Shihab E. O. Khogali

Integration of e-learning resources into a medical school curriculum

Background: E-learning has the potential to make important contributions to medical education, but there has been limited study of a blended approach in which the digital resources are introduced alongside traditional teaching methods such as lectures. Methods: We describe the successful embedding of an e-learning resource into 3 of the 5 weeks of cardiovascular system teaching for 164 first-year medical students by providing scheduled slots in the timetables. A questionnaire completed by the students at the end of the 5 weeks had a response rate of 66%. Students varied in how they made use of the resource, some systematically working through it and others browsing and studying sections felt to be personally most relevant. Results: Almost all (96%) rated the e-learning resources as probably or definitely of value: they particularly valued interactive activities, animations, video demonstrations, video clips of experts and self-assessment exercises. Graduate students had a significantly more favourable assessment of the e-learning resources than their undergraduate colleagues, while female students felt the value in supporting existing learning opportunities more strongly than male students. Conclusions: It should not be assumed that all students will choose to use an e-learning resource in the same way and instructional design should enable alternative approaches. The sequence in which the e-learning resource is used in relation to the other learning opportunities, such as lectures and PBL group discussions, may be important and merits further consideration. The experiences reported in this study provide encouragement and pointers for others engaged in the integration of e-learning in their curriculum.

Adoption and integration of simulation-based learning technologies into the curriculum of a UK Undergraduate Education Programme

Context  At a time of significant changes in medical education world‐wide, the international dimensions and global issues relating to the application of new learning technologies have been recognised.

Interaction between Glutamine Availability and Metabolism of Glycogen, Tricarboxylic Acid Cycle Intermediates and Glutathione

After exhaustive exercise, intravenous or oral glutamine promoted skeletal muscle glycogen storage. However, when glutamine was ingested with glucose polymer, whole-body carbohydrate storage was elevated, the most likely site being liver and not muscle, possibly due to increased glucosamine formation. The rate of tricarboxylic acid (TCA) cycle flux and hence oxidative metabolism may be limited by the availability of TCA intermediates. There is some evidence that intramuscular glutamate normally provides alpha-ketoglutarate to the mitochondrion. We hypothesized that glutamine might be a more efficient anaplerotic precursor than endogenous glutamate alone. Indeed, a greater expansion of the sum of muscle citrate, malate, fumarate and succinate concentrations was observed at the start of exercise (70% VO2(max)) after oral glutamine than when placebo or ornithine alpha-ketoglutarate was given. However, neither endurance time nor the extent of phosphocreatine depletion or lactate accumulation during the exercise was altered, suggesting either that TCA intermediates were not limiting for energy production or that the severity of exercise was insufficient for the limitation to be operational. We have also shown that in the perfused working rat heart, there is a substantial fall in intramuscular glutamine and alpha-ketoglutarate, especially after ischemia. Glutamine (but not glutamate, alpha-ketoglutarate or aspartate) was able to rescue the performance of the postischemic heart. This ability appears to be connected to the ability to sustain intracardiac ATP, phosphocreatine and glutathione.

Amino Acid Transport during Muscle Contraction and Its Relevance to Exercise

The functional significance of amino acid transport in skeletal muscle has been explored by the use of a variety of techniques including work in isolated perfused organs, isolated incubated organs and tissue culture of muscle cells. The results suggest that although there is a wide variety of amino acid transport systems of different characteristics and with different responses to ionic, hormonal and nervous modulation, the amino acid glutamine (transported by system Nm) demonstrates some unusual properties not observed with amino acids transported by other systems. Glutamine is transported at very high rates in skeletal muscle and heart and both the glutamate and glutamine transporter appear to be adaptively regulated by the availability of glutamine. Glutamine appears to be involved in the regulation of a number of important metabolic processes in heart and skeletal muscle (e.g., regulation of the glutathione reduced/oxidised ratio and regulation of protein and glycogen synthesis). Furthermore, glutamine transport appears to interact with systems for regulation of volume control and many of the metabolic features attributable to changes in glutamine concentration appear to be modulated via alteration in cytoskeletal status.

Study guides: a study of different formats

More emphasis is being placed on students as independent learners with teachers acting as facilitators. It has been argued that student-centred learning can be supported usefully by study guides. This paper supports previous claims as to the value of study guides as perceived by students. But what should study guides look like? A total of 151 second-year medical students at the University of Dundee were given three versions of a study guide covering the topic of hypertension, each incorporating a different educational approach but with the same content. A timetable-based version of the guide focused on the students’ day-to-day timetable and related the learning outcomes to each of the scheduled learning opportunities. A problem-based version of the guide introduced a clinical problem and encouraged the students to think of the learning outcome for the module as they related to the problem. Thirdly, an outcome-based version was structured round the 12 key areas of the learning outcomes. The timetable-based guide was preferred by the majority of students, although some preferred the problem-based guide and others the outcome-based guide. This may in part be due to students’ lack of familiarity with a problem-based and outcome-based approach. It may also relate to what is seen as a key function of a study guide: to lead the student through the day-to-day learning experiences in a course and to introduce a student to a course or a topic and provide an overview of what is to be achieved in their studies of it.

Team-based learning: a practical guide: Guide Supplement 65.1--viewpoint 1.

The practical aspects and potential benefits of team-based learning (TBL) are outlined on the recent guide published by Parmelee et al. (2012). TBL provides a strategy for active student-centred collaborative learning which involves multiple small groups in a single classroom setting, incorporating many of the adult approaches to learning, more frequently seen in problem-based learning (PBL). A single teacher who is a content-expert, who need not have any experience in the group processes to deliver a successful session, instructs the student groups. Unlike PBL and traditional small group learning, TBL provides opportunities to hold each student accountable for their own performance and their individual contributions to the team (Parmelee et al. 2012). A limited search of ‘PubMed’ revealed that TBL is being used and evaluated internationally as an educational strategy, with virtually no published papers on TBL from the UK. This may suggest either little current interest on the use of TBL by UK medical educators or that the UK is currently not contributing a great deal to the literature on TBL. There may be a need to research the effectiveness and outcomes of TBL in a UK context of medical education.