Volume 12, Number 1, 2003
W hen Robert Neeves, professor of health, nutrition and exercise sciences, was asked to teach a section of an anatomy course in a problem-based learning format, he says he was more than a bit skeptical.
After all, this approach would involve the development of problem-based learning modules incorporating the use of human organs that had been plastinated--specially preserved in a lifelike state--and interactive computer routines, as well as traditional textbooks. It would be quite a change for Neeves, who had been teaching in the traditional lecture style since coming to UD in 1970.
Problem-based learning is a process that uses real-world situations to motivate students to identify problems and apply research concepts and information while collaborating and communicating effectively in small groups. Most often, instructors say, it is a learning experience for teachers as well as students.
"You have to determine well in advance what tools are needed and what assessment measuring capabilities will be required," says Shelley Provost-Craig, associate professor of health, nutrition and exercise sciences and Neeves' teaching partner in the course last fall. "It was a real eye-opener, and we started learning a lot in a very short time."
The course in question, "Anatomy and Physiology," placed students in the hypothetical role of on-call cardiologists in a hospital emergency room.
In one of the scenarios that Neeves and Provost-Craig developed, a fictional Mr. Hart arrives in the ER, complaining of chest pains and sweating profusely. On examining his medical records, the student doctors in the class learn that Mr. Hart's blood pressure (170/90 mmHg) isn't good and his cholesterol level (259 mg/dl) is even worse. He's been advised by his family doctor to take a cholesterol-lowering medication but has failed to do so.
His exercise-stress-test electrocardiogram indicates the presence of coronary artery disease, and a follow-up cardiac catheterization discloses a 95 percent blockage in his left main coronary artery. Mr. Hart, it seems, has suffered a myocardial infarction, something non-professionals would call a heart attack.
Based on this information, the problem-based learning students were given a series of questions about the possible structural cardiovascular damage and nervous system changes that Mr. Hart had experienced and what changes he should make in his lifestyle.
"The hard part is figuring out what questions to use," Neeves says. "The job of the students was to solve a real-life problem that a lot of human beings will experience."
The instructional format designed for the course incorporated such teaching enhancements as board illustrations, Internet sites and PowerPoint presentations. Case studies also were used for small-group problem-solving sessions during each class period.
In addition to the drawings and handouts, students used a new interactive anatomy tutorial web site, which Neeves and Provost-Craig developed with the help of staff members at The PRESENT. An acronym for Practical Resources for Educators Seeking Effective New Technologies, The PRESENT is a University program designed to help faculty use technology effectively in the classroom.
Perhaps the most unusual teaching tools used in the anatomy course were plastinated human hearts, lungs and other organ specimens, which had been prepared by Neeves and Ronald S. Wade, director of the Anatomical Services Division of the University of Maryland School of Medicine.
The plastination process involves injecting red and blue dyes into the arteries and veins of donor hearts. The hearts then are fixed in a formalin solution, dehydrated in subfreezing acetone and vacuum-impregnated with liquid silicone.
The result is rubberized teaching specimens that are portable, durable, odorless, biologically inert, easy to store and safe to handle while retaining all their anatomical features. The plastinated organs used in the problem-based learning course all possessed evidence of some type of medical problem.
"The students had to examine the organs to identify the problems and then present their findings," Provost-Craig says.
Students in the UD anatomy class last fall were divided into two groups, a problem-based learning group and a control group that was taught using traditional textbook and lecture methods. Both groups were given pre- and postclass tests.
As it turned out, Provost-Craig says, both groups did well on the objective phase of their posttest, but their approaches to the essay portion were very different.
"The control group only provided very limited, pat answers, because their only sources of information came from the standard lectures and basic textbook facts," Provost-Craig says. "The problem-based learning students, on the other hand, provided answers that were extremely creative."
She says those students not only provided the basic answer, but they suggested diagnostic testing methods, pharmacological approaches, possible outcomes of therapy and necessary lifestyle changes for the patient.
"The problem-based learning students pursued information on their own, including the use of outside resources," Provost-Craig says. "They became responsible for their own education. They became their own teachers."
The value of this approach will become more apparent to these students as they enter dental or medical schools or begin their careers in allied health fields, according to Neeves.
"They will have to do a lot of problem solving when they get to medical school," he says. "This approach helps to motivate students. It makes the whole idea of helping others become real to them."
--Jerry Rhodes