William B Cutrer, MD, M.Ed. - Vanderbilt University School of Medicine; Geoffrey M Fleming, MD - Vanderbilt University School of Medicine
Integrating basic science preclinical learning with the clinical learning of clerkship training remains challenging1,2. While content delivery via PowerPoint® lectures is frequently the educational strategy of choice, for both the basic science and clerkship experiences, students remain passive preventing optimal understanding and application of the concepts. New strategies for helping students connect basic science understanding with patient disease manifestation are needed.
To foster knowledge integration and the application of physiologic concepts, third-year Pediatric clerkship students participated in two sessions pairing classroom discussion with PICU patient examination. A PICU attending led a "chalk talk"-style session using Socratic-questioning and sketched diagrams to facilitate a dynamic physiology discussion, which was followed immediately by examination of ICU patients demonstrating the concepts discussed. Pairing the blackboard and bedside experiences provided vivid examples, such as preload's effect on cardiac output as demonstrated by liver depression in patients with intravascular monitors. One session focused on hypoxia while the other highlighted cardiovascular physiology. Students were surveyed regarding the combination of didactic and patient experiences, personal physiology understanding, and evaluation of the sessions' effectiveness.
39 of the 104 students contacted (38 %) completed the survey. 82% of students Agreed or Strongly Agreed that they preferred the blackboard-style discussion to a traditional PowerPoint-style lecture. On a 100-point visual analog scale, self-assessed understanding of the hypoxia physiology improved from a pre-session mean of 49.2 to a post-session mean of 69.4 (p<0.001 using paired t test). Self-assessed understanding of cardiovascular physiology improved from a pre-session mean of 52.3 to a post-session mean of 66.8 (p<0.001 using paired t test). 87.5% of students Agreed or Strongly Agreed that combining the discussion of physiology with bedside patient examination improved their understanding of hypoxia physiology, while 92.8% of students Agreed or Strongly Agreed the session improved their understanding of cardiovascular physiology.
Clerkship students prefer blackboard style discussions to PowerPoint lectures and also believe that combining the physiology discussion with the bedside examination of patients improves their understanding of the topics. Future efforts will need to formally measure student topic understanding to examine the true impact of this educational strategy.
1. Sakles, J., Maldonado, R., & Kumari, V. Integration of Basic Sciences and Clinical Sciences in a clerkship: a pilot study. Journal of the International Association of Medical Science Educators. 2006; 16(1):4-9.
2. Schmidt, H. Integrating the teaching of basic sciences, clinical sciences and biopsychosocial issues. Academic Medicine. 1998; 73(9): S24-S31.