31.12.12 Challenges and Difficulties Associated with Physiology Learning in Undergraduate Medical Students in Integrated Curriculum

Original Article

 

Challenges and Difficulties with Physiology Learning in Undergraduate

Challenges and Difficulties Associated with Physiology Learning in Undergraduate Medical Students in Integrated Curriculum

Sadaf Fatima1, Syed Tousif Ahmed2, Shazia Hashmat2, Haider Abbas3, Zahra Safiuddin3 and Kevin Borges4

ABSTRACT

Objective: To find out the difficulties and challenges associated with learning of Physiology in undergraduate medical students in integrated curriculum.

Study Design: Cross sectional study.

Place and Duration of Study: This study was conducted at the Ziauddin Medical College, Ziauddin University, July 2017 to June 2018.

Materials and Methods: The study participants included 1st, 2nd, 3rd year medical students. There were 147 MBBS students in this study. A questionnaire was distributed to each student. The questionnaire included 23 items from why is Physiology hard for students to learn? It included items related to subject, teaching and learning of Physiology. The medical students were asked to select a response for each item on likert scale from 1 to 5.  The Physiology learning responses were compared between 1st, 2nd & 3rd MBBS students.

Results: The medical students thought that characteristics of discipline including well defined syllabus (90.7%), understanding of physiological phenomena (88.8%), and use of scientific terms (89.3%) were more important aspects. Regarding the teaching factors including integration (84%), use of active learning methods (81.7%), use of graphs and flow charts by teachers (80%), teachers’ response to student questions (88.4) were found to be more important. In relation to student learning important factors was rote learning than understanding (92%), time commitment (83.6%), and not taking guidance from other students (80.4). The comparison was done between MBBS 1st 2nd and 3rd year medical students.  A significant difference was found in factors including basic concepts (0.01), passing exams by using short books (0.01) and integration (0.002).

Conclusion:   The medical students provided perspective regarding the difficulties in learning physiology and the reasons of these difficulties.

Key Words:  Physiology, Teaching, Learning, Integrated Curriculum

Citation of article: Fatima S, Ahmed ST, Hashmat S, Abbas H, Safiuddin Z, Borges K. Challenges and Difficulties Associated with Physiology Learning in Undergraduate Medical Students in Integrated Curriculum. Med Forum 2020;31(12):53-58.

 

 

INTRODUCTION

In creating 21st century physicians, the primary goal is to educate future doctors who can completely incorporate the new sciences and technology into humane patient care1.

 

 

1. Department of Physiology, Jinnah Medical and Dental College, Karachi.

2. Department of Physiology / 4th MBBS3/Anatomy4, Ziauddin Medical College / University, Clifton Campus, Karachi.

 

 

Correspondence: Dr. Sadaf Fatima, Associate Professor, Department of Physiology, JM&DC, Karachi.

Contact No: 03342476112

Email: drsadafnaqui@yahoo.com@yahoo.com

 

 

Received:    March, 2020

Accepted:    August, 2020

Printed:        December, 2020

 

 

 

 

 

 

Currently many medical schools are designing innovative medical curricula in their bachelor programs2. Many medical schools are progressing towards a more student centered approach to learning and assessment3. Integration is established as a vital educational strategy in medical education4. Integration promotes better retention of knowledge and the skill to execute basic science principles in the appropriate clinical context5. 

During first two years of medical school, basic science content provides an essential foundation for clinical experiences6. Basic science concepts forms schema for clinical reasoning and therefore they work as building blocks for any clinical decision making7. This knowledge helps students to rebuild the relationship between features and diagnosis of disease8. Recently many medical schools have started to modify their preclinical curricula to indicate the importance of basic science to practice9.  The coherence between basic and clinical science is provided by early patient contact in the first year simultaneous with basic science teaching and by clinical principles mingled into basic science courses10. Understanding the applicability of basic science education in the establishment of patient assessment, diagnosis, and treatment is critically important to competent medical practice11.

Physiology is one of the basic science disciplines taught at undergraduate level in traditional & integrated curriculum, in medical, dental and other health professional education12. Its importance lies in its application in clinical practice13. The close association of physiology with clinical medicine is highlighted in the preclinical years, and also in hospital practice later14. Being one of the mandatory basic science disciplines, Physiology is also experiencing changing trends in teaching. Student centered learning methods have been found to be most helpful in concept building of physiological sciences14. As the knowledge of Physiology is the basis of good clinical practice, a questionnaire was designed to study the different aspects of Physiology learning. The objective of the study was to find out the difficulties and challenges associated with learning Physiology in undergraduate medical students in integrated curriculum.

MATERIALS AND METHODS

The study design was cross sectional. The study was conducted at Ziauddin Medical College. The study was conducted in 1st, 2nd and 3rd year medical students. There were 147 MBBS students in the study. The participants were selected by convenient sampling technique. The time duration of study was one year, from July 2017 to June 2018. The study was approved by Ethics review board of Ziauddin University. After getting the ethics approval, the participants were enrolled in the research study. Informed consent was obtained from each participant.

In order to study the challenges associated with Physiology learning, questionnaire was distributed to 1st, 2nd and 3rd year medical students. The questionnaire included 23 items from why is Physiology hard for students to learn? The students were asked to select a response for each item on likert scale from 1 to 5. The medical students provided their opinion about the difficulties in learning physiology and the reasons of these difficulties. The questionnaires were collected and the data was analyzed.

The data were analyzed using SPSS version 20. The results of all quantitative data were expressed as mean ±SD. The comparison of qualitative data was expressed by Chi Square test. In all statistical analysis, only
p-values ≤ 0.05 were considered significant.

RESULTS

There were 147 MBBS students in the study. The mean age of students was 19.99± 1.3 years (male 36% & female 64%).

Table I showed the cumulative percentage of items included in the questionnaire as marked by MBBS students. The medical students thought that characteristics of discipline including well defined syllabus (90.7%), understanding of physiological phenomena (88.8%), and use of scientific terms (89.3%) were more important aspects.

Table No. I: The cumulative percentage of Physiology learning responses of MBBS students

Q.No.

Option

Cumulative %tage

1.

A

73.3

 

B

11.1

 

C

15.6

2

A

87.9

 

B

7.6

 

C

4.5

3

A

80.9

 

B

10.7

 

C

8.4

4

A

74.2

 

B

19.1

 

C

6.7

5

A

89.3

 

B

8

 

C

2.7

6

A

84

 

B

12

 

C

4

7

A

90.7

 

B

5.8

 

C

3.6

8

A

92

 

B

5.3

 

C

2.7

9

A

83.6

 

B

12.4

 

C

4

10

A

71.1

 

B

19.1

 

C

9.8

11

A

38.2

 

B

18.7

 

C

43.1

12

A

88.8

 

B

8.5

 

C

2.7

13

A

51.6

 

B

26.2

 

C

22.2

14

A

44.9

 

B

23.1

 

C

32

15

A

80

 

B

12.4

 

C

7.6

16

A

79.6

 

B

9.3

 

C

11.1

17

A

75.1

 

B

13.3

 

C

11.6

18

A

57.3

 

B

16.4

 

C

26.2

19

A

88.4

 

B

5.3

 

C

6.2

20

A

89.8

 

B

8

 

C

1.8

21

A

81.7

 

B

12.1

 

C

6.2

22

A

80.4

 

B

14.7

 

C

4.4

23

A

40.9

 

B

29.8

 

C

29.3

 

Regarding the teaching factors including integration (84%), use of active learning methods (81.7%), use of graphs and flow charts by teachers (80%), teachers’ response to student questions (88.4) were found to be more important. In relation to student learning important factors was rote learning than understanding (92%), time commitment (83.6%), and not taking guidance from other students (80.4).

Table 2 showed the comparison of Physiology learning responses between 1st, 2nd and 3rd year MBBS. The frequency, percentage and chi square value of each item is mentioned in the table. Table II included items related to basic concepts, scientific terms, new researches in medical science, interaction between systems, well defined physiology syllabus, understanding physiology, commitment of time for learning physiology, importance of case study, passing physiology exams by short books, teaching physiology by giving concepts, correlating different topics, guiding students about learning resources, use of graphs & flow charts in teaching, integration of physiology teaching, covering large content in lecture, responding to student questions and use of active learning methods.

 

 

 

Table No.2: Comparison of Physiology learning between 1st, 2nd and 3rd year MBBS students

Q.No.

n

Year

Frequency

Percentage

Chi square

 

 

 

A

B

C

A

B

C

 

1

225

1

101

14

11

61.2

56

31.4

0.018

 

 

2

29

4

8

17.6

16

22.9

 

 

3

35

7

16

21.2

28

45.7

2

225

1

115

8

3

57.9

47.1

30

0.422

 

 

2

35

3

3

17.8

17.6

30

 

 

3

48

6

4

24.4

45.3

40

3

225

1

104

11

11

57.1

45.8

57.9

0.118

 

 

2

30

9

2

16.5

37.5

10.5

 

 

3

48

4

6

26.4

16.7

31.6

4

225

1

97

22

7

58.1

51.2

46.7

0.475

 

 

2

28

11

2

16.8

25.6

13.3

 

 

3

42

10

6

25.1

23.3

40

5

225

1

114

9

3

56.7

50

50

0.312

 

 

2

39

2

0

19.4

11.1

0

 

 

3

48

7

3

23.9

38.9

50

6

225

1

105

15

6

55.6

55.6

66.7

0.817

 

 

2

33

6

2

17.5

22.2

22.2

 

 

3

51

6

1

27

22.2

11.1

7

225

1

114

8

4

55.9

61.5

50

0.937

 

 

2

38

2

1

18.6

15.4

12.5

 

 

3

52

3

3

25.5

23.1

37.5

8

225

1

118

6

2

57

50

33.3

0.664

 

 

2

37

3

1

17.9

25

16.7

 

 

3

52

3

3

25.1

25

50

9

225

1

111

12

3

59

42.9

33.3

0.067

 

 

2

31

9

1

16.5

32.1

11.1

 

 

3

46

7

5

24.5

25

55.6

10

225

1

90

24

12

56.2

55.8

54.5

0.313

 

 

2

32

8

1

20

18.6

4.5

 

 

 

3

38

11

9

23.8

25.6

41

11

225

1

37

25

64

43

59.5

66

0.019

 

 

2

23

5

13

26.7

11.9

13.4

 

 

3

26

12

20

30.2

28.6

20.6

12

225

1

114

11

2

56.8

57.9

33.3

0.694

 

 

2

35

4

1

17.6

21.1

16.7

 

 

3

51

4

3

25.6

21.1

50

13

225

1

63

34

29

54.3

57.6

58

0.979

 

 

2

22

11

8

19

18.6

16

 

 

3

31

14

13

26.7

23.7

26

14

225

1

49

30

47

48.5

57.7

65.3

0.259

 

 

2

20

10

11

19.8

19.2

15.3

 

 

3

32

12

14

31.7

23.1

19.4

15

225

1

102

14

10

56.7

50

58.8

0.898

 

 

2

31

7

3

17.2

25

17.6

 

 

3

47

7

4

26.1

25

23.5

16

225

1

102

8

16

57

38.1

64

0.296

 

 

2

32

4

5

17.9

19

20

 

 

3

45

9

4

25.1

42.9

16

17

225

1

91

18

17

53.8

60

65.4

0.125

 

 

2

36

5

0

21.3

16.7

0

 

 

3

42

7

9

24.9

23.3

34.6

18

225

1

59

23

44

45.7

62.2

74.6

0.002

 

 

2

25

7

9

19.4

18.9

15.3

 

 

3

45

7

6

34.9

18.9

10.2

19

225

1

106

10

10

53.3

83.3

71.4

0.139

 

 

2

37

1

3

18.6

8.3

21.4

 

 

3

56

1

1

28.1

8.3

7.1

20

225

1

115

10

1

56.9

55.6

25

0.081

 

 

2

35

5

0

17.3

27.8

0

 

 

3

52

3

3

25.7

16.7

75

21

225

1

100

15

11

54.1

55.6

78.6

0.372

 

 

2

36

5

0

19.7

18.5

0

 

 

3

48

7

3

26.2

25.9

21.4

22

225

1

105

16

4

58

48.5

40

0.516

 

 

2

32

8

1

17.7

24.2

10

 

 

3

44

9

5

24.3

27.3

50

23

225

1

45

40

41

48.9

59.7

62.1

0.2

 

 

2

20

14

7

21.7

20.9

10.6

 

 

3

27

13

18

29.3

19.4

27.3

 

 

 

DISCUSSION

In this study, challenges and difficulties associated with Physiology learning were studied. Table II showed comparison of Physiology learning responses between MBBS 1st, 2nd and 3rd years. There was a significant difference found in Item 1, 11 and 18. Item 1 was regarding knowledge of basic concepts of physics and chemistry. It is known that transfer, the capability to use something learned in one context in another context, is difficult, and this evidently contributes to students’ lack of ability to use their prerequisite knowledge (chemistry and physics) in learning physiology. This is consistent with the study done by Michael15.  He asked the physiology faculty to fill the questionnaire regarding difficulty in studying physiology and Calthorpe et al16 who asked the students to mark the difficult topics according to the modules .Item 11 was related to passing physiology exams by reading short books. Physiology tutors expect more than only retention of knowledge from their students. Our study findings are same as Michael15 study and Miller et al17. study. Students believe that learning and memorizing is the same thing. It was also mentioned in Sonmez18 et al and slominski19 et al. The memory of students’ knowledge of human physiology has been identified by numerous physiology educators to be wildly inconsistent20. Item 18 was regarding teachers integrating physiology teaching with other skills.  The educators need to employ creative teaching strategies that involve the students in active learning21. In active learning, the higher thinking processes of students are stimulated21. In rest of the table items, significant difference was not observed.

Physiology was rated as one of the most difficult courses by medical students, and its knowledge is generally not enough at a senior level of their medical education20. To acquire the physiology concepts, a variety of cognitive processes, such as memorization, comprehension, analysis, classification, summarization, calculation, multidisciplinary connections, and clinical application is required, and it is inevitable that students with different cognitive levels and study styles learn at different paces20. Causal reasoning, use of graphs and sectionalize were remarkably important than any other aspect of teaching in making physiology hard to learn15. 

There is a significant difference between teaching and learning. The fact is, there is too much teaching and inadequate learning22. Teaching is not only passing the information to students about what we know, but it is instead, to show the students how we learn22. Teachers expect “understanding” or the ability to “think” about physiological mechanisms15, 19. It is reported that students generally enter the physiology classroom lacking the expected prior knowledge and skills23. It is also noticed that students, both pre and post instruction, have serious misconceptions about physiological phenomena24. Students find it difficult to interpret graphs and to acquire a conceptual understanding of phenomena15, 19.

There is an urgent requirement for teaching reforms to improve the teaching efficacy of human physiology in medical schools20. The duty of teachers is to help students learn physiology15. The more they understand about learning, the better they acknowledge the causes of problems that students have in learning physiology and the better they can do their job15.

CONCLUSION

The medical students provided perspective regarding the difficulties in learning physiology and the reasons of these difficulties.

Author’s Contribution:

Concept & Design of Study:

Sadaf Fatima

Drafting:

Syed Tousif Ahmed, Shazia Hashmat

Data Analysis:

Haider Abbas, Zahra Safiuddin, Kevin Borges

Revisiting Critically:

Sadaf Fatima, Syed Tousif Ahmed

Final Approval of version:

Sadaf Fatima

Conflict of Interest: The study has no conflict of interest to declare by any author.

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