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Abraham, R.R. , Upadhya S., Torke, S., & Ramnarayan, K. (2004). Clinically oriented physiology teaching: strategy for developing critical-thinking skills in undergraduate medical students. Advances in Physiological Education, 28, 102-104.

The physiology curriculum at the Melaka Manipal Medical College was revised to incorporate clinical case studies and critical-thinking questions (CTQ) in an attempt to relate physiology to real-life problems and enhance motivation for learning.  This COPT approach was assessed using a pre-test (exam 1) and post-test (exam 2) which included recall and CTQ questions.  Student feedback was determined using a nine question survey on the Likert scale.  A significant increase in mean percentage scores for both recall and CTQ questions was observed from exam 1 to exam 2.  Most students felt that CTQs improved understanding and reduced misconceptions.  This article was instructive in proving the benefit of this approach, but its value was diminished because no specifics of the clinical case studies or the CTQs was given.  No analysis or discussion of the student feedback surveys was included.  This is relevant to my work because it deals with teaching physiological concepts using case studies approach.


Bowman, K, & Husbands, J.L.  (2011) Dual use issues in the life sciences: challenges and opportunities for education in an emerging area of scientific responsibility.  CBE-Life Sciences Education, 10, 3-7.

This feature summary describes the work of the National Research Council’s Board on Life Sciences to address the education of students and researchers  on the “dual use dilemma” – the idea that our scientific advances give us knowledge, tools and techniques that can be used for good work or for ‘evil’ (i.e. biological weapons, terrorism).  The science community needs to be kept up-to-date, be engaged and understand ethical conduct.  Responsible conduct , biosafety and bioethics should be incorporated into courses and curriculums.  Appropriate educational materials need to be developed which will be applicable to the life as well as physical sciences, engineering and mathematics and which are disseminated widely using current technologies.  Teaching methods need to use active learning strategies and programs to train faculty in the dual use issues should be developed.  This article introduced me to another facet of bioethics instruction and resource materials that may be important and useful to consider as I refine case studies that incorporate bioethics.


Bryant, J.A. & Morgan, C.L. (2007). Attitudes to teaching ethics to bioscience students: an interview-based study comparing British and American university teachers.  Bioscience Education eJournal, 9.  Retrieved from

Surveys were conducted to determine awareness and attitudes of UK professors of the QAA benchmarks for bioethics teaching in the biosciences.  Their responses were compared to USA professors where no QAA requirements exist. All felt that teaching ethics should be compulsory; it would enhance learning and life skills, enable them to better communicate societal benefits of science and "make them better citizens".  Greatest difference was WHO should teach ethics. Most Americans (46%) felt only professional ethicists should teach such materials, whereas the British felt biologists (33%) or teachers with dual training (33%) would be qualified.  Most interesting to me was the fact that: 1) the UK has very specific requirements for teaching bioethics; and 2) that the independent monitoring of quality at institutions of higher education appears to be compulsory and transparent with reports easily accessible on the web.  This article lends a global perspective to ethics teaching and supports my view of bioethics as an valuable component of physiology teaching, enhancing the science and the citizenship.

Cliff, W.H. (2006). Case study analysis and the remediation of misconceptions about respiratory physiology. Advances in Physiological Education, 30, 215-223.

This article examined the use of case study analysis, combined with lecture and class discussion, to correct student misconceptions of fundamental respiratory physiology.  A directed case study was developed that addressed four common misconceptions and this assignment was embedded in a sequence of activities throughout the course.  Assessments included a pre- and post-test, which were identical, and a mid-test that queried students with a different form of questions. Remediation of only one of the four misconceptions occurred (36%) with case analysis, but closer interpretation of student answers suggests greater benefits beyond this single concept remediation.  Authors did an excellent job of describing the specifics of the timeline and activities, the questions used and the analysis of the data.  Information on assessment methods and ways of incorporating case studies and assessments into the course structure will be valuable for refinement of my case studies and timelines and the design of assessment strategies. 


Downie, R. & Clarkeburn, H. (2005). Approaches to the teaching of bioethics and professional ethics in undergraduate courses.  Bioscience Education eJournal, 5.  Retrieved from

Whereas Abraham et al (2004) above dealt with the more philosophical discussion of the UK QAA benchmarks and ethics instruction, these authors attempt to address more practical issues such as strategies for ethics incorporation into teaching, who should teach and what goals should be met, by highlighting the approach at University of Glasgow.  Ethics can be embedded within a course or designed as a separate module and should be reintroduced throughout the "levels" or years of a degree program.  They argue that bioscience staff can be trained to teach ethics; it is already very common for faculty to teach in areas that are outside of their expertise. The aim of instruction should be both professional ethics (e.g. best practice in research) as well as personal ethics (e.g. animal experimentation) where students are exposed to and gain respect for differing views.  Interactive instruction is the most beneficial and the workshop style with role-playing works well.  Finally, they emphasize that one needs to be realistic about outcomes and "don't expect miracles" - you won't have all students appreciating the value and importance of bioethics I was hoping that this article would give more specifics that I could use to refine my incorporation of bioethics in my case studies, but the information was more general.  The idea of a workshop style approach may be a possible improvement on my current method.


Ribbens, E. (2006).  Chemical Eric:Dealing with the disintegration of central control (PDF documents and PowerPoint slides). Retrieved from National Center for Case Study Teaching in Science website,

This case study used for undergraduate teaching deals with the concept of the pituitary gland as the master controller of hormone secretion.  It follows the medical history of a male patient who manifests symptoms of a pituitary tumor during childhood and continues to experience medical problems through middle age, due to the absence of a functioning pituitary.  These different medical crises help illustrate the different functions of pituitary hormones on multiple organ systems.  Slides contains 'clicker' questions for class discussion and two pdfs contain a thorough description of the case and helpful teaching notes.  This pituitary hormone case is very germane to my research which pertains to improving student retention and understanding of the concept of the hypothalamic-pituitary-gonadal axis.  Query questions will probably be most helpful.


Vari, R.C., Borg, K.E., McCleary, V.L., McCormack, J.T., Ruit, K.G., Sukalski, K.A., & Olson, L.M.  (2001). Endocrine physiology in a patient-centered learning curriculum.  Advances in Physiological Education, 25, 241-248.

Patient-centered learning (PCL) curriculum was developed at the University of North Dakota medical school and the instruction of endocrine physiology in year one using PCL is the topic of this article.  Students move through blocks of themes and subthemes organized around organ systems with patient cases.  Students receive a case at the beginning of each week and progressively acquire new information such as symptoms, physical exam results, diagnostic test results, etc. to help them eventually make a diagnosis and recommend treatment.  They also research faculty-directed learning objectives and are then required to refine these to enhance their own learning.  Authors provide good examples of patient case studies and the progressive information provided to the students.  This should be helpful in designing new case studies or improving the presentation of existing case studies for my class.  The deficiency in these studies is the lack of any assessment of the effectiveness of PCL to teach fundamental concepts of endocrine physiology.  I would be very interested to see what methods were used to do this.  This is one thing that is still lacking in my initial searches of current literature and other resources.

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