A students as partners approach to developing online interactive physiology content

Physiology is widely considered to be a challenging subject by students on medicine and medical science degrees [1,2]. To increase student engagement and understanding of complex content, many educators have adopted active learning approaches. While active learning has been shown to be effective in improving exam performance across STEM subjects [3] there are challenges. This includes negative perceptions among students and lack of guidance for educators [4]. Personally, we have found active learning approaches can be more difficult to integrate with large class sizes.

Here, we share our experiences of student-led online interactive content creation. Our two resources were targeted at year 2 undergraduate medical sciences students (n=220) and year 1 undergraduate medical students (n=330) to supplement respective cardiovascular physiology teaching. Content was created using H5P (HTML5 Package) and hosted on a WordPress website.

The first resource developed was “Escape the Pharoh’s Tomb” digital escape room. This consisted of a series of 6 interactive puzzles including a cipher and crossword. Correctly solving each puzzle revealed a code to “unlock” the door and allow the participant to progress to the next room. To simulate the physical escape room experience, a countdown timer which carried across pages was integrated into the design. Secondly, we developed a clinical case study about a patient presenting to his GP with atrial fibrillation and hypertension. The interactive elements included multiple choice questions, fill in the blanks and labelling a diagram.

The resources were shared with both cohorts of students via email and a QR code displayed during an in-person lecture. Anonymous feedback was collected using surveys (Microsoft Forms), including both Likert scales and free text questions. To assess interaction with the content, the H5PxAPIkatchu plugin was used to collect data including puzzle scores. Google Analytics was used to quantify number of page views and average time spent on each page.

The feedback for both resources was overwhelmingly positive. Over 90% of respondents (n=14) strongly agreed that the escape room was enjoyable and helped them apply their cardiovascular physiology knowledge. In the free-text comments, most students (n=7) found it engaging but some (n=3) reported difficulties with the ECG puzzle and found the clues confusing. This was reflected in the analytics data which showed students spent more than twice as long on this puzzle than any other (557 vs. ≤224 s). All respondents (n=14) reported the case study was clear and 92.3% strongly agreed it was a good supplement to their lectures. Several positively commented that the case study covered a range of lecture content and it was useful for revision (n=5).

In conclusion, involving students as co-designers is a successful approach for developing new online interactive physiology content.

References
1. Bordes SJ, Manyevitch R, Huntley JD, Li Y, Murray IVJ. Medical student misconceptions in cardiovascular physiology. Advances in Physiology Education. 2021 Jun 1;45(2):241–9.
2. Michael J. What makes physiology hard for students to learn? Results of a faculty survey. Advances in Physiology Education. 2007 Jan;31(1):34–40.
3. Freeman S, Eddy SL, McDonough M, Smith MK, Okoroafor N, Jordt H, et al. Active learning increases student performance in science, engineering, and mathematics. Proceedings of the National Academy of Sciences. 2014 May 12;111(23):8410–5.
4. Rhodes A. Lowering barriers to active learning: a novel approach for online instructional environments. Advances in Physiology Education. 2021 Sep 1;45(3):547–53.