Active learning strategies to teach renal-cardiovascular integration with high student-to-teacher ratios.

To address the challenge of increasing opportunities for active learning into a medical physiology course with approximately 190 students enrolled, we chose an integrated approach. This was facilitated by the availability of a patient simulator facility at the School of Nursing at the Medical College of Georgia, and an approximately 20-min simulation of acute hemorrhage on the simulators comprised the first of three components in our approach. The second component was a small-group problem-solving session that each group conducted immediately after their patient simulator session. It brought in the more complex physiological responses to acute hemorrhage using an exercise we designed using free downloadable simulation software from the Department of Physiology and Biophysics at the University of Mississippi Medical Center. The third component was a student worksheet exercise that was built around data collected from 12 students who volunteered to collect a 24-h urine sample and have blood pressure measured after 3 days on either high or low salt intake. The worksheet was completed independently, and the answers and student data formed the basis for a classroom lecture. The approach has met with increasingly positive reviews due to testing the first two components on second-year medical student volunteers before its implementation, keeping the first component as simple as possible, keeping the second component to <30 min, and continued revision of the third component to increase clinical context of the study questions. An integrated active learning approach can enhance student interest in integrating cardiovascular-renal physiology, particularly if faculty members are willing to revise the approach in response to student feedback.