WHO WANTS TO BE A PHYSICIAN?
AN EDUCATIONAL TOOL FOR
REVIEWING PULMONARY PHYSIOLOGY
Justin R. Moy, David W. Rodenbaugh, Heidi L. Collins, and Stephen E. DiCarlo
Department of Physiology, Wayne State University, School of Medicine, Detroit, Michigan 48201
T
raditional review sessions are typically focused on instructor-based learning. However, experts in the field of higher education have long recommended teaching modalities that incorporate student-based active-learning strategies. Given this, we developed an educational game in pulmonary physiology for first-year medical students based loosely on the popular television game showWho Wants To Be A Millionaire. The purpose of our game, Who Wants To Be A Physician, was to provide students with an educational tool by which to review material previously presented in class. Our goal in designing this game was to encourage students to be active participants in their own learning process. The Who Wants To Be A Physician game was constructed in the form of a manual consisting of a bank of questions in various areas of pulmonary physiology: basic concepts, pulmonary mechanics, ven-tilation, pulmonary blood flow, pulmonary gas exchange, gas transport, and control of ventilation. Detailed answers are included in the manual to assist the instructor or player in comprehension of the material. In addition, an evaluation instrument was used to assess the effectiveness of this instructional tool in an academic setting. Specifically, the evaluation instrument addressed five major components, including goals and objectives, participation, content, components and organization, and summary and recommendations. Students responded positively to our game and the concept of active learning. Moreover, we are confident that this educational tool has enhanced the students’ learning process and their ability to understand and retain information.ADV PHYSIOL EDUC 24: 30 –37, 2000.
Key words:collaborative learning; education
Traditionally, review sessions consist of the instructor answering random questions proposed by the student or a lecture-based format in which the instructor provides a brief review of concepts previously pre-sented in class. Termed instructor-based learning, stu-dents’ role in this situation is one of a vessel passively waiting to be filled with a predetermined body of knowledge. In contrast, student-centered learning fo-cuses discussion around the student. In this role,
work is improved (3, 6). Therefore, we sought to design an educational tool to be used as a review in which students are active participants in their own learning process and the instructor a moderator or director of discussion. An additional goal was to in-crease student participation in the review session and to increase students’ interaction with each other and the instructor.
To achieve our goals, we designed a game based loosely on the popular television game show Who Wants To Be A Millionairefor the medical physiology course taken by first-year medical students. This game specifically focused on pulmonary physiology. The Who Wants To Be A Physician game is an active-learning exercise, because answering the questions requires not only knowledge of fundamental pulmo-nary concepts previously presented in class but tests the student’s ability to apply this information as well. Furthermore, students are actively participating by answering questions and collaborating with other stu-dents. In employing a game-show format, we also sought to make the review session an enjoyable ex-perience by providing a novel and innovative means by which to review the course material.
MATERIALS AND METHODS About the Game
The Who Wants To Be A Physician game was de-signed based on the format of the popular television show,Who Wants To Be A Millionaire. The manual of the Who Wants To Be A Physician game can be obtained, free of charge, by contacting the authors. The game was designed for first-year medical students having completed the pulmonary section of a medical physiology course.
The game manual consists of a bank of questions in areas of pulmonary physiology. Specifically, we chose seven areas based on chapters contained within a previously created syllabus to develop a series of questions around basic concepts, pulmonary mechan-ics, ventilation, pulmonary blood flow, pulmonary gas exchange, gas transport, and control of ventilation. Questions are provided with a short, abbreviated an-swer that is often followed with a more detailed explanation and figure.
Creating the Game
The questions and answers for the Who Wants To Be A Physician game were written by one the authors (J. R. Moy) in partial fulfillment of the requirements for a non-thesis Masters degree. Over the summer and fall semesters, J. R. Moy wrote questions and answers based on a previously created syllabus for the pulmo-nary physiology section of the medical physiology course. The computer files were created by a second graduate student (D. W. Rodenbaugh) over a 2-wk period using PowerPoint. This division of labor re-duced the time investment in creating the question-and-answer templates as well as provided educational projects for students.
Initially, eight game files were created. One file was the starting game board, and the seven remaining files corresponded to each chapter of the syllabus. The starting game file had one slide with seven text boxes identifying each chapter of the syllabus: Basic Con-cepts, Pulmonary Mechanics, Ventilation, Pulmonary Blood Flow, Pulmonary Gas Exchange, Gas Transport, and Control of Ventilation (Fig. 1). Each text box was hyperlinked to the PowerPoint file corresponding to that chapter of the syllabus. Unique colors were also used to fill each text box to further distinguish each chapter.
FIG. 1.
Once the files were constructed, color-coordinated slides for each chapter of the syllabus were created. The first slide in the series of a chapter contained the title of that chapter, an icon of a house hyperlinked to the starting game board file, and 10 text boxes denoting point values arranged in a table format (Fig. 2). The point values were 100; 200; 300; 400; 500; 1,000; 2,000; 3,000; 4,000; and 5,000. Next, a color-coordinated tem-plate slide was made for the question slides of each chapter. This template slide consisted of an “A” text box that was hyperlinked to the correct answer for a ques-tion and a text box that was hyperlinked to the first slide of the corresponding chapter (Fig. 3). A title to identify the chapter and point value and an icon of house hy-perlinked to the starting game board file were also in-cluded. Questions were “cut” from a Microsoft Word document and “pasted” onto the corresponding ques-tion slides. On compleques-tion of all 10 quesques-tion slides, each point value text box in the first slide of a chapter was hyperlinked to its corresponding slide.
Next, an answer template slide was created. This slide had an icon of a house hyperlinked to the starting game board file, a text box hyperlinked to the first slide of the chapter, and an icon hyperlinked to the corresponding question slide (Fig. 4). The text for each answer was cut from the Microsoft Word
docu-ment and pasted to each slide. Supporting figures were cut from the syllabus document and pasted into the answer slides. If more than one figure was re-quired, additional slides were created to hold these figures and text boxes were added to hyperlink all the figures for a question together. This process was pleted for each chapter of the syllabus. Once com-pleted, “bonus question” text boxes were inserted on the answer slides as needed. These text boxes were hyperlinked to any additional questions/answers for a chapter. The bonus question text boxes had auto-matic animations applied so that they would appear after the answer slide was open for 10 s. All work was performed on a Gateway 2000 E-3110 using Microsoft Office 97, which provides both Microsoft Word and Microsoft PowerPoint.
Suggestions for Play
At the beginning of the review session, students who wished to directly participate in the game were asked to put their names into a hat. A “contestant” was determined by drawing a name out of the hat. The selected player then chose one of the seven pulmo-nary physiology chapters and was asked questions from that chapter, beginning with the lowest valued amount. With each correctly answered question, the
FIG. 2.
An example of the first slide in the series of a chapter containing the title of that chapter, an icon of a house hyperlinked to the starting game board file, and 10 text boxes denoting point values arranged in a table format.
FIG. 3.
player increased his/her total winnings and advanced to the next question. The player could choose to withdraw from the game at any time, retaining all winnings previously accumulated. If a question was answered incorrectly, the amount of the incorrectly answered question was subtracted from the player’s total winnings, and the player was disqualified from further participation in the game.
Each player was entitled to the use of four different lifelines. A lifeline was a method by which a player sought assistance. If the player chose to use a lifeline, he/she was permitted to1) ask a friend for the answer, 2) ask a friend for a hint,3) answer the question with a preliminary answer and ask the audience to vote if the preliminary answer is correct or not before committing to a final answer, or4) ask the instructor for a hint. The player was allowed to use each lifeline only once.
The game was concluded at the end of a designated time period. The player who had accumulated the most money was declared the winner of the game and awarded a certificate of achievement (Fig. 5).
Evaluation
To determine the effectiveness of the educational tool, we used an evaluation instrument (2) that was completed after playing the Who Wants To Be A Physician game (Table 1). Twenty-eight statements were employed to evaluate five general areas:1) goals and objectives, 2) participation,3) content, 4) com-ponents and organization, and 5) summary and rec-ommendations. Students were asked to evaluate the extent to which they agreed with the statements on a scale from 1 to 5 (1, strongly disagree; 2, tend to disagree; 3, neither agree nor disagree; 4, tend to agree; 5, strongly agree). In addition, a general com-ments section was included for any additional sugges-tions or comments. The medical students were asked to complete this survey after playing the game.
RESULTS
Approximately one-half of the class attended the re-view session and participated in the game. Students were given a survey at the beginning of class to
FIG. 4.
determine the effectiveness of the educational tool. One-hundred and nine medical students returned the evaluation form. This represented an;90% response rate of those students who participated in the game. The evaluation tool and the responses of the students are presented in Table 1.
The evaluation instrument was divided into five gen-eral categories, and the ovgen-erall mean response for each of these categories is summarized in Fig. 6. The overall response of the students to the game was very positive. Among these scores, the students rated goals and objectives highest, with a mean score of 4.5 6 0.03. The lowest scoring category was participation, with a mean score of 3.960.05.
In regards to the individual questions within the cat-egories, students reported that basic information was integrated to understand broader concepts and mech-anisms (statement 13, 4.4 6 0.07) and that the
the-matic organization helped to develop higher levels of thinking (statement 17, 4.3 6 0.07). Students also reported that they had an opportunity to assess their understanding through questions and answers pro-vided (statement 23, 4.46 0.07). For example, one student commented that the “review was a great summary of the course content” and that it “helped to identify areas that I need to study more intensely.” Students also reported that the materials fulfilled the goals and objectives as stated in the introduction (statement 4, 4.56 0.08). Students responded most negatively to the following statements: characterize your involvement in the game (statement 5, 2.9 6 0.12), and there was much opportunity for participa-tion (statement 6, 3.960.10).
Of the 109 surveys returned, 55% of the respondents provided written comments and/or suggestions. Overall, students’ comments were very enthusiastic and encouraging, including statements such as, “a
FIG. 5.
novel and fun way to review, I enjoyed it” and “the idea for the game was excellent.” Other students enjoyed the game because it made “learning interac-tive and entertaining.” Another student thought that the game was “a good way to review material.”
Most of the suggestions concerned the pace of the game and the range of material covered. These stu-dents often felt that a multiple-choice format would increase the pace of the game and increase the amount of material covered. For example, one stu-dent wanted “to get to more concepts quicker.”
An-other student suggested that “questions should be multiple choice to make the game faster so more people can play.”
DISCUSSION
This educational tool was used as a review of pulmo-nary physiology concepts presented to a class of first-year medical students. The review was administered at the end of a 10-h series in pulmonary physiology. The relatively high attendance and participation in the game, approximately one-half of the class
enroll-TABLE 1
Evaluation of instructional materials on pulmonary physiology
Results
Goals and objectives
1. The purpose of and rationale behind the materials are fully explained. 4.560.07 2. The goals and objectives of the materials are clearly identified. 4.560.07 3. The content of the materials is directed to the achievement of the stated goals and objectives. 4.660.06 4. The assessment techniques that measure student achievement of the goals and objectives are included in the materials. 4.560.08
Participation
5. How would you characterize your involvement in the game? 2.960.12 6. There was much opportunity for participation. 3.960.10 7. The use of lifelines was helpful in answering questions. 4.460.08 8. The amount of collaboration was sufficient. 4.260.08 9. The collaboration facilitated my understanding of respiratory physiology. 4.360.08
Content
10. The questions were clear. 4.060.09 11. The answers to questions were clear. 4.360.08 12. Contains challenging and motivating materials for this subject matter. 4.460.07 13. Teaches basic information which must then be integrated to understand broader concepts and mechanisms. 4.460.07 14. The game was free of confusing or conflicting concepts and mechanisms. 4.060.09 15. There was sufficient elaboration/discussion of respiratory concepts in answers. 4.560.07 16. The materials clearly identify major points of understanding. 4.560.07 17. There is a thematic organization of content to develop higher level thinking skills. 4.360.07 18. I found the questions interesting and stimulating. 4.160.09 19. The overall material presented in the game was challenging but appropriate for my level of education. 4.360.08
Components and organization
20. The materials were clear, concise and easily understood. 4.360.09 21. The materials were not too lengthy or complex in their format. 4.160.11 22. The structure and layout of material facilitated learning and did not distract from the information being presented. 4.360.08 23. An opportunity to assess an individual’s understanding through questions and answers was provided. 4.460.07
Summary and recommendations
24. These materials fulfill the goals and objectives as stated in the introduction. 4.560.07 25. This method of presenting material was as effective as any other I have encountered. 4.460.07 26. These materials were educationally attractive due to the novelty of their style and format. 4.560.00 27. The interactive nature of these materials facilitated my learning of this content area. 4.460.09 28. I would recommend the development and utilization of similar materials for other content areas. 4.560.08
ment, suggest a strong interest in this educational tool. The review was conducted using a game-show format. The students were afforded the opportunity to answer questions, make calculations, and discuss answers. The evaluations were returned after the con-clusion of the class period.
A review session typically involves an overview of course concepts followed by a period of questions and answers. These sessions are purposeful in provid-ing insight into topics that may be covered durprovid-ing the exam. However, often times, these review sessions are uninformative and uninteresting; simply a brief lecture on material previously covered. The Who Wants To Be a Physician game transcends this typical review-session format. Students are active partici-pants in the learning process and are afforded the opportunity to answer, rather than ask, questions in a game-show format. This student-active technique sends the message that students can actively discover, analyze, and use knowledge on their own. With this participatory empowerment, students come to the understanding that they assume individual account-ability and personal responsibility for their learning.
Lifelines were an important component to the suc-cess of this learning experience. It was important that
students felt a sense of responsibility for the success of their classmates and that the success of each indi-vidual depended, in part, on the participation of the class. Furthermore, lifelines kept everyone interested because the audience could be called upon at any time. Therefore, four lifelines were designed:1) ask a friend for the answer, 2) ask a friend for a hint, 3) answer the question with a preliminary answer and ask the audience to vote if the preliminary answer is correct or not before committing to a final answer, or 4) ask the instructor for a hint. These lifelines were designed to motivate the audience members to an-swer questions on their own in the event that they were called upon for assistance by the contestant. Furthermore, by answering on their own, students could compare their answers with the contestant’s response. The students were challenged to learn ma-terial from a different perspective by interacting with the instructor and working together cooperatively with other students to accomplish shared learning goals. Finally, the use of lifelines promotes the devel-opment of crucial collaborative social skills. That is, it requires all individuals involved to listen actively, not interrupt, encourage others, be open minded, tact-fully defend one’s views, compromise, give construc-tive feedback, and show respect for others. This is an important component because employment opportu-nities in the future will require employees to work cooperatively to solve problems and develop solu-tions.
In general, the students reported that they found the educational tool extremely useful, well presented, thorough in its content, and valuable in the mecha-nisms it reinforced from their prior course in pulmo-nary physiology. What they appeared to value most was the novel and innovative method of reviewing course material. Furthermore, the students seemed to enjoy the interaction and collaboration that this edu-cational game encouraged. As one student com-mented, “the best teaching tools are those which make you feel like they aren’t teaching tools.”
The results of the evaluation tool demonstrated a favorable opinion of the game. The students reported that the goals and objectives of the materials were clearly identified. Students also reported that there was sufficient amount of collaboration and that the collaboration facilitated understanding of the
pulmo-FIG. 6.
The evaluation instrument was divided into 5 general categories, and the overall mean response for each of these categories is summarized in Fig. 2. The overall response of the students to the game was very posi-tive. Among these scores, the students rated Goals and Objectives highest, with the mean score of 4.53 6
nary physiology. One student commented that the “interaction motivates my understanding.” With re-gards to the content of the material, students also responded favorably. They felt that the questions and answers were not only clear and concise, but also interesting and stimulating. They also reported that the material covered was both challenging and appro-priate. Finally, students reported that this method of presenting material was as effective as any other they had encountered.
The most common criticism was the amount of par-ticipation and involvement in the game. Throughout the 2-h review session, only five students were se-lected to directly participate as contestants in the game. However, although only a limited number of students participated as “contestants,” all students were encouraged to participate through the lifelines.
The most common suggestion that students had re-garding the game was the usage of a multiple-choice format. We chose a short-answer format to encourage in-depth answers and discussion. However, many stu-dents felt that a multiple-choice format would allow the game to progress more quickly and thus increase the number of players and topics covered. At the end of the 2-h session, we were able to complete only three of the seven chapters in pulmonary physiology. However, the contestants were able to choose the chapters and thus were able to control which material was reviewed.
Our goal in creating this educational tool was to provide a fun, interactive, and innovative method by which students could learn and review basic pulmo-nary physiology concepts. On the basis of the positive feedback, we believe that the goals and objectives were accomplished. Moreover, we hope that this will serve as a model for future class review sessions.
We thank Michael F. Copado, audio/visual technician, for expert technical assistance setting up the classroom for the game format.
Address for reprint requests and other correspondence: S. E. Di-Carlo, Dept. of Physiology, Wayne State Univ., School of Medicine, 540 East Canfield Ave., Detroit, MI 48201 (E-mail: sdicarlo@med. wayne.edu).
Received 4 April 2000; accepted in final form 21 August 2000
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