Download enhancing learning biochemistry through reflection

ENHANCING LEARNING
BIOCHEMISTRY THROUGH
REFLECTION
Emine Erçıkan Abalı, PhD
Department of Biochemistry and Molecular
Biology
M1 Course Director
Biomedical Sciences
Digestive Systems, Nutrition and Metabolism
Melissa Calt, Rick DeMaio and Sam Schild, M2
Louis Chai and Michael Ullo, M3
Sangita Phadtare, PhD-Rowan University
Kadriye Ercikan, PhD-University of British
Columbia
by Morgan Weistling b.1964 –
Reflections
Student Comments
Dr. Abali had the unfortunate distinction of
teaching most of the biochemistry lectures,
which is by far the least favorite topic of many of
us.
The Tree Of Knowledge? Biochemistry
For Medical Students:"not Just A Lot
Of Facts, More A Way Of Life"
Why has the teaching of biochemistry to
medical students, the relevance of
biochemistry to clinical medicine, been
such a difficult, and to some extent
contentious, question both among
teachers and between teachers and
students? In the case of the latter, the
diagnosis is, I think, fairly simple. There is a
vicious circle based on different concepts
and understanding of the words
'knowledge' and 'learning'. Thus, in many
cases pre-clinical (and also clinical)
medical students tend to see no important
role for the knowledge or learning of
biochemistry in medicine.
Margot Kogut, PhD
Biochemical Education
July 1974, Vol 2 N0 3
Motivating Students to
Attend Basic Science Lectures
Motivating students
to attend basic science lectures in a
large classroom setting is an admitted
challenge. Faculty monologues
attempting to integrate basic science
facts and concepts into clinical
medicine are not always an engaging
experience. Contact with patients,
especially early in medical school,
has reported positive effects
including motivation to study,
development of a professional identity,
and an appreciation of the patient’s
experience of illness.
Donald Sefcik, DO, MBA
Lon J. Van Winkle, PhD
Acedemic Medicien, Vol. 86, No.2
/February 2011
Interprofessional Case Discussions (ICDs)
• integrate patient care with clinical
correlates of Biochemistry.
• are held by patients/families and
their team of healthcare providers to
demonstrate to M1 medical students
the significance of interdisciplinary
teamwork to provide the best patient
care.
• aim to foster an appreciation for the
fundamental relationship between
the study of Biochemistry and current
clinical medicine.
Overall in terms of reinforcement of concepts,
and integration of course material, the
interdisciplinary case discussion sessions met
my learning needs.
60
# of participants
50
40
30
20
10
0
Strongly
disagree
Disagree
Neutral
Agree
Strongly
agree
• ICD: If Dr. Abali's lectures could
be kept to a minimum, we could
hear more from the patients
and doctors. I feel like ICDs are
better kept for patients and/or
MD's to present clinical
scenarios on the information
covered in Dr. Abali's lectures.
• The ICD's were interesting
when the patients came in, but
the extra lectures during the
ICDS were just more
information for us to know and
took away from the
patient/physician experience.
Hypothesis
Attitudes of the first year (M1)
Rutgers-Robert Wood Johnson
Medical students towards
biochemistry and patient care
would improve after participating
in a guided journal reflection on
the ICDs, a structured
metacognitive process which has
been shown to enhance student
learning.
Study Design
Phase 1
Phase 3
Beginning of Course
Phase 2
End of Course
3 Questionnaires
Total 30 minutes
RLS
ASQ
CVI
Throughout Course
3 Questionnaires
Total 30 minutes
RLS
ASQ
CVI
4 Post ICD Sessions
(Approx. 30 min /
Session)
Multiple Choice Questions
about ICD Topic
N=45
F=26
M=19
Short answer questions on
ICD experience
N=39
F=26
M=13
Phase 2 TIMELINE
Date
Friday
2/28/14
9:30-11:30 AM
11:30 AM-noon
Friday
3/7/14
9:00-11:00 AM
11:00-11:30 AM
Friday
3/14/14
9:30-11:30 AM
11:00-11:30 AM
Tuesday
3/11/14
1:00-4:00PM
4:00-4:30 PM
Tuesday
3/18/14
10:00-11:30 AM
11:30-noon
Wednesday
3/19/14
9:00M-noon
Thursday
3/20/14
1:00-1:30PM
Topic
Celiac Disease
REFLECTION
Gout
REFLECTION
Consequences of Protein Misfolding: Cystic Fibrosis
REFLECTION
Muscle Metabolism at Rest and Exercise
REFLECTION
Metabolic Syndrome: Diabetes
REFLECTION
Approaches to Overcome Obesity
REFLECTION
Reflection Questions
① What key things did I learn during this ICD?
② Can I apply what I learned in this ICD to aspects of life outside the
classroom setting?
③ What patterns and relationships between the ICD and the Biochemistry
lectures can I identify?
④ Did this ICD change your motivation and/or attitude towards the study of
Biochemistry?
⑤ What knowledge do you need to improve and what skills do you need to
develop as a future doctor to understand a patient’s disease and provide
effective care? How are you going to improve your knowledge and
develop your skills?
⑥ Have your feelings about learning Biochemistry changed over time? - or
in the course of writing this reflection- suggesting that your own way of
looking at it has changed?
⑦ How can I apply what I learned from the relevant Biochemistry lectures
to this ICD?
Positive Attitude Scored +1
Negative Attitude Scored -1
•
•
No my feelings have changed. I have very
negative feelings towards biochemistry and
the learning of it. I do not enjoy it but I do
appreciate that it is important to becoming a
good doctor. I enjoy any opportunity to see
patients and to hear their stories and that
reminds me why I am here. But my feelings
towards biochem have not changed.
•
No it did not. Although it is cool to see the
patients and to learn how important
biochem is to the treatment of patients and
the understanding of their diseases, I am still
not motivated to learn the topic. My attitude
to the topic has not changed due to this ICD.
Appreciated hearing from the patient and
him taking the time to come talk to us.
•
My feelings about learning biochemistry
have not changed. This is not my first time
learning the topic and I, unfortunately, have
had very negative learning experiences in the
past. I know that learning biochemistry is
important to becoming a good doctor, but I
still do not like it and my feelings have
remained unchanged.
•
•
This course has brought new perspective to a
number of topics I had been exposed to but not
fully delved into. While my feelings about
learning biochemistry remain unchanged, my
appreciation for its expansive applicability has
increased. With each ICD, the disease we learn,
which often involves some small biochemical
alteration, proves critical to the normal
function of the body. By realizing this
relationship, I am more motivated to learn and
understand the biochemical pathways and
deficits involved in these diseases.
So far, I feel even better about learning
Biochemistry. I used to really loathe learning
about pathways, but seeing everything be
integrated in the lectures as well as seeing the
real-life examples in the ICD's really makes this
more tolerable. Since the beginning of this
course so far, I feel a lot more enthused about
learning biochemistry.
It has made the course seem much more
relevant and imperative to understand. I take
the time to understand the material better as it
will affect how well I can treat patients. I want
to master the material to be a better doctor.
#1
#2
#3
#4
#5
#6
1.20
1.00
0.80
0.60
0.40
0.20
0.00
Can I apply
Did this ICD
Have your
what I learned change your feelings about
in this ICD to mo va on
learning
aspects of life and/or a tudebiochemistry
outside the
towards the changed
classroom
study of
throughout the
se ng?
Biochemistry? dura on of this
course so far?
OVERALL
① Students found the ICDs
useful and were able to
integrate clinical
understanding of disease
with the biochemical basis of
disease.
② There was a positive change
in student feelings about
learning biochemistry
throughout the duration of
the course,
③ However students’ attitude
towards the study of
Biochemistry did not change
as much.
“Reflection in Learning” survey assesses self-determination of
students for the ability to reflect on learning
Male students in the reflection groups
had the highest course grades
Restricted
Partial
Ample
Maximal
Pretest
2
28
51
3
Post
0
22
56
6
Restricted: Require extensive additional preparation
Partial: Need incentives and opportunities.
Ample: Have autonomy under favorable conditions.
Maximal: Have full autonomy even under negative
pressure
70
Reflection Male
0
75
Control Male
10
Reflection Female
20
80
Control Female
30
85
Male
40
Female
# of students
50
90
Reflection
Grades in Numerics
60
Control
RLS survey demonstrated the majority of
students fall into ample process of learning
Significant
changes in means
between
pretest/posttest
control and
reflection groups
A two-way repeated ANOVA.
RLS scores range from 14 to 98.
Statistical significance: P < 0.05.
Summary
As the course progressed, students became more autonomous about their learning
and less dependent on incentive to learn.
The intervention group which kept a journal showed a significant improvement in the
following attitudes:
• Reviewed previously studied subjects during each term
• Sought out interrelations between topics in the course with each other and with
those of other courses and training activities
• Conscientiously sought to adapt to the varied demands of the different courses
and training activities
Structured journal’s reflective scores demonstrated that ICDs together with selfreflection are valuable instructional strategies to foster an appreciation of the
understanding of Biochemistry in patient care.
The external validity of this study will be tested by repeating it in the DSNM course
next year.