted learning in content knowledge, analysis, and integration. In addition, this curriculum proved to be an improvement over the previous traditional lecture curriculum as students in the new curriculum scored higher on knowledge, analysis, and integrative questions than students in the traditional curriculum. While these results demonstrate that holistically the revised curriculum enhanced learning, analysis of the specific curricular components indicated that each contributed independently and differently to learning.
For example, use of the Spine Board manipulative to answer questions and problems enhanced learning and improved analytical skill learning beyond what was achieved by doing practice problems using pencil and paper. An analysis of the postactivity quiz scores indicated that even though both the pencil-and-paper group and the Spine Board group improved after problem-solving sessions, the Spine Board group had a greater improvement in scores on higher-order thinking questions. These results are consistent with previous investigations that used manipulatives to improve learning. Studies have reported that manipulatives improved comprehension in college chemistry and life science classrooms by helping students visualize molecular structure and associated function (3, 8, 9, 11, 14). In addition, extensive research in the precollege classroom, especially in mathematics, has shown that manipulatives are a valuable tool for increasing comprehension and improving analytical skills (5, 6, 17, 23).
The second component of the revised curriculum, the truncated lecture, was also key to improving learning. By eliminating details, providing students with minimal information, and focusing instead on a global view of the topic, this lecture format was able to shift the roles of instructor and student in the classroom such that the instructor's role was diminished (24). This was reinforced in the laboratory, where the instructor continued in a diminished role and acted only as a resource and facilitator of learning and not as a source of answers or knowledge. In contrast, the student's role in the learning process increased such that the student was expected to identify relevant or missing information and then be responsible for acquiring it. This was fostered in the laboratory by the practice problems that, along with the instructor, guided student inquiry.
Finally, the third component of the revised curriculum, the practice problem set, was shown to be an effective learning activity independent of the rest of the curriculum. By doing practice problems in the laboratory, students significantly enhanced learning as evidenced by the improved postactivity quiz scores. Practice problems incorporated several pedagogical practices attributed to enhancing learning. First, by working in teams to solve problems and answer questions, students incorporated a valued learning tool, collaborative learning, into the activity (15). Second, practice problems were designed such that they could not be answered readily using the information presented in lecture. Students needed to investigate the topic and acquire additional knowledge on their own to answer questions. Finally, as with any problem set, this exercise provided students with the opportunity to practice their skills and test their knowledge. While this study did not independently measure the contributions of student-driven learning, collaborative learning, and self-testing, it did assess their composite value to enhancing learning through value-added quiz scores.
A self-reporting survey indicated that students felt positive about using the Spine Board as a learning tool. They reported that they enjoyed using the Spine Board, thought that it clarified difficult concepts, helped them recognize misconceptions, and enabled them to envision the global application and function of the spinal tracts. These data reaffirm that the revised curriculum aided students with higher-order learning such as application, analysis, and integration with other knowledge. The survey also suggests that students gained an appreciation for the manipulative as a learning tool, presenting the tantalizing possibility that an instructor may be able to influence student learning preferences.
This study demonstrates that a revised curriculum composed of truncated lectures, practice problems, and a manipulative was able to enhance learning. While the results show that each component of the curriculum contributed to learning in a finite way, they also indicate that neither lecture nor problem sets nor manipulatives functioned alone and that, in fact, their respective contributions were integrative and possibly synergistic.
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GRANTS
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This project was supported by a Teaching Career Enhancement Award from the American Physiological Society.
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Acknowledgments
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The author thanks the American Physiological Society for support and Patti Thorn for professional advice in the implementation of this project.
Received for publication November 14, 2007.
Accepted for publication January 30, 2008.
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Abstract
Introduction
