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Medical Physiology and Experimentation: Reconsidering the Undergraduate Examination Structure
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     The structure of the examination procedure is indicative of the teaching goals set by the tutors, because it focuses on the (so thought to be) "essential parts" of the provided knowledge. When there is a clear view of what one wants the students to know, a well-designed examination system can be established to evaluate this learning outcome. Vice versa, a clear view of what the examiners are likely to ask makes the students more active and careful during the teaching of the so-called "essentials" (1). However, recently, there has been a typical (one might use the term "disdained") approach toward experimental demonstrations as part of biological, physiological, and allied health biochemical education. Experimental demonstrations have become a rare, nonpopular sometimes, event. Medical students believe that experimental demonstrations (where attendance is not voluntary) 1) are (in their majority) not well designed or instructed (and thus considered to be "boring"), 2) are not a task of evaluation (and thus are not considered as "essential"), 3) do not provide knowledge in an innovative way (because some of the experimental apparatus and demonstration material have remained unchanged for more than 20 yr), and 4) do not cope with public concerns of animal use for teaching. Moreover, one should consider that most of these students are under increasingly strong pressure to cope with the dreaded "licensure exams," a fact that makes secondary activities (such as laboratory demonstrations) a meaningless procedure.

    We, herein, provide a short view of how we think the undergraduate evaluation of medical physiology should be to enhance a more active participation of the students in the small-group experimentation lectures taking place during the teaching of medical physiology. Primarily, we believe that the teaching of medical physiology should take place in three semesters: the second, third, and fourth [the undergraduate medical program at the Medical School of Athens (University of Athens, Athens, Greece) is a 6-yr academic program in which medical physiology is examined by the end of the third and fourth semester]. The teaching should be done in the following blocks: 1) block I (second semester: essential aspects, neuromuscular system, autonomic nervous system, endocrine system, and immune system); 2) block II (third semester: cardiovascular system, respiratory system, renal system, temperature regulation, and gastrointestinal system); and 3) block III (fourth semester: intermediate metabolism and growth, central nervous system, sensory systems, higher functions, and reproductive systems). The evaluation of each block should take place right after the end of each semester, through written examinations. We propose that the examination should consist of four parts (Table 1).

    In the first part (part A), all 5 topics analyzed in each block should be examined via 25 (total) multiple-choice questions. Each correct answer should be rewarded with 1 point (with a maximum of 25 points for this part). In the second part (part B), each of the five topics analyzed in the past semester should be examined by a representative question (total of 5 questions). The latter should be a multiple-choice question followed by a short-answer request (2–3 sentences long; a limited provided space in the answer sheet would be helpful). Each correct multiple-choice answer should be rewarded with 1 point, whereas each correct short answer should be rewarded with 1–4 points (with a maximum of 25 points for this part). The third part (part C) should consist of 3 main questions (randomly selected among questions provided by tutors and concerning the 5 examined topics of the current block). Each answer (not >5–8 sentences long) should be rewarded with a maximum of 10 points (with a maximum of 30 points for this part).

    Finally, we believe that the fourth part (part D) should provide five questions concerning one of the experimental demonstrations that took place during the passing semester. Each answer (expected not to exceed 10 sentences in length) should be rewarded with 1–4 points (with a maximum of 20 points for this part). Through part D, students should be encouraged to provide clear and comprehensive answers, a fact that can be established through the examiners' request.

    By examining the experimental demonstration learning of medical students, we will force them to be more active during these teaching sessions and provide them with a better thinking of collecting, analyzing, and evaluating experimental data by simultaneously reviewing the major ideas of physiology (as presented in the ordinary lectures) (2). However, before we proceed to such a measure, the faculty members should 1) redesign the demonstrations' structure to provoke more active student participation; 2) renew the experimental apparatus and demonstration material; and 3) be more selective as to what is essential to demonstrate during these experimental classes, with a clear view of what has been mentioned during the ordinary lectures and how it was discussed.

    REFERENCES

    Craig JR and Metze LP. Methods of Psychological Research (2nd ed.). Belmont, CA: Brooks/Cole, 1989.

    Gupta S, Westfall TC, Lechner AJ, and Knuepfer MM. Teaching principles of cardiovascular function in a medical student laboratory. Adv Physiol Educ 29: 118–127, 2005.(Apostolos Zarros)