Microcomputer-based learning in a medical biochemistry course

users may concentrate on the most effective use of this new, essentially untested, teaching tool.

Acknowledgement We wish to thank Dr S Bellard for providing atomic coordinates of myoglobin, chymotrypsinogen A and lactate dehydro- genase.

Footnote The Biochemistry Microcomputer Group was created to provide a vehicle for the communication of applications and software written for microcomputers by biochemists. The Group publishes a Newsletter (30- 40 pages) three times a year and has a mailing list in excess of 100 at present. Further information on the group may be obtained from the authors at Department of Biochemistry, University of Liverpool, PO Box 147, Liverpool, UK, L69 3BX.

References 1 North, A C T (1980)Biochemical Education 8, 98-99 2Bernstein, F C, Koetzle, T F, Williams, G J B, Merger, E F, Brice, M D, Rodgers, J R, Kennard, O, Shimanouchi, T and Tasumi, M (1977) JMol Biol 112, 535-542

3Newman, W M and Sproul, R F (1979) 'Principles of Interactive Computer Graphics'

4Rogers, D F and Adams J A (1976) 'Mathematical Elements for Computer Graphics' McGraw Hill Book Co, NY

SBeynon, R J (1982) in 'Computing in Biological Sciences' (eds M Geisow and A N Barrett) in press

6Giles, I T (1981) IntJBiochem 13, 673-680 7Kibby, M R (1981) Biochemistry Microcomputer Group Newsletter No 4, 14-16

8Beynon, R J (1980) Trends in Biochem Sci 6, V1-VII 9place, G A (1981) Biochemistry Microcomputer Group Newsletter No 4, 4-13

l°McFerran, N V (1981) Biochemistry Microcomputer Group News- letter No4, 17-22

Biochemistry Microcomputer Group Newsletter Organized by R J Beynon and G A Place (Department of Biochemistry, University of Liverpool), the Biochemistry Microcomputer Group aims to provide a forum for the ex- change of applications and software written for microcomputers by biochemists. The group publishes a Newsletter (30-40 pages) three times a year. Recent topics covered have been data analysis (Issue 3), graphics (Issue 4) and analytical equipment interfacing (Issue 5). The communications published in the Newsletters provide a useful insight into the various techniques described. The only slight complaint might be that there is a distinct bias towards those micros that use the 6502 microprocessor, eg the Apple and Pet. It would be nice to see the Z-80 users more catered for, either up-market (eg machines running (CPM) or down-market (eg Sinclair ZX81, Nascom etc). Perhaps the onus is really on the Z-80 users out thereto contribute more communications to the Newsletter.

Nonetheless, the service that the 'BMG' provides to the users of the increasing number of microcomputers to be found in Biochemistry departments represents remarkable value. The subscription is £3 pa (UK) or £6 pa (overseas airmail). Further details of the BMG are available from R J Beynon, Depart- ment of Biochemistry, University of Liverpool, PO Box 147, Liverpool, L69 3BX, UK. Overseas subscribers should arrange a draft in pounds sterling drawn on a British bank.

Issue No. 4 (1981) contains the following articles: G A Place, '3-D Graphics Animation Packages'; M R Kibby, 'The Figure Grow Program'; N V McFerran, 'Molecular Models on a Micro'; J M Garland, 'Teaching of Biochemistry using Com- puter-animated Graphics on the PET Commodore'; and I A Nimmo, 'Comments on the Choice Between Parametric and Non-parametric Statistical Methods.' AGB

B I O C H E M I C A L E D U C A T I O N 10(3) 1982

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Microcomputer-Based Learning in a Medical Biochemistry Course

M C BLANCHAER

Department o f Biochemistry Faculty o f Medicine, University o f Manitoba Winnipeg, Canada

Introduction Although computers have been used as a learning aid in higher education for over 20 years, it was only recently that the advantages and disadvantages of computer-based learning of Biochemistry were reviewed in detail by BryceJ However, even since the appearance of that review there have been extensive developments in computer technology, particularly the appearance of a variety of relatively inexpensive microcomputers with enhanced graphic capabilities that facilitate the presentation of plotted data, tabulated material and metabolic schemes. Of perhaps greater educational significance is the simplification of some computer languages to the point that an instructor with little or no programming experience can prepare an interactive tutorial relatively quickly. Thus, microcomputers offer the possibility of a relatively easy and inexpensive way of facilitating student mastery of biochemical facts and concepts. Interesting examples of programmes that assist the user to learn and test his understanding of the relatively complex topics of nearest-neighbour frequency analysis of DNA and enzyme kinetics have been published. 1

The present account describes the use of microcomputers in a learning environment devised for first year medical students who have already completed a course in the basic aspects of biochemistry. Our course 2'3 stresses problem-solving in a medical context and includes a number of patient-management exercises that require the student to commit himself to a series of decisions, each based on the evidence available at that time, before he obtains the instructor's response to his choices, which are hidden in a latent image. 4 Into this setting we have recently introduced microcomputers to help students test their knowledge of some important facts and concepts through programmed multiple-choice questions; each question has a short interactive tutorial appended to assist in the learning of material known to be difficult conceptually for some students. Three additional, more extensive, programmes present a range of simple-to-complex clinical case-studies, each requiring identification of the patient's underlying biochemical distur- bances and the appropriate principles of management. These various formats and their implementation are discussed below.

Multiple Choice Questions All the standard forms of such questions can be used. Correc- tive feedback appropriate to each particular incorrect response can be given to the student immediately. If the instructor wishes, a student who makes a certain number of incorrect decisions can be transferred directly to a remedial tutorial (see below).

Uncued Questions Instead of requiring a student to respond with a number or letter, as in the usual multiple-choice format, he can be asked to type in the answer - in his own words. Since key words or phrases required in the correct answer can be identified by the computer programme, the student is allowed greater freedom

108

in composing his response. Such a 'free language' mode, however, presents a considerably greater challenge than a multiple-choice question since the user must select from the facts and concepts he has learned those needed to answer the question. (The inclusion of incorrect or irrelevant words can be drawn to the student's attention if the instructor wishes.)

Tutorials Computer-based tutorials are most effective when presented in an interactive, rather than didactic, mode. The tutorial may begin by exploring the learner's knowledge of basic facts and concepts. Depending on his response to one or more questions, posed in multiple-choice or free language form, appropriate information can be provided and conceptual misunderstandings corrected. His grasp of this remedial material may then be tested immediately and if difficulties persist, the learner recycled through the same or another informational section. When the required level of competence has been demonstrated the student may be moved through additional cycles of testing, remediation and retesting, each at a progressively higher level of knowledge.

Problem Solving in a Clinical Setting In our experience, exercises giving students an opportunity to apply the facts and concepts they are encountering in other parts of the course to identifying and solving clinical problems improves motivation for learning the basic aspects of biochemistry. Such clinical applications seem most appealing when they deal with the problems of individual patients and employ the interactive mode described above. Although it need not be immediately apparent to the student, this format can also be used to demonstrate how the approach to clinical problems in certain ways resembles that employed in bio- medical research. Perhaps because of their appeal, such exercises can introduce academically-demanding material without eliciting negative student comment.

Evaluation It would be premature to attempt an evaluation of our experience with this learning approach as only one medical class has used it to date, and then only on a voluntary basis. No record of the performance level of individual students was kept. However, anecdotal feedback indicates that, for a variety of reasons ranging from insecurity to intellectual curiosity, about 70% of the class averaged about an hour each at the computer. Some expressed preference for tutorial programmes which included review sections dealing with difficulties revealed by incorrect responses to multiple choice or uncued questions of the type described above. However, the three exercises requiring the use of basic biochemical knowledge for the solution of clinical problems proved most popular, especially when students who had worked through an exercise were offered a printed summary 'for review purposes'.

As might be expected from the varied student motives for trying these programmes, those who worked through a specific clinical problem did not perform significantly better than those who had not, on a short essay examination question which tested the problem-solving skills featured in that particular computer-based problem.

Technical Aspects For large banks of multiple choice questions macrocomputers


are superior to smaller machines because of their greater storage capacity. On the other hand, microcomputers tend to be more 'user friendly' to both the programmer and to the computer-naive user of learning exercises. Also, without special terminals, larger computers usually cannot display high resolution 'graphics' such as plots of data and metabolic pathways as easily as some microcomputers now on the market.

With most microsystems, graphics can be shown on a portion of the screen while related information or a series of questions, exploring the viewer's understanding of the graphic material, is presented beside it. At least one programming language (Apple PILOT) allows graphics to be changed in response to the student's answers to concurrently presented questions. This combination of graphics with interactive exchanges between the user and the 'programmed' instructor is particularly useful for exploring biochemical concepts that some students find difficult. Frequent use of graphics, to illustrate abstract concepts or to present data which the student must interpret, relieves the tedium of having to read an uninterrupted series of text 'pages' on the screen. An example of this use of graphics is described in the Appendix.

The performance of individuals can be recorded and returned to the instructor or provided as a score to the student. Feed- back to the instructor on the answers of the users as a group to each question posed in an exercise may be helpful in revising its content and structure.

In our experience, faculty often overestimate the difficulty of learning a programming language and the technical aspects of dealing with a microcomputer. On the other hand, there is a tendency to underestimate the time needed to refine computer-based materials before they are ready for use by students. Fortunately, exercises written in PILOT can be modified readily with minimal programming skills to meet local circum- stances. Thus, an instructor lacking the time or background to prepare clinically-based exercises can adapt such materials, originally programmed at other centres, to the learning needs of his students.

The author is prepared to supply interested readers with copies of his programmes in the PILOT language at cost. These diskettes can be run on any Apple II Plus computer with one disk drive, and can be modified to suit local needs if the recipient has available an additional disk drive and the Apple PILOT software.

For programming in Apple PILOT, an Apple II Plus microcomputer with 48 K RAM and 2 disk drives is required. In our experience, one additional Apple II Plus with one disk drive allowed sufficient student access time for a class of 95 when about 1.5 hours of programmed material was offered for use on a voluntary basis during the 3.5 months over which our 110-hour Human Biochemistry course is presented.

Appendix Figures 1 - 4 show successive 'pages' presented on the computer screen by a clinical problem-solving programme 'Charly' as it responds to a student's input. (Only the 'text window' changes in these figures.)

In Figure 1 the student has typed in an incorrect response, 'glucose', to the question 'What is Y?'. He is allowed three additional tries (not shown here). Repeatedly incorrect answers elicit increasingly specific hints, ending finally with the programme providing the correct answer, 'lactate'. Figure 2 shows

F i g . 1 ~r~oh ~hn~l~ t;mnnli~ p l ~qm~ l i y i , rnnr~n-

£~'~ofi"6~oh~',"afir~fig-and afteh ...... p a r t i a l occlusion o? arm's blood supply.

Fwhat is "Y"? l

° il l touch RETURN]

[glucose I INo. I t ' s not I the plasma 91ucose I

lleuel. _I

TIME . ~-- //~

i Text Window I

F i 9 . 2

Graph shpw~ v e n o q s ela~ma " ~ra~lon before, ourlng and p a r t i a l occlusion 09 arm's

LUSION

TItlE >

I

Y" concen- agter blood supply.

Good!

"Y" i s lactate.

Is this the kind o9 lactate curve ~c,u expect in

harlg?

Please tgpe UyesU or ~no" and touch RETURN

F i g . 3

G r a p h s h o w s venous p l a s m a " tration b e f o r e , during and p a r t i a l occlusion o9 arm's

TIME >

Y'~. concen- after blood supply,

That's r i g h t !

A l l the earlier Findings make such a large rise in venous lactate unlikely in Charly.

PRESS RETURN KEY TO CONTINUE

F i g . 4 ~r~oh RhnhlR t;~nnlJ~ D1 ~m~ i i y . rnnr~n--

p a r t i a l occlusion o9 ~rM'S blood supplu.

0 N

? , i y 11

TIME >

The plasma lac ta te curve ~ O U see iS

hat oF a heal thy p e r s o n .

Here's what Charl9'$ looked l i k e . . .


109

the programme's response when the student himself provides the answer. After confirming that lactate is correct, the programme tests whether he can predict the changes in the venous lactate level expected in 'Charly' in view of earlier findings. Figure 3 shows the response when he gives the correct answer, 'no', to the question in Figure 2, and Figure 4 provides the confirming data.

References IBryce, C F A in 'Biochemical Education' (ed Bryce, C F A) Croom Helm, London (1981) p 169

2Dakshinamurti, K (1979) 'A New Syllabus for Medical Biochemistry', Biochemical Education 7, 70

3Dakshinamurti, K in 'Biochemical Education' (ed Bryce, C F A) Croom Helm, London (1981) p 58

4Blanchaer, M C (1975) 'Simulated Clinical Problems in Medical Biochemistry Course', Biochemical Education 3, 71

An Essay on Metabolism

C JOHN GARRATT

Departm en t o f Ch em istry

University o f York, UK

Introduction I have been stimulated to write this essay by two things. Firstly I have become increasingly disturbed by the 'knowledge' displayed by 17 year-old schoolchildren studying biology and chemistry to Advanced level in the General Certificate of Education in England and Wales. Many of them can recite the intermediates of the tricarboxylic acid cycle but few have any understanding of its role in fatty acid oxidation, or indeed that fatty acids have a role in what they call respir- ation; in this sense they have been shown the metabolic 'trees' but given no opportunity to appreciate the intricate and beautiful pattern of the metabolic 'wood'. Even in showing them the trees we have asked them to wear dark glasses and blinkers, for almost none have ever seen the chemical structures of the intermediates and so they have been denied the opportunity to see the elegant simplicity with which nature has designed an oxidation pathway. I can see only one reason for teaching the facts as we do: it is relatively easy to devise an objective examination of the knowledge. If we are interested in education rather than examination surely we should either take them to a far distance and let them survey the whole wood, or take them right into the forest for a careful examination of selected trees. My preference is for the former, since most of them will never be specialist biochemists, nor are they likely to sit in family circles reciting the reactions of the tricarboxylic acid cycle for pleasure, whereas I can imagine intelligent people discussing the processing of different foods in the body.

My second stimulus was a letter about the problems of teaching metabolism in a general introductory biology course at an American University where many students have practically no knowledge of chemistry. It would certainly be hard to teach such students the reactions of the tricarboxylic acid cycle in a short course. Indeed, I would wish to avoid doing it because of my fear that it would be as meaningless and useless to them as are the same reactions to most English schoolchildren. I would prefer them to be shown the wood from afar.

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Microcomputer-based learning in a medical biochemistry course