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THE SINGAPORE MAGAZINE OF RESEARCH,
TECHNOLOGY AND EDUCATION
About Innovation
COVER STORY:
Learning by Doing
The Value of Science Practical Classes in Medical Education Learning
by Michael A. Ferenczi

s LKCMedicine is a new medical school we had the privilege to import the best pedagogies and practices from around the world, and to build on the proven curriculum developed over the years at Imperial College London. A decision was taken to include Science Practical classes in the curriculum during the first two years of the five-year MBBS course. The purpose of the practicals is to reinforce the principles and theories learned during our Team-Based-Learning (TBL) classrooms and to augment the learning experience with handson access to real laboratory and clinical equipment.

Having the advantage of selecting activities for an initially empty teaching laboratory, we had the freedom to purchase new equipment to focus on activities that are closely linked to the TBL learning outcomes, thus enriching the TBL process, and also on activities of direct clinical relevance wherever possible.

Many of the practicals were inspired by the practicals used in the two early years in the Imperial College MBBS course, especially in the Medical Sciences course 'Molecules, Cells and Disease'. However new practicals were also developed. In year 1, 16 practicals lasting 3 hours each are offered to our students, with 6 practicals in year 2. Students are asked to work individually, in pairs or in small groups, depending on the task. Our current teaching laboratory holds 42 students. All practicals are repeated twice as the laboratory only holds half the cohort at a time. Our new laboratory to be completed in August 2015 will hold 100 students. Students are provided with an online Practical Guide which they are asked to study in advance. The Practical Lead usually provides a short introduction to the practical at the beginning of the class to highlight safety issues, dress code, proper behaviour etc, as well as a demonstration of some of the procedures, aided with cameras and projector screens. One microscope in every three is equipped with a digital camera and Wi-Fi connection to the students' iPads.

Practicals are followed by a one or two-hour data analysis session. For these, students are given access to the compiled experimental data recorded by the whole cohort. The data provides the opportunity for the development of analytical and statistics skills in a way that is directly relevant to the students. They explore sources of experimental variation and the meaning of significance. The laboratory results provide rich material for discussion, for example to explore the importance of experimental evidence. The results are discussed in the light of the TBL Learning Outcomes.

Scheduling of the practicals is in sync with the TBL topics. The practicals demonstrate key scientific principles, explore important technologies used in clinical pathology laboratories and give insight into clinically relevant techniques.

Examples of Practicals

In Year 1, practicals include:

  • Determination of the relationship between contraction of the sum and frequency of stimulation of the median nerve in the wrist using surface stimulating electrodes, and observation of the electrical activity of the muscle induced by voluntary contractions. This is an opportunity for students to explore features of nerve and muscle conduction, twitch and tetanic contractions as well as motor unit recruitment.
  • Measurement of the left ventricle ejection fraction using ultrasound on volunteer male students, under the guidance of professional sonographers. A modern imaging technique is used here to provide understanding of the dynamics of cardiac contraction in healthy subjects, illustrate important physiological features of the heart and provides the opportunity to measure cardiac output.
  • Exploration of 12-lead and 3-lead electrocardiograms on healthy volunteers to determine features of the electrical activity of the heart. This practical gives a first taste of this important clinical tool, to illustrate the relationship between cardiac function and the detectable electrical signals at the surface.
  • Diagnostic microbiological characterization of commonly encountered pathological bacteria. This practical illustrates the role of the clinical pathology laboratory in the hospital, as well as giving students their first opportunity to observe a range of bacteria under the microscope.
  • Assessment of breathlessness in which volunteer students use cycle ergometers to determine their VO2max. Students measure parameters of lung function at rest as well as during and after exercise.
In Year 2, student practicals include:
  • Examination of gall-bladder size by ultrasound in volunteer male students, before and after ingestion of ice cream. This is the third practical in which ultrasound is used to explore the dynamics of healthy organs.
  • Study of age-related impairments on activities of daily living in which student volunteers wear a variety of contraptions (e.g. goggles, ear mufflers, weights, splints) which simulate aspects of the impairments that develop in ageing. This practical is relevant to the patient demographics our students will encounter in their career.

All practicals have undergone a rigorous risk assessment, and approval by the school ethics committee was obtained when necessary. All volunteers have agreed to the procedures and signed consent forms.

Assessment of the Practicals

For four of the Year 1 practicals, students are asked to submit a summary of their work in the form of a 1000-word scientific abstract submitted online. This is designed to develop scientific writing skills as well as the ability to synthesize and summarize their laboratory experiences. The write-ups are doubly marked and feedback is provided to the students on the quality of their work. The assessment is formative only. Unsatisfactory or late write-ups require a second or third attempt.

Are practicals well received?

All practical classes, as well as all our other teaching sessions are assessed through the collection of prompted anonymous student feedback through our ¡®Student Voice¡¯ web portal. A random fraction of the cohort is asked to score seven important characteristics of the practicals, such as ¡®the learning experiences helped me to develop understanding of important concepts and/or skills¡¯. In addition, free-text comments are encouraged. Responses were generally positive. Examples of responses are shown below for the Year 1 ¡®cardiac ultrasound¡¯ practical:

Illustrative Comments: Science Practical Process

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INNOVATION magazine is a joint publication of Nanyang Technological University, National University of Singapore and World Scientific Publishing Co Pte Ltd