Medical students and the cardiovascular system

Medical students possess large amounts of prior knowledge when entering medical school, consisting of a mixture of formal science knowledge and experimental, informal and even folk knowledge about medical systems and diseases (Boshuizen, Schmidt, Custers, & Van de Wiel, 1995). This is a huge challenge for university teachers who are probably not that well aware of the understandings of their students. Systemic understanding seems to be vital in medical contexts (Sodervik, 2016), which requires, for example, understanding of human anatomy and physiology and the functional interactions between both. The basis of systemic understanding is constructed during the first two years in traditional medical study programmes in Europe (pre-clinical phase).

Our studies, capturing the complex phenomenon of developing systemic understanding of the central cardiovascular system (CCVS), were conducted first on longitudinal and cross-sectional levels, and later using online methodology. First, we followed one cohort of medical students (N = 119) during their first study year and another cohort (N = 33) during their third study year. We also investigated internal medicine residents (N = 13) from one university hospital as a control group for the medical students. In our studies, our leading research questions were: “What kind of alternative models do students have; how do the students change their conceptual understanding concerning CCVS during their study years, and how does the quality of conceptual understanding influence the clinical reasoning of the students?” In our longitudinal and cross-sectional study, we used pre- and post-test design and open-ended generative tasks requiring explanations of the cardiovascular system (Ahopelto, Mikkila-Erdmann, Olkinuora, & Káápa, 2011; Mikkila-Erdmann, Sodervik, Vilppu, Káapá, & Olkinuora, 2012; Sodervik, Mikkila-Erdmann, & Vilppu, 2014; Sodervik, Vilppu, Ósterholm, & Mikkila-Erdmann, 2017).

Our results revealed that highly-selected medical students have many alternative models consisting of misconceptions in the first study year before the introductory course on the central cardiovascular system, revealing that students did not understand the synchronous functioning of the heart and lungs (double loop) (Ahopelto, Mikkilii-Erdmann, Olkinuora, et al, 2011; Mikkila-Erdmann et al., 2012; Sodervik, 2016).

After the introductory course, one-third of the students still had misconceptions. Furthermore, an important finding was that the quality of the biomedical knowledge was connected to the clinical reasoning skills of the students. We also found indicative support in our online study that those students who showed high diagnostic competence in reasoning tasks had also high levels of biomedical understanding (Sodervik et al., 2017).

In summary, our results indicate that even high-performing students have misconceptions based on their everyday knowledge and interactions with the world and from school. The cardiovascular system is a typical scientific system that requires understanding two parallel, almost simultaneously functioning systems. It can be suggested that the learning environment also plays a role in conceptual change processes. Medical students studied in a traditional study programme that only partly consisted of a learning environment that promoted active interaction and group work. We assume that medical students need metacognitive, in particular, metaconceptual support in studying complex systems.

Student teachers' challenges in understanding photosynthesis

Classroom teachers play an important role in supporting young students’ construction of scientific knowledge and facilitating conceptual change from everyday knowledge to scientific knowledge (Sodervik et al., 2014). A classroom teacher is a mediator between the everyday world and scientific knowledge for the children. Photosynthesis is one of the key theoretical concepts in science (i.e., energy comes through plants to the ecosystem), which is dealt with early on during the first school years and so enables students to understand the role of plants in ecosystems and, eventually, how to support sustainable development.

In our first study we used a case study approach in a pre-and post-test laboratory setting. We analysed (through open-ended questions) what kind of conceptions concerning photosynthesis the student teachers had. The results indicated that half of the students (9/18) had severe misconceptions concerning photosynthesis (Aho-pelto, Mikkila-Erdmann, Anto, & Penttinen, 2011; Penttinen et al., 2013; Vilppu, 2016). Most of them thought that a plant takes energy from the soil in the form of water or nutrients. After the pre-test, we let the students read a refutational text, making them aware of their probable misconceptions and then allowing them to revise these. The post-test results showed that adult students changed their conceptions radically and none of them had misconceptions about the nutrient supply of plants; however, five students presented synthetic models which were a mixture of scientific and everyday knowledge (Vosniadou, 1994). Our further study revealed that students’ self-regulation, metaconceptual awareness, and learning goals were connected to conceptual change concerning science content. Students who experienced conceptual change had system level learning goals and seemed to have realistic metaconceptual awareness. In summary, self-regulation, metacognition, and metaconceptual awareness seem to play a role in conceptual change (Ahopelto et al., 2011; Penttinen et al., 2013; Vilppu, 2016).