U N I V E R S I T Y  O F  P I T T S B U R G H

 A newsletter devoted to the support of teaching and learning at the University of Pittsburgh 

First-year medical students solve clinical problems

As director of the Medical Pharmacology course for the
School of Medicine, William de Groat teaches a group of “bright, motivated students.” Many of these first-year medical students are capable of learning independently, but de Groat’s goals for his students require them to discover ways of solving clinical problems that cannot be arrived at by reading a text or listening to a lecture. Aware that at this critical stage they are developing strategies and techniques for dealing with information that will serve as a foundation for their studies and careers, de Groat strives to make classes so stimulating that students will feel compelled to attend in order “to change their ways of thinking about pharmacology.”

De Groat believes building students’ thinking processes is so critical that he is willing to forego some course content, if necessary, to allow them time to acquire problem-solving skills. This is especially challenging because of a “ballooning volume of material in the field. However, at this early stage in their medical training, it is more important to influence the way they think about pharmacology and the basic principles of drug actions rather than to have them commit to memory a profusion of facts and details. Furthermore, because drugs often change or even disappear in 10 years, students need a foundation in their thinking skills about how drugs work, what kind of information is needed to prescribe a particular drug, and how to monitor drug use.”

Real-world Scenarios
De Groat’s strategies in his large “lecture” classes could serve as models across the disciplines for ways to engage students and foster higher-level thinking. For example, he makes generous use of real-world clinical scenarios as springboards for discussing ways to analyze the effects of drugs and drug treatments. Often using a drug he has researched himself, he shows a slide with basic information about the drug’s properties and then asks students to use that information to solve a clinical problem. Using an open-ended questioning format, he might ask, “What is the mechanism through which the drug is producing this response?” This oral discovery process helps students appreciate the importance of factors such as the patient’s age and the specific disease that comprise a “clinical situation.”

De Groat attributes some of his enthusiasm for teaching to the opportunities it gives him to share his own extensive research in the field of autonomic pharmacology. “Drugs that affect the autonomic nervous system are very important clinically and provide excellent examples for clinical problem solving. Pharmacology is an integrative subject combining information from anatomy, physiology, and molecular biology. Students must understand all the basic functions of the body to understand how drugs work. Since this is a basic science course (and perhaps the first time these students have had clinical experience), Medical Pharmacology tests their integrative capacities. The bottom line is this: it’s fun because students appreciate the importance of the topic. They realize they will be using this information for their careers. Virtually all of them have taken prescription drugs; now they are learning how these drugs work.”

Interactive Lectures
De Groat’s lectures are interactive, even in classes of more than 140 students. By pausing to ask questions as he walks around the lecture hall, he reduces the pace of a lecture, gives students time to reflect on the topic, and encourages students to be alert, since they never know whom he will address with a question. But he cautions students not to feel intimidated about giving wrong information, telling them, “It’s good for me to know if you have a different concept in mind so that we can go over it.” At the same time, he fosters an atmosphere that values thinking, rather than the “right” answer. In a spirit of collaboration, students are encouraged to question or disagree with their peers. “They think this is fun, and it engages them and makes them start thinking. It also encourages them to come to class prepared.”

Dr. de Groat provided exciting stories which helped me learn pharmacology. He has the art of explaining concepts in different ways (visual and vocal) in order to help students understand the material.
…
He emphasized big concepts and reviewed constantly…I enjoyed his problem-solving, question-posing style.

Reaching Diverse Students
Since de Groat is aware that some students enter the medical school more prepared than others, he tries to compensate for this disparity by providing a profusion of learning channels to the course information. “Over the years I have found different activities that stimulate different students’ interests.” His “syllabus” includes all the information from the text book, with the addition of many of his own drawings and photos. Lectures are videotaped so students can go through them at their leisure. Supplemental class conferences of smaller groups of students facilitated by faculty members give students an opportunity to go into deeper detail in areas of special interest. This class “conference approach” benefits all students, especially those who have fallen behind, but de Groat is careful “not to let the unprepared student control the pace of class.” Thus, as he strives to engage each student, de Groat helps all of his students to engage in transformative ways of thinking about this critical component of their medical careers.

A newsletter devoted to the support of teaching and learning at the University of Pittsburgh

Center for Instructional Development & Distance Education
1996-2005 © University of Pittsburgh, CIDDE. All Rights Reserved.
Editor: Carol DeArment, Production: Joyce Walsh
Questions or comments, please contact CIDDE Webmaster, 05/27/2008