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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 by Morgan Weistling b.1964 – Reflections Melissa Calt, Rick DeMaio and Sam Schild, M2 Louis Chai and Michael Ullo, M3 Sangita Phadtare, PhD-Rowan University Kadriye Ercikan, PhD-University

ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

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Page 1: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

ENHANCING LEARNING BIOCHEMISTRY THROUGH

REFLECTION

Emine Erçıkan Abalı, PhDDepartment of Biochemistry and Molecular

BiologyM1 Course DirectorBiomedical Sciences

Digestive Systems, Nutrition and Metabolism

by Morgan Weistling b.1964 – Reflections

Melissa Calt, Rick DeMaio and Sam Schild, M2 Louis Chai and Michael Ullo, M3Sangita Phadtare, PhD-Rowan UniversityKadriye Ercikan, PhD-University of British Columbia

Page 2: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

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.

Page 3: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

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, PhDBiochemical EducationJuly 1974, Vol 2 N0 3

Motivating Students toAttend Basic Science Lectures

Motivating studentsto attend basic science lectures in alarge classroom setting is an admittedchallenge. Faculty monologuesattempting to integrate basic sciencefacts and concepts into clinicalmedicine are not always an engagingexperience. Contact with patients,especially early in medical school,has reported positive effectsincluding motivation to study,development of a professional identity,and an appreciation of the patient’sexperience of illness.

Donald Sefcik, DO, MBALon J. Van Winkle, PhDAcedemic Medicien, Vol. 86, No.2 /February 2011

Page 4: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

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.

Page 5: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

• 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.Strongly

disagreeDisagree Neutral Agree Strongly

agree

0

10

20

30

40

50

60

Overall in terms of reinforcement of concepts, and integration of course material, the interdis-ciplinary case discussion sessions met my learn-

ing needs.

# of

par

ticip

ants

Page 6: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

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.

Page 7: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

Study Design

Phase 1Beginning of Course3 QuestionnairesTotal 30 minutes

RLSASQCVI

Phase 2Throughout Course

4 Post ICD Sessions(Approx. 30 min /

Session)

Phase 3End of Course

3 QuestionnairesTotal 30 minutes

RLSASQCVI

Multiple Choice Questionsabout ICD TopicN=45F=26M=19

Short answer questions onICD experience N=39F=26M=13

Page 8: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

Phase 2 TIMELINE

Page 9: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

Reflection Questions① 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?

Page 10: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

Positive Attitude Scored +1• 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.

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.

Page 11: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

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.

Page 12: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

Restricted Partial Ample Maximal0

10

20

30

40

50

60

# of

stud

ents

“Reflection in Learning” survey assesses self-determination of students for the ability to reflect on learning

RLS survey demonstrated the majority of students fall into ample process of learning

Male students in the reflection groups had the highest course grades

Cont

rol

Refle

ction

Fem

ale

Mal

e

Cont

rol F

emal

e

Refle

ction

Fem

ale

Cont

rol M

ale

Refle

ction

Mal

e70

75

80

85

90

Grad

es in

Num

eric

sRestricted: Require extensive additional preparationPartial: Need incentives and opportunities.Ample: Have autonomy under favorable conditions.Maximal: Have full autonomy even under negative pressure

Page 13: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

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.

Page 14: ENHANCING LEARNING BIOCHEMISTRY THROUGH REFLECTION

SummaryAs 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 self-reflection 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.