A Review from Medical Science Educator from Dr. Steven Crooks

This month the IAMSE Publications Committee review is taken from the article titled Medical Biochemistry Without Rote Memorization: Multi-Institution Implementation and Student Perceptions of a Nationally Standardized Metabolic Map for Learning and Assessment published in the Medical Science Educator, Volume 24, (pp 87-92), by Douglas B. Spicer, Kathryn H. Thompson, Michelle S. Tong, Tina M. Cowan, Tracy B. Fulton and Janet E. Lindsley.

As a medical educator, I’m always interested in learning about new instructional approaches that emphasize meaningful learning over rote learning—especially in subjects, like biochemistry, that are notoriously perceived as isolated from patient care. Consequently, I was pleased to discover an article recently published in Medical Science Educator by Spicer and colleagues (see reference below) examining the effects of an intervention designed to facilitate meaningful learning in medical biochemistry.

By way of background, the authors cite the growing worldwide problem of metabolism-related chronic diseases (e.g., diabetes, stroke) and the failure of medical schools to adequately prepare medical professionals to address this problem. They attribute the cause of this problem to biochemistry curricula that emphasize rote memorization of facts over the diagnosis and treatment of patient problems. Furthermore, they claim this emphasis on extensive factual knowledge (e.g., Krebs cycle) causes students to experience excessive cognitive load, poor retention, and undue stress.

To address this problem, the authors proposed shifting the curricular emphasis from memorizing facts (e.g., enzymes and intermediates) to gaining a deeper understanding of how those facts relate to disease, diagnosis, and patient care. To enable this shift from memorization to application, the authors proposed providing students with relevant factual information in an adjunct display (e.g., graphic organizer) that can be referenced as needed during higher-level learning activities (including assessment) within the context of patient care. The authors hypothesize that this approach will enable students to direct their limited cognitive resources toward acquiring the larger picture of skills germane to patient care, as opposed to memorization and fact recall.

To test their hypothesis, the authors elicited student perceptions about the advantages and disadvantages of using MetMap, a graphic organizer containing medically relevant factual information (e.g., metabolic pathways). MetMap was developed by Stanford University School of Medicine faculty, in collaboration with the Association of Biochemistry Educators, and can be downloaded from Stanford’s Lane Medical Library website (see Pathways of Human Metabolism: https://metabolicpathways.stanford.edu/). MetMap is currently used at several medical schools both as a teaching tool and as a reference for students during assessments.

The authors obtained survey responses from MS1 and MS2 students (N=481; 84% response rate) who had been using a searchable, digital version of MetMap in their studies. The students responded to open-ended questions eliciting their perceptions about the advantages and disadvantages of MetMap during both learning and assessment. Using thematic content analysis, the researchers identified emergent themes from the responses.

In terms of advantages, the students felt that MetMap was useful for both learning and assessment. More specifically, it helped them to visually and mentally organize information in a manner that promoted deeper learning and application. Students also enjoyed the decreased emphasis on memorization and felt that this reduced their exam anxiety. In terms of disadvantages, some students expressed reduced motivation for and time spent studying. They also expressed fears of being unprepared for licensing exams.

In this era of competency-based education, EPAs, and milestones, we need more research on instructional tools—such as MetMap—that can help students to lift their focus beyond memorization of facts to the development of real competence. As we advocate for competency-based education, it’s important that we also provide the tools and strategies that will make this important effort possible. In this spirit, I commend the developers of MetMap for making this tool publicly available; hopefully, more in-depth research will be conducted on this and similar tools designed to facilitate professional competencies.

Thank you,
Steven Crooks, PhD