The Wright Table Project. Validating a Novel Active Learning Tool for the Cardiac Cycle in Valvular Pathologies

Abstract

In response to students’ traditional struggles understanding the physiological dynamics of the cardiac cycle, the first author conceived a novel model, the Wright table of the cardiac cycle, that helps students visualize the heart working as a pump. This model shows direction of blood flow in response to pressure changes within cardiac chambers and major vessels, correlated with valve opening and closing as well as electrical events and auscultatory findings. Whether students could create and use Wright tables on their own as part of their active learning was unknown. Hypothesis We hypothesized that in mixed groups of year 1 & 2 medical students, that students would be capable of 1) creating versions of the Wright table for specific pathologies and 2) using this table as a teaching and learning tool to increase cardiac cycle and cardiac pathophysiology knowledge. Methods This initial phase of a multi-phase project was designed to validate the Wright Table as an active learning tool for cardiac physiology and pathophysiology using qualitative and quantitative data. Following IRB approval, teams of 2-3 students from research and cardiology clubs were each assigned 1 of 8 valvular disorders following their participation in an educational session on the Wright table for the normal cardiac cycle. Over three weeks, each team created a model for their condition citing resources used. Student-crafted Wright tables were presented in a Delphi-type session, allowing student attendees to choose, by anonymous vote, the best model representing each assigned cardiac pathology. Data collected and analyzed included qualitative process and progress feedback from student groups during model development; quantitative measurement of cardiac cycle physiology before and after initial exposure to the Wright table; and quantitative measurement of student understanding of cardiac valvular pathophysiology before and after the final Delphi session. Results 68 students began the study, and 46 finished all assignments. Of 32 starting groups, 22 tables with resources were submitted for Delphi review. In pre-and post-tests for valvular disorders, students demonstrated a significant increase in understanding valvular pathophysiology (36% to 47%, p< 0.001) after the Delphi session. The qualitative data revealed that the models that received the highest votes (>70%) were clear, simple, provided arrows to indicate blood flow, compared between either right and left heart or between normal and diseased heart, emphasized the damaged valve, highlighted the heart sounds and murmur, and provided brief notes on opening and closing of valves during the cardiac cycle. Conclusion The results have provided an initial level of validation for the Wright table of the cardiac cycle as an effective teaching tool for certain pathologies. The table can be used as an active learning tool by students to illustrate changes in cardiac pathophysiology in valvular disorders. Data from this process will inform the further development of this teaching tool. The next phase of this research project will include repeating this study with more time for student teams to research and create their respective tables.