Co-authored by David Van Reyk, Hui Chen and Brian Oliver

Human Pathophysiology describes and explains human diseases in terms of physiological adaptations and maladaptations, and is a core component in our Faculty’s Medical Science and Advanced Science programs. It is content-heavy, increasing the likelihood that students adopt a ‘surface approach’ to their learning.

The subject design and delivery did not discourage this type of learning, emphasising lecture content, quizzes, exams, and classroom-style workshops focused on completing exercises in a workbook. In recent years, however, there have been several innovations and redesign, all in the hope of supporting deeper learning.

Making a start: clinical judgement and problem-based learning

As part of a broader initiative in pathophysiology teaching we started by drawing on problem-based learning, incorporating written case histories into tutorials. We brought in clinical expertise from two of our team (Professor Hui Chen and Professor Brian Oliver) as well as nurse educators who were part of the co-redesign project, supported in part through a UTS Teaching and Learning Grant. The design drew on established models of clinical judgement and required students to proffer diagnostic and treatment decisions. These were based on detailed case notes and a narration of the patient presentation and relied on students having a deep understanding of the linked lecture content.  

Written case histories compare poorly, however, with learning opportunities for health professional students when they interact with patients during placements – with all the attending patient variations and mix of auditory, verbal, and visual cues that come with such interactions. What else could we take from health professional education as we continued to innovate in this space?  

Next steps: let’s pretend!  

Simulations are a low-risk teaching strategy in the progressive training of health professionals and range from role-play scenarios to more technology-enhanced set-ups. In collaboration with clinical educators from our Faculty of Health, we reworked two of our case studies into clinical simulations.

Here, students played the role of doctor interacting with an automated manikin ‘patient’ voiced by a hidden operator reading from a prepared script. Props were included such as simulated coffee-ground vomitus – an indicator of stomach bleeding. Familiarised with the case notes, students collaborated to make clinical evaluations and judgments and followed this up by communicating these to the patient to obtain consent for any intervention or treatment.  

Pre-briefing: video to the rescue 

Although post-class evaluations reflected the value students found in these exercises, engagement was impacted by the veracity of the manikin’s responses, but also due to students’ lack of prior experience speaking with patients (an example of a student’s response being the title of this blog post). This prompted a rethink of the procedure, leading to the inclusion of some pre-briefing resources.

In an effort to prepare students a video was produced of two of our clinically-experienced group undertaking a consultation with the manikin. This also provided exemplars for collecting information from the patient, reinforced in a video of simulated consultation between Prof Hui Chen as the physician and another academic as the patient. Another video shows Hui taking ‘vital sign’ measurements on a pre- and post-exercising subject (‘played’ by David), demonstrating clinical practices that in subsequent classes students were to perform on each other. 

The big pivot, and innovation in gamified learning 

When we shifted to full online teaching during the pandemic, we felt its impact less in Human Pathophysiology as we had already established a library of video resources. These were available as substitutes for on-campus demonstrations as well as enabling asynchronous learning to mitigate increased class absences.  

If there is anything close to a ‘silver’ lining (aluminium, perhaps?) from the imposition of remote learning during the pandemic, it would be the continued embrace of learning technologies even after the return to on-campus teaching. In one of our more recent ’embraces’, we developed an animated scenario using a video game platform called ‘Don’t Die’. The video below shows a demonstration of the game.

With the player in the role of patient, students engaged in decision-making regarding their own treatment, with different decisions triggering different outcomes. Specifically, unsound judgements lead to the demise of the patient. In this way the students not only were able to apply their new knowledge to authentic problems, but the resource supported learning outcomes linked to the development of work-ready skills, such as reflection and professional and ethical responsibility. 

Deeper learning for us, not just students

The opportunity to ‘own’ a subject you are passionate about over a number of years allows for staged improvements, and these innovations have been embedded in repeated cycles of implementation, evaluation (including student surveys) and redesign. These processes not only offer us a sense of validation but also unexpected student insights and further springboards for publications.

Cross-faculty partnerships underpinned by collaborative missions such as this allow for a sharing of both material and intellectual resources. The pandemic may have dragged us into the latest in learning design thinking and learning technologies, but some of us have decided this space is not as scary as we first thought. 

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