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LETTER TO THE EDITOR
Department of Physiology and Biophysics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
Address for reprint requests and other correspondence: H. Carvalho, Dept. of Physiology and Biophysics, School of Medicine, Virginia Commonwealth Univ., 1101 E. Marshall St., PO Box 980551, Richmond, VA 23298 (e-mail: hde{at}vcu.edu)
THIS LETTER is intended to contribute to the discussion of active versus passive learning in physiology. Here are some thoughts for consideration: are we, as teachers, making a difference in the learning process? How do we ensure that we emphasize the acquisition of knowledge rather than short-term memorization?
Considering the pertinent discussion regarding the quality of learning in physiology by undergraduate students, a short survey with cardiorespiratory questions was distributed at the end of a physiology course (Table 1). Students were informed that the survey was voluntary. It was emphasized that students did not have to answer questions if they did not know the answer. Of 50 students, 40 students returned the questionnaire. The outcome shows results similar to surveys conducted in several different educational institutions across the country (1, 2, 4).
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Another important point brought out by this survey was the presence of misconceptions. When students were asked about the respiratory changes after quickly climbing a set of stairs, the majority of them (85%) knew that the respiratory rate would increase, but only 40% of them correctly responded that the depth of respiration would increase as well. Among these students, only 24% of them could explain the role of chemoreceptors. Similar findings have been described in a previously published survey including seven United States institutions (1).
There are many possible interpretations for the results of the survey, but it is clear that despite our efforts to provide high-quality lectures and computerized laboratory exercises, only a small proportion of the material taught is effectively learned, and student performance does not meet our expectations.
In our survey, student performance on questions that aimed to test the application of understanding of the material was significantly lower than questions testing for the assimilation of information. How do we then prepare our students so that they assimilate facts but are able to integrated them and apply them into new situations that they have not previously encountered?
This issue of students not accomplishing a deeper understanding of physiology is also a reflection of teacher's ineffectiveness. In reality, what has been repeated for generations is preparing the student for the exam. This invariably results in a low level of deep understanding at the end of a course.
We seem to focus more on the "teaching facts" than on the "learning concepts." We as teachers are preoccupied in making sure that we expose the students to as much of the information as is available, often neglecting how much our students are able to apply the information. Teachers budget their time in class in favor of comprehensive coverage of the material and at the expense of ensuring learning and application. Instructors tend to overestimate the students' abilities to apply their knowledge, as described in a survey (6) given to the instructors questioning their impressions with regard to student knowledge.
The teaching method based on students passively receiving material that has already been "digested" does not meet the desired outcome for the future health professional. Richardson (5) demonstrated that naïve students (those without previous exposure to formal physiology teaching) performed similarly to two other student groups of experienced students when asked questions that tested for the mastery of concepts and their application. According to the author, the low retention of the experienced students probably relates to the passive didactic lecture style of teaching in elementary physiology courses (5).
Laboratory sessions that are complimentary to the lecture can serve as a great supplement, but for them to be effective the student must be engaged in the activities and not merely following the steps dictated in a laboratory manual. The practical laboratory could be the ideal opportunity for active learning, but it is often ineffective when the laboratory manual is used merely as a "cookbook."
To help the students learn in an everlasting way, we are implementing changes to engage students in active learning and consequently develop a better understanding of physiology. At the beginning of each laboratory session, one teaching assistant (TA) reviews the laboratory exercises that are about to take place. Students are then divided into small groups, and, before they begin the exercises, they predict the results and discuss them with the TA that oversees their work. After the laboratory, the TA reviews the results and clarifies differences from the predictions. The opportunity to predict and verbalize expected outcomes seems to promote better understanding to correct misconceptions, as previously described (3).
According to the constructivist theory of learning, a student's conceptual understanding improves when the student is actively engaged in the learning process. When we attempt to bring a strategy to introduce active learning into the classroom, students resist it because they are used to the conventional passive lecture style. We all know that students, as well as teachers, are not always open to change, but if we are committed to improving learning toward a deeper understanding of the material, we must search for alternative ways to produce future health professionals who can effectively address the health challenges our society faces.
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