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Studies: Physiology (37)


Updated: 22 Dec. 2006

 


Boivin, R. Use of audiovisual techniques in practical teaching in physiology.   [French] [Journal article] Sciences et Techniques de l'Animal de Laboratoire. 1983. 8: 2, 115-118. 

 

 

Brown G, Collins G, Dewhurst D, Hughes I. Computer simulations in teaching neuromuscular physiology--time for a change from traditional methods? Alternatives to Laboratory Animals: ATLA 1998;16:163-174.

 

 

Breves, G.  Schroder, B. Computer simulation as an alternative for nerve, muscle and heart experiments using frog tissues.   [German] [Conference paper.  Journal article] Deutsche Tierarztliche Wochenschrift. 2000. 107: 3, 122-123.  

 

 

Bulyalert D. Computer simulation for teaching synaptic potential. International Journal of Biomedical Computing 1994 Oct;37(2):181-187. Department of Internal Medicine, Chiang Mai University Faculty of Medicine, Thailand.


An interactive simulation of neuronal synaptic potential is presented. The set-up comprises of two synaptic terminals and one postsynaptic membrane from which the intracellular potential is recorded. Certain parameters are interactively changeable by the user. For example, each synaptic terminal may cause changes in the membrane conductance to sodium, potassium, or chloride ions, or some combinations of them. One synaptic terminal may be turned on/off to allow study of the spatio-temporal summation of postsynaptic potentials with adjustable delay. The postsynaptic membrane may also be set at various values in order to study the effects of membrane potentials on the direction and magnitude of postsynaptic potentials. This simulation has been used with some success as an aid for teaching cellular neurophysiology.

 

 

Chorney KM. Visualizing physiological concepts and research hypotheses: a hypermedia module of the drainage of the cerebrospinal fluid by lymphatics. The Journal of Biocommunication 998;25(3):25-32.


Hypermedia, animation and color coding were used to develop a module to visualize the lymphatic drainage of the cerebrospinal fluid and the research procedures that quantitate this drainage, to help researchers present their findings to a variety of audiences. Basic and clinical science evaluators found the method successful. Suggested uses for the module included teaching, conference and Web presentation, and liaising with research sponsors. Respondents emphasized that researchers need private investment to afford the cost of hypermedia modules. A thorough literature review, formative feedback, and post-evaluation proved fundamental to the development of this hypermedia program.

 

 

Clarke KA. The use of microcomputer simulations in undergraduate neurophysiology experiments. Alternatives to Laboratory Animals: ATLA 1987;14:134-140.

 

One undergraduate student cohort (group) performed a physiological frog experiment on an isolated sciatic nerve preparation, while another cohort used a computer simulation of the same experiment. There was no significant difference between student cohorts in marks derived for the laboratory report, the standard form of assessment for a wet lab.
 

 

Clarke KA. Microcomputer simulations of mechanical properties of skeletal muscle for undergraduate classes. Alternatives to Laboratory Animals: ATLA 1988;15:183-187.

 

 

Davis MJ. Basic principles of synaptic physiology illustrated by a computer model. Advances in Physiology Education 2001 Dec;25(1-4):1-12. Department of Medical Physiology, Texas A&M University System Health Science Center, College Station, Texas 77843, USA.


A computer model is described that simulates many basic aspects of chemical synapse physiology. The model consists of two displays, the first being a pictorial diagram of the anatomical connections between two presynaptic neurons and one postsynaptic neuron. Either or both of the presynaptic cells can be stimulated from a control panel with variable control of the number of pulses and firing rate; the resulting presynaptic action potentials are animated. The second display plots the membrane potential of the postsynaptic cell versus time following presynaptic stimulation. The model accurately simulates temporal and spatial summation when the presynaptic cells are arranged and stimulated in parallel and simulates presynaptic inhibition when they are arranged and stimulated in series. Excitatory and inhibitory postsynaptic potentials can be demonstrated by altering the nature of the ionic conductance change occurring on the postsynaptic cell. The effects on summation of changing length constant or time constant of the postsynaptic cell can also be illustrated. The model is useful for teaching these concepts to medical, graduate, or undergraduate students and can also be used as a self-directed computer laboratory exercise. It is available for free download from the internet.

 

 

Davis MJ, Gore RW. Determinants of cardiac function: simulation of a dynamic cardiac pump for physiology instruction. Advances in Physiology Education 2001 Dec;25(1-4):13-35. Department of Medical Physiology, Texas A&M University System Health Science Center, College Station, Texas 77843, USA.


A computer model is described that simulates the cardiac cycle of a mammalian heart. The model emphasizes the pressure-volume plot as a teaching tool to explain the behavior of the heart as a pump. It exhibits realistic responses to changes in preload, afterload, contractility, and heart rate while displaying time-dependent changes in pressure and volume in addition to the pressure versus volume plot. It differs from previous models by graphing these parameters on a beat-to-beat basis, allowing visualization of the dynamic adaptation of the pumping heart to various stimuli. A system diagram is also included to further promote student understanding of the physiology of cardiac function. The model is useful for teaching this topic to medical, graduate, or undergraduate students. It may also be used as a self-directed computer laboratory exercise.

 

 

Dewhurst D. Computer-based alternatives to using animals in teaching physiology and pharmacology to undergraduate students. ATLA 2004;32 Suppl 1:517-520.

 

[Repeated under 'Pharmacology.']

 

 

Dewhurst DG, Brown GJ, Meehan AS. Microcom­puter simulations of laboratory experiments in physiology. Alternatives to Laboratory Animals: ATLA 1988;15:280-289.
 

One undergraduate student cohort (group) performed a physiological frog experiment on an isolated sciatic nerve preparation, while another cohort used a computer simulation of the same experiment. There was no significant difference between student cohorts in marks derived for the laboratory report, the standard form of assessment for a wet lab.

 

 

Dewhurst DG, Hardcastle J, Hardcastle PT, Stuart E. Comparison of a computer simulation program and a traditional laboratory practical class for teaching the principles of intestinal absorption. The American Journal of Physiology 1994 Dec;267(6 Pt 3):S95-S104. Faculty of Health and Social Care, Leeds Metropolitan University, United Kingdom.
 

[Six undergraduate students working independently with a computer program gained equal knowledge, at one-fifth the cost, as eight supervised students using freshly killed rats.]

 

Here we describe an evaluation of the effectiveness, compared with a traditional laboratory, of an interactive computer-assisted learning (CAL) program, which simulates a series of experiments performed using isolated, everted sacs of rat small intestine. The program is aimed at undergraduate students of physiology and is designed to offer an alternative student-centered learning approach to the traditional laboratory-based practical class. The evaluative study compared two groups of second-year [UK] undergraduate students studying a module on epithelial transport: one group worked independently using the CAL program and associated learning materials, and the other group followed a conventional practical class approach, working in the laboratory under supervision. Knowledge gain of each group was measured by means of a test consisting of a range of question types (e.g., short-answer factual, calculation, interpretation) given to students before and after the module. Student attitude to both approaches was assessed by questionnaire, and the resource requirements were also compared. It was found that the knowledge gain of both groups of students was the same [and interestingly, the tutors who ran this teaching session did not identify laboratory/animal skills as primary learning objectives], that students had a positive attitude toward using CAL programs of this type [students using the CAL program became more positive about the experience after using it], and that the cost of the conventional laboratory-based approach was five times greater [the computer program was used with a printed workbook but no tutor support, whereas the wet lab required full tutor and some technical support]. The potential for integrating CAL programs into the undergraduate curriculum is discussed.

 

 

Dewhurst DG, Hardcastle J, Hardcastle P, Williams A. An interactive computer simulation of experi­ments to teach the principles of nutrient transport in the small intestine. Alternatives to Laboratory Animals: ATLA 1992;20:529-535.

 

 

Dewhurst DG, Meehan AS. Evaluation of the use of computer simulations of experiments in teaching undergraduate students. British J. Pharm. Proc. 1993;Suppl.108:238. 

 

Undergraduate students using computer simulations performed equally well as students using traditional approaches in physiology and pharmacology laboratories.

 

 

Dewhurst DG, Wdliams AD. Frog skin: a computer simulation of experiments performed on frog skin in vitro to investigate the epithelial transport of ions. Alternatives to Laboratory Animals: ATLA 1993;21:350-358.

 

 

Dwyer TM, Fleming J, Randall JE, Coleman TG. Teaching physiology and the World Wide Web: electrochemistry and electrophysiology on the Internet. The American Journal of Physiology 1997 Dec;273(6 Pt 3):S2-S13. Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson 39216-4505, USA. Full Text: http://advan.physiology.org/cgi/reprint/273/6/S2.pdf.


Students seek active learning experiences that can rapidly impart relevant information in the most convenient way possible. Computer-assisted education can now use the resources of the World Wide Web to convey the important characteristics of events as elemental as the physical properties of osmotically active particles in the cell and as complex as the nerve action potential or the integrative behavior of the intact organism. We have designed laboratory exercises that introduce first-year medical students to membrane and action potentials, as well as the more complex example of integrative physiology, using the dynamic properties of computer simulations. Two specific examples are presented. The first presents the physical laws that apply to osmotic, chemical, and electrical gradients, leading to the development of the concept of membrane potentials; this module concludes with the simulation of the ability of the sodium-potassium pump to establish chemical gradients and maintain cell volume. The second module simulates the action potential according to the Hodgkin-Huxley model, illustrating the concepts of threshold, inactivation, refractory period, and accommodation. Students can access these resources during the scheduled laboratories or on their own time via our Web site on the Internet (http./(/)phys-main.umsmed.edu) by using the World Wide Web protocol. Accurate version control is possible because one valid, but easily edited, copy of the labs exists at the Web site. A common graphical interface is possible through the use of the Hypertext mark-up language. Platform independence is possible through the logical and arithmetic calculations inherent to graphical browsers and the Javascript computer language. The initial success of this program indicates that medical education can be very effective both by the use of accurate simulations and by the existence of a universally accessible Internet resource.

 

 

Euliano TY. Small group teaching: clinical correlation with a human patient simulator. Advances in Physiology Education 2001 Dec;25(1-4):36-43. Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida 32610-0254, USA. tammy@anest4.anest.ufl.edu.


The popularity of the problem-based learning paradigm has stimulated new interest in small group, interactive teaching techniques. Medical educators of physiology have long recognized the value of such methods, using animal-based laboratories to demonstrate difficult physiological principles. Due to ethical and other concerns, a replacement of this teaching tool has been sought. Here, the author describes the use of a full-scale human patient simulator for such a workshop. The simulator is a life-size mannequin with physical findings (palpable pulses, breath/heart sounds, blinking eyes, etc.) and sophisticated mechanical and software models of the cardiovascular and pulmonary systems. It can be connected to standard physiological monitors to reproduce a realistic clinical environment. In groups of 10, first-year medical students explore Starling's law of the heart, the physiology of the Valsalva maneuver, and the function of the baroreceptor in a clinically realistic context using the simulator. With the use of a novel pre-/postworkshop assessment instrument that included student confidence in their answers, student confidence improved for all questions and survey items following the simulator session (P < 0.0001). The students give these laboratory exercises uniformly superior evaluations with > 85% of the students rating the workshop "very good" or "excellent".

 

 

Fawver AL, Branch CE, Trentham L, Robertson BT, Beckett SD. A comparison of interactive videodisc instruction with live animal laboratories. American Journal of Physiology 1990;259 (Advances in Physiology Education 4):S11–S14.

 

Abstract:

This study compared interactive videodisc-simulated laboratories with two types of traditional labs: a traditional general cardiovascular physiology participation lab and a traditional fibrillation/positive pressure ventilation demonstration lab. The two laboratory sections (a total of 85 first-year veterinary medical students) were divided into 12 lab groups of 3-4 students per lab section. These groups were randomly assigned to either a traditional live animal laboratory or an interactive videodisc-simulated laboratory to compare the effectiveness and efficiency of these methods in teaching physiology. A 22-item, multiple-choice/short answer test was given to all students after the laboratories. In both the participation and the demonstration laboratories, there were no significant differences between group test scores of the interactive videodisc groups and the live animal laboratory groups, but there were differences in time spent by both students and instructors. It was concluded that the interactive videodisc-simulated lab was as effective as the traditional live-animal labs and was more time efficient than the traditional participation lab.

 

 

Gersting JM, Rothe CF. Cardiovascular interactions tutorial: architecture and design. Journal of Medical Systems 2002 Feb;26(1):29-38. Department of Computer Science, University of Hawaii at Hilo, USA. johng@Hawaii.edu.


This work examines the design and architecture of a delivery system for a computerized, interactive tutorial on the physiology of the cardiovascular system. Emphasis in this paper is on the mechanisms used to coordinate the user's Lab Workbook, subject-oriented Information file, and the cardiovascular interaction (CVI) simulation model. Techniques described are sufficiently generic to allow for different tutorial content and/or different simulation models. Implementation uses Visual Basic and deployment is CDROM-based.

 

 

Greenspan JD. A laboratory exercise in somesthesis that is expeditious, inexpensive, and suitable for large classes. The American Journal of Physiology 1993 Dec;265(6 Pt 3):S2-S9. Department of Neurosurgery, State University of New York Health Science Center at Syracuse 13210.

A teaching laboratory is described that demonstrates two principles of the somatosensory system: 1) the "spot-like" nature of skin sensitivity and 2) tactile acuity. This laboratory has been used for a large medical school class (140-160 students). One reason for the success of this laboratory is the ability to provide a sufficient number of stimulating apparatuses. The two-point discrimination device used to measure tactile acuity can be made easily and cheaply. In addition, two other demonstrations are described that are suitable for smaller classes or that students can do on their own. Although this lab was designed for medical students, the content makes it suitable for undergraduate or high school students.

 

 

Habashi NM, Borg UR, Reynolds HN. An in vitro physiologic model for cardiopulmonary simulation: a system for ECMO training. The International Journal of Artificial Organs 1994 Jul;17(7):399-407.

 

 

Hammer P, Litvack D, Saul JP. Interpreting open- and closed-loop transfer relations between cardiorespiratory parameters: lessons learned from a computer model of beat-to-beat cardiovascular regulation. Methods of Information in Medicine 1997 Dec;36(4-5):237-240. Boston University, Children's Hospital, Department of Cardiology, Harvard Medical School, MA, USA. hammer_p@al.tch.harvard.edu.

A computer model of cardiovascular control has been developed based on the response characteristics of cardiovascular control components derived from experiments in animals and humans. Results from the model were compared to those obtained experimentally in humans, and the similarities and differences were used to identify both the strengths and inadequacies of the concepts used to form the model. Findings were confirmatory of some concepts but contrary to some which are firmly held in the literature, indicating that understanding the complexity of cardiovascular control probably requires a combination of experiments and computer models which integrate multiple systems and allow for determination of sufficiency and necessity.

 

 

Haschke, G.  Diener, M. Interactive learning for the training of veterinarians: development of a multimedia programme for physiology.   [German] [Journal article] Pferdeheilkunde. 1999. 15: 2, 184-186. 

 

A multimedia programme, of 3500 screen pages, is described for teaching and learning veterinary physiology. The programme is written in Toolbook, and can be used with Windows 95.

 

 

Hudson JN, Buckley P, McMillen IC. Linking cardiovascular theory to practice in an undergraduate medical curriculum. Advances in Physiology Education 2001 Dec;25(1-4):193-201. Department of Physiology, Adelaide University, Adelaide, South Australia 5005, Australia. nicky.hudson@adelaide.edu.au.

 

Case-based teaching (CBT) tutorials were introduced by the Physiology Department at Adelaide University to bridge the gap between theory and practice in the early years of undergraduate medical education. With the use of a clinical case-based environment, CBT aimed to achieve integration of structure-function relationships and an increase in students' capacity to apply a physiological understanding to clinical observations/symptoms and data. With peer-peer interactions in small groups, students could trial history taking and examination skills, interpret common investigations, and relate their findings to an understanding of structure and function. Here, the cardiovascular tutorials highlight the centrality of an understanding of structure and function in the evaluation of a case of syncope. An independent evaluation of the students' learning experience demonstrated that CBT tutorials were successful in their aims. The "hands-on" experience was highly rated, with students reporting that the CBT approach gave relevance to structure and function. Whatever the curriculum learning style, underpinning practice with an understanding of theory remains a desirable feature of medical education

 

 

Leathard HL, Dewhurst DG. Comparison of the cost effectiveness of a computer-assisted learning program with a tutored demonstration to teach intestinal motility to medical students. ALT-J 1995;3(1):118–125.

 

No significant difference was found in the performances of preclinical medical students who used a traditional live animal laboratory and those who used a computer simulation on intestinal motility.

 

 

Lilienfield LS, Broering NC. Computers as teachers: learning from animations. The American Journal of Physiology1994 Jun;266(6 Pt 3):S47-S54. Department of Physiology and Biophysics, Georgetown University Medical Center, Washington, District of Columbia 20007.


The effectiveness of an interactive multimedia computer program, the "Electronic Textbook in Human Physiology," in improving the knowledge of students studying cardiovascular physiology was determined from scores on tests given before and immediately after completion of a two-hour animation program on the Cardiac Cycle and Introduction to Electrocardiography and by comparison of performance on a final examination taken later with their unexposed (control) classmates. Unsigned comments on the use of the program were obtained from all participants and were universally laudatory. A marked and significant improvement in the immediate posttest compared with the pretest scores was found. More importantly, the students who had used the computer program achieved a significantly higher grade in the cardiovascular section of the final exam than their (control) classmates. Several possible explanations of the results are offered; the most likely one is that the use of the computer program facilitated learning. The implications of this, especially for curriculum planning, are discussed.

 

 

Maw S, Frank J, Greig G. A spinal circuitry simulator as a teaching tool for neuromuscular physiology. The American Journal of Physiology 1996 Jun;270(6 Pt 3):S50-S68. Division of Neuroscience, University of Alberta, Edmonton, Canada.

Many concepts in neuromuscular physiology can be difficult for instructors to teach and for students to understand. The behaviors of various components in neuromuscular systems do not always interact in obvious ways, and the function of hundreds of components can be very different from the function of just one or two "representatives." In this paper, a simulator is presented that can model both small and large spinal circuitry systems thus allowing students to explore the dynamic functional implications of the static circuitry diagrams that are common in many neuroscience textbooks. The simulator brings to life many concepts in neuromuscular physiology and permits students to explore such concepts without extensive supervision. The benefits and drawbacks of using this kind of simulator in the classroom are discussed, based on initial field tests with undergraduate and graduate students as well as input from the literature. It was found that such a simulation can be very useful as a teaching tool if it is used properly with the right audience

 

 

Modell HI. Computer software for physiology education. American Journal of Physiology 1992;262:S29-S33.

 

 

Modell HI. How to help students understand physiology? Emphasize general models. Advances in Physiology Education 2000 Jun:23(1):101-107. National Resource for Computers in Life Science Education, Seattle, Washington 98115, USA.


Students generally approach topics in physiology as a series of unrelated phenomena that share few underlying principles. In many students' view, the Fick equation for cardiac output is fundamentally different from a renal clearance equation. If, however, students recognize that these apparently different situations can be viewed as examples of the same general conceptual model (e.g., conservation of mass), they may gain a more unified understanding of physiological systems. An understanding of as few as seven general models can provide students with an initial conceptual framework for analyzing most physiological systems. The general models deal with control systems, conservation of mass, mass and heat flow, elastic properties of tissues, transport across membranes, cell-to-cell communication, and molecular interaction.

 

 

Nicol S, Narkowicz C. Learning physiology from cardiac surgery patients. The American Journal of Physiology 1998 Jun;274(6 Pt 2):S74-S83. Department of Anatomy and Physiology, University of Tasmania, Hobart, Tasmania 7001, Australia. Full Text: http://advan.physiology.org/cgi/reprint/274/6/S74.pdf.

A number of pressures have led to a very great reduction or complete abandonment of the use of animals in the teaching of physiology in most medical schools. Often animal experiments have been replaced by computer simulations, but a simulation is only as good as the model or algorithm on which it is based and can never contain the depth of information or unpredictability displayed by real animals or patients. We used a computer-based system to collect cardiovascular data from patients instrumented for cardiac surgery, allowing students to "replay" an operation. These recordings were annotated with notes, diagrams and video clips, and a student workbook was written. The resulting package contained a wealth of physiological data and was perceived by students to be very clinically relevant. The very wealth of information, however, tended to overwhelm students, and so a series of introductory Computer tutorials were written to provide students with the background necessary to cope with the clinical data.

 

 

Nosek TM, Bond GC, Ginsburg JM, Godt RE, Hofman WF, Jackson WJ, Ogle TF, Porterfield SP, Stoney SD Jr, Wiedmeier VT, Work JA, Lewis LA, Levy M. Using computer-aided instruction (CAI) to promote active learning in the physiology classroom. Annals of the New York Academy of Sciences 1993;701:128-129.

 

 

Pankiewicz PR. Software review: The DynaPulse 200M. The American Biology Teacher 1995;57(2):121-122.

 

 

Phelps JL, Nilsestuen JO, Hosemann S. Assessment of effectiveness of videodisc replacement of a live animal physiology laboratory. Distinguished Papers Monograph, American Association for Respiratory Care. 1992.

 

Nursing students who studied using an interactive video program on cardiac output principles performed better on a post-test than did students taught by lecture and live animal physiology laboratory.

 

 

Rupnik M, Runovc F, Sket D, Kordas M. Cardiovascular physiology: simulation of steady state and transient phenomena by using the equivalent electronic circuit. Computer Methods and Programs in Biomedicine 2002 Jan;67(1):1-12. Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, 1104, Ljubljana, Slovenia.

By using commercially available software it is readily possible to design electronic circuits and to analyze them. By introducing the concept of equivalent quantities a simulation of various physiological phenomena is possible. This includes the steady state as well as various complex transient phenomena. This paper describes the use of an equivalent electronic circuit in simulating the cardiovascular system. It allows a stepwise upgrading. The first step is a one-ventricle circuit similar to the Starling heart-lung preparation. The final step is an equivalent circuit allowing simulation of various normal as well as pathological states (e.g. effects of heart rate, negative intrathoracic pressure, exercise, hemorrhage, heart failure, and hypertension). The degree of disturbance can be set by adjusting the value of single components. Following this, the optimal type of compensation (e.g. the increase in blood volume in failure of the right ventricle; systemic venoconstriction in failure of the left ventricle) of the basic disturbance can be searched for, activated and the consequences studied. The described approach has been found a useful tool in teaching physiology and pathophysiology for postgraduate medical students.

 

 

Samsel RW, Schmidt GA, Hall JB, Wood LDH, Shroff SG, Schumacker PT. Cardiovascular physiology teaching: computer simulations vs. animal demonstrations. Advances in Physiology Education 1994;11:S36–S46.

 

Medical students used both computer demonstrations and animal (dog) demonstrations, and rated the former higher for learning cardiovascular physiology.

 

 

Smith AM. A model circulatory system for use in undergraduate physiology laboratories. The American Journal of Physiology 1999 Dec;277(6 Pt 2):S92-S99. Department of Biological Sciences, Butler University, Indianapolis, Indiana 46208, USA. ansmith@butler.edu. Full Text: http://advan.physiology.org/cgi/reprint/277/6/S92.pdf


The cardiovascular system is a central topic in physiology classes, yet it is difficult to provide undergraduates with quality laboratory experiences in this area. Thus a model circulatory system was developed to give students hands-on experience with cardiovascular fluid dynamics. This model system can be constructed from readily available materials at a reasonable cost. It has a realistic pressure drop across the different vessels. Using this system, students can investigate the effect that blood volume, vessel compliance, vessel construction, and heart activity have on blood pressure and flow. The system also demonstrates the effect of vessel diameter on resistance and fluid velocity. This model may give students a more concrete, intuitive feel for cardiovascular physiology. Another advantage is that it allows dramatic and easily controlled manipulations with quantitative results. Finally, its simple construction allows students to interchange components, giving them greater flexibility in experimentation.

 

 

Specht PC. Computer graphics interface to a complex simulation. Puerto Rico Health Sciences Journal 1988 Aug;7(2):184-188. Pharmacology Department, School of Medicine, University of Puerto Rico, San Juan.

The program "Cardio VascularCat" is a simulation of a laboratory experiment on the cardiovascular system of the cat, for students of physiology or pharmacology. There are two important innovations in this version, utilizing the "Macintosh environment": 1) The functioning of the program is highly interactive with the student. Any manipulation almost immediately produces some result in the (simulated) experimental animal. 2) The input from the student, and the output to the student, are handled in simple and intuitive ways. The mouse and menu system are utilized to simplify the control of the program. The keyboard is eliminated. The Macintosh graphics capabilities provide for an output display that is easily and quickly interpreted by the student. The program has been tested with a small sample of medical students. As measured by an objective test, the results are equivalent to learning from a textbook. An attitude survey revealed that the Macintosh program is clearly superior for reinforcement and review.

 


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