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Dynamiskt lärande: En ämnesdidaktisk avhandling om fysiologiska fenomen och läkarstudentens lärande
Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

It is well known that the outcome of teaching and learning in higher education is often unsatisfactory. Earlier studies have shown that medical students often have a surface approach to their studies and that misconceptions of fundamental physiological phenomena are common. The aim of this thesis is to support educational practice in medicine, particularly in medical physiology. The thesis can be categorised as subject matter-specific education research, which means that questions about teaching and learning are closely linked to the subject studied. The researcher should be well acquainted with the subject in question. The subject area dealt with in this thesis is physiological phenomena related to cardiovascular pressure-flow relations.

The thesis consists of studies of 3-dimensional intra cardiac pressure-flow phenomena in the heart (studies 1 and 2) and studies of how students conceive of and develop an understanding of physiological phenomena related to blood pressure and blood pressure regulation (studies 3 and 4).

Flow in the left atrium as well as inflow-patterns to the left ventricle were studied. The 3-dimensional method elucidates vortical flow phenomena which were previously unknown. The findings could contribute to increasing physicians and technicians understanding of flow phenomena in the diagnosis and assessment of heart disease and to the further development of diagnostic methods. In the studies of learning and understanding of physiological phenomena, the findings point to new aspects of a deep approach to learning, which have to do with the students’ ability to change perspective and adopt a variety of learning strategies to a phenomenon (Moving) versus a tendency to hold on to one explanatory model (Holding). The study also investigates the students’ ability to identify and apply fundamental physiological principles as well as how they conceive of the importance of detailed knowledge for understanding of physiology. The findings point to differences in the students’ conceptions of physiological principles. A problemising approach, which includes not only causally described relations, indicates a more complex conception of physiological phenomena. The study shows aspects of understanding which are seldom assessed in examinations.

The findings indicate a connection between the students’ approaches to learning and the quality of their understanding of fundamental physiological principles. In the thesis, teaching interventions are proposed in order to stimulate dynamic learning and a learning environment where students are not afraid to challenge their conceptions in order to acquire a rich and nuanced picture of physiological phenomena.

Place, publisher, year, edition, pages
Institutionen för medicin och vård , 2007.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 976
Keyword [sv]
Lärande, Förståelse, Fysiologi
National Category
Physiology
Identifiers
URN: urn:nbn:se:liu:diva-9026ISBN: 91-85643-34-3 (print)OAI: oai:DiVA.org:liu-9026DiVA: diva2:23720
Public defence
2007-01-18, Berzeliussalen, Campus US, Universitetssjukhuset, Lihköping, 13:00 (English)
Opponent
Supervisors
Available from: 2007-06-04 Created: 2007-06-04 Last updated: 2009-08-22
List of papers
1. Three-dimensional flow in the human left atrium
Open this publication in new window or tab >>Three-dimensional flow in the human left atrium
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2001 (English)In: Heart, ISSN 1355-6037, Vol. 86, no 4, 448-455 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Abnormal flow patterns in the left atrium in atrial fibrillation or mitral stenosis are associated with an increased risk of thrombosis and systemic embolisation; the characteristics of normal atrial flow that avoid stasis have not been well defined.

OBJECTIVES: To present a three dimensional particle trace visualisation of normal left atrial flow in vivo, constructed from flow velocities in three dimensional space.

METHODS: Particle trace visualisation of time resolved three dimensional magnetic resonance imaging velocity measurements was used to provide a display of intracardiac flow without the limitations of angle sensitivity or restriction to imaging planes. Global flow patterns of the left atrium were studied in 11 healthy volunteers.

RESULTS: In all subjects vortical flow was observed in the atrium during systole and diastolic diastasis (mean (SD) duration of systolic vortex, 280 (77) ms; and of diastolic vortex, 256 (118) ms). The volume incorporated and recirculated within the vortices originated predominantly from the left pulmonary veins. Inflow from the right veins passed along the vortex periphery, constrained between the vortex and the atrial wall.

CONCLUSIONS: Global left atrial flow in the normal human heart comprises consistent patterns specific to the phase of the cardiac cycle. Separate paths of left and right pulmonary venous inflow and vortex formation may have beneficial effects in avoiding left atrial stasis in the normal subject in sinus rhythm.

Keyword
atrium, blood flow, magnetic resonance imaging, haemodynamics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14554 (URN)10.1136/heart.86.4.448 (DOI)
Available from: 2007-06-04 Created: 2007-06-04 Last updated: 2016-03-14
2. Pitfalls in Doppler evaluation of diastolic function: insights from three-dimensional magnetic resonance imaging
Open this publication in new window or tab >>Pitfalls in Doppler evaluation of diastolic function: insights from three-dimensional magnetic resonance imaging
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1999 (English)In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 12, no 10, 817-826 p.Article in journal (Refereed) Published
Abstract [en]

Ultrasound-Doppler assessment of diastolic function is subject to velocity errors caused by angle sensitivity and a fixed location of the sample volume. We used 3-dimensional phase contrast magnetic resonance imaging (MRI) to evaluate these errors in 10 patients with hypertension and in 10 healthy volunteers. The single (Doppler) and triple (MRI) component velocity was measured at early (E) and late (A) inflow along Doppler-like sample lines or 3-dimensional particle traces generated from the MRI data. Doppler measurements underestimated MRI velocities by 9.4% ± 8.6%; the effect on the E/A ratio was larger and more variable. Measuring early and late diastolic inflows from a single line demonstrated the error caused by their 3-dimensional spatial offset. Both errors were minimized by calculating the E/A ratio from maximal E and A values without constraint to a single line. Alignment and spatial offset are important sources of error in Doppler diastolic parameters. Improved accuracy may be achieved with the use of maximal E and A velocities from wherever they occur in the left ventricle.

Place, publisher, year, edition, pages
Amsterdam: Elsevier Science B.V., 1999
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14555 (URN)10.1016/S0894-7317(99)70186-0 (DOI)83255200007 ()10511650 (PubMedID)
Available from: 2007-06-04 Created: 2007-06-04 Last updated: 2016-03-14
3. Student approaches to achieving understanding ― Approaches to learning revisited
Open this publication in new window or tab >>Student approaches to achieving understanding ― Approaches to learning revisited
2007 (English)In: Studies in Higher Education, ISSN 0307-5079 (print) 1470-174X (online), Vol. 32, no 2, 149-165 p.Article in journal (Refereed) Published
Abstract [en]

This article presents a phenomenographic study that investigates students' approaches to achieving understanding. The results are based on interviews, addressing physiological phenomena, with 16 medical students in a problem-based curriculum. Four approaches—sifting, building, holding and moving—are outlined. The holding and moving approaches describe variations in deep-level processing. The moving approach is characterised by an intention to continuously refine understanding in an open-ended process. The student strives for a change in perspective and deliberately creates actions that are rich in variation and challenge. The holding approach is characterised by an intention to reach a final goal. This is achieved by high degrees of structure and control in the learning act. Understanding is sometimes sealed, 'held on to' and can be threatened by new input and other students' viewpoints. The study also shows how students deal with details when constructing understanding of wholes.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14556 (URN)10.1080/03075070701267194 (DOI)
Available from: 2007-06-04 Created: 2007-06-04
4. Students' conceptions of underlying principles in medical physiology: An interview study of medical students understanding in a PBL curriculum
Open this publication in new window or tab >>Students' conceptions of underlying principles in medical physiology: An interview study of medical students understanding in a PBL curriculum
2007 (English)In: Advances in Physiology Education, ISSN 1043-4046, Vol. 31, 364-369 p.Article in journal (Refereed) Published
Abstract [en]

Medical physiology is known to be a complex area where students develop significant errors in conceptual understanding. Students’ knowledge is often bound to situational descriptions rather than underlying principles. This study explores how medical students discern and process underlying principles in physiology. Indepth interviews, where students elaborated on principles related to blood pressure and blood pressure regulation, were carried out with 16 medical students in a problem-based learning curriculum. A qualitative, phenomenographic approach was used, and interviews were audiotaped, transcribed, qualitatively analyzed, and categorized. Four categories were outlined. The underlying principles were conceived as follows: 1) general conditions for body function at a specified time point, 2) transferable phenomena between organ systems and time points, 3) conditionally transferable phenomena between organ systems and time points, and 4) cognitive constructions of limited value in medical physiology. The results offers insights into students’ thinking about underlying principles in physiology and suggest how understanding can be challenged to stimulate deep-level processing of underlying principles rather than situational descriptions of physiology. A complex conception of underlying principles includes an ability to problemize phenomena beyond long causal reasoning chains, which is often rewarded in traditional examinations and tests. Keywords for problemized processing are as follows: comparisons, differences, similarities, conditions, context, relevance, multiple sampling, connections, and dependencies.

Keyword
general models, phenomenography, problem-based learning
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14557 (URN)10.1152/advan.00108.2006 (DOI)
Available from: 2007-06-04 Created: 2007-06-04 Last updated: 2009-04-28

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