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Adv Physiol Educ 39: 120121, 2015;

Illuminations doi:10.1152/advan.00167.2014.

Collaborative teaching strategies lead to retention of skills in acid-base

physiology: a 2-yr follow-up study
Jacob P. Hartmann,1 Linea Natalie Toksvang,2 and Ronan M. G. Berg1,3
Renal and Vascular Research Section, Department of Biomedical Sciences, Faculty of Health Sciences, University of
Copenhagen, Copenhagen, Denmark; 2Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet,
Copenhagen, Denmark; and 3Department of Clinical Physiology, Nuclear Medicine & PET, University Hospital
Rigshospitalet, Copenhagen, Denmark
Submitted 31 December 2014; accepted in final form 6 March 2015

A BASIC UNDERSTANDING of acid-base physiology is critical for 100 Collaborative Group

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the correct assessment of arterial blood gases in the clinical
setting (1). In this context, collaborative teaching strategies in Control Group
the undergraduate classroom setting may be useful, since it has
been reported to enhance both transfer and retention of learned **

Proportion of students, %
material in a time-efficient fashion (3). In a previous study (4),
we investigated whether different collaborative teaching strat-
egies would improve medical students skills in acid-base
physiology. Students received a 45-min ex cathetra class on
acid-base physiology, which was followed by a 20-min inter- 50
active session, where students assessed eight different arterial
blood gases. The latter was either done by conventional group
work, where students worked in pairs and spent 2 min on each
arterial blood gas, or by Mazurs peer instruction technique (2), 25
where students worked individually for 1 min and then in pairs
of two for 1 min. We found that conventional group work and
peer instruction equally enabled second-year medical students
to diagnose common acid-base disorders immediately after
class, indicating successful transfer of the learned material (4). 0 1 2 3 4
In the present 2-yr followup study, we investigated whether Total test score
these collaborative strategies also lead to long-term retention of Fig. 1. Total test scores. Overall difference between the collaborative and
the learned skills. control groups: **P 0.01.
We obtained institutional approval for the present study
from the Faculty of Health Sciences of the University of participated in the same physiology course 2 yr earlier, but
Copenhagen, and participation was voluntary. Twenty-four without any collaborative elements, were recruited (control
months after our initial study on collaborative teaching strate- group). The two groups were similar with regard to age, sex,
gies for diagnosing common acid-base disorders was con- and previous experience with diagnosing acid-base disorders
ducted (4), we recruited 31 of the 41 students who had (data not shown). All students underwent an individual written
originally participated (collaborative group), of which 14 test, in which they were to diagnose acid-base disorders by
students had been subjected to conventional group work and 17 assessing four arterial blood gases (Table 1). During the test,
students had been subjected to the peer instruction technique. students received a sheet with normal ranges for all arterial
Furthermore, 58 other fourth-year medical students that had acid-base variables, and for each of the four arterial blood
gases, they were to provide a diagnosis and report how confi-
Address for reprint requests and other correspondence: R. M. G. Berg, Dept. of
dent (0-100%) they felt that their diagnosis was correct. Stu-
Clinical Physiology, Nuclear Medicine & PET, Univ. Hospital Rigshospitalet, dents completed the test in 5 min. In the analysis of test
Blegdamsvej 9, Copenhagen DK-2100, Denmark (e-mail: results, one point was awarded for each correctly diagnosed

Table 1. Arterial blood gases

Arterial PO2, Arterial O2 Arterial HCO3, Base Excess,

kPa Saturation, % PCO2, kPa pH mM mM Correct diagnosis

Arterial blood gas 1 12.0 98 6.7 7.32 24.0 0 Respiratory acidosis without compensation
Arterial blood gas 2 11.0 96 3.7 7.22 12.9 15.2 Metabolic acidosis with partial respiratory
Arterial blood gas 3 11.7 98 6.4 7.53 38.9 15.3 Metabolic alkalosis with partial respiratory
Arterial blood gas 4 19.3 99 8.5 7.15 18.4 6.3 Combined respiratory and metabolic acidosis
Normal range 11.014.0 9398 4.56.0 7.357.45 22.026.0 2.0 to 2.0

120 1043-4046/15 Copyright 2015 The American Physiological Society


Table 2. Correct answers and confidence levels

Collaborative Group Control Group

Arterial blood gas Correct answers, % Confidence level, % Correct answers, % Confidence level, %

1. Respiratory acidosis without compensation 94 95 (85100) 78 80 (6593)

2. Metabolic acidosis with partial respiratory compensation 97 90 (70100) 79* 80 (7195)
3. Metabolic alkalosis with partial respiratory compensation 97 90 (80100) 78* 80 (5090)
4. Combined respiratory and metabolic acidosis 71 80 (70100) 41 73 (5084)*
Confidence levels are reported as medians, with interquartile ranges in parentheses. Differences between collaborative and control groups: *P 0.05
and P 0.01.

acid-base disorder. IBM SPSS Statistics for Macintosh (ver- DISCLOSURES

sion 22.0, IBM, Armonk, NY) was used to compare test scores No conflicts of interest, financial or otherwise, are declared by the author(s).

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and confidence levels by nonparametric statistics (Mann-Whit-
ney U-test). Unless otherwise stated, data are reported as AUTHOR CONTRIBUTIONS
medians with corresponding interquartile ranges. Author contributions: J.P.H. performed experiments; J.P.H., L.N.T., and
The collaborative group reached higher total test scores than R.M.G.B. analyzed data; J.P.H., L.N.T., and R.M.G.B. interpreted results of
the control group (P 0.01; Fig. 1). For three of the four experiments; J.P.H., L.N.T., and R.M.G.B. edited and revised manuscript;
acid-base disorders, a higher proportion of students in the J.P.H., L.N.T., and R.M.G.B. approved final version of manuscript; L.N.T.
collaborative group reached the correct diagnosis and generally prepared figures; R.M.G.B. conception and design of research; R.M.G.B.
drafted manuscript.
did so with a higher level of confidence (Table 2). Within the
collaborative group, there were no differences between test
scores or confidence levels of students that had learned acid-
base physiology by conventional group work or the peer 1. Berend K, de Vries AP, Gans RO. Physiological approach to assessment
of acid-base disturbances. N Engl J Med 371: 1434 1445, 2014.
instruction technique (data not shown). 2. Mazur E. Peer instruction: getting students to think in class. In: The
Our findings indicate that collaborative teaching strategies Changing Role of Physics Departments in Modern Universities. Proceed-
may both enhance confidence and long-term retention of skills ings of the ICUPE, edited by Redish EF, Rigden JS. Woodbury, NY: The
for diagnosing common acid-base disorders, regardless of American Institute of Physics, 1997,. p. 981988.
whether conventional group work or the peer instruction tech- 3. Michael J. Wheres the evidence that active learning works? Adv Physiol
Educ 30: 159 167, 2006.
nique is used. Such strategies may therefore be beneficial for 4. Petersen MW, Toksvang LN, Plovsing RR, Berg RM. Collaborative
conveying the complexity of acid-base physiology to under- strategies for teaching common acid-base disorders to medical students.
graduate students in a time-restricted setup. Adv Physiol Educ 38: 101103, 2014.

Advances in Physiology Education doi:10.1152/advan.00167.2014