Clinically oriented laboratory illuminates challenging respiratory concepts to the pre-clinical medical students

Dear Sir

As the pre-clinical curriculum in medical schools evolves toward active learning and clinical applications, traditional physiology laboratories have been trying to find their niche. Since most medical students perceive the mastery of respiratory physiological concepts as formidable, we constructed a hands-on spirometer laboratory to equip our first-year medical students to proficiently comprehend and apply some of the basic concepts in respiration. In this lab, students record and interpret Forced Vital Capacity (FVC) test in real time.

In the last 4 years the laboratory was conducted in clinical examination rooms using IQmark digital spirometer machines (Midmark Diagnostics Group, Versailles, Ohio). In each year, the class of approximately 54 students was divided into six groups, each with its own machine. By performing the test on peers, students collected the following parameters: FVC, FEV1 (Forced Expiratory Volume at 1 second), the FEV1/FVC ratio and the subject's height. Then each student drew a figure and briefly discussed the relationship between height and these parameters. Furthermore, to simulate restrictive lung diseases, a bandage was tightly wrapped around a volunteer student's chest and an FVC test was performed. Finally, the students completed a survey to assess the value of the lab in their comprehension of theoretical concepts learned in the classroom and the relevance to their medical education.

On an average, 88% of the students rated the lab as extremely or very useful in helping them understand physiological concepts of the pulmonary function test in normal and pathological conditions. Although these evaluations are more subjective based on the students’ perception, the responses were consistent in the last four consecutive years. The majority of the class (>85%) correctly showed the expected linear correlation between the height and the FVC and FEV1 while the FEV1/FVC ratio did not change, as well as the simulation of restrictive lung diseases on these parameters. The clinically oriented setting of the lab energized the students and enhanced their efforts to link the challenging abstractions of the classroom to practical applications. As previous reports indicate (Euliano 2000), this method appears to improve students’ proficiency in challenging concepts and needs to be implemented more frequently in the pre-clinical curriculum.

Adel Elmoselhi, Morehouse School of Medicine, Physiology Department, 720 Westview Drive, SW, Atlanta, GA 30310, USA. E-mail: [email protected]