When it was approved by the college curriculum committees in Human Medicine and Osteopathic Medicine, Medical Biochemistry consisted of 45 sessions of classical didactic lectures taught simultaneously to students in both colleges. Over the last two years the course has been transformed into a blended format to better serve student needs and interests.
In terms of biochemistry, the range of backgrounds of the 350+ students in the two medical schools has been very wide. Biochemistry is a requirement (must be in the pre-medical curriculum of undergraduates) for admission to COM; it is not, however, required for CHM. Even amongst those students fulfilling the prerequisite for entry into medical school, there appeared to be great disparity in terms of depth of experience (some were biochemistry majors in college; others were English or philosophy majors who took one semester of the subject). Therefore, BMB514 begins assuming no prior exposure to biochemistry and builds the foundation from ground up.
On the other hand, medical school students as a whole are a highly-selected, gifted, and driven bunch. Those with some biochemistry background become bored and discontented during the early phase of the BMB514, when much of the effort of the faculty are devoted to bringing those with little prior exposure up to speed. In addition, because the clientele of BMB514 is exclusive (in the medical schools), all of the students become more motivated when the subject matter is presented in the context of clinical medicine. It was important, therefore, to bring in real-life clinical cases as early as possible. Finally, the faculty felt that most (if not all) of the students were capable of learning much of the rudimentary introduction to chemical structure and nomenclature on their own, provided that we present the material in organized tutorials, supplemented with opportunities for confirming their understanding via online exercises, etc.
On the basis of these considerations, the goals of revising BMB514 into a blended course were three-fold: (a) to substitute the early didactic lectures on structure and nomenclature with tutorials and interactive exercises such that students can self-assess their competency; (b) to introduce to students the full-range of information gathering process (history taking, physical exam, laboratory results) in the analysis of a patient; and (c) to use classroom time for in-depth discussion of clinical scenarios, in which more than one response to clicker questions can be defended.
In 2007, the number of lecture sessions was decreased from 45 to 42 (about 150 minutes). In their place, four online tutorials for self study, a clinical case, a two hour class session using clickers and small group discussion were added.
In 2008, the number of lecture sessions was decreased even more, from 42 to 38, replaced by an online interactive module on gluconeogenesis, an animation illustrating the steps of fatty acid synthesis, another “over-arching” clinical case (on diabetes and integration of metabolism) discussed in a second two-hour clicker session; and two mini clinical cases were discussed at the end of two regular class sessions.
Evidence of Effectiveness
Feedback from student evaluations and focus group meetings over a period of two years indicated that the revisions made in the course were very well received. The majority of the narrative evaluations on the “most effective components” of BMB514 cited three key elements: (a) how the tutorials, especially the interactive module, were helpful in learning the fundamentals of structure, nomenclature, and pathways; (b) how the students appreciated the early link to clinical medicine; and (c) how the clicker sessions helped the students integrate many pathways of metabolism.
TeamJohn LaPres, Ph.D., Assoc. Prof., Dept. Biochemistry & Molecular Biology.
Carol Wilkins, Ph.D., Instructor, Dept. Biochemistry & Molecular Biology.
