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TEACHING IN THE LABORATORY
Department of Physiology, Faculty of Medicine, Hacettepe University, Sihhiye/Ankara, Turkey
Address for reprint requests and other correspondence: Z. D. Balkanci, Dept. of Physiology, Faculty of Medicine, Hacettepe Univ., 39, Sihhiye/Ankara 06100, Turkey (e-mail: zbalkanc{at}hacettepe.edu.tr)
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Abstract |
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 TOP Abstract IntroductionMETHODSRESULTSDISCUSSIONREFERENCES |
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Key words: physiology education; lectures; teaching laboratories
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Introduction |
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TOPAbstractIntroductionMETHODSRESULTSDISCUSSIONREFERENCES |
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The main educational models used in Turkish medical faculties are teacher centered and mixed, whereas in a small number of them, student-centered models are used. The courses are mainly traditional didactic lectures together with various teaching techniques for active participation of the students (17–19).
The National Core Curriculum (NCC) prepared by the Medicine Health Education Council in 2002 aimed at the standardization of medical education. Although this program determined the basic content of physiology courses in medical faculties regarding local priorities, the final decisions about the ratio of lectures and practical sessions and the subjects of practicals are left to the faculties or departments.
In a previous study (21) examining medical physiology courses of 117 medical faculties in 50 different countries throughout the world, it was found that the teaching methods, duration of lectures, course content, and assessment of students differed in different geographical regions. A recent study (4) analyzing the teaching programs of 32 European medical faculties established that the number of physiology class hours is different and more or less than the minimum requirements suggested by the European University Association (EUA).
The Turkish Medical Association (TMA) prepares reports (17–19) regarding the status of undergraduate medical education in Turkey every 2 years. There is insufficient information about physiology education in Turkish medical faculties other than these general data.
The physiology departments of medical faculties in our country are responsible for the physiology courses of other faculties, such as dentistry, pharmacy, and various colleges and faculties related to health sciences, in addition to that for medical students. In the present study, we aimed to determine the general status of undergraduate physiology training of medical students in Turkey. There has been no previous study on this subject as far as we know. We consider that we have created a source of information that can be helpful in comparing the possible changes in physiology education in the future and also useful for national standardization studies.
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METHODS |
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According to the undergraduate medical education report of the TMA, 42 faculties were present at the time this study was started. We determined 38 faculties having academic personnel in physiology departments and continuing education at least for 3 years. The educational models, years of establishment, and student admission are shown in Table 1. Departments were informed about the aim of the questionnaire by interviewing either the Chair of the department or one of the academic personnel before the forms were sent, and we requested them to fill out the forms in accordance with the program they used for medical students only. When an inconsistency between the two parts of the questionnaire was detected, the person who provided the information was contacted, and, whenever possible, the voids were filled following telephone conversations. Data were collected between the years of 2003 and 2005. All of the 38 departments (100%) answered the questionnaire; however, in some faculties, all the desired information could not be obtained due to incomplete filling of the questionnaire or due to discordance of the issues in the student-centered educational model employed.
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RESULTS |
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TOPAbstractIntroductionMETHODSRESULTSDISCUSSIONREFERENCES |
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The lectures and teaching laboratories are carried out by the academic staff and instructors; assistance from other teaching personnel (postdoctorates, research assistants, master, and doctorate students) is required for practical sessions. The number of academic staff and instructors in 38 physiology departments was 1–17 (mean 5 ± 3.4); the number of total teaching staff was 1–27 (mean 9 ± 6.6).
The ratio of students in the second year of the study to the total number of teaching staff was 17.5 ± 10.5, ranging from 5.6 to 58, based on the information gathered from all the participating departments.
Class hours of physiology courses. Physiology courses are only in the second year of study in 6 faculties, both in first and second years of study in 27 faculties, and in first, second, and third years of study in 5 faculties. Data about the lectures from two faculties using a student-centered educational model at the time of the present study could not be evaluated since they carry out medical education completely via problem-based learning (PBL) sessions and the lectures are few in quantity, in addition to the fact that their number and content changes each year.
The total number of lectures per student during his/her medical education is 169.3 ± 30.7 lectures in average, ranging from 110 to 238 h. The duration of 1 class hour is reported as 45, 50, or 60 min by different faculties.
Physiology practical sessions are only in the second year of study in 15 faculties, both in first and second years of study in 22 faculties, and in first, second, and third years of study in only 1 faculty. One student participates in 12–64 laboratory hours with a mean of 35.0 ± 11.5 h. The ratio of practical sessions to the total physiology program in 36 faculties, excluding 2 faculties with a student-centered educational model, was 17.1 ± 4.6% in average with a minimum and maximum of 7.6% and 28.1%, respectively.
In five faculties, each physiology lecture is repeated twice, due to the high number of students (three faculties) or two separate classes in English and Turkish (two faculties). The practical sessions in the second years of study are repeated twice in 10 faculties, three times in 1 faculty, four times in 12 faculties, five times in 2 faculties, six times in 1 faculty, and nine times in 1 faculty. Thus, the fraction of time spent on physiology lessons by the teaching staff is greater than the number of physiology lessons per student.
The number of physiology lectures per academic personnel is an average of 54 ± 40 lectures, ranging from 14 to 190 h. This number was reported as 1–20 h in 20 faculties, 51–100 h in 11 faculties, 101–150 h in 4 faculties, and >150 hours in 1 faculty.
It is worth mentioning that, as the number of teaching staff increased, the number of practical hours performed increased. The numbers of academic (R = 0.776) and total teaching (R = 0.754) staff exhibited a statistically significant correlation with the number of practical hours, as established by Pearson analysis using SPPS for Windows 15.0 software (P < 0.01). On the other hand, no such correlation was observed between the number of lectures and the number of academic staff.
Content of lectures. The distribution of lectures based on the subjects was determined according to data obtained from 30 of 36 faculties (83%) due to incomplete filling of the questionnaire. The physiology topics instructed by some departments other than the ones shown in Table 2, such as integrative physiology, are classified as "others." It was found that in one of the faculties, excretory, endocrine, and reproductive physiology lessons are not instructed by the physiology department.
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Practical sessions. Experiments in the practical hours are either carried out by student groups of 2–29 or demonstrated to groups of 8–80 students.
The methods used in the practical sessions are laboratory experiments (38 faculties), demonstration of films (13 faculties), computer simulation and/or animation (21 faculties), and others (3 faculties). "Others" includes observational studies in clinical laboratories and/or studies with models.
In 29 of 38 faculties (76%), students are presented with prepractical written materials in the form of laboratory text (15 faculties), book (8 faculties), or both (6 faculties).
Based on the data from the 38 departments that answered the related issue in the first part of the questionnaire, practicals in blood and circulation physiology subjects are carried out in all of the 38 faculties (100%). The other subjects are listed as follows: muscle physiology practicals in 34 faculties (89.5%), respiratory practicals in 33 faculties (86.8%), peripheral and central nervous system practicals in 30 faculties (78.9%), physiology of special senses practicals in 24 faculties (63.2%), cellular physiology and gastrointestinal system practicals in 19 faculties (50%), metabolism and endocrine system practicals in 10 faculties (26.3%), and renal practicals in 9 faculties (23.7%). In addition to the above subjects, practical sessions on manipulations, such as injection and blood withdrawal using models or human subjects as well as an introduction to devices, which were reported to be performed by five departments, are categorized as "others" (13.2%).
The second part of the questionnaire, including issues about the content and duration (in class hours) of each practical subject, was answered by 35 departments. These results are shown in Table 3. Data on the peripheral and central nervous system and special senses physiology practicals were evaluated together as "nerve and special senses." The time devoted to the practical sessions exhibited great variation among faculties, and this is most pronounced in the blood physiology practical, which ranged from 2 to 28 h.
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The second part of the questionnaire, including issues about the content of each practical subject and equipment as well as blood and circulation laboratories, which are common to all faculties, was analyzed in detail. Based on answers from 33 departments, the list of experiments, number of departments performing these experiments, and whether they are included in the manipulative skills specified by the NCC or not are shown in Table 4, in addition to the main laboratory equipment used in blood and circulation physiology practical sessions. All departments performed hematocrit measurement and electrocardiogram analysis among the various experiments on blood and cardiovascular physiology. Other experiments were performed in different percentages. Table 4 was prepared according to the data as presented by the departments.
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All the faculties make assessments of the physiology practicals either via theoretical examination (10 faculties), an independent examination (18 faculties), or both (10 faculties). The most frequently used method is "independent oral examination with practice," which is applied in 21 faculties. The second most common method of assessment is "multiple-choice questions," which is used in 15 faculties (Table 5). The total number shown in Table 5 is more than the total number of participating faculties since some departments use more than one method of assessment.
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None of the departments indicated any plan to change their current status in their response to the "planned changes in physiology practical sessions in the future years" item in the survey.
There was no significant information about the courses other than theoretical or practical sessions carried out as laboratory introductory lectures, discussion hours, PBL sessions, or small-group discussions. According to the 2004 report (18) of TMA, PBL sessions constitute <10% of the total hours of the faculties using mixed models and 10–25% in six Turkish medical faculties, whereas in 2006, this ratio was reported as 10–25% in most of the faculties (19).
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DISCUSSION |
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TOPAbstractIntroductionMETHODSRESULTSDISCUSSIONREFERENCES |
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The medical faculties in Turkey apply teacher-centered, student-centered, and mixed education models, although, as shown in Table 1, some faculties have changed their model, which is in accordance with the general trend in medical education in the world (5). The number of faculties employing the student-centered model has increased to four faculties in 2006 from two faculties at the beginning of this study (19).
Physiology courses of the medical faculties are mainly given in the first 2 years. The average number of physiology lectures per medical student is 169 h according to the data of 36 faculties. In the report by Somjen (21), the average number of physiology lectures in 77 departments from 50 countries throughout the world is given as 114 h (21). However, this number is much greater in the Middle East, Africa, and Asia compared with Europe and America. The average number of physiology lectures in our country is similar to the numbers in Middle Eastern and African countries, but they exhibit a wide range of 110–238 h. We believe that it is natural that the number of physiology lectures is greater in Turkey since the medical students are high school graduates with no physiology background compared with countries where college education includes physiology courses before entering medical faculties.
Practical physiology sessions cover an average of 35 h in 38 faculties together with the 2 faculties applying the student-centered education model. The percent ratio of this time in total physiology courses is 17.1%, varying between 7.6% and 28.1%. The mean number of practical sessions of 75 physiology departments is 39 h, as indicated by the Somjen report (21). The number of practical sessions is quite low in North America and West Europe, such as 7 and 9 h. On the other hand, in the Middle East, Africa, and Asia, this value increases to 40 h and even over 60 h. It is worth considering that some medical faculties in the United States have no practical physiology lessons (10) and that the hours are decreasing gradually in most of the others.
A study (4) performed by Dusek and Bates analyzing teaching programs of European medical faculties in 2001–2002 specifies the minimum recommended class hours by EUA for physiology/immunology as 192 h. They examined 32 medical faculties and found that class hours exhibited great variations, being above or below the EUA's recommendations in most cases. In our country, there is no minimum number as determined by the NCC. This decision is left to faculties or departments. As featured in the Somjen report (21), the emphasis on physiology topics was similar in different parts of the world, and we determined that the status in Turkey is the same. Despite the variations in class hours assigned to a specific topic, the share of topics in the whole curriculum is similar. For example, the nervous and cardiovascular systems make up the largest proportion in every faculty. This study revealed that even though the content of the lectures is similar among Turkish medical faculties, their number shows great variation. Determination of minimum requirements for the time devoted to each subject would be useful for the standardization of physiology education in Turkey.
Physiology practical sessions are carried out in all Turkish medical faculties. Practical sessions are important in physiology teaching since they assure the consolidation of subjects taught in lectures, create an opportunity for discussion in a laboratory environment with smaller groups, and provide students with opportunities to acquire skills and create chances for analytical thought (13, 20). The topics of practical sessions, content, and duration of each practical subject demonstrates important differences in our country. Different applications among faculties may be explained by different conditions. The number and quality of the teaching staff, number of students, and problems of physical environment and equipment supply all have limiting roles in the performance of practical sessions. The present study pointed out that the time devoted to physiology practical sessions increased in relation to the number of participating teaching staff (P < 0.01).
Only hematocrit measurement and electrocardiogram analysis, of the various blood and circulation physiology experiments that are recommended in the NCC, were performed in physiology practicals in all of the participating faculties. Since other experiments included in the NCC are carried out by other basic or clinical departments, they are not performed by all of the physiology departments. Other experiments that are not mentioned in the NCC are left to the decision of the departments, which is why they did not report any change in their program. However, we would expect them to plan to improve the technology used in the teaching laboratories.
Developments in science and technology are incorporated into physiology practical sessions. Students can design experiments, acquire and analyze experimental data easily, and interpret the results using computerized systems. It has been established that these systems facilitate learning and increase motivation in the student (6). We point out that computerized systems, which are easier to use by students and provide a myriad of experiments on human subjects (1), are found in some physiology student laboratories in Turkey. Other forms of technology use in the laboratories are watching experiments as animations, video clips, or simulations (12, 16). In our study, some physiology departments reported use of interactive CDs in cardiovascular physiology laboratories to demonstrate experiments. Although active participation of the students is not feasible, these methods are assumed to be useful for creating appropriate conditions of discussions in crowded classrooms and in laboratories lacking sufficient equipment.
Although different methods are employed, it was heartening to learn that all of the departments value practical sessions. Objective structured practical examination is a good objective tool of assessment that discriminates between good and bad performers and also improves student performance quality in laboratories but is only used by a minority of Turkish medical faculties (15).
Another subject investigated in the present study was animal use in teaching laboratories, but this is decreasing gradually all over the world due to various reasons such as higher cost and animal rights. Although computer models have started to be used extensively, discussions continue as to whether or not they can replace live tissues (6, 14, 16). The superiority of experiments using animals in better understanding of physiology subjects is accepted universally both by teaching staff and medical students (14, 19a, 22). A study was carried out by the Department of Physiology of the Faculty of Medicine of Hacettepe University to question the attitudes of medical students toward the use of animals in teaching experiments. This indicated that 76% of students find the animal experiments useful and necessary to reinforce the theoretical instruction in the lectures about muscle, nerve, and cardiovascular physiology (unpublished data). Eight of thirty-four faculties use only human subjects in physiology practical sessions. The number of faculties that reported animal use was 26 faculties. The most widely used animals are frogs. For example, the physiological properties of heart muscle are studied using frogs in 16 of 33 faculties. This is a practical session aiming at consolidation of theoretical knowledge. Since there is no clinical skill acquisition among the targets of this practical, it is not included in the application list of the NCC. There are many such experiments in other physiology practicals. Therefore, although it is useful for the standardization of content and time devoted to each topic of lectures, the NCC should not be the single major determinant for the content of practical sessions.
Seventy-six percent of the faculties give the students written material in the form of laboratory texts and/or books, including experimental protocols, and ask them to perform the experiments presented as templates. Under these circumstances, it is not possible for the students to plan their own protocols to achieve a given goal with the present equipment. There is an increasing tendency in the world to replace these repetitive "cookbook" practicals/experiments with inquiry-based laboratory courses (2, 11). In our country, such applications have not yet begun.
Lectures and/or practical sessions are repeated more than once in some faculties. The reason for this repetition in five faculties is either the high number of students allocated into two separate classrooms or English- and Turkish-instructed divisions in the same faculty. The limited number of laboratory equipment necessitates dividing students into many groups who perform experiments at different times, and this increases the professional effort of the teaching staff.
The academic personnel in Turkish medical faculties are required to handle both the responsibilities of a researcher and an instructor. On the other hand, for each step in the academic career and for promotions in Turkey, the quality and quantity of the published research articles are very important. Although the first mission of the universities is defined as "teaching," this is not rewarded by achievement points, and this is expected to have a negative impact on teaching laboratories. Even the technologically supported practical courses need skilled and motivated instructors to be performed well. Unmotivated instructors with an "I can explain theoretically; why spend so much time?" approach are a big threat to physiology practical courses. However, the results of the present study showed that 17% of total physiology education, an average of 35 h, is devoted to practical courses despite the low numbers of teaching staff. This is in accordance with the undeniable fact that the importance of undergraduate education has been increased together as a result of the changes in medical education in Turkey in the last decade.
The increasing amount of computer use in medical education in the world (6) does not seem to find reflection in Turkey. Although some faculties have already started to use computers for practicals and for simulations or animations, other computer-assisted learning facilities, such as "on-line learning," are still not an option. The problems arising from large numbers of students, insufficient numbers of teaching staff, and ethical issues concerning animal rights may be overcome with computer-assisted learning.
After the completion of this study, new medical faculties have been established in our country; one medical faculty was closed, and its students were taken over by a newly established one. In the 2007–2008 academic year, the number of medical faculties admitting students is 48 faculties, but the infrastructure and requirement for teaching staff of most of the new medical faculties has not yet been completed. In two of these, the teaching staff supplied by the other medical faculties carry out undergraduate education, and students of five faculties are educated in other faculties. The number of faculties carrying out medical education with their own facilities and teaching staff is still 41 faculties (13a). The 38 faculties investigated in this study constitute a source of information reflecting the status of physiology education in 2003–2005 in Turkish medical faculties, and this is not far from current conditions.
The educational load is heavy and the number of teaching staff is low in most of the Turkish medical faculties. It was determined that in 16 of the departments, 1 academic instructor alone gives over 50 lectures to undergraduate medical students. It should be remembered that, although the same teaching staff is responsible for the physiology courses of other schools and faculties of universities, which greatly increases the education load, physiology practical sessions are performed in all of the medical faculties. A decreasing tendency to become a scientist-physician worldwide has been reported (10). Although there is no such determination in Turkey, increasing needs for teaching staff with increasing number of medical faculties is a critical fact. In the event that the need for staff development and mentoring of the new staff is not met, a decrease in the numbers of physiology courses, starting with practical sessions, as observed in faculties in many parts of the world (9, 10), may emerge as a solution. However, physiology is an experimental complementary course integrating knowledge of basic sciences and prepares a basis for clinical sciences in the continuum of undergraduate medical education. Taking all these together, increasing the interest in physiology and other basic science departments should be one of the main goals of Turkish medical faculties for graduating good physicians.
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Acknowledgments |
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Results from this study have been presented as a poster at the Association of Medical Education in Europe 2006 Congress on September 14–18, 2006, in Genoa, Italy, where the authors were given grants for participation and travel expenses.
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Footnotes |
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Received for publication April 11, 2008. Accepted for publication October 17, 2008.
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REFERENCES |
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TOPAbstractIntroductionMETHODSRESULTSDISCUSSIONREFERENCES |
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