The Integrated Biochemistry Learning Series

JAMES BAGGOTT and SHARON E DENNIS

Department o f Biological Chemistry Hahnemann University School o f Medicine Philadelphia, PA 19102-1192 and Eccles Health Sciences Library University o f Utah Salt Lake City, UT84112, USA

Introduction This article briefly describes a system, the Integrated Biochemistry Learning Series (IBLS), we have developed for presenting an entire medical biochemistry course in an interactive computer-based format. This project was initiated in 1988 using HyperCard on the Macintosh computer , and it is now approaching completeness; approximately 80% of the course presented at Hahne- mann University School of Medicine is currently available in this form.

The project was an attempt to address several concerns that bear on basic science education in medical school, and on medical education in general. These include the following: (1) Medical schools typically have overcrowded curricula which are heavily scheduled, and in which students are expected to master a very large and growing volume of facts in a short amount of time, 1 (2) Preclinical courses are often taught in a block that is separated from clinical considerations, both in time (being presented during the first year-and-a-half to two years) and in content (being taught by PhDs, who sometimes give little attention to the clinical interests of their students,) 2 (3) The teaching and learning processes are often examination-driven, with the immediate focus being course examinations, and the long-term focus being the national licensure examinations, (4) Courses are usually taught by the entire staff of the department, but some- times with little integration among the faculty, except at the level of assigning specific topics to specific faculty members.

Computer-based Learning Program It seemed to us that the kind of computer-based learning program needed to address these concerns would be a complete, student-controlled learning environment. It would contain four major elements. 3 (1) The complete material content of the course in detail, including all graphs, tables, graphics (animated if appropriate), behavioral objectives, sound (eg for pronunciation of words), and references to textbooks and other literature (see Figs 1 and 2). The material is developed in an interactive manner, using advance organizers to prepare students to receive new information. An on-screen note- taking facility and a scientific calculator for making calculations necessary to solve numerical problems involv- ing logarithms, etc, are incorporated into the program. (2) Review and drill materials, which consist of tables in

Figure 1 A typical screen from a lecture module. A: initial appearance. B: appearance after user reveals details by clicking on text in boldface type. Clicking on the details hides them, but checkmarks remain to indicate the material has been seen. Clicking on any rectangular button to the right reveals material corresponding to the button's name. Eg, "Reference" gives a reference to a standard wxtbook, "Objective" gives specific behavioral objectives JOt" the topic, "Calculate" reveals an on-screen scientific calculator, etc

which the key information about intermediary metabolism is summarized in a manner that compares the similar, contrasts the dissimilar and arranges the information in visual patterns that assist learning. The tables are inter- active in that they are presented in partly completed form, and the user is expected to fill in the missing information in the blank cells. Hints are available, and the correct responses can be viewed or hidden at will. (3) Examin- ation questions for self-evaluation, a bank of 491 standard multiple choice questions categorized by topic, incorpor- ating hints and commentary on the users" responses. (4) Realistic applications of the basic information to a series of problems with biochemical content derived from the clinical periodical literature. In this learning environment the student would be able to determine what activity to engage in at any time, and the program would allow the student to move freely among types of learning activities within a topic as well as from topic to topic.

BIOCHEMICAL EDUCATION 22(1) 1994

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Figure 2 An animated sequence. A: initial appearance. B: appearance after the animation has run its course. Clicking on the "Do It" button in panel A reveals the products of the phospholipase C-catalyzed reaction. These compounds then move to their sites of action and produce their effects. Secondary effects then appear on the screen, etc, ultimately leading to cellular responses. Clicking on the "Repeat" button in panel B allows repetition of the sequence

IBLS is designed to meet these criteria. It is a student- controlled learning experience, tailored by each user to his or her own learning style. The user selects a subject area from a menu, and then chooses the manner in which he or she wishes to study that subject: 'lecture', tabular review, examination questions or clinical problem. The User may move freely from this initial choice to any other activity. For example, if in the course of working through a clinical problem a need arises to review a point in the lecture, a student can go to the on-line lecture for the pertinent information (using a 'find' function that serves as an automated substitute for an index), and then return directly to the pertinent point in the clinical problem to continue. In addition, it is possible to switch subject areas at any time by returning to the main menu.

Rationale and Intention IBLS is intended to be a replacement for all aspects of a course except small-group and one-on-one student-faculty

interactions. It allows students the freedom to learn what they want when they want, at their own pace, and in the manner that they want, although in our course all students must take scheduled examinations simultaneously. In addition, it serves as an alternate authoritative source of information that students might have missed during the lecture. In a problem-based curriculum, IBLS could serve as a reference tool, as a source of the 'distilled essence' that constitutes a good lecture presentation.

IBLS allows the faculty to deliver the course content ideally, with no chance for confusing slips of the tongue or accidental failure to mention some important point. Although emphasis through body language is absent, sound (including voice) has been incorporated, and animations and other visually striking presentations diffi- cult to achieve in other media are used wherever appropriate.

The most exciting aspect of hypermedia, the ability to integrate information into networks which allow the user to explore information in all of its significant relationships to the rest of the body of knowledge, is one that we have just begun to incorporate into IBLS. This enterprise requires that the knowledge base be complete, as IBLS soon will be. Then it will be possible to construct links (using models that we have already developed) which will allow the user to navigate freely through the entire program, exploring any ramification of a specific point, never losing his or her place in the original train of thought.

Conclusions Thus Far Student response has been overwhelmingly favorable. Most students use IBLS in addition to attending the lectures, though the lecture modules were designed to be replacements for live lectures. Use is consistent through- out the academic term; no initial burst of interest, with decreased use near the end, occurs. Topics deemed more difficult receive more use time (proportional to the number of lectures) than easier topics, and the most popular single module is the examination question module. During the period when Biochemistry is taught, IBLS accounts for up to 70% of Macintosh computer use time in the library's microcomputer learning laboratory. When the project was young, and only a few modules were complete, we received encouraging comments from many students. Having acted on those comments, and nearly completed the project, we find that students are beginning to demand an accelerated schedule for finishing the remaining modules. This, too, is encouraging.

References ~Chandrasekharan. N (1988) Biochemistry in the Medical Curriculum Biochemical Education 16, 16-19

2 Rothstein, William G (1988) American Medical Schools and the Practice of Medicine: A History, Oxford University Press, New York

3Dennis. S E and Baggott, J (1989) Student Controlled Learning in a Medical Biochemistry Course. Proceedings of the International Con- ference of the Association for the Development of Computer-Based Instructional Systems 33, 107-111

BIOCHEMICAL EDUCATION 22(1) 1994