A Review from Medical Science Educator from Dr. Louis B. Justement

Each month the IAMSE Publications Committee reviews published articles from Medical Science Educator. This month’s review, written by Dr. Louis B. Justement is taken from the article titled Medical Biochemistry Without Rote Memorization: Multi-Institutional Implementation and Student Perceptions of a Nationally Standardized Metabolic Map for Learning and Assessment (doi:10.1007/s40670-018-00631-y) published in Medical Science Educator, Volume 29, (pages 87-92), 2019 by Douglas B. Spicer.

As a member of the Publications Committee, I wanted to highlight an interesting article in Medical Science Educator, the journal of IAMSE, on the use of a Metabolic Map that is designed to facilitate the ability of medical students to not only learn biochemistry but to do so in a practical, applied manner. The title of the article is Medical Biochemistry Without Rote Memorization: Multi-Institutional Implementation and Student Perceptions of a Nationally Standardized Metabolic Map for Learning and Assessment by Douglas B Spicer (Medical Science Educator (2019) 29:87-92).

Understanding the principles of biochemistry and biochemical pathways have traditionally proven to be very challenging for medical students due to the complex, interrelated nature of biochemical processes. Students often fail to comprehend how this material is relevant for their future practice of medicine and also express a significant amount of stress when faced with the prospect of memorizing large numbers of biochemical pathways without the appropriate context being provided. This leads to the creation of an excessive cognitive load that interferes with the development of an integrated understanding of normal and pathophysiological metabolic processes.

To address this problem, Stanford University School of Medicine Faculty worked in conjunction with the Association of Biochemistry Educators to develop a map that contains medically-relevant metabolic pathways for use as a standardized national resource that is readily available for download (Pathways of Human Metabolism: (https://metabolicpathways.stanford.edu/). The goal of this Metabolic Map (MetMap) is to provide a resource for students to aid in their appreciation of the relationship between metabolic processes and disease that will avoid the need to memorize biochemical pathways without context. This MetMap is designed to be used as both a study aid or resource for students and as a resource during assessment.

The MetMap is currently being utilized by a number of institutions across the country and to assess its impact on student perceptions of biochemistry, the authors conducted a survey of 481 students from three different medical schools that integrate biochemistry content with other topics in interdisciplinary courses longitudinally in the MS1 year. The survey results support the value of the MetMap as a resource for student learning of normal metabolic processes and how dysregulation leads to disease. Students responded that the MetMap: 1) aids visual and mental organization of metabolic pathways, 2) Promotes deep learning and the application of knowledge learned in the context of disease processes, 3)decreases the need for memorization, 4) reduces anxiety of exams and 5) aids in long-term recall.

Although students give the MetMap high marks in general, there were some concerns raised that are of note. The first and foremost is that although the MEtMAp is an effective learning resource, students were concerned that because it is often used in both learning and assessment activities, that reliance on the MetMap may result in under preparing for licensing exams. Students were concerned that it may still be necessary to memorize a lot of facts in order to be fully prepared for licensing exams. This raises the question of whether in the future such standardized national resources will be incorporated into licensing exams. This very question is currently under discussion by a USMLE Metabolic Map Task Force. A second issue noted by students was that the MetMap is still quite complex in nature, however, they also indicated that through repetitive use of the MetMap, they were able to develop a more integrated understanding of metabolic pathways and their relationship to disease.  Going forward, studies to assess the impact of the MetMap on student learning outcomes should provide important insight regarding whether the MetMap is effective as a resource for teaching metabolic processes and their relationship to disease.

Louis B. Justement, PhD
Director, GBS Immunology Graduate Theme
Director Undergraduate Immunology Program
Associate Director, Medical Scientist Training Program
Professor, Department of Microbiology University of Alabama at Birmingham
Member, Publications Committee