Virtual Laboratories of Physiology and Pathophysiology as a Learning Tool for the Pre-Clerkship Curriculum

Brief outline of the project

RATIONALE

Teaching of physiology and pathophysiology at the Pre-Clerkship level is currently done in a purely theoretical manner, without hands-on labs to apply and consolidate acquired knowledge, a gap that can be partially filled with the use of simulation programs that can mimic experimental and clinical situations.

The project aims to develop and assess such virtual laboratories that would complement some of the major topics covered during the pre-clerkship formation. The relevance of the project is actually in line with the AFMC's recommendation that medical schools must "ensure that the medical curriculum includes instruction in the scientific method including hands-on or simulated exercises in which medical students collect or use data to test and/or verify hypotheses or address questions about biomedical phenomena…“ (Element 7.3 of the Accreditation Committee of the Faculties of Medicine of Canada).

A growing number of applications are now available and can be used to mimic specific physiological or clinical situations (e.g. Oxygen delivery - baillielab.net, Hemodyalysis - childrenshospital.org) but the simulation system "Human Model", developed by the University of Mississippi Medical Center (UMMC), clearly stands out as a tool particularly suited to reproduce hands-on labs. Its unique feature is that it constitutes an integrated simulation program that offers the determination of over 4000 variables related to the cardiovascular, renal, respiratory, endocrine, neural and metabolic systems. Furthermore, some 750 parameters can be modified to study physiological and pathological alterations. Constructed from an extensive number of published data, the model has been shown to accurately predict both qualitative and quantitative changes in clinical and experimental settings.

Two versions of Human Model are currently available in the form of freely downloadable programs, called “HumMod” and “QCP” (Abram et al, 2007). Both are explicitly allowed by UMMC to be used for educational purpose.

CURRENT USE OF QCP AS A PEDAGOGIC TOOL

The program QCP is currently used in some of our undergraduate courses (ANP and PHS courses) offered to Health Sciences students. Constructed as assignments to complement the theory seen in class, students are essentially asked to develop experimental protocols and perform measurements that allow them to predict changes under some situations; for example: “What would be your blood pressure if you sit in a sauna? Your arterial and venous pH if you run on a treadmill? Your cardiac output if you stand upside down? Explain those changes.” Although those assignments were developed mainly to stimulate critical thinking, not to reproduce the scientific method, they confirm two key assumptions related to the present proposal: 1) QCP can be mastered relatively easily by the students, 2) A majority of students recognized the pedagogic value of the simulation program and even demonstrated interest in using it for their own personal formation, as shown by surveysto students and as previously reported by others (Rodriguez-Barbero & Lopez-Novoa, 2008).

PROPOSED USE OF QCP AS VIRTUAL LABS FOR UNDERGRADUATE MEDICAL STUDENTS

The proposal aimsto develop bilingual virtual labsto be integrated within the pre-clerkship curriculum. It is a continuation of a project developed in 2018 which, unfortunately, could not pursued further until this year.

The work done so far is the following:

  1. Development of Videos on mastering QCP Two videos were developed in both languages and intended to act as a guide for the QCP program to be used by the students as well as tutors (videos available on request). The first video shows the user how to download and manipulate the simulation program and provides an explanation of the software features. The second video shows the user how to complete a laboratory activity and demonstrates the physiological variables available on QCP.
  2. Development of laboratories protocols (in both French and English) Several scenarios have been developed to cover major topics related to Unit 1 of UGME. These scenarios were developed according to Ericsson et al.’s conceptual framework of expertise (Ericsson, 2004) and its five basic criteria: 1) Task is varied across content areas, 2) Task motivates the learner through improvement, 3) Task takes into account learner’s pre-existing knowledge, 4) Task allows repetition of the skills multiple times, and 5) Task is accompanied by immediate feedback.

The protocols covered the following topics (listed according to the Unit 1 schedule):

− Cardio, week 1: Applied cardiovascular physiology

− Cardio, week 3: Chronic Heart Failure

− Cardio, week 4: Stable valvular heart disease

− Resp, week 1: Respirology: Fundamentals

− Resp, weeks 3, 4: Asthma and COPD

− Renal, week 2: Acute renal failure

− Renal, week 3: Chronic renal failure

− Renal, week 5: Hypertension

Below is a succinct example of such an experimental protocol: Systolic vs diastolic heart failure

Diagram

 

  1. Development of an assessment form intended for the evaluators. Example of survey questions covering Ericsson’s conceptual framework:
  • The virtual labs are a motivational learning tool.
  • Students are able to repeat simulations in a focused way to assist in their hypothesis testing.
  • The virtual labs provide immediate feedback, rapidly conveying key concepts.
  • The virtual labs are pertinent to multiple medical science disciplines.
  • The virtual labs are a relevant complement to the material taught in the pre-clerkship curriculum.

 

OBJECTIVE AND METHODS

The overall objectives of the project are:

  1. To gather a formal assessment of the virtual labs and their pedagogic values from second-year medical students, residents and content experts. To our knowledge, such an assessment has never been done before and would therefore constitute new, original research in the field of medical education. The evaluation of the labs by medical experts would also allow a direct, critical appraisal of the actual accuracy and limitations of the simulations.
  2. Based on those assessments, to develop a formal proposal to CCRC for the implementation of virtual labs within the medical education curriculum.

Participants will be asked to assess the labs according to Ericsson et al.’s conceptual framework of expertise as given in the previous section. Residents and content experts will also be asked to comment on the accuracy and limitations of the simulations.

TIMELINE

  1. Solicitation of evaluators: medical students, residents and specialists of the division of general internal medicine and teachers in Unit I will be personally contacted to participate in the project. To limit the workload, only one simulation will be assigned per participant, but three different topics will be given according to the expert: cardiovascular, respiratory and renal. It is expected that the activity, from learning the program to the assessment of the lab, should take about one hour.
  2. Analysis of the assessments.
  3. Adjustments of the protocols according to the assessments.
  4. Formal proposal to CCRC for integration of the labs to the pre-clerkship curriculum.

The student will participate in the first three phases of the project.

 

REFERENCES
Abram, S., Hodnett, B., Summers, R., Coleman, T., & Hester, R. (2007). Quantitative Circulatory Physiology: an integrative mathematical model of human physiology for medical education. Adv Physiol Educ, 202-210. Ericsson, K. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med, 70-81. Rodriguez-Barbero, A., & Lopez-Novoa, J. (2008). Teaching integrative physiology using the quantitative circulatory physiology. Adv Physiol Educ, 304-311.

 

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