What was the activity?
The final year module ‘Clinical Biochemistry’ [originally shared between the BSc in Biomedical Science and BMedSci in Medical Science, De Montfort University (DMU), UK] was comprehensively reviewed to introduce specialised case studies to strengthen the clinical applied component and facilitate acquisition of analytic and diagnostic skills for prognosis and management of disease (Peña-Fernández et al., 2019). Throughout the course, students attended specialised workshops to resolve case studies of increasing difficulty, specifically designed to facilitate acquisition and strengthening of clinical reasoning and reflection skills, as reflection is effective in enhancing continuous learning and gaining practical skills (Davi et al., 2017). These formative case studies consisted of a short medical history with a detailed biochemical profile and a few short answer questions about potential strategies and biochemical techniques to appropriately manage the patient. To encourage precision and writing skills, students were asked to produce a short report. They were provided with comprehensive feedback and formative marks on their ability to: a) extract all the fundamental concepts; b) synthesise information; and c) reflect and comment. A case study was also introduced in the unseen final exam to substitute the traditional long-answer question used, which presented a similar structure to those used for training (normal/reference ranges were provided so students can focus on the applied aspect of clinical biochemistry rather than learning data). Students select one from a pool of two case study questions, which has a significant weight in their exam (30 marks out of 100). Higher marks are provided for demonstrating critical thinking, a process of reflection pivotal for making safe, evidence-based, effective decisions in a clinical environment (Carter et al., 2017). Health and medical programmes are required to promote the development of clinical reflective practice (Sweet et al., 2019).
To overcome time constraints and strengthen students’ confidence to face an unseen case study in an examination, implemented to evaluate acquisition of clinical capabilities and reasoning, we populated, in 2020, the open-access virtual environment e-Biology© ( http://parasitology.dmu.ac.uk/ebiology/) with different resources for the teaching and learning of Clinical Biochemistry, including specific laboratory practicals and specialised case studies in liver and kidney pathology. To assist navigation, the package has four interactive modules (see image below): i) theoretical; ii) laboratory (to learn important biomedical techniques, for example, medical histology/ tissue staining); iii) microscope (with digitised virtual human tissue slides); and iv) case studies. The package also covers the specifications for AS and A level described by the Assessment and Qualifications Alliance (AQA) for human biology and the specifications of the first-year modules related to human biology and biomedicine, to support the large variety of students’ backgrounds in our clinical science programmes, including the Business and Technology Education Council (BTEC) qualification, and to aid retention/transition.
Mini and major virtual case studies were created following students’ feedback collected in the specialised workshops, and previously successful experience in the development of multimedia units. The e-Biology© resource contains multiple media (text, images, video, audio) to facilitate active learning (Roberts, 2017) Briefly, each case study is presented with a medical history of a “virtual patient”; the user is requested to provide a potential diagnosis based on the clinical biochemistry profile provided and other e-Biology© resources (for example theoretical or laboratory units). To enhance engagement and support self-learning, students are prompted with different formative assessments and mini-games meanwhile navigating through the case study, for the management, differential diagnoses or treatment of the virtual patient. Instant feedback is provided for each mini-game/case study question, which the user could use to attempt the subsequent exercise, as well as to check their natural learning progression. Specific information about how this virtual package and the assessments were developed can be found in Peña-Fernández et al. (2019). Owing to the occurrence of the COVID-19 pandemic, the e-Biology© package also proved pivotal for the online delivery of Clinical Biochemistry in the BSc Biomedical Science course, specifically for the teaching of the laboratory practicals and specialised workshops.
How did it impact students?
By the end of the course and following completion of the virtual clinical biochemistry case studies, 82.6% students (n=46/166; 2021/21) indicated learning of specific tests for diagnosing pathologies affecting the kidney; 69.6% gained knowledge of specific tests to manage patients with kidney diseases. Although students reported high levels of learning, our results did not show statistical differences when comparing the scores of two MCQ tests distributed at the beginning (prescore; 46.2% successful) and end of the module (postscore; 38.6% successful) using a Kendall’s tau b correlation analysis (p=0.262), possibly attributed to the low number of questionnaires that were able to be paired (n=11). A significant positive correlation (r=0.61, p<0.001) was found between the design of the e-Biology© package and the students’ impressions that learning this content will be useful for their future careers. They also pointed out that the package helped them to prepare their final exam (71.7%). The use of specialised clinical case studies seemed to facilitate the acquisition of reflective skills, pivotal to gaining clinical skills, which could be easily adopted by other academics and institutions, seemed to aid the learning of basic skills to work in a chemical pathology laboratory.
Any advice for others?
The different resources available in the e-Biology© package are publicly available. We suggest introduction of the package at the beginning of the course, and using its resources to deliver mini-case studies (for example using the microscopic virtual slides of tissues) within lectures to encourage familiarisation, prior to the introduction of the virtual case studies. e-Biology© can be also used for learning other biomedical sciences, such as histology or general human anatomy and physiology.
Other contextual details
The e-Biology© package was an appropriate resource for online teaching during the COVID-19 pandemic. The package was also used by other colleagues from higher education institutions (for example Chester Medical School) delivering bioscience degree programmes during this time, as previously reported by our team (Peña-Fernández et al., 2021). The package is being used this current academic year as a support teaching of ‘Clinical Biochemistry’ in a hybrid model (in other words using a combination of face-to-face and online teaching as a blended approach).
Carter, A. G., Creedy, D. K. and Sidebotham, M. (2017) ‘Critical thinking evaluation in reflective writing: Development and testing of Carter Assessment of Critical Thinking in Midwifery (Reflection)’, Midwifery, 54, pp. 73–80.
Devi, V., Abraham, R. R. and Kamath, U. (2017) ‘Teaching and assessing reflecting skills among undergraduate medical students experiencing research’, Journal of clinical and diagnostic research: JCDR, 11(1), JC01–JC05. 10.7860/JCDR/2017/20186.9142
Peña-Fernández, A., Evans, M.D., Young, C., Escalera, B., Angulo, S. and Peña, M.Á (2019) ‘Learning clinical biochemistry diagnostic skills through reflection’, in Roig Vila, R. (Coord.) Lledó Carreres, A. Antolí Martínez, J.M. and Pellín Buades, N. (eds.) Redes de investigación e innovación en docencia universitaria. Volum 2019, Alicante: Universidad de Alicante. Instituto de Ciencias de la Educación (ICE), pp. 125-132.
Peña-Fernández, A., Peña, MA., Smith, S., Evans, M.D., Torrado, G., Breda, C. and Randles, M.J. (2021) ‘Introduction of e-Biology at two English universities to strengthen self-learning of ‘clinical skills’, ICERI2021 Proceedings 2021, pp. 9104-9109.
Roberts, D. (2017) ‘Higher education lectures: From passive to active learning via imagery?’, Active Learning in Higher Education, 20(1), pp. 63-77. https://doi.org/10.1177/1469787417731198
Sweet, L., Bass, J., Sidebotham, M., Fenwick, J. and Graham, K. (2019) ‘Developing reflective capacities in midwifery students: Enhancing learning through reflective writing’, Women and birth: journal of the Australian College of Midwives, 32(2), 119–126. 10.1016/j.wombi.2018.06.004