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Possibly not an axiom?

Posted · Report post

I recently had an experience that has at least led me to question a concept often touted on this site as essentially being an axiom. Unfortunately, I cannot go into details. Basically, it involved two groups of students taking the same phsiology based class. One group had completed a stand alone year long course in anatomy and physiology with labs while the other only had anatomy and physiology integrated into their training course. The pass rates of both groups were statistically insignificant.

While not absolutely compelling it is leading me to at least consider long held beliefs. I assumed that one group would have performed significantly better, but that certainly was not the case. With that said, many factors were certainly uncontrolled and I am not presenting this as valid evidence, but rather an anecdote that goes against formal convention.

I would ask for productive conversation regarding the topic at hand. You can be as specific or as broad as you want. Additionally, I would prefer to see literature on this issue as I have not found anything particularly compelling, one way or the other.
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Posted (edited) · Report post

Hmmm, what I'm pondering is the comprehensive nature of the Stand Alone Class. The comprehensive class would have included everything contained within the integrated class, but can we say the same in reverse? Perhaps the reason they were statistically insignificant is because both classes knew the content, but you're evaluating the stand alone class based on the requirements of the integrated one, what would happen if your integrated class was evaluated based on the knowledge required to pass the stand alone class?

To make an easy analogy, a high school senior and a first grader pass a spelling test of three letter words at the first grade level with a similar score...now, what would the results be if the two were to write a spelling test of 3 - 8 letter words at the 12th grade level? Edited by Arctickat
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Posted · Report post

Did you consider the difficulty level of the exam? If the exam covered only concepts limited to what was covered in the integrated class, then obviously the integrated class students will do well since they had less material to cover and it was more directed. The stand-alone class students might do similar, because they knew the same material, but more. Also, the stand-alone students might have had more time from when they learned the material to taking the test.

Does the exam test their ability to have working knowledge of A&P? Scenarios asking what might possibly be going on with a patient based on signs/symptoms you might get in the field. Might the A&P Standalone students do better in pathophysiology overall because they have a better foundation?
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Posted · Report post

The stand alone course is the typical year of anatomy and physiology that most every nursing and allied health student must complete. It is fairly comprehensive and includes a total of eight credits. Six of which are lecture and two are lab. The course typically occurrs over two semesters where the students do a three credit lecture and one credit lab per semester.

Again, I cannot go into detail, but it at least makes me wonder if mandating a year of anatomy and physiology makes a quantitative difference. For example, would nurses and paramedics do better with stand alone A&P versus integrated A&P? I've yet to find smoking gun evidence to support my assertion that mandating a year of A&P makes students learn A&P better than an integrated course.
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Posted · Report post

What I was trying to get at is, how are you judging the doing "better"?
Better at passing a paramedic exam? The integrated one might teach to the test more, because you're worried (understandably) on making sure you teach them what they need to pass... and thus extra material is left out (again understandably).

Passing the exam does not necessarily translate to having a better grasp of A&P and having a better foundation to learn about other topics like pharmacology or being able to use the information in the field (or remembering new information they might get from a journal article or an explanation by a doctor).

Or hell, it might be that an integrated class allows them to only remember what they need to know and that actually does make them better medics? Doubtful, but can't rule it out.

Also, what grades are the students getting on the A&P classes? An A student with integrated A&P knowledge might do better than a C- student with stand-alone class knowledge.
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Posted · Report post

It's really hard to say, as you've mentioned, but the mental exercise is fun..

Though I'm sure you can't show it, seeing the exam would be necessary I think. As Kat explained so well, it would depend on the level of the exam not only from a level of how thorough and expansive the knowledge would need to be for one to pass it, but how abstract the concepts being tested were. Was the exam mostly common memorization, or were students forced to use their biological education to solve physiological problems, and if so, did that go beyond such things as interference(s) in blood/gas barriers as commonly taught to entry level healthcare providers?

I know you love this question, and I actually spent several hours determined to come up with the bell wringing appropriate research to post...but man, I've got nothing. And that's come to seem really weird to me, as it seems like such an important question. But, perhaps there has been collegiate level research that showed that less college is equally valuable...I'm guessing that the sponsoring college would be less than motivated to push for the publication of such a study, yet who else would be motivated to sponsor it?
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Posted · Report post

As others have said, it all depends on how you are evaluating the learning. If you gave the National Registry EMT-B test to a group who had just taken a 150 hour US EMT-B course and to a group a newly graduated degree paramedics from Australia, I would not be surprised if the better educated paramedics did no better.

I suspect that this would be the challenge in trying to research this type of thing as well. It will be difficult to come up with a truly valid test and two nearly identical groups to do the different courses. Even with that much working out, the applicability of the results to any setting other than where the study was conducted would probably be limited.
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To be clear, I am talking about a freshman level pathophysiology class.
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I'm replying as someone who has done both pathways. First, was a semester each general anatomy then physiology class both with labs. A few years after completing those I undertook a non-US based paramedic degree that had combined elements of A&P over two semesters with very limited lab time. Topics covered were almost identical as were exams and marking criteria. I performed equally in both.

As both classes met their objectives I wouldn’t think that there would be much different solely based upon being integrated or not. The only thing that comes to mind would be with the integrated class, is that if students are covering other topics simultaneously, while someone may choose to solely do an independent class thus having more focused time.

At the end of the day, as stated in the first post, I think you are still going to have good performers and poor performers independent on what the layout is like. Like some of the others have pointed out, the hard thing is the ability of to measure both the betterness and the long term effects of both pathways (i.e. differences in retaining and applying knowledge, who makes a better practitioner, etc)
Interesting topic nevertheless
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Posted · Report post

I've been looking for any kind of research on this particular topic and am also coming up short. If it's there I'm just not finding it. Does the research comparing similar situations even exist? Honest question. I don't know.

My initial thoughts were along the lines of Kat's discussion. I realize that's not very helpful and a bit of a cop out contribution to the discussion. But he articulated what I was thinking pretty well.

What's not addressed, either, is how well the students from the stand alone class fare over the long run in terms of academic preparation and professional growth and development when compared to the integrated students who only learned what's on the test. That, I think, would be an interesting long term study in which to engage.
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As you mentioned you have sparked my interest. Your post always make me think, that is why enjoy reading your comments so much.

It is a little disheartening though. Until now I just thought I was AWESOME!

Bummer.
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[quote name='chbare' timestamp='1352757525' post='290327']
To be clear, I am talking about a freshman level pathophysiology class.
[/quote]
Oh, so I'm assuming it can't be very in-depth, then. I'm taking one now that has anatomy and physiology as pre-reqs, one quarter class, and getting more in-depth than medic school, but not that much more. Overall class time on pathophys topics was less or similar to medic school.
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Posted · Report post

Uhm, by "exam" are we talking about the NREMT? If so, then perhaps your underlying question is flawed in and of itself.

My underlying question is "is the NREMT a fair assessment of a paramedics competence or course success?" I think any experienced paramedic would say "no" ( and to be fair even the NREMT doesn't think so, they intend it to establish the minimum for an entry level brand new paramedic...nothing more).

The one advantage of a separate course is that they are very standardized, and I think the variation of quality would be less. Where in the so called integrated approaches your quality would be largely dependent on the instructors, who may or may not be qualified to discuss detailed patho-physiology outside of the paramedic course.

Besides, why not do both? Repetition is a key point of learning. And having students with a good foundation makes them better prepared to discuss pertinent physiology on a higher level, hitting the ground running so to speak. So I like the best of both worlds...
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Posted · Report post

I made it clear that I am not talking about the NREMT exam.
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Posted · Report post

Good on you for having a look at this mate, it's a topic very near and dear to my heart and I know you feel the same way

As has been said, can the people who took the integrated course pass the same exam as the people who took the stand-alone? I think that is a better test, or an even better test is how they can apply the knowledge they have learnt in clinical context of pathophysiology and rationale for signs/symps/treatment etc

Certainly I am vehemently opposed to anything other than stand-alone anatomy and physiology taught by a subject matter expert but then again I suppose I only have empiric evidence to support my view.

Carry on.
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Posted (edited) · Report post

[quote name='chbare' timestamp='1352948436' post='290388']
I made it clear that I am not talking about the NREMT exam.
[/quote]

I looked back, and I see where you mentioned a physiology course, I wouldnt call it "clear", but its not a point worth arguing.

I think the point I and others have raised is a valid one. If you are judging the success of the students by passing an exam, any exam..while easy to measure, it may be a fundementally flawed assumption.

I guess the first question ou must ask yorself is "What is the goal you are looking for,". Preperation for passing a test, passing a liscensing exam, or success in the field? Obviously one is harder to measure than the other, I will give you that. And one you may have control over, the others you may not.
But if you are only measuring success by a single exam, you may be missing the impact of a stand alone course on the "big picture" of the students overall success.


So some "food for thought" type of self reflection questions:


So what is the " goal" of the class?

What are you trying to achieve/instill in the students by requiring the class in the big picture?

And it the success (or lack of difference between one group or the other) consitant and reproducable over multiple groups in similar circumstances using the same curricula but differnet instructors? Edited by croaker260
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Posted · Report post

I'm not requiring a class for anything. I simply made an anecdotal observation about two groups of students taking the same pathophysiology class. One group had in theory significantly more preparation in the form of an entire year of dedicated A&P taught by a dedicated A&P professor. Additionally, they all had microbiology, a year of English and chemistry. The other group only had the integrated A&P as stated. The results, anecdotal as they may be, challenged a common assertion. Upon researching, I've been unable to find strong evidence supporting said traditional assertions and now I'm putting it to the City.

I appreciate the comments, but do not add anything else into this. I'm not making conclusions, changing policy or making mandates. I simply noticed something interesting and am having difficulty scratching the itch it has created.

Just to be clear, this was a class that I did not teach and was not involved with it or the instructor.
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Posted · Report post

I think ability to use the information gained in clinical context vs. being able to pass a test is a much better way of evaluating the two methods of teaching personally.
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Posted · Report post

Like so much in EMS, there are no studies out there. Opinions, like assholes and everyone has one. It can be very frustrating, especially for those that want to move the profession forward.
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[quote name='chbare' timestamp='1353013954' post='290396']

I appreciate the comments, but do not add anything else into this.
[/quote]The comments we're leaving are attempts to alleviate that itch. Something about the results you got seemed weird to you, so maybe there's a good explanation. Or maybe not...but the more comments you get, the more angles you might find to it...
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I think that it may be worth you to repeat the observations over several classes to see if what you first saw, holds true repeatedly.
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[quote name='AnthonyM83' timestamp='1353036921' post='290404']
The comments we're leaving are attempts to alleviate that itch. Something about the results you got seemed weird to you, so maybe there's a good explanation. Or maybe not...but the more comments you get, the more angles you might find to it...
[/quote]
Agreed, I just don't want people adding more into my motives or assuming I am up to something other than looking at an isolated piece of data and saying "huh, that's interesting."

[quote name='croaker260' timestamp='1353041128' post='290408']
I think that it may be worth you to repeat the observations over several classes to see if what you first saw, holds true repeatedly.
[/quote]

That would be interesting but I'm not sure it would be possible. I'm not really involved with that class and I cannot dig for too much information as that could encroach on student privacy. I would actually like to see if any related literature exists however.
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I believe the stand alone A&P classes reflect most institutes of higher learning "Perpetual student" attitude, where having the student taking multiple classes loosely related to the core curriculum makes for a more well rounded graduate, In college I took Pharm classes much more in depth than required by my program, and it helped foster a deeper understanding and appreciation of it. (Probably should have done the same with Cardiology and all those sciences, alas I was a broke college student)

For the goal of putting EMS providers on the street, the inter-graded classes are the quickest and most cost effective, but as an educator I would rather my students learn every subject much more in depth than I have the opportunity or time to teach. It's kind of a catch 22.
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I do not disagree; however, I would like to see evidence that a well rounded curriculum creates a better provider. Unfortunately, the evidence that I have seen in other fields is quite mixed. Even "landmark" studies involving higher educated nurses have significant flaws. I think we are going to have to produce evidence and essentially force people to change, but the evidence needs to exist. We are transitioning to an A&P and English class requirement for most EMS levels at our institution with a push toward degree only paramedic classes. Perhaps I will be able to to some sort of cohort comparison or look at certain other indicators in past classes with newer classes. Of course, that will likely take years.
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