Received Date: December 01, 2011; Accepted Date: January 05, 2012; Published Date: January 07, 2012
Citation: Gurpinar E, Boz A, Alper O (2012) Cystic Fibrosis in Medical Education. J Community Med Health Edu 2:117. doi:10.4172/2161-0711.1000117
Copyright: © 2012 Gurpinar E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Aim: The aim of the present study was to introduce the Problem Based Learning (PBL) module on cystic fibrosis applied in Akdeniz University Medical School, to present the feedbacks of the tutors and the students about the module and to evaluate the student success achieved in the module.
Method: The study group consists of all first semester students (n=208) and the tutors in charge of this PBL module (n=21). In order to acquire the feedbacks of the students and tutors on the scenario and the implementation of the PBL module, a questionnaire consisting of six questions was administered to the study group at the final session of the PBL course. Additionally, another questionnaire was administered to the students to determine the opinions of the students about whether the module positively contributed to their present knowledge level.
Results: 94.7% of the students (n=197) and 85.7% of the tutors (n=18) responded to the feedback form aimed at receiving the feedbacks on the scenario and implementation of the PBL module. The responses given to this questionnaire showed that the tutors and the students gave identical scores to all the items and there was not a statistically significant difference between the two groups. The average PBL exam score of the students was 112.3 (maximum score=150) and their average course committee examination score was 539.7 (maximum score=850).
Conclusion: As a result, it was determined that the feedbacks of the students and tutors about the PBL module on cystic fibrosis, a fatal health problem that has received attention in the recent years, were positive and high student success was achieved with the module.
Cystic fibrosis; Problem based learning; Undergraduate medical education
Since 1970s, there has been a tendency to revise educational programs, implement up-to-date and novel methods and focus on student-oriented education in order to educate better qualified doctors [1,2]. In our country, the milestones of this change process are the student-oriented education, which began to be implemented in 1997, and the National Seed Program, which was published in 2001 [3,4]. One important purpose of these changes is to furnish the students with the adequate knowledge and skills that they need in approaching frequently seen diseases and to bring about a change in their attitude. Studentoriented instructional methods contribute greatly to the achievement of this purpose . The most commonly used student-oriented educational method is Problem-Based Learning (PBL). This educational model helps the student to develop the skills of using his/her knowledge in problem-solving, analyzing and synthesizing information, determining what he/she needs to learn and finding out how to access the knowledge he/she lacks. In the end, the student becomes able to synthesize and analyze information, acquires the ability of lifelong learning [6-8] and learns where and how to use the knowledge he/she gained [9,10]. These benefits of PBL make it increasingly more popular in the medical schools throughout the world.
The most important instrument of PBL in achieving the abovementioned purposes is “the scenario”. The scenario is written according to a set of rules and structured in a way that it will help the student to achieve the intended educational aims. It is crucial that the scenario is based on a disease that is prevalent in the general population. Thus, the student can be able to gain knowledge both on pre-clinical medicine by learning the underlying physiological mechanism affected by a disease and on clinical medicine by scrutinizing the malfunction in the related mechanism and the disease process. Additionally the student seizes the opportunity of learning about a common disease at an early stage of his/her medical education. Cystic fibrosis (CF) is one of the most appropriate diseases, on which a scenario can be based. CF is the most common genetically inherited fatal autsosomal recessive disease [11-14].
The present study aims at introducing the PBL module related to cystic fibrosis, which was conducted in Akdeniz University Medical School, and presenting the feedbacks of the students and tutors about the module and the related student success.
The educational program
In Akdeniz University Medical School, a total of 10 PBL modules (one for each course) are included in the 1st and 2nd semesters of the first year that is aimed at pre-clinical medicine education. The courses given during the first and second semesters have an integrated structure. Usually, during the second week of the courses; a scenario, which is based on a specific topic scheduled to be covered in the course and a common disease in the general population and is aimed at assisting the student in acquiring the necessary clinical and pre-clinical knowledge is prepared. In accordance with the educational aims, each year new scenarios are formed and new patient cases are used.
21 tutors took charge in each PBL module. As usual, the students (total=208) were assigned into groups of 9 or 10 and the PBL examinations were held five days after the end of each PBL module week. The PBL examination, which is evaluated separately from the course examination and has a weight of 120 points, consists of a multiple choice test (60 points) and CORE (Clinical Objective Reasoning Examination, 60 points). CORE is an examination method that queries whether the students reached the educational goals set by the PBL module, and allows the students to see the right and wrong answers during the examination. Additionally, using a form, the attitude and behavior of the students are evaluated by the tutors and the students receive points (up to 30 points) from this evaluation. Thus, the total PBL module weight rises to 150 points. The total weight of the course examinations, on the other hand, is 850 points.
The PBL session that constitutes the subject of this study was based on cystic fibrosis and conducted in Akdeniz University Medical School, during the third course of the first semester of the 2009-2010 academic year. The module targeted the achievement of 11 primary and 4 secondary learning aims. These aims are listed below:
1. Introduction to the concept of genes and the discovery of the relation between genes and diseases.
2. Memorization of the cell membrane structure
3. Learning about the nature and functional importance of macromolecules and ion channels that are present in the cell membrane
4. Learning about how Na and CI ions pass through the cell membrane and about the electrochemical gradient
5. Learning about the Mendelian inheritance models.
6. Learning about the single gene diseases and genetic diagnosis methods
7. Learning about the types of the genetic mutations and apprehension of compound heterozygosity.
8. Learning about the prenatal diagnostic methods for single gene diseases
9. Apprehension of cystic fibrosis and its genetic properties
10. Learning about the sweat test and how it is performed.
11. Learning about the prenatal diagnostic methods for cystic fibrosis
1. Learning about genetic consultation and its importance
2. Learning about consanguineous marriage and its results
3. Learning how to prepare pedigree charts
4. Learning about how cystic fibrosis affects different systems (the findings related to pulmonary and gastrointestinal involvement).
Brief content of the scenario:
The case in the scenario was 7 years old male who complained about growth retardation, common fatigue, and persistent cough. In medical history, the family recognized growth retardation comparing their son with the children at the same age regarding height and weight. Frequent pneumonia attacks were seen. Although good appetite, the patient cannot gain weight. Frequent defecation and steatorrhea were prominent.
His mother and father were relatives.
In physical examination, growth retardation and common fine crackles in oscultation of the lungs were detected.
Results of the investigation tests (complete blood count, sedimentation rate, CRP, sweat test, molecular genetic analysis) supported the diagnosis of CF.
The study group consisted of all first semester students (n=208) and all the tutors in charge of the PBL module (n=21). After the aim of the study was explained to the study group and their consent was obtained, the surveys were distributed and filled out anonymously by the participants.
Survey forms and evaluation
In order to collect the feedbacks of the students and tutors regarding the scenario used in the PBL module and its implementation, a survey consisting of six questions was administered to the study group during the final PBL session. Along with this survey, a survey consisting of 13 questions was administered to the students in order to determine their opinions about whether PBL brought out a change in their knowledge level related to the topics covered in the PBL sessions. Both surveys included 5-point likert scales. The items on the scale prepared to receive the participants’ feedbacks ranged from “1-insufficient” to “5-Very good” while the scale querying the increase in the knowledge level of the students ranged from “1-I definitely do not agree” to “5-I definitely agree”. To evaluate student success, PBL examination scores were used while the scores received from the examinations included in the related course (Cell Biology and Genetics) were used as control.
SPSS 13.0 software was used for statistical analysis. PBL examination scores and course examination scores were compared using correlation analysis. Mann-Whitney U-test was used to compare the feedback scores of the tutors and the students.
Feedbacks related to scenario and the implementation of the PBL module
The survey form aimed at receiving the feedbacks related to the scenario and PBL module implementation was responded by 94.7% of the students (n=197) and 85.7% of the tutors (n=18). In the survey form, the item that received the highest score from the tutors was “The PBL module ensures that the students reach different hypotheses” (4.11 points) whereas the item that received the highest score from the students was “The history, physical examination and laboratory results were consistent with the hypotheses” (4.27 points). The scores of the students and tutors for the general evaluation category aimed at the general evaluation of the implemented PBL module were 3.81 and 4.05, respectively. It was determined that, for all items, the scores of the tutors and students were close and there was no statistically significant difference between the two groups (Table 1).
|Mean ± SD||Mean ± SD||u*||p|
|The first section, allowing for the creation of different hypotheses||4.11 ± 0.90||3.88 ± 1.22||1674||0.68|
|Overall assessment||4.06 ± 0.72||3.81 ± 1.23||1516||0.75|
|History, physical examination and laboratory results of the compliance with the hypotheses||4.05 ± 0.72||4.27 ± 1.04||1340||0.06|
|Providing access to learning objectives||3.94 ± 0.73||4.05 ± 1.10||1466||0.24|
|The following sections provide hypotheses agreed on introducing||3.94 ± 1.11||3.97 ± 1.17||1714||0.81|
|Interesting||3.55 ± 1.38||3.67 ± 1.36||1678||0.69|
Table 1: The Students and Tutors Feedback Related to Scenario and PBL Practice.
The opinions of the students about whether the PBL module brought out a change in their knowledge level
93.8% of the students (n=195) responded to the survey form aimed at determining whether the PBL module brought a change in their knowledge level. Among the items included in the survey form, the item that received the highest score was “I learned that cystic fibrosis is a disease related to many systems” (4.51 points) while the item that received the lowest score was “I could have learned about cystic fibrosis better from a lecture” (3.13). It was determined that 8 out of 13 items received points equal to and higher than 4 (Table 2).
|I learned that cystic fibrosis is a multisystem disease.||4.51||0.84|
|The scenario helped me learn what cystic fibrosis is.||4.34||0.84|
|The scenario helped me learn the health problems caused by consanguineous marriage||4.21||0.88|
|The scenario gave me an idea about how I should approach genetic diseases after birth||4.19||0.97|
|The scenario helped me learn how to diagnose genetic diseases before birth||4.14||1.01|
|I know how to approach cystic fibrosis patients now||4.14||0.99|
|The scenario helped me learn the cellular mechanism behind cystic fibrosis||4.09||1.12|
|The scenario helped me acquire general knowledge about genetic diseases||4.02||1.04|
|I apprehended the importance of cellular transport mechanisms, which was a topic previously covered in the physiology course, in cystic fibrosis||3.95||1.22|
|Thanks to the subjects covered in the medical biology course, I understood the biological and genetic basis of cystic fibrosis better||3.89||1.15|
|This scenario helped me better understand the importance of membrane potentials, which were previously covered in the biophysics course||3.75||1.25|
|The lectures in the cell biology course helped me better understand this scenario||3.74||1.15|
|I could have learned about cystic fibrosis better from a lecture||3.13||1.61|
Table 2: Students’ Opinions about the Learning Objectives.
The success rate of the students
The average score received from the PBL examination was 112.3 (upper bound: 150 points) whereas the average score received from the related course examination was 539.7 (upper bound: 850 points). The investigation of the correlation between the two examination scores shows that the two scores have a positive, powerful and significant correlation (r=0.68, p=0.00) (Table 3).
|Classic course||PBL||Statistical analysis|
|Mean||(±) SD||Mean||(±) SD||R*||p|
Table 3: Students Test Scores.
During the medical education process, it is essential that the students acquire the basic knowledge, skills and attitudes that will enable them to deal with the common diseases. As it is known, cystic fibrosis is an important health problem, which is commonly seen in the general population and shortens life span to a great extent. It is a complicated multisystem disease that involves the respiratory tract, the male genital tracts, the hepatobiliary system, the endocrine system and the epithelium cells of the perspiratory glands. Additionally, the gene of the disease and the protein that is the product of the disease (Cystic Fibrosis Transmembrane Regulator Protein) and its functions are clearly defined [13-15]. Thus, it offers a good model in helping the students acquire both clinical and molecular knowledge. Since it is a prevalent and preventable disease and it serves as a good model for acquiring knowledge on the physiological mechanisms, which are the subject of pre-clinical medicine, it is highly important for the students to learn about and gain experience in cystic fibrosis in the early years of their medical education. It can be easier to achieve the educational aims if a method, which actively involves the student in the learning process and is approved by them, is used. It is known that PBL is a method that is approved and found satisfactory by both the students and the tutors [16-18]. Similarly, the scores given to the item titled “General Evaluation” in the feedback survey show that the study group was satisfied with the PBL module. Furthermore, the responses given to the questions in the feedback survey suggest that by helping the students first reach general hypotheses and then limit the scope of these hypotheses with the help of additional knowledge, the scenario ensures the achievement of the educational aims. These data regarding the tutors and the students can be considered as an indicator of the fact that the implemented PBL module is technically adequate and appropriate.
The analysis of student success rate revealed a powerful correlation between PBL and course scores. Based on this result, it can be suggested that the students were successful with both educational methods. Additionally, as the scores they received in PBL and in the course examinations are examined according to the upper bounds of these examinations, it can be concluded that the students were more successful at PBL. It is natural for the students to be successful in the examinations of an educational method, which they are pleased with. This result is important since it indicates that PBL may help students learn subjects better, graduate as better educated doctors and serve better to the society, all of which are steps leading to the objective of creating a healthier society. This can also be considered as indicating that the PBL module achieved its purposes.
One of the objectives of PBL is helping students obtain basic medical knowledge and learn the mechanisms behind diseases using a scenario based on a prevalent disease; and develop the ability of judging how, where and why to use their basic medical knowledge when exercising their profession. The responses given to the following items included in the survey that was aimed at assessing the contribution of the PBL module to the students’ knowledge level seem to support this view: “This scenario helped me better understand the importance of the cellular transportation mechanisms in cystic fibrosis, which had been previously covered in physiology courses”, “This scenario helped me better understand the importance of membrane potentials, which had been previously covered in biophysics courses,” and “Thanks to the cell biology courses, I apprehended this scenario better”. The fact that that the two items “The scenario helped me learn cystic fibrosis” and “I could learn about cystic fibrosis better from a lecture” received the second highest and the lowest scores, respectively, can be considered as indicating that, with the help of PBL, the students achieve the educational goals better.
The authors would like to thank Akdeniz University Research Fund for financial support.
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