Clinical Physiology Research Articles

The Development and Implementation of a Competency-Focused Curriculum in Health and Exercise Sciences

Historically, undergraduate programs in Health and Exercise Sciences (i.e. Kinesiology) are rooted in common areas such as physiology, anatomy, biomechanics, motor control, psychology, nutrition, and rehabilitation. A typical four-year program offers a general education across these areas often delivering a breadth of knowledge in many areas, albeit often lacking in transferable technical skill that relates to industry. With many graduates now pursuing advanced training in professional programs there is a need to develop more competency-focused curricula to better prepare students for entry into professional fields. Further, overburdened healthcare systems worldwide combined with an ageing population find themselves with a gap in service delivery, given the growing body of evidence supporting the benefits of high-quality exercise training in the prevention, treatment and management of chronic conditions. In 2018, following feedback from provincial ministries, the University Senate, faculty, students, and community partners, the School of Health and Exercise Sciences at the University of British Columbia Okanagan underwent a strategic review. This review led to the development of a professionally focused, competency-based program, now known as the Bachelor of Health and Exercise Sciences. Within this program are three concentrations geared towards developing knowledge and skills in differing areas dependent on student interest and desired career path: Kinesiology and Allied Health, Health Behaviour Change, and Clinical Exercise Physiology. The development of the revised curriculum involved crucial components such as defining new program and concentration level learning outcomes, competency profiles, definitions, progressions, and practical assessment strategies. Additionally, each concentration integrates a community practicum designed to enhance mastery of competencies within a professional setting. Establishing these practicums necessitates ongoing collaborative efforts with both existing and new community partners, the formulation of standards, and the implementation of a process to ensure students possess a baseline skill level before engaging with the community. A substantial challenge in the revised curriculum is the instruction of technical skills in a lab environment, as well as effective practical skill assessment that meets industry standards, for upwards of 200 students. To this end a great deal of planning was required from a resources standpoint, onboarding of new faculty with industry experience, as well as alignment with pre-existing certifying bodies including the American College of Sports Medicine, Exercise & Sport Science Australia, and the Canadian Society for Exercise Physiology. Looking to the future we anticipate both challenges and opportunities as we continue to redefine professional competencies and remap them throughout the curriculum to enhance skill progression and ensure our graduates are fit for purpose. Further, we are excited to continue to work alongside provincial entities and existing certifying bodies as we look toward the professionalization of the field. Lastly, but up utmost importance, is the dissemination of our process to other organizations and institutions in hopes to build momentum in the quickly evolving academic and professional landscape of Health and Exercise Sciences. None. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Application of Biomechanics in Medical Sciences

Abstract Biomechanics, the study of the mechanical behavior of living organisms, finds numerous applications in medicine, from understanding normal physiological functions to designing medical devices and treatments. Biomechanics plays a vital role in various medical specialties and applications, from diagnosing and treating musculoskeletal disorders to designing medical devices, optimizing rehabilitation strategies, and advancing regenerative medicine. Integrating biomechanics into medical physiology enhances our understanding of human function and drives innovation in medical technology and therapies.

Near-peer interactive sessions: a paradigm shift in medical physiology teaching in India.

Near-peer interactive sessions: a paradigm shift in medical physiology teaching in India.

Empowering students to create their dramatizations increases understanding of physiology.

Complex subjects such as physiology can be challenging for students to learn. These challenges are not uncommon in implementing the learning process in physiology and affect learning outcomes. Dramatization is an interactive and effective method to improve learning outcomes. In a project designed by senior medical students, junior medical students were guided in creating dramatizations related to three topics. Senior students were trained and assisted to prepare scenarios and make videos. The dramatizations were then carried out with junior medical students to help them better understand physiology and pathophysiology topics. A group of junior students receiving the same topics in a lecture format served as a control group. Pretest and posttest questionnaires were used to measure the improvement of learning outcomes. Assessment results showed an increase in performance in both groups. This study shows that dramatizations provide an effective alternative to lectures for instructing junior medical students.NEW & NOTEWORTHY The preparation of dramatizations involved students. The ideas, analogies, and dramatizations were originally from students. Dramatization is an alternative form of understanding learning objectives of medical physiology in an interesting way to increase motivation.

The learning styles of Australian exercise science and clinical exercise physiology students

ABSTRACT There has been a shift in tertiary education, whereby large portions of theory are now taught online, and the practical skills underpinned by this knowledge taught in clinical environments. It is unclear if this flipped approach is appropriate for the learning styles Exercise Science (ES) and Clinical Exercise Physiology (CEP) students. First- and second-year ES and CEP students at a South Australian metropolitan university were invited to participate between March 2021 and October 2022. Eligible participants completed the Kolb’s Learning Style Inventory (KLSI) (Version 3.1) to identify learning styles. Descriptive statistics were calculated for the four KLSI learning orientations. Group scores for the learning orientations were used to identify group preference for abstractness over concreteness and action over reflection. A total of 69 students completed the KLSI fully. As a single cohort, Accommodators were the most common learning style, and there was a preference for concreteness over abstractness when gaining experience and a preference for action over reflection when transferring experience into knowledge. These findings indicate that Australian ES and CEP students have a unique learning style that may be suited to flipped classroom approaches, but only if they include opportunity to experience skill learning in a hands-on manner, while also allowing time for reflection.

140 A Pilot Project Program to Foster the Inclusion of Undergraduate Faculty and Students and Graduate Students to Work with Experienced Researchers in a Mentored Research Experience in Clinical and Translational Science Succeeds Beyond Geographical and Institutional Boundaries

OBJECTIVES/GOALS: The Title V Project at the Medical Sciences Campus aims to expand the knowledge in Clinical and Translational Research (CTR) and diversify the CTR workforce throughout Puerto Rico. A Pilot Project Program (PiP) offers research training for Undergraduate students (UgS), Graduate Students (GS), and Undergraduate program Faculty (UgF). METHODS/STUDY POPULATION: Since 2021, the Title V Project has established a rolling application process to which researchers from any scientific background related to CTR in all post-secondary institutions in Puerto Rico may submit research proposals. These are peer-reviewed considering the following criteria: the research team composition must include UgS, GS, and UgF; the primary researcher’s expertise; the significance of the proposed topic related to Puerto Rico’s health problems; and the research plan’s quality. In addition, proposals must include a career plan for student and faculty members to participate in further training in CTR-related topics, such as scientific communication and statistical analyses, also offered through the Title V program. RESULTS/ANTICIPATED RESULTS: Twelve (12) PiP research teams showcase diversity in research areas with representation from Nursing, Occupational Therapy, Cancer, Cell Biology, Microbiology, Anatomy and Medical Images, Electro-Chemistry, Anatomy, and Physiology. In addition, Pip’s team members represent eleven (11) different institutions across seven different geographical areas, whose complete profiles we delineate in the presentation. Teams have the participation of twelve (12) primary researchers, five (5) mentors, twelve (12) UgF, seventeen (17) UGs, four (4) medical students in different stages, and nine (9) GS. We will present the composition, research topics, development, and participants' feedback. DISCUSSION/SIGNIFICANCE: The PiP program has been instrumental in organizing interdisciplinary and interinstitutional research teams. It has proven to be an effective strategy for fostering inclusion, diversity, and equity in CTR and promotes the practice of team science. Teams' research responds to health issues in this Hispanic population.

Teaching stress reduction techniques including biofeedback for managing stress in medical students

IntroductionMedical students have been under immense pressure throughout their studies, impacting their mental health and academic performance. Stress reduction is a fundamental skill that all students require to manage their studies and lives efficiently. Biofeedback devices providing information about physiological states have been shown to aid stress reduction. Methods to reduce stress should be taught to medical students to help them tackle the challenges of medical school.ObjectivesOur goal was to teach stress reduction methods such as extracurricular activities and paced breathing aided by biofeedback training and its application in simulated healthcare situations to medical students.Methods15 medical students who completed medical physiology were recruited for an elective course of 7 sessions on practical techniques in stress management. One credit was offered to those who completed the course requirements consisting of participation in sessions and individual biofeedback training. Sessions (classes) consisted of presentations on good sleeping and eating patterns, group simulations of stressful hospital environments, visiting a science centre with interactive displays, an orchestra performance, and nature walks. Before biofeedback training, heart and respiration rates were taken individually by a biofeedback device during the first week of the course. Data was processed using a code created in statistical software. Heartbeats per minute and heart rate variability (HRV) for every 10 seconds were calculated and plotted on a graph. Two measurements were taken with each student: a baseline measurement for 10 minutes and another measurement during controlled breathing paced at 6 breaths per minute for 15 minutes, of which the first 10 minutes were used for calculation and plotting. Students provided narrative feedback in an essay submitted after the course was completed.Results5 males and 10 females from years 2-5 registered for the elective, and 12 participated in individually scheduled sessions. Heart beats per minute decreased, whereas HRV increased during paced breathing sessions in 83% of them. Most students reported feeling calm and drowsy during the sessions, and 2 students fell asleep by the end.Feedback from 11 students showed that the music session and the science centre visit were the highlights throughout the elective. Improvements recommended were to have a consistent time slot for all sessions and fewer simulations.Conclusions In concert with the literature, biofeedback training seems to be a feasible and effective method for relaxation in medical students. This method could be offered as part of mental health services for students. Data could be used to follow students’ progress and identify those requiring extra support. Providing them with avenues to de-stress while emphasizing activities outside medicine could boost their confidence and improve their coping skills.Disclosure of InterestNone Declared

Comparative analysis of GPT-3.5 and GPT-4.0 in Taiwan's medical technologist certification: A study in artificial intelligence advancements.

This study examines the comparative effectiveness of GPT-3.5 and GPT-4.0, in the certification of medical technologists (MT) in Taiwan, exploring their adeptness in processing complex medical language and their contributory role in the educational and communicative aspects of professional healthcare training. This study used GPT-3.5 and GPT-4.0 to test the medical laboratory technician professional college entrance examination questions. The questions in different fields, including six subjects, such as Clinical Physiology and Pathology, Hematology, and Blood Bank, among others were answered one-on-one using two generative pretrained transformer (GPT) versions, simulating the situations during exam preparation. A total of 480 questions were analyzed and the results showed that both versions of the GPT met the certification standards. Version 4.0 was better than version 3.5 for all subjects, particularly in Clinical Biochemistry (score = 96.25) and Microbiology (score = 91.25). Outstanding performance compared to version 3.5, which had an average score of 65.42 and a maximum score of 77.5. Overall, version 4.0, which was significantly better than version 3.5 in both median and average scores, reflects a significant improvement in professional knowledge processing capabilities. The GPT can provide valuable support for both the upstream and downstream processes of MT certification. Future research can further explore the application of GPT in different educational and certification contexts and improve the passing rate of medical personnel in the certification process. This study provides useful information for exploring the potential applications of GPT in certifying medical examiners. Furthermore, it provides new directions for future research in medical education.

Clinical physiology: the crucial role of MRI in evaluation of peripheral artery disease.

Peripheral artery disease (PAD) is a common vascular disease that primarily affects the lower limbs and is defined by the constriction or blockage of peripheral arteries and may involve microvascular dysfunction and tissue injury. Patients with diabetes have more prominent disease of microcirculation and develop peripheral neuropathy, autonomic dysfunction, and medial vascular calcification. Early and accurate diagnosis of PAD and disease characterization are essential for personalized management and therapy planning. Magnetic resonance imaging (MRI) provides excellent soft tissue contrast and multiplanar imaging capabilities and is useful as a noninvasive imaging tool in the comprehensive physiological assessment of PAD. This review provides an overview of the current state of the art of MRI in the evaluation and characterization of PAD, including an analysis of the many applicable MR imaging techniques, describing the advantages and disadvantages of each approach. We also present recent developments, future clinical applications, and future MRI directions in assessing PAD. The development of new MR imaging technologies and applications in preclinical models with translation to clinical research holds considerable potential for improving the understanding of the pathophysiology of PAD and clinical applications for improving diagnostic precision, risk stratification, and treatment outcomes in patients with PAD.

Alignment of learning objectives, assessments, and active learning to promote critical thinking in a first-year medical physiology course: lessons learned.

Medical students must be adept at critical thinking to successfully meet the learning objectives of their preclinical coursework. To encourage student success on assessments, the course director of a first-year medical physiology course emphasized the use of learning objectives that were explicitly aligned with formative assessments in class. The course director introduced the physiology discipline, learning objectives, and evidence-based methods of studying to students on the first day of class. Thereafter, class sessions started with a review of the learning objectives for that session and included active learning opportunities such as retrieval practice. The instructor provided short answer formative assessments aligned with the learning objectives, intended to help the students apply and integrate the concepts. Midsemester, students received a link to an online survey with questions on studying habits, class attendance, and student engagement. After finals, students were invited to participate in focus groups about their class experience. A qualitative researcher moderated focus groups, recorded responses, and analyzed the narrative data. Of 175 students, 95 submitted anonymous online surveys. Student engagement was significantly correlated with in-person class attendance (r = 0.26, T = 2.5, P = 0.01) and the completion of open-ended formative assessments (r = 0.33, T = 3.3, P = 0.001). Focus groups were held via videoconference. From the class, 14 students participated in 4 focus groups; focus group participants were mostly women (11 of 14) and mostly in-class attendees (13 of 14). The students in this sample valued critical thinking but misunderstood expectations on exams and few students used learning objectives to study.NEW & NOTEWORTHY We introduced formative assessments and study techniques to first-year medical students in a physiology course. Mastery of learning objectives was emphasized as the key to success. We asked how they studied physiology through an anonymous online survey and focus group interviews. The students enjoyed physiology but had difficulty with exam expectations. Helping students use learning objectives to guide their study may lead to improved exam scores. It may also help administrators meet their curriculum goals.

MEDICAL PHYSIOLOGY: ADVANCEMENTS IN TEACHING APPROACHES AT MEDICAL UNIVERSITIES

This article addresses the pressing issues of training modern medical and dental doctors as well as masters in biology at higher medical institutions, examining contemporary theoretical and practical approaches to integrating medical physiology as a fundamental medical amd biological discipline. It delves into current challenges in teaching physiology within the modern educational landscape, particularly focusing on the Department of Physiology at the Poltava State Medical University. This discipline is delivered by the Department of Physiology for students of the second (Master) level of higher education in the field "Healthcare" and "Biology". Physiology is a cornerstone discipline that fosters interdisciplinary integration in medical education, bridging theoretical knowledge with practical application in clinical settings. Emphasizing a practically oriented teaching principle, the article underscores the pivotal role of physiology in preparing students for clinical practice. The department adopts a comprehensive approach, developing and updating educational materials and manuals, including laboratory work with detailed descriptions of physiological research methods. Highlighting the department's achievements, it mentions their contribution to the first Ukrainian translation of the renowned physiology textbook "Medical Physiology” by Guyton and Hall in two volumes. It concludes by stressing the importance of enhancing the quality of education in medical institutions through continuous improvements in teaching practices, integration of advanced scientific developments and technologies, and the provision of modern educational resources and facilities, particularly in the field of physiology, which serves as the theoretical backbone of clinical medicine.

Utility of single fibre electromyography (SFEMG)and motor unit number estimation technique (MUNE) in the diagnosis and differentiation of polyneuropathies of different aetiology.

To determine whether single fibre electromyography and motor unit number index can distinguish between axonal and myelin lesions in polyneuropathies. This case-control study was conducted at the Department of Medical Physiology, School of Medicine, University of Duhok, Iraq, and the Neurophysiology Department, Hawler Teaching Hospital, Erbil, Iraq, from January 2021 to March 2022. Group A had patients diagnosed with polyneuropathy regardless of the aetiology, while group B had age-matched healthy controls. Both groups were subjected to single fibre electromyography and motor unit number index as well as conventional nerve conduction study and concentric needle electromyography. Data was analysed using SPSS 26. Of the 140 subjects, 60(43%) were patients in group A; 40(67%) males and 20(33%) females with mean age 55.3±7.2 years. There were 80(57%) controls in group B; 43(54%) females and 37(46%) males with mean age 53.81±7.15. Group A had significantly higher single fibre electromyography jitter, and mean consecutive difference (MCD) values than group B (p<0.05). Group A patients with axonal polyneuropathy had a higher mean jitter (MCD) value (36.476.7ms) than those with demyelinating polyneuropathy (23.262.31 ms) (P <0.05). Patients in group A had a motor unit number index value with a significantly lower mean value (p<0.05) when compared to the controls. Axonal polyneuropathy patients had a lower MUNIX value (99.612.8) than demyelinating polyneuropathy patients (149.845.7) (P< 0.05). Single fibre electromyography and motor unit number index could help differentiate between the pathophysiology of axonal and demyelinating polyneuropathy.

ERS International Congress 2023: highlights from the Respiratory Clinical Care and Physiology Assembly.

It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of laboratory-based science, clinical trials and qualitative research that were presented during the 2023 European Respiratory Society International Congress within the sessions from the five groups of Assembly 1 (Respiratory Clinical Care and Physiology). Selected presentations are summarised from a wide range of topics: clinical problems, rehabilitation and chronic care, general practice and primary care, electronic/mobile health (e-health/m-health), clinical respiratory physiology, exercise and functional imaging.

Standard technical specifications for methacholine chloride (Methacholine) bronchial challenge test (2023)

Standard technical specifications for methacholine chloride (Methacholine) bronchial challenge test (2023)

Issue-based learning in medical training: report of experience of monitor of the INTA University Center, UNINTA

This article explores the implementation of the issue-based learning methodology in the Physiology discipline of the INTA University Center (UNINTA), emphasizing the enriching experience of students and monitors. Medical physiology, crucial for understanding the basis of pathophysiology, connects basic sciences to medical practice. Monitoria, as a pedagogical tool, seeks to introduce students to the teaching profession and to stimulate the exchange of knowledge. In the methodology, monitors deepened in themes, elaborating objective and open questions to stimulate critical reasoning, focusing on physiological contextualization in clinical practice. Questions were validated by the advisor. Results highlight a gradual increase in adherence to the method, overcoming initial resistance. Teacher collaboration and forms via Google Forms with automatic feedback were essential. The conclusion is that issue-based learning promoted in-depth learning and positive academic outcomes. The monitoring proved valuable, broadening the students-monitors' perspective on the studied content, contributing to comprehensive learning.

Targeting the prefrontal-supplementary motor network in obsessive-compulsive disorder with intensified electrical stimulation in two dosages: a randomized, controlled trial

Obsessive-compulsive disorder (OCD) is associated with a high disease burden, and treatment options are limited. We used intensified electrical stimulation in two dosages to target a main circuitry associated with the pathophysiology of OCD, left dorsolateral prefrontal cortex (l-DLPFC), and pre-supplementary motor area (pre-SMA) and assessed clinical outcomes, neuropsychological performance, and brain physiology. In a double-blind, randomized controlled trial, thirty-nine patients with OCD were randomly assigned to three groups of sham, 2-mA, or 1-mA transcranial direct current stimulation (tDCS) targeting the l-DLPFC (F3) and pre-SMA (FC2) with anodal and cathodal stimulation respectively. The treatment included 10 sessions of 20-minute stimulation delivered twice per day with 20-min between-session intervals. Outcome measures were reduction in OCD symptoms, anxiety, and depressive states, performance on a neuropsychological test battery (response inhibition, working memory, attention), oscillatory brain activities, and functional connectivity. All outcome measures except EEG were examined at pre-intervention, post-intervention, and 1-month follow-up times. The 2-mA protocol significantly reduced OCD symptoms, anxiety, and depression states and improved quality of life after the intervention up to 1-month follow-up compared to the sham group, while the 1-mA protocol reduced OCD symptoms only in the follow-up and depressive state immediately after and 1-month following the intervention. Both protocols partially improved response inhibition, and the 2-mA protocol reduced attention bias to OCD-related stimuli and improved reaction time in working memory performance. Both protocols increased alpha oscillatory power, and the 2-mA protocol decreased delta power as well. Both protocols increased connectivity in higher frequency bands at frontal-central areas compared to the sham. Modulation of the prefrontal-supplementary motor network with intensified tDCS ameliorates OCD clinical symptoms and results in beneficial cognitive effects. The 2-mA intensified stimulation resulted in larger symptom reduction and improved more converging outcome variables related to therapeutic efficacy. These results support applying the intensified prefrontal-SMA tDCS in larger trials.

INTERNATIONAL CRITERIA EKG COMPARISON STUDY

https://youtu.be/4jm0uzAQNm8 BACKGROUND There has been an evolution of athlete specific Electrocardiogram (EKG) criteria over the years, resulting in improved specificity and lower false positive rates, starting with the European Society of Cardiology 2005 guidelines and most recently with the current 2017 International Recommendations. The consistency of EKG interpretation with the 2017 International Criteria have been compared between various groups, including local and specialized center physicians. Whether novice EKG interpreters (undergraduate/graduate students) can be taught to accurately interpret athletes’ EKGs with the 2017 International Criteria has not been extensively studied. This study seeks to assess the accuracy and variability of novice EKG interpreters, compared to cardiologist interpretations and expert readers. METHODS Three novice EKG interpreters (undergraduate exercise science students) were trained in interpreting EKGs of athletes with the 2017 International Criteria during one semester under the instruction of an expert reader. During an annual high school, sports screening day 1350 EKGs were collected and assigned a corresponding number. The on-site cardiologists evaluated the EKGs in real-time and classified as “normal” or “abnormal” according to the International Criteria. Following the sports physical day, three novice EKG interpreters (students), a cardiologist and a Clinical Exercise Physiology Professor (expert reader) were asked separately to classify the same EKGs as “normal or “abnormal” according to the International Criteria. All readers were blinded to the initial classifications made by the cardiologist during the sports physical event. Information regarding the athlete's age, gender, race/ethnicity, and sport was provided on the EKGs. We assessed the agreement between the cardiologist, expert reader and students in interpreting EKGs using Fleiss' kappa analysis. RESULTS 1350 athlete EKGs (males = 879; females = 471, age (mean + SD) 15.09 + 1.3y) including 37 (2.7%) abnormal cases were reviewed. The inter-rater agreement between novice readers, expert reader, and physicians in classifying an EKG as abnormal was good (k = 0.7, p &amp;lt; .001). CONCLUSION This study demonstrated that novice EKG readers could correctly classify EKGs based on the International Criteria as “normal and abnormal” to identify athletes at high risk of acute cardiovascular events

CLINICIAN-LEADERS IN CARDIAC REHABILITATION: CLINICAL EXERCISE PHYSIOLOGISTS

https://youtu.be/5aocJv-Xyk0 BACKGROUND Clinical exercise physiologists (CEP) are members of the multidisciplinary team in cardiac rehabilitation (CR). CEPs undertake multiple roles, including individualizing patient care to help restore or improve daily functioning in patients with heart disease. CEPs are equipped with a wide range of knowledge and skills for successful patient care and also have the skillset to propel career development to serve in leadership roles. The Million Hearts Cardiac Rehabilitation Collaborative (CRC) is working to achieve the goal of increasing enrollment to 70% CR participation in eligible patients. However, given the critical healthcare staffing shortage, the workforce poses a unique challenge to adequately staff clinics to improve access to CR, especially in historically marginalized rural and urban communities. PURPOSE: Describe the prevalence of CR programs that are solely staffed by CEPs and the job tasks they perform in the United States. METHODS CR program managers in the United States were sent an email invitation to participate in an electronic survey from the American Association of Cardiovascular and Pulmonary Rehabilitation. Depending on the participant’s responses, the final survey could be as few as 11 and up to 44 required multiple choice questions. RESULTS Among 297 CR programs that responded to the survey, 86% (n= 256) stated they staff a CEP and 12% (n= 30) stated their program is run entirely by CEPs. Among the programs run entirely by CEPs, the minimum degree for CEP staff was a bachelor’s in 93% (n= 28) and a master’s in 7% (n= 2). The ACSM clinical exercise physiology credential was preferred or required in 73% (n= 22) of programs. Job tasks performed by CEPs in these CR programs were provided patient education (100%), monitored ECG during exercise (100%), assessed patient symptoms (100%), screened patients entering CR (100%), measured blood pressure via auscultation (97%), measured blood glucose (97%), and administered supplemental oxygen (93%). CEPs can hold a leadership position in 83% (n= 25) of these institutions. CONCLUSIONS Leveraging the CEP practice patterns to serve as CR clinical leaders permits other health care professionals, such as nurses, to be used in other areas of health care. Although no formal framework exists on the educational preparation for a CEP career ladder, findings suggest that CEPs are competent to run and oversee CR programs. Innovative strategies to improve referral, enrollment, and retention of patients with heart disease into CR will require increases in CR capacity which can be filled by CEPs.

Development and Implementation of a Microlearning Curriculum of Physiology Formulas for Postgraduate Clinical Fellows in Pediatric Critical Care Medicine.

Postgraduate medical education in clinical settings poses many challenges secondary to the large volume of knowledge to be acquired, competing clinical responsibilities, and fatigue. To address these challenges, a microlearning curriculum using flipped classroom methodologies was created to facilitate the mastering of fundamental physiology formulas by pediatric critical care medicine fellows. Forty physiology formulas were distilled into 5-minute microlearning sessions. Fellows were provided the weekly formula and encouraged to self-study prior to the face-to-face learning. The 5-minute session took place at the beginning of a regularly scheduled clinical care conference where normal values, explanatory diagrams, and board-like questions were discussed. A faculty or fellow facilitator then provided a more in-depth explanation and shared clinical pearls related to the formula. Following the session, an e-mail summarizing the learning points was sent. The curriculum was well received by fellows and faculty. Over 5 years, the curriculum evolved through phases of active development, implementation, minor modifications, transition to a virtual platform, shift to senior fellow-led instruction, and harmonization with other curricular activities. Engagement and sustainability were addressed with a fully flipped classroom, where senior fellows served as teachers to junior fellows. Microlearning in a multimodal manner is an excellent method for teaching busy postgraduate clinical trainees fundamental physiology formulas that underpin pediatric critical care decision-making. The gradual transition from individual learning to a flipped classroom taught by peers with faculty support was well tolerated and consistent with adult learning theories. The transition was essential to ensure the sustainability of the curriculum.

Health-related fitness in medical students: a curricular intervention in Bogota, Colombia

ObjectiveTo evaluate the impact of a curricular intervention to promote health-related fitness (HRF) among medical students in Bogota, Colombia.MethodThe study was conducted between May 2014 and December 2015 as part of the medical physiology course, in which 208 medical students were enrolled.The curricular intervention included two lectures on physical activity (PA) and student-led group presentations on the physiological effects of exercise on human physiology. An academic incentive (10% of final grade) was given to students who reported and documented regular PA practice during the semester. This study assessed students’ HRF variables, perceptions of the curriculum intervention, and PA practices using quantitative and qualitative approaches.Results55% of the students were female, with a mean age of 19.5 years. Body fat, estimated maximum oxygen consumption (VO2max), handgrip, and sit-up strength showed statistically significant improvements at the end of the intervention. Students reported that PA practice was positively influenced by the curriculum intervention, particularly the academic incentive and the HRF tests. Students reported a wide variety of PA practices, which were mainly done with friends, classmates, or family members. Lack of time was the main reported barrier to PA practice.ConclusionThe curricular intervention was effective in improving HRF and promoting PA. It remains to be investigated whether these gains are sustained over time.