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.

Providing the choice of in-person or videoconference attendance in a clinical physiology course may harm learning outcomes for the entire cohort.

Clinical Physiology 1 and 2 are flipped classes in which students watch prerecorded videos before class. During the 3-h class, students take practice assessments, work in groups on critical thinking exercises, work through case studies, and engage in drawing exercises. Due to the COVID pandemic, these courses were transitioned from in-person classes to online classes. Despite the university's return-to-class policy, some students were reluctant to return to in-person classes; therefore during the 2021-2022 academic year, Clinical Physiology 1 and 2 were offered as flipped, hybrid courses. In a hybrid format, students either attended the synchronous class in person or online. Here we evaluate the learning outcomes and the perceptions of the learning experience for students who attended Clinical Physiology 1 and 2 either online (2020-2021) or in a hybrid format (2021-2022). In addition to exam scores, in-class surveys and end of course evaluations were compiled to describe the student experience in the flipped hybrid setting. Retrospective linear mixed-model regression analysis of exam scores revealed that a hybrid modality (2021-2022) was associated with lower exam scores when controlling for sex, graduate/undergraduate status, delivery method, and the order in which the courses were taken (F test: F = 8.65, df1 = 2, df2 = 179.28, P = 0.0003). In addition, being a Black Indigenous Person of Color (BIPOC) student is associated with a lower exam score, controlling for the same previous factors (F test: F = 4.23, df1 = 1, df2 = 130.28, P = 0.04), albeit with lower confidence; the BIPOC representation in this sample is small (BIPOC: n = 144; total: n = 504). There is no significant interaction between the hybrid modality and race, meaning that BIPOC and White students are both negatively affected in a hybrid flipped course. Instructors should consider carefully about offering hybrid courses and build in extra student support.NEW & NOTEWORTHY The transition from online to in-person teaching has been as challenging as the original transition to remote teaching with the onset of the pandemic. Since not all students were ready to return to the classroom, students could choose to take this course in person or online. This arrangement provided flexibility and opportunities for innovative class activities for students but introduced tradeoffs in lower test scores from the hybrid modality than fully online or fully in-person modalities.

Spasticity, Pain, and Fatigue: Are They Associated With Functional Outcomes in People With Stroke?

PURPOSE: The purpose of this study was to determine whether spasticity, pain, and fatigue symptoms were related to functional outcomes in people with stroke. DESIGN: A longitudinal correlation design was used. METHODS: Twenty-two stroke patients experiencing spasticity, pain, and fatigue were followed for 7 days over 6 weeks: 3 days in acute rehabilitation units, 3 days postdischarge to home/community, and an additional 1 day at 1 month postdischarge. Demographics, numeric ratings, and PROMIS tools were used to determine associations over time. RESULTS: Pain was related to fine motor activities on admission. Fatigue was significantly associated with activities of daily living, motor functions, mobility, and ability to perform physical tasks at 1 month. Spasticity was significantly related to activities of daily living, pain experiences and fatigue at 1 month. CONCLUSIONS: Symptoms of spasticity, pain, and fatigue were associated with functional outcomes in this sample of patients. CLINICAL RELEVANCE TO REHABILITATION NURSING: Symptoms can influence physical recovery; therefore, nurses could improve care through recognition of suspected correlation of symptoms in people with stroke.

Are Symptoms of Spasticity, Pain, and Fatigue Related in People With Stroke?

PURPOSE: The purpose of this study was to determine whether symptoms of spasticity, pain, and fatigue are correlated in people with stroke. DESIGN: A longitudinal-correlation, mixed-method design was used. METHODS: Spasticity, pain, and fatigue symptoms were explored in 22 patients with stroke admitted to three different rehabilitation units certified by the Commission on Accreditation of Rehabilitation Facilities. Data were obtained upon admission, postdischarge, and 1 month after discharge. Demographics, numeric ratings, and a semistructured interview were used to determine associations over time. RESULTS: Symptoms of spasticity, pain, and fatigue were quite variable. Fatigue was more likely to impair recovery. Spasticity appears to contain pain experiences. Pain does not appear to be a major factor over time. CONCLUSIONS: In this sample of patients with stroke, symptoms of spasticity, pain, and fatigue were correlated. CLINICAL RELEVANCE: In managing poststroke spasticity, pain, and fatigue, nurses should recognize that these symptoms are correlated.

Physiology educators find community in the Physiology Majors Interest Group.

The Physiology Majors Interest Group (P-MIG) is a grass-roots consortium of physiology educators with the common interest of creating program-level guidelines for undergraduate physiology and related programs. A key component of the consortium's activities are the annual P-MIG conferences that have been held at different universities over the past 3 yr (Michigan State University, 2017; University of Arizona, 2018; and University of Minnesota, 2019). Postconference surveys indicate that the conferences are highly valued by the participants, as they have provided an opportunity to get to know others who are passionate about undergraduate education, to discuss best practices in program and course delivery, and to form working groups with the goal to develop national and international guidelines for physiology program delivery and assessment.

Spasticity over time during acute rehabilitation: a study of patient and clinician scores.

AIMS: The aims of this study were to describe spasticity trajectories as a function of time, gender, and diagnosis and to explore the correspondence between patient and clinician scores of spasticity. BACKGROUND: Discrepancy between examiner assessment and patient rating of spasticity exists. Assessments that include the patient perspective are critical for patient safety. This mixed-method study provided patient descriptors of spasticity integrated with clinical scales. METHOD: Twenty-three participants provided spasticity descriptors and rated their spasticity based on Numeric Rating Scale (NRS) scores. A clinician evaluated spasticity daily using the Modified Ashworth Scale (MAS). This resulted in 1976 points of data for analysis. RESULTS: Spasticity was highly variable over time. The empirical correspondence between the clinician-rated MAS and the patient-rated NRS revealed that patient and examiner understanding of spasticity were diverged considerably. CONCLUSIONS: Clinical evaluation protocols should include patient reports on spasticity. Knowledge about patient word choice can enhance patient-provider communication.

Original research: The perioperative experience of patients with Parkinson's disease: a qualitative study.

OBJECTIVE: The goals of this study were to hear from patients with Parkinson's disease about their perioperative experiences and to describe those experiences using the patients' own words, particularly with regard to antiparkinson medication withholding and symptom exacerbation. METHOD: We conducted a descriptive, qualitative study of patients' perioperative experiences with Parkinson's disease symptom management, performing 14 semistructured interviews with 13 participants who had Parkinson's disease and had undergone any type of surgery excepting Parkinson's disease surgeries. RESULTS: Patients' responses indicated concerns that hospital routines aren't flexible enough for their complex medication regimens; that hospital staff may not recognize a patient's own expertise in Parkinson's disease; and that hospital staff need more education about Parkinson's disease, especially regarding the interactions between the disease and surgery or anesthesia (or both). CONCLUSIONS: Participants' comments made it clear that the actions of nurses could affect the perioperative experience for better or for worse. Our findings further highlight the need for clinical care guidelines for hospitalized patients with Parkinson's disease. Nurses should take the lead in the development of guidelines for Parkinson's disease symptom management.

Perioperative medication withholding in patients with Parkinson's disease: a retrospective electronic health records review.

BACKGROUND: Carbidopa-levodopa (Sinemet), the gold-standard treatment for Parkinson's disease, has a short half-life of one to two hours. When patients with Parkinson's disease are placed on NPO (nil per os, or nothing by mouth) status for surgery, they may miss several doses of carbidopa-levodopa, possibly resulting in exacerbation of Parkinson's disease symptoms. Clear guidelines regarding perioperative symptom management are lacking. OBJECTIVES: The goals of this study were threefold: to measure the perioperative duration of the withholding of carbidopa-levodopa in patients with Parkinson's disease, to record the time of day surgeries were performed on these patients, and to record perioperative exacerbations of Parkinson's disease symptoms. METHODS: We conducted a retrospective review of patient electronic health records at a Midwestern public medical center. After applying inclusion and exclusion criteria and evaluating the eligible records, we had a final sample of 89 separate surgical events for 67 discrete patients who had been diagnosed with Parkinson's disease, had undergone any type of surgery excepting Parkinson's disease surgeries, and were taking carbidopa-levodopa. RESULTS: The median duration of carbidopa-levodopa withholding was 12.35 hours, with most surgical procedures (86%) starting at 9 AM or later. The most commonly reported exacerbation of Parkinson's disease symptoms was agitation or confusion. CONCLUSIONS: For best symptom management, careful consideration should be given to scheduling surgery at the earliest possible time, administering medications as close to the patient's usual dosing schedule as possible, and providing nursing education about optimal medication management for this patient population.