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Medical research is defined as "all scholarly activities that deal with any of the areas of studies being conducted in the pre, para, and clinical areas being taught in a medical school". Such a definition is somewhat arbitrary, as medical research covers a much larger field and ultimately affects every individual. The results of research activities are directly translated into social action, such as pollution control, vaccinations, mass fluoridation and nutritional improvements. The eradication of diseases like smallpox, poliomyelitis and plague, the decline in the death rate from infectious and cardiovascular diseases, and the diagnosis of genetic disorders are some examples of how medical research helps to provide improved health care. Thus, the wealth of medical knowledge that grows through the process of discovery and research development becomes part of daily living. The aim of scientific research is always to extend the frontiers of knowledge and to discover rational correlations and principles [1, 2]. Medical research can be divided into biomedical (basic medical), clinical, and health science research. The areas overlap each other and health science research has a component of social research. Experimental research covers areas such as physiology, biochemistry, microbiology, pharmacology and pathology and is relatively easy to conduct. If adequate financial support is obtained, the necessary infrastructure for laboratory research could be built and experimental animals maintained in an animal house. For clinical research, the patients with a particular disease are the direct object of study. This type of research involves dealing with the clinical picture, diagnosis, therapy and prognosis of the disease. Dealing with human beings requires stringent regulations and precautions to be observed. It requires setting up a research team in the hospital to monitor and chart out guidelines involving the ethical dimension of the problem to be studied and maintain a systematic medical recording system. Moreover, it is through a prolonged study of a large number of cases of the same disease that clinical research learns to predict the likely prognosis and judge the efficacy of the treatment. This type of research activity has limitations in the form of having a restricted number of cases of the disease under investigation, a need to update one's knowledge concerning laboratory techniques from which he obtains his 'cues', and the longer time interval required to complete the work. Health science research is a recent development of medical research due to the demands placed on many health services. More often basic medical and clinical research go hand in hand and are inseparable. Furthermore, clinical research workers often conduct studies on experimental animals, due to either the limited number of human cases or for ethical considerations.

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Health research improves healthcare: now we have the evidence and the chance to help the WHO spread such benefits globally

• Stephen R Hanney 1 &
• Miguel A González-Block 2  

Health Research Policy and Systems volume  13 , Article number:  12 ( 2015 ) Cite this article

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There has been a dramatic increase in the body of evidence demonstrating the benefits that come from health research. In 2014, the funding bodies for higher education in the UK conducted an assessment of research using an approach termed the Research Excellence Framework (REF). As one element of the REF, universities and medical schools in the UK submitted 1,621 case studies claiming to show the impact of their health and other life sciences research conducted over the last 20 years. The recently published results show many case studies were judged positively as providing examples of the wide range and extensive nature of the benefits from such research, including the development of new treatments and screening programmes that resulted in considerable reductions in mortality and morbidity.

Analysis of specific case studies yet again illustrates the international dimension of progress in health research; however, as has also long been argued, not all populations fully share the benefits. In recognition of this, in May 2013 the World Health Assembly requested the World Health Organization (WHO) to establish a Global Observatory on Health Research and Development (R&D) as part of a strategic work-plan to promote innovation, build capacity, improve access, and mobilise resources to address diseases that disproportionately affect the world’s poorest countries.

As editors of Health Research Policy and Systems ( HARPS ), we are delighted that our journal has been invited to help inform the establishment of the WHO Global Observatory through a Call for Papers covering a range of topics relevant to the Observatory, including topics on which HARPS has published articles over the last few months, such as approaches to assessing research results, measuring expenditure data with a focus on R&D, and landscape analyses of platforms for implementing R&D. Topics related to research capacity building may also be considered. The task of establishing a Global Observatory on Health R&D to achieve the specified objectives will not be easy; nevertheless, this Call for Papers is well timed – it comes just at the point where the evidence of the benefits from health research has been considerably strengthened.

The start of 2015 sees a dramatic increase in the body of evidence demonstrating the benefits arising from health research. Throughout 2014, the higher education funding bodies in the UK conducted an assessment of research, termed the Research Excellence Framework (REF), in which, for the first time, account was taken of the impact on society of the research undertaken. As part of this, UK universities and medical schools produced 1,621 case studies that aimed to show the benefits, such as improved healthcare, arising from examples of their health and other life sciences research conducted over the last 20 years. Panels of experts, including leading academics from many countries, published their assessments of these case studies in December 2014 [ 1 ], with the full case studies and an analysis of the results being made public in January 2015 [ 2 , 3 ].

As we recently anticipated [ 4 ], the expert panels concluded that the case studies did indeed overwhelmingly illustrate the wide range and extensive nature of the benefits from health research. Main Panel A covered the range of life sciences and its overview report states: “ MPA [Main Panel A] believes that the collection of impact case studies provide a unique and powerful illustration of the outstanding contribution that research in the fields covered by this panel is making to health, wellbeing, wealth creation and society within and beyond the UK ” [ 3 ], p. 1. The section of the report covering public health and health services research also notes that: “ Outstanding examples included cases focused on national screening programmes for the selection and early diagnosis of conditions ” [ 3 ], p. 30. In their section of the report, the international experts say of the REF2014: “ It is the boldest, largest, and most comprehensive exercise of its kind of any country’s assessment of its science ” [ 3 ], p. 20.

The REF2014 is therefore attracting wide international attention. Indeed, some of the methods used are already informing studies in other countries, including, for example, an innovative assessment recently published in Health Research Policy and Systems ( HARPS ) identifying the beneficial effects made on healthcare policies and practice in Australia by intervention studies funded by the National Health and Medical Research Council [ 5 ].

The REF also illustrates that, even when focusing on the research from one country, there are examples of studies in which there has been international collaboration and which have built on research conducted elsewhere. For example, one REF case study on screening describes how a major UK randomised controlled trial of screening for abdominal aortic aneurysms (AAA) involving 67,800 men [ 6 , 7 ] was the most significant trial globally. The trial provided the main evidence for the policy to introduce national screening programmes for AAA for men reaching 65 throughout the UK [ 2 ]. The importance of this trial lay partly in its size, given that it accounted for over 50% of the men included in the meta-analyses performed in the 2007 Cochrane review [ 8 ] and the 2009 practice guideline from the US Society for Vascular Surgery [ 9 ]. Nevertheless, two of the three smaller studies that were also included in these two meta-analyses came from outside the UK, specifically from Denmark [ 10 ] and Australia [ 11 ].

Moreover, a recent paper published in HARPS also included descriptions of how the research contributing to new interventions often comes from more than one country. These accounts are included in a separate set of seven extensive case studies constructed to illustrate innovative ways to measure the time that can elapse between research being conducted and its translation into improved health [ 12 ]. While being a separate set of case studies, one of them does, nevertheless, explore the international timelines involved in research on screening for AAA, and, in addition to highlighting the key role of the UK research, it also highlights that the pioneering first screening study using ultrasound had been conducted in 1983 on 73 patients in a US Army medical base [ 13 ].

These case studies therefore further reinforce the well-established argument that health research progress often involves contributions from various countries. However, as has long been argued, not all populations fully share the benefits. In recognition of this, in May 2013, the World Health Assembly requested the World Health Organization (WHO), in its resolution 66.22, to establish a Global Observatory on Health Research and Development as part of a strategic work-plan to promote innovation, build capacity, improve access, and mobilise resources to address diseases that disproportionately affect the world’s poorest countries [ 14 ].

As editors of HARPS , we are delighted that our journal has been invited to help inform the establishment of the WHO Global Observatory by publishing a series of papers whose publication costs will be funded by the WHO. In support of this WHO initiative, Taghreed Adam, John-Arne Røttingen, and Marie-Paule Kieny recently published a Call for Papers for this series [ 15 ], which can be accessed through the HARPS webpage.

The aim of the series is “ to contribute state-of-the-art knowledge and innovative approaches to analyse, interpret, and report on health R&D information… [and] to serve as a key resource to inform the future WHO-convened coordination mechanism, which will be utilized to generate evidence-informed priorities for new R&D investments to be financed through a proposed new global financing and coordination mechanism for health R&D ” [ 15 ], p. 1. The Call for Papers covers a range of topics relevant to the aims of the Global Observatory. These include ones on which HARPS has published articles in the last few months, such as approaches to assessing research results, as seen in the Australian article described above [ 5 ]; papers measuring expenditure data with a focus on R&D, as described in a recent Commentary by Young et al. [ 16 ]; and landscape analyses of platforms for implementing R&D, as described in the article by Ongolo-Zogo et al. [ 17 ], analysing knowledge translation platforms in Cameroon and Uganda, and partially in the article by Yazdizadeh et al. [ 18 ], relaying lessons learnt from knowledge networks in Iran.

Adam et al. also make clear that the topics listed in the Call for Papers are examples and that the series editors are also willing to consider other areas [ 15 ]. Indeed, in the Introduction to the Call for Papers, the importance of capacity building is highlighted. This, too, is a topic described in recent papers in HARPS , such as those by Ager and Zarowsky [ 19 ], analysing the experiences of the Health Research Capacity Strengthening initiative’s Global Learning program of work across sub-Saharan Africa, and by Hunter et al. [ 20 ], describing needs assessment to strengthen capacity in water and sanitation research in Africa.

Finally, as we noted in our earlier editorial [ 4 ], the World Health Report 2013: Health Research for Universal Coverage showed how the demonstration of the benefits from health research could be a strong motivation for further funding of such research. As the Report states, “ adding impetus to do more research is a growing body of evidence on the returns on investments … there is mounting quantitative proof of the benefits of research to health, society and the economy ” [ 21 ]. We noted, too, that since the Report’s publication in 2013, there had been further examples from many countries of the benefits from medical research. The REF2014 in the UK signifies an additional major boost to the evidence that a wide range of health research does contribute to improved health and other social benefits. The results of such evaluations highlight the appropriateness of the WHO’s actions in attempting to ensure all populations share the benefits of health research endeavours by creating the Global Observatory on Health Research and Development. This will not be an easy task, but we welcome the opportunity afforded by the current Call for Papers for researchers and other stakeholders to engage with this process and influence it [ 15 ].

Abbreviations

Abdominal aortic aneurysms

Health Research Policy and Systems

Main Panel A

Research and development

Research Excellence Framework

• World Health Organization

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The authors thank Bryony Soper for most helpful comments on an earlier draft.

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Stephen R Hanney

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Hanney, S.R., González-Block, M.A. Health research improves healthcare: now we have the evidence and the chance to help the WHO spread such benefits globally. Health Res Policy Sys 13 , 12 (2015). https://doi.org/10.1186/s12961-015-0006-y

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DOI : https://doi.org/10.1186/s12961-015-0006-y

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Preparing the Research Presentation

If you have never presented a paper at a scientific meeting, you should read this article. Even if you have presented before, it is likely that this article contains information that will improve your presentation. This article contains a set of practical, proven steps that will guide your preparation of the presentation. Our assumptions are that you will schedule appropriate planning and preparation time, are interested in doing the best job possible, and know that a quality presentation is a combination of good research and communication skills. This and subsequent articles will focus on planning, preparation, creating visual aids (slides), and presentation skills for a scientific presentation. The intent of this series of articles is to help you make a favorable impression at the scientific meeting and reap the rewards, personal and professional, of a job well done.

To begin with, you need to create an outline of the topics you might present at the meeting. Your outline should follow the IMRAC format (introduction, methods, results, and conclusion). This format is chosen because your audience understands it and expects it. If you have already prepared a paper for publication, it can be a rich source of content for the topic outline.

To get you started, we have prepared a generic outline  to serve as an example. We recognize that a generic outline does not necessarily adapt to all research designs, but we ask you to think, "How can I adapt this to my situation?" To help you visualize the content you might include in the outline, two types of examples have been included, one that describes a cross-sectional study using a survey methodology (example A), and a second using a combination of a case-control and cohort designs (example B).

Use the Preparing the Research Presentation Checklist  to assist you in preparing the topic outline.

The Importance of Medical Research

Dr. Peace Chikezie

Published 01 Jun 2022 - Updated 17 Mar 2023

Introduction

Every treatment, intervention, medication, way of care, and aftercare in the medical field or health care system came from discoveries. This high quality of care we can experience today was not discovered overnight, but rather through years of effort by medical professionals who investigated the risk factors, causes, preventions, and treatments of diseases. This type of investigation is known as medical/health research. 

The general definition of research is, 'an investigation that is intentionally designed to help develop or contribute to knowledge'. When you add a medical purpose to 'research', the general definition stays the same, but the goal becomes more specific. Ultimately, the goal shifts to a focus on increasing medical knowledge, improving patient care, developing new medicines or procedures, and enhancing the already existing medicines and procedures.

Forms of Medical Research

There are several forms of medical research being conducted today. Here are 3 common forms:

• Basic or Laboratory-based research: This is usually conducted in a laboratory where chemical interactions of biological materials are observed in a controlled environment. For most researchers, this is the first step toward developing methods or products that can be used in other forms of research studies.
• Clinical Trials: This is perhaps the most familiar form of healthcare research. Often, patients volunteer to participate in these studies to test the efficacy and safety of new medical interventions. Alternatively, medical interventions on participants may not be used, but only observation instead.
• Epidemiological Research: An increasingly large portion of health research is now information based. A great deal of research entails the analysis of data and biological samples that were initially collected for diagnostic, treatment, or billing purposes, or that were collected as part of other research projects, and are now being used for new research purposes. This secondary use of data is a common research approach in fields such as epidemiology, health services research, and public health research, and includes analysis of patterns of occurrences, determinants, and natural history of the disease; evaluation of health care interventions and services; drug safety surveillance; and some genetic and social studies

The Importance of Research in Medicine

Why is research important in medicine? The simple answer is that medical research has led to many medical breakthroughs and developments. It would also strongly contribute to shaping the future of medicine.

Here's how:

A. Medical research importance in disease diagnosis:

Medical research has led to the development of diagnostic tools and technologies that allow for earlier and more accurate diagnoses of diseases. 

For instance, breast cancer is one of the most common cancers worldwide. Medical research led to the development of an effective screening method known as mammography which has resulted in earlier detection and a 20% fall in mortality rates. 

Another example is the development of pap smears for the early diagnosis of cervical cancer. This as well as caused a significant decrease in late presentation and mortality rates due to cervical cancer.

A host of other effective screening methods have been developed as a result of medical research such as genetic testing, imaging techniques, and so on. 

B. The importance of medical research in innovative treatments

Medical research has led to the development of new treatments for a wide range of diseases, such as cancer, allergies, HIV/AIDS, heart disease, and so on.

Research is essential to find out what treatments work best, and more specifically what treatments work best for what patient. It can provide important information about how effective a medical intervention is and its possible adverse effects. These interventions include drugs, vaccines, medical devices, and others. 

By being specific with participant requirements, medical professionals can study how certain groups of people react to certain treatments . An example of this can be seen here at Infiuss Health. As a CRO in Africa, we at Infiuss Health focus on the demographics of the continent to ensure people of African ancestry receive effective care.

Medical research would lead to newer developments in medicine such as personalized medicine and targeted therapies, that would ensure that each individual would have treatment options unique to them. Increasing research in this area is the only way to make this a reality in the future of medicine.

C. The role of medical research in disease prevention

Medical research has contributed to the prevention of diseases such as polio, smallpox, and measles which caused the deaths of millions of people in the past.

Recently, following the Covid-19 pandemic, medical research led to the development of vaccines that gradually slowed down the progress of the disease. 

D. The importance of medical research in public health

Medical research has contributed to our understanding of public health issues and how to address them.

A typical example was in 1854 when there was an outbreak of cholera in the Golden Square Area in London. An Anaesthesiologist known as John Snow conducted an epidemiological study and found that the source of contamination was a public pump. When the contaminated pump was closed from public access, the outbreak of cholera ended. 

Research provides important information about disease trends and risk factors, outcomes of treatment or public health interventions, functional abilities, patterns of care, and health care costs and use. 

E. Medical research's importance in improving the economy:

Economists have found that medical research can have an enormous impact on the quality of healthcare which in turn affects human health and longevity.

Healthy individuals tend to be more productive and that contributes greatly to the national economy. If the research enterprise is impeded, or if it is less robust, important societal interests are affected.

Covid-19 vaccine development, for example, contributed to the lifting of the lockdown in many countries and allowed individuals to resume work.

Compared to treatment, current research on disease prevention shows that preventive services are able to significantly reduce deaths and illnesses at reasonable costs. All of these findings have informed and influenced national budget planning and policy decisions.

The simple fact is that clinical research improves our lives. It leads to significant discoveries, improves health care, and ensures that patients receive the best care possible. It is what makes the development of new medicines and treatments possible, without it we would not be able to move forward in the development of medicine.

Infiuss Health, as a CRO in Africa, aims to make it easier to do more clinical trials/ medical research in Africa by use of technology and other means.

When you support, participate in, or conduct medical research, you are helping to continue to build the future of medicine.

Find new health insights

Infiuss Health insights contains inspiring thought leadership on health issues and the future of health data management and new research.

Princeton Correspondents on Undergraduate Research

How to Make a Successful Research Presentation

Turning a research paper into a visual presentation is difficult; there are pitfalls, and navigating the path to a brief, informative presentation takes time and practice. As a TA for  GEO/WRI 201: Methods in Data Analysis & Scientific Writing this past fall, I saw how this process works from an instructor’s standpoint. I’ve presented my own research before, but helping others present theirs taught me a bit more about the process. Here are some tips I learned that may help you with your next research presentation:

More is more

In general, your presentation will always benefit from more practice, more feedback, and more revision. By practicing in front of friends, you can get comfortable with presenting your work while receiving feedback. It is hard to know how to revise your presentation if you never practice. If you are presenting to a general audience, getting feedback from someone outside of your discipline is crucial. Terms and ideas that seem intuitive to you may be completely foreign to someone else, and your well-crafted presentation could fall flat.

Less is more

Limit the scope of your presentation, the number of slides, and the text on each slide. In my experience, text works well for organizing slides, orienting the audience to key terms, and annotating important figures–not for explaining complex ideas. Having fewer slides is usually better as well. In general, about one slide per minute of presentation is an appropriate budget. Too many slides is usually a sign that your topic is too broad.

Limit the scope of your presentation

Don’t present your paper. Presentations are usually around 10 min long. You will not have time to explain all of the research you did in a semester (or a year!) in such a short span of time. Instead, focus on the highlight(s). Identify a single compelling research question which your work addressed, and craft a succinct but complete narrative around it.

You will not have time to explain all of the research you did. Instead, focus on the highlights. Identify a single compelling research question which your work addressed, and craft a succinct but complete narrative around it.

Craft a compelling research narrative

After identifying the focused research question, walk your audience through your research as if it were a story. Presentations with strong narrative arcs are clear, captivating, and compelling.

• Introduction (exposition — rising action)

Orient the audience and draw them in by demonstrating the relevance and importance of your research story with strong global motive. Provide them with the necessary vocabulary and background knowledge to understand the plot of your story. Introduce the key studies (characters) relevant in your story and build tension and conflict with scholarly and data motive. By the end of your introduction, your audience should clearly understand your research question and be dying to know how you resolve the tension built through motive.

• Methods (rising action)

The methods section should transition smoothly and logically from the introduction. Beware of presenting your methods in a boring, arc-killing, ‘this is what I did.’ Focus on the details that set your story apart from the stories other people have already told. Keep the audience interested by clearly motivating your decisions based on your original research question or the tension built in your introduction.

• Results (climax)

Less is usually more here. Only present results which are clearly related to the focused research question you are presenting. Make sure you explain the results clearly so that your audience understands what your research found. This is the peak of tension in your narrative arc, so don’t undercut it by quickly clicking through to your discussion.

• Discussion (falling action)

By now your audience should be dying for a satisfying resolution. Here is where you contextualize your results and begin resolving the tension between past research. Be thorough. If you have too many conflicts left unresolved, or you don’t have enough time to present all of the resolutions, you probably need to further narrow the scope of your presentation.

• Conclusion (denouement)

Return back to your initial research question and motive, resolving any final conflicts and tying up loose ends. Leave the audience with a clear resolution of your focus research question, and use unresolved tension to set up potential sequels (i.e. further research).

Use your medium to enhance the narrative

Visual presentations should be dominated by clear, intentional graphics. Subtle animation in key moments (usually during the results or discussion) can add drama to the narrative arc and make conflict resolutions more satisfying. You are narrating a story written in images, videos, cartoons, and graphs. While your paper is mostly text, with graphics to highlight crucial points, your slides should be the opposite. Adapting to the new medium may require you to create or acquire far more graphics than you included in your paper, but it is necessary to create an engaging presentation.

The most important thing you can do for your presentation is to practice and revise. Bother your friends, your roommates, TAs–anybody who will sit down and listen to your work. Beyond that, think about presentations you have found compelling and try to incorporate some of those elements into your own. Remember you want your work to be comprehensible; you aren’t creating experts in 10 minutes. Above all, try to stay passionate about what you did and why. You put the time in, so show your audience that it’s worth it.

For more insight into research presentations, check out these past PCUR posts written by Emma and Ellie .

— Alec Getraer, Natural Sciences Correspondent

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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.

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• v.29(4); 2019 Dec

The Impact of Supplementing PowerPoint with Detailed Notes and Explanatory Videos on Student Attendance and Performance in a Physiology Module in Medicine

Mohammed h. abdulla.

1 Department of Physiology, School of Medicine, Western Gateway Building, University College Cork, Cork, Ireland

Eleanor O’Sullivan

2 Department of Oral Surgery, Cork University Dental School and Hospital, University College Cork, Cork, Ireland

PowerPoint is widely used in higher education with reported advantages on student learning. The aim of this study was to examine the impact of detailed notes and videos as a supplement to PowerPoint slides on student attendance and performance. First-year medical students’ opinion on whether the supplementary material assisted their learning of Physiology in addition to demographics was collected in a survey. Attendance was similar for participants who used notes and videos to those who did not, for male vs. female and for participants from biomedical vs. non-biomedical backgrounds. However, within the non-biomedical cohort, attendance of male respondents was significantly higher (95 ± 3 vs. 81 ± 6%, P  < 0.05), although both groups used notes and videos. Similarly, attendance of female participants of biomedical background was higher ( P  < 0.05) than female participants of non-biomedical background ( biomedical vs. non-biomedical : 94 ± 3 vs. 81 ± 6%) even though both cohorts used notes and videos. Providing notes and videos had no adverse impact on attendance (90 ± 2%, 8 lectures) and tended to enhance exam scores for low-performing students in the class when compared with those of previous years’ cohorts ( 2018 vs. 2017 and 2016 : 61 ± 5% vs. 55 ± 6% and 47 ± 8%, respectively). There was an increase in the immediate gain of knowledge following watching/listening to videos ( after vs. before : 65 ± 3% vs. 48 ± 3%). The survey revealed a positive student perception of supplementary material mainly because they felt it reduced the time required to search for relevant information.

Introduction

PowerPoint is a widely used teaching tool in higher education for many years now. One of the benefits of this technology is its potential to enhance students’ engagement and empower effective learning [ 1 – 3 ]. Moreover, this technology helps students to organise their notes if they use it as a starting point to expand their knowledge from assigned textbooks. However, many students use PowerPoint as their sole study source even though all learning objectives might not have been covered in a lecture. Moreover, due to time constraints, teachers tend to list the important points in the lecture as bullet points and leave students to take notes. However, it is reported that most students are poor note takers, typically recording less than 50% of critical points in a lecture [ 4 ]. One possible solution to this issue is to provide supplementary material with each lecture. This material expands on the information provided in the lecture rather than just reiterating the lecture content. Previous research indicated that this approach improved students’ learning experience by enhancing their immediate recall and academic performance [ 5 – 7 ].

In addition to PowerPoint presentations, students can be provided with supplementary notes that expand on what is mentioned in the slides. Previous studies indicated that students who were provided with detailed notes, i.e. notes that contain main ideas in addition to supporting details, performed better in their exams than students who reviewed their own notes [ 8 – 10 ]. Moreover, Kobayashi [ 11 ] showed that low-performing students gained greater benefits from this approach compared with higher performance students. The effect of explanatory notes on students’ learning of Physiology in medicine and their attitude towards using them as a learning and review material was examined in the present study.

Similarly, supplementary videos that explain important concepts can be introduced as a complementary learning tool to PowerPoint slides. Indeed, videos add visual and auditory elements that cannot be found in the text notes. They can enhance student understanding of main concepts when more time is needed to explain these concepts than is available during a lecture. Indeed, these videos can also act as an effective revision tool at exam time [ 5 ]. The videos can be interactive by introducing pre- and post-video quizzes. A recent study indicated that students who used interactive videos with instructor’s explanations scored higher in the post-video test compared with a pre-video test [ 12 ]. Similarly, the use of conceptual videos was found to enhance students’ understanding of calculus in a previous study by Swedberg [ 13 ].

Information about the effect of supplementary notes and explanatory videos on medical students’ learning of Physiology is lacking in the literature. The aim of this study was to examine students’ attitude and behaviour towards the use of supplementary notes and videos in addition to PowerPoint slides in a programme that is known to be limited in time. We hypothesise that this approach assists students’ learning by providing detailed explanations of the main concepts in the form of text or as an interactive video.

Research Questions

The focus of the study was on two questions regarding the use of supplementary notes and pre-recorded videos in conjunction with PowerPoint slides:

• Does the use of supplementary notes and videos enhance understanding of core concepts and therefore improve exam scores?
• What is the students’ attitude towards the use of supplementary notes and videos as a learning and revision tool?

Participants and Setting

This study involved first-year graduate entry to medicine students in UCC in Fundamentals in Medicine II (module code GM1002). The study was conducted over a 9-week period from January to March 2018. The graduate entry to medicine class ( n  = 82) includes students of different ages (21–35 years), region of origin (European, EU; and non-European, non-EU) and undergraduate degree backgrounds (biomedical and non-biomedical). The EU students are mainly from Ireland while the non-EU students are from Africa, Asia, Middle East and North America. This study was approved by the Social Research Ethics Committee (SREC) in UCC (Log 2018-028). Teaching comprised a series of 8 traditional lectures of approximately 50 min long, delivered by one instructor in the Department of Physiology in UCC. For this module, lecture attendance was encouraged, but not compulsory; students were not required to sign a daily attendance register.

Lecture material, including PowerPoint slides, written notes and videos, was made available to students ahead of the actual lecture time with a comprehensive list of learning objectives. The PowerPoint slides were constructed with a focus on main points without using too much text, using figures and diagrams when relevant. Further details on important points on the slides and explanations of any figures and diagrams were inserted at the bottom of each slide (supplementary notes) using the PowerPoint space allocated for notes, i.e. the notes pane. In addition, clinical scenarios and interactive questions related to the main concept on the slide were included.

Explanatory videos were recorded by the instructor ahead of lectures using Quick time player on a MacBook Pro, using the PowerPoint slides as a background. PowerPoint provides a pen option whereby the pointer can be changed into a pen or a highlighter to write, draw on the slides or highlight important points. Videos were utilised for two particular concepts in cardiovascular Physiology that required detailed explanation, i.e. electrocardiography (ECG) and electrical and mechanical events during the cardiac cycle. Students’ feedback from previous years indicated that students frequently struggle with these concepts in this module. The videos, which averaged approximately 27 min, were uploaded to blackboard. Blackboard is a web-based server software platform to which module material can be uploaded for student use. Links to these videos were embedded in between pre- and post-video tests for self-assessment using blackboard quiz options.

Quantitative Assessment of the Effect of Supplementary Videos/Notes on Student Learning

As mentioned above, pre- and post-video tests were utilised to examine students’ performance before and after watching explanatory videos. This approach was intended to provide a higher level of interaction compared with a passive approach of only watching/listening to the videos [ 14 ]. In this study, six multiple-choice questions (MCQ) were provided to allow students to assess their understanding of a concept followed by a video explaining that concept. After viewing the video, the students completed a post-test comprised of identical questions to the pre-test but randomised in order. Once the test was finished, blackboard provided students with an exit report summarising their test score and giving detailed feedback on why a given answer should be selected. Data from two videos were analysed and used in the present study.

Quantitative assessment of students’ performance in the final exam following the use of explanatory notes was also studied. Eleven MCQs were chosen from the 2017 and 2018 end of module and end of year exams based on whether the question content was related ( n  = 5 MCQs) or not ( n  = 6 MCQs) to the explanatory notes attached to PowerPoint slides. The responses were compared with the identical questions in 2016 where no explanatory notes were given. The MCQs related to explanatory notes aimed to assess three of the Bloom’s taxonomy categories, namely:

• Knowledge recall (i.e. provided nearly verbatim in the notes pane). There was only one MCQ under this category.
• Comprehension (i.e. provided, but not verbatim, in the notes pane). There were 2 MCQs under this category.
• Application (i.e. not provided in the notes pane and required students to solve a new problem using information they had to comprehend from the notes pane). There were 2 MCQs under this category.

To minimize the effect of having different students over the years with varied academic ability on any possible change in performance, student performance on identical MCQ questions across the same study period from the Pharmacology content in this module was analysed. The Pharmacology part was taught consistently to the same cohort of students and in parallel to Physiology but without the use of the intervention used in this study.

Students’ Self-Reported Perception of Learning

A survey with both Likert-type and non-Likert type questions was utilised at the end of the module to examine students’ perception of supplementary notes and pre-recorded videos and their perceived effectiveness on students’ learning of core concepts in cardiovascular Physiology lectures, utilising Google Forms ( https://www.google.com/forms/about ) web-based survey options. The survey questionnaire took approximately 10 min to complete and participation was voluntary and anonymous. Also, failure to participate in the survey did not result in any negative consequences for the student and no extra credits were offered for its completion. Participants were asked to consent the use of the survey data as part of a research project. The survey link was sent to students via students’ university email and they were given 4 weeks to complete the questionnaire. A total of 68 (83%) participants completed the survey.

The first part of the survey consisted of demographic questions on gender, age, nationality and undergraduate background. Students also reported their attendance to the 8 cardiovascular Physiology lectures in this module. The second part included attitudinal questions regarding the usefulness or otherwise of the supplementary notes and pre-recorded videos to students’ learning using a Likert scale ranging from very useful/strongly agree (5) to not useful at all/strongly disagree (1). This was followed by checkbox-type questions exploring why students thought the supplementary notes were useful or otherwise to their learning of Physiology in this module. In order to arrange the responses into particular themes, students were provided with a list of suggested answers but were also given a free text option if their reason for the use or otherwise of notes/videos is not included in the list. There were two checkbox questions in the survey regarding notes, the first one was “Why do you think the supplementary notes attached to the PowerPoint slides were useful (Please select all that apply from the list below)” while the second one was “Why do you think the supplementary notes attached to the PowerPoint slides were NOT useful (Please select all that apply from the list below)”.

Students’ response regarding the use of explanatory videos was obtained using a short answer text question to respond to the statement “Please insert any comments you have about your usage of explanatory blackboard videos”. In addition, students’ explanations for lack of use of these videos were obtained by asking students to pick the most relevant answer for this question “Please indicate the reason(s) for lack of usage of supplementary blackboard videos (Select all that apply from the list below)” from a suggested list of answers. Finally, the survey ended with open text question inviting general comments about students’ perception of supplementary notes/videos in this module.

Statistical Analysis

The informational and attitudinal survey questions were analysed by gender, region of origin and biomedical background using chi-square contingency analysis using GraphPad Prism (GraphPad v6 Software Inc., San Diego, CA, USA). Similarly, the self-reported attendance in this module was compared between female and male subgroups of either EU and non-EU, biomedical and non-biomedical degree or < 25 and 25–35 years participants using parametric and non-parametric data analysis using unpaired student’s t test and Mann Whitney test respectively. Students’ performance in the pre- and post-video tests was compared using a paired student’s t test. To compare students’ performance in exams over 3 years (2016, 2017 and 2018) and between questions related/not related to supplementary PowerPoint notes, a repeated measure two-way analysis of variance (ANOVA) was used. Data are expressed as mean ± standard error of the mean (S.E.M.) with significance at P  < 0.05.

The Effects of Demographic Variables on Students’ Attendance

Demographic information as well as self-reported lecture attendance is presented in Table ​ Table1. 1 . The 82 students in the GM1002 class were comprised of 45 (55%) females and 37 (45%) males. A total of 68 students (83% of the class) participated in the survey of which 37 (54%) were females and 31 (46%) were males. The age of survey participants was almost equally divided between those aged < 25 years or 25–35 years. Non-EU students showed a higher participation rate than EU students (54 vs. 46%). According to the survey, there were fewer students from non-biomedical compared with biomedical degree background (43 vs. 57%). The attendance in this part of the module was not recorded by the lecturer and therefore the attendance data were solely self-reported. The survey showed an average attendance of almost 90% of cardiovascular Physiology lectures in this module with similar attendance rates reported by female and male participants and among students aged < 25 years compared with 25–35 years. Analysis of attendance by gender and age category showed a tendency for higher attendance by male participant of < 25 years old compared with females of that category (92 ± 4 vs. 82 ± 6%, n.s.). Conversely, females aged 25–35 years tended to have higher attendance rates than male participants of that age category. While the overall attendance of biomedical and non-biomedical participants was similar, male non-biomedical degree students had a significantly higher attendance rate than female non-biomedical degree students (95 ± 3 vs. 81 ± 6%; P  < 0.05). Furthermore, attendance of female participants of biomedical background was higher ( P  < 0.05) than the attendance of fellow female participants of non-biomedical background (94 ± 3 vs. 81 ± 6%). The attendance was not adversely impacted by providing supplementary videos and detailed notes. Analysis of self-reported attendance showed similar attendance of users and non-users of supplementary videos (90 ± 2 vs. 84 ± 6%).

Self-reported demographic data of survey participants and answers to attitudinal question regarding the usefulness or otherwise of supplementary notes/videos. A Likert scale was used to rank usefulness of the supplementary notes or degree of agreement that explanatory videos assisted students’ understanding of core concepts. Usefulness rank was set as 5 for very useful, 4 for useful, 3 for neutral, 2 for not useful and 1 for not useful at all. Agreement rank was set as 5 for strongly agree, 4 for agree, 3 for neither agree nor disagree, 2 for disagree and 1 for strongly disagree. * P  < 0.05 non-biomedical vs. biomedical participants, # P < 0.05 female vs. male participants

Self-reported information about frequency of viewing/listening to explanatory videos in the different age, gender, nationality and undergraduate degree groups is shown in Table ​ Table1. 1 . There was a similar number of participants in the male vs. female, < 25 vs. 25–35 years and EU vs. non-EU categories who watched or listened to pre-recorded videos. However, there was a higher number ( P  < 0.05) of students of non-biomedical background who watched or listened to videos compared with their biomedical peers (93 vs. 72%).

The Effects of Demographic Variables on Self-Reported Perception of Supplementary Videos/Notes

The response to attitudinal questions regarding the utilisation of supplementary videos/notes is presented in Table ​ Table1. 1 . Two Likert scale questions were analysed from the survey questions. The first was “Viewing the supplementary videos helped me to better understand the material presented in the lecture” while the second question was “How useful did you find the supplementary notes attached to the PowerPoint slides in learning cardiovascular Physiology concepts in this module”. There was a similar attitude regarding the use of videos/notes in this part of the module by the different age, gender, nationality and undergraduate background groups. The data showed that most of the students (91%, average response 4.3/5) indicated that explanatory videos/notes helped them to develop a better understanding of the key concepts in this part of the module and were useful to students’ learning.

The Effect of Supplementary Videos/Notes on Students’ Performance

Figure ​ Figure1 1 illustrates the impact of explanatory PowerPoint notes on the students’ performance. As no explanatory notes were provided in 2016, it was used for comparison with student performance in 2017 and 2018 where notes were provided. To examine any possible effect of explanatory notes on different academic performers, the class was divided into thirds based on students’ overall mark in end of module and end of year exams. As demonstrated in Fig. ​ Fig.1, 1 , there was no significant difference in the overall student performance in 2017 and 2018 compared with 2016 for all questions directly related to the explanatory notes provided with PowerPoint slides or in questions not related to explanatory notes. However, the lower third students’ performance in identical questions in 2017 and 2018 showed a trend towards a higher performance in notes-related questions by almost 17% and 29% respectively compared with the performance in 2016. In order to exclude the effect of having different students’ academic level between the 3 years, a parallel analysis of students’ performance in 14 identical Pharmacology MCQs across the same period was used as shown in Fig.  2 . Students had similar academic performance in 2017 and 2018 compared with 2016. Likewise, the performance of the lower third students in this exam did not show any significant changes in 2017 (50 ± 4%) or 2018 (50 ± 5%) compared with 2016 (57 ± 4%).

Student performance in the end of module exam over 3 years (2016, 2017 and 2018). The upper panel demonstrates the performance for all students in this module over the 3 years. The middle and lower panels present the performance of upper and lower thirds of the class in this exam respectively. It should be noted that no supplementary notes were used in teaching this module in 2016

Student performance in a parallel end of year Pharmacology exam across 3 years (2016, 2017 and 2018). The same cohort of students were studied and identical items were utilised across the years

The effect of supplementary videos on students’ performance is presented in Fig.  3a . The average performance of all students who used these videos in the post-video test was increased by more than 30% ( P  < 0.05) compared with the pre-video test. This significantly enhanced performance was seen for both upper and lower third performers in this class. However, the highest gain of more than 40% ( P  < 0.05) was seen for the upper third performers compared with 24% ( P  < 0.05) for the lower third performers in these tests. The usefulness of supplementary videos pre- and post-tests was further demonstrated by students’ attitudinal response to the question “How useful did you find the pre-/post-video test (e.g. before and after the Wiggers’ diagram or ECG vectors video)”. The results indicated that more than 70% of respondents ( n  = 55) to this question indicated that pre- and post-video test is either “Very useful” or “Useful” to them. Over 25% of the students gave a “Neutral” response while 4% felt that the pre-/post-video test was “Not useful” (Fig. ​ (Fig.3b 3b ).

Student performance ( a ) and attitude ( b ) in using the pre- and post-video tests. a Students’ performance data were collected from two pre-recorded explanatory videos with test questions that are MCQ style. A total of 11 questions were analysed from the two videos for 49 participants. * P  < 0.05 post- vs. pre-test. b Students’ attitude regarding the pre- and post-video tests. A Likert style survey question about the usefulness of pre- and post-video tests was analysed for 55 (81%) responses. Students responded to the question “How useful did you find the pre-/post-video test”

Student Opinion on the Use of Supplementary Videos/Notes

Analysis of responses to the open-ended (23 responses, 34%) and checkbox (62 responses, 91%) questions regarding the use of supplementary videos and notes respectively is presented in Fig.  4 . Students felt the videos aided learning by (i) consolidating learning from the lectures and assisting knowledge retention (41%), (ii) providing a visual element to learning (27%), (iii) being a repository review resource (18%), (iv) allowing pause and replay (9%) and (v) reducing the time required to search for information online (5%) (Fig. ​ (Fig.4a 4a ).

Students’ comments on the use of supplementary videos ( a ) and notes ( b ). a Students responded to the open text question “Please insert any comments you have about your usage of supplementary videos” by listing their opinion regarding supplementary videos use in this part of the module (22 responses). b Student responded to the question “Please indicate the reason(s) for lack of usage of videos” by selecting all that that apply from a list. c Students responded to the question “Why do you think the supplementary notes attached to the PowerPoint slides were useful” by selecting from a list of suggested answers (62 responses). It should be noted that students were allowed to select more than one answer for the second question and this explains why there is a total of 147 responses in the bar chart of this question

Thirteen students (19%) indicated that they had not used the pre-recorded videos in this study. According to these students, they did not use videos in this module because (i) the concepts illustrated in the videos were explained in lectures (72%), (ii) time is limited in this module (17%), (iii) viewing/listening to videos is not their favourite learning style (15%), (iv) they did not know they were there (8%) and (v) the videos contained too much information/too long (8%) (Fig. ​ (Fig.4b 4b ).

When asked why they think the supplementary notes attached to the PowerPoint slides were useful, almost 77% of the responses to this question was that it is because they lessen the need to look for relevant information from external sources. The second most common reason given (60%) was that these notes are an available review resource at times of exam preparation. The next important reason for the usefulness of notes according to 55% of the responses was that these notes provided more detailed explanation of the slides than could be covered during a lecture. Furthermore, around 45% of the responses agreed that these notes were useful because they lessen the need to take notes during the lecture (Fig. ​ (Fig.4c). 4c ). Finally, there were few comments using “others” option with one student commented “Really good (notes) for providing context to students from a non-science background”, another said “If anything was missed when listening to the lecturer, the supplemental notes could cover myself” while a third student commented “… Good learning aids for concepts I maybe didn’t fully grasp at the time of the lecture”. Finally, there was one response in this survey who indicated lack of use of supplementary notes due to limited time to go through supplementary material in this course.

In this article, we showed that providing supplementary notes and videos along with PowerPoint slides assisted students’ understanding of cardiovascular Physiology in a medical programme and did not affect lecture attendance. This study revealed that the use of explanatory notes enhanced exam performance especially for low-performing students. Similarly, the use of conceptual videos in this module enhanced students’ immediate gain of knowledge as shown by enhanced performance in post-video test compared with pre-video test. Students valued the utilisation of supplementary videos and notes as a learning and revision tool in this module. The main reason that the supplementary videos were helpful, as per students’ feedback, is that the videos consolidated their learning from the lectures and helped their retention of knowledge. On the other hand, students thought that notes were useful mainly because they lessen the need to look for relevant information from external sources within the limited time available to study in this programme.

The Effects of Demographic Variables on Students’ Attendance and Perception of Videos/Notes

The survey results are representative of the class as 83% participated in the survey and the gender distribution of participants was similar to the overall class gender distribution. The attendance of students during the period of the study was examined to identify any differences related to the varied gender, age, nationality and undergraduate degree background. It should be noted that full attendance is required in this module and it is checked sporadically but not routinely. The self-reported attendance data showed no significant differences in attendance of the demographic groups. Interestingly, the data showed that female students from a non-biomedical background had poorer attendance compared with male non-biomedical students or to their female biomedical counterparts. Ellaway et al. [ 15 ] examined the impact of combining students of biomedical degree background with non-biomedical degree background. They highlighted the challenges imposed on non-science students both socially and academically and suggested that support should be provided to those students. It is possible that lower attendance of this subgroup is related to these challenges.

The present study demonstrated that providing students with detailed notes and supplementary videos did not impact upon their lecture attendance. The average attendance in the cardiovascular Physiology part of the GM1002 module was as high as 90%. The finding that attendance of this cohort of students was not affected by having detailed notes and explanatory videos available before the lectures is in line with previous reports [ 16 , 17 ].

The Effect of Supplementary Notes on Students’ Performance

PowerPoint is widely utilised in today’s higher education teaching but there is an ongoing question as to whether students should be provided with notes. Looking at data from this study as well as the literature [ 18 – 20 ], the authors are in favour of using supplementary notes at least in time-pressured medical programmes such as the graduate entry to medicine. Students in the accelerated programmes are under pressure to develop as much foundational knowledge as they can, while a reasonable number of them are from non-biological background. However, the authors are aware of the potential implications of this approach on students’ independent learning strategies and the possibility that it might detract from the goal of preparing them to become independent life-long learners. However, this programme is well enriched with several avenues for self-directed learning and problem-based exercises that are completely driven by students themselves.

Furthermore, the type of notes could vary between detailed notes and those that have main points only [ 20 , 21 ]. It is suggested that students provided with detailed notes can achieve higher recall of information and test performance than students provided with no notes [ 8 ]. Students usually take notes during lectures to ensure they do not miss important information and utilise these notes as a study source when preparing for exams. However, a previous study showed that students do miss critical points in this process [ 22 ]. Therefore, the present study examined the impact of providing detailed notes attached to each concept description in PowerPoint slides on student learning of Physiology in the graduate entry to medicine programme. The notes were provided with almost every slide of the PowerPoint presentation of lectures in this study. Although this study utilised limited number of MCQs to study performance, it compared identical MCQs across years. These MCQs were sought to assess three Bloom’s taxonomy categories, namely, knowledge recall, comprehension and application. The final exam scores of the lower third performers in the class were enhanced by almost 30% in 2018 compared with 2016 in questions related to supplementary notes, particularly those under Bloom’s application category. This indicates that enhancement in performance of this cohort was not simply due to recall of rote learning of answers provided. In addition, the authors are not aware of any extracurricular activities for students in this course. As such, there appears to be no external factor that would have detracted from Physiology learning in 2016. The finding of improved performance of this cohort was supported by a previous study showing that low-performing students gained greater benefits from detailed notes compared with high-performing students [ 11 ].

The overall class performance was only marginally enhanced after introducing detailed notes. This indicates that providing detailed notes was not the only factor in determining exam performance in this class. One important determining factor for usefulness of supplementary notes is the time at which these notes are used during the course as students use notes differently depending on the time of the year as shown by a previous study [ 23 ]. Grabe and Christopherson [ 23 ] found that the students’ use of the supplementary notes peaked during the time when the corresponding unit of content was being presented in the class and was less towards the exam time.

The detailed notes were received positively by students according to the survey feedback. One student mentioned “I like to use the notes under the slides for study as they condense the relevant information” while another student commented “I do like having the notes underneath the slides so I don't have to worry about taking notes and can focus on listening in class instead”. There was also another comment “I love the supplementary notes and think that the slide structure is easy to understand (great pictures with few, but relevant, explanations)”. Interestingly, one student pointed out that these notes were useful to students of a non-biological background “Having a non-science background, the additional notes/videos etc. really help to make the content more accessible and easier to understand”. The notes in this study served as a repository for learning and revising the key concepts at exam time, particularly if students miss valuable information during the lecture. It should be noted that one student indicated a lack of use of supplementary notes due to limited time in this module.

Advantages and Disadvantages of Providing Detailed Supplementary Notes

This study suggests that detailed notes serve as an important learning and revision tool for students. However, this intervention may also have a number of potential disadvantages, namely (i) it possibly promotes passive learning [ 24 ], and (ii) may encourage students’ absence from lectures [ 21 ]. However, students in this study were not discouraged from taking their own notes but were given supplementary notes as a repository. In addition, these notes included explanations of diagrams and figures on the PowerPoint slides to save students the time needed to search for explanations of these diagrams and figures. Furthermore, students’ attendance was not adversely affected by having these explanatory notes. This is in agreement with a previous study which indicated that students’ attendance can be improved by providing lecture notes before the lecture time [ 25 ]. Students’ self-reported attendance in the present study showed a very good attendance rate despite the provision of detailed notes and supplementary videos before lectures. It can be suggested, based on the attendance profile of students in this course [ 16 ], that a negative impact of providing detailed notes on attendance is unlikely.

The Effect of Supplementary Videos on Students’ Performance

The present study demonstrated an enhanced short-term gain of knowledge on the basis of performance in post- vs. pre-video test. Literature on the use of videos has demonstrated beneficial results on students’ learning in biology courses [ 5 , 26 – 28 ]. A blended mode similar to the one utilised in this study using videos in addition to traditional face-to-face lectures offered positive outcomes and enhanced students’ learning experience [ 28 ]. The videos in this study were made interactive through the pre- and post-video tests. Moreover, students can control their watching/listening experience by speeding up or slowing down and by stopping and replaying these videos when needed. In addition, the pen option on PowerPoint was used to highlight important points. In a previous study [ 14 ], interactive videos were showed to be satisfactorily received by students and were more effective in improving students’ performance than non-interactive videos. Finally, the present study showed that supplementary videos did not inversely impact students’ attendance; this is in line with a recent study in a biology course [ 29 ].

When students were asked why they felt videos were useful, they mentioned learning consolidation and enhanced retention of knowledge which was in line with quantitative data from post- vs. pre-video test results. The second reason given by students was that these videos add a visual element to learning. Some students focused on the benefits of videos as a review resource while others found these videos useful due to their interactive nature and because they save time searching for explanatory videos online. These views are in line with previous reports on the use of videos in teaching [ 5 , 30 ]. That said, 19% of respondents in this study said they did not use the videos. The most common reason for the lack of use was that students thought the videos simply explained concepts that are already covered in the lecture. Some students felt that time pressures in this module made it difficult to utilise supplementary resources besides PowerPoint slides.

Student feedback from the survey questionnaire showed that most of the students valued the videos and felt that the videos improved their understanding of core concepts in this part of the module. For example, one student commented “It was difficult to fully understand everything just by looking at the PowerPoint slides - however the video was able to help with this” while another student mentioned “If I needed to go back and understand a concept better, it would be easily accessible on blackboard” . A student also responded, “Thank you for taking the time to make sure we understood the material, providing additional resources (videos) and allowing us time to identify gaps in our knowledge”.

The research findings and questions that emerged from this study have implications for Physiology teaching in the medical programmes. The first observation is that students from a non-biological background utilised supplementary videos more than students from a biological background. This points to the importance of supplementary material in supporting students from non-biological background during their preclinical years. It is worth noting that the provision of videos in addition to detailed notes did not adversely impact on students’ attendance. Moreover, students’ attitude towards the use of this approach was overwhelmingly favourable. The feedback from the questionnaire showed a positive attitude by students towards the use of detailed notes and explanatory videos in addition to PowerPoint presentation.

Limitations and Future Research

A number of limitations to this study must be acknowledged. Firstly, there was no control group (i.e. students not provided with notes/videos) for direct comparison of performance. That said, every effort was made to maintain consistency across the years by utilising exactly the same questions and comparing performance of content outside Physiology for the same cohort of students. The Pharmacology content used for comparison was taught consistently across the 3 years without the intervention used in Physiology. Secondly, the present study did not examine the effect of providing detailed notes and explanatory videos on students’ note-taking practices or the impact of supplementary notes and videos on classroom interaction. However, classroom observation showed that this student cohort had higher level of engagement in interactive classroom exercises during lectures, tutorials and practical sessions throughout the module. Thirdly, the present study only examined one part of the module in one programme in medicine, i.e. the graduate entry programme. This may limit generalizability of any results from this study to that particular programme. Future research should address the impact of note access in a different medical programme to see if these results can be reproduced.

Conclusions

This study supports the provision of detailed explanatory notes and videos in addition to PowerPoint lecture slides. We demonstrated that students’ attendance in this first-year medical degree course was not adversely impacted by making these additional resources available before lectures. In terms of academic performance, the supplementary notes seemed to be particularly useful to the low-performing students in this cohort more than highly achieving students. Videos on another hand were useful for short-term recall of information. Finally, students in this class liked the use of supplementary notes/videos and found them useful to their learning of cardiovascular Physiology as part of this programme.

Compliance with Ethical Standards

The authors declare that they have no conflict of interest.

This study was approved by the Social Research Ethics Committee (SREC) in UCC (Log 2018-028).

Consent was required before taking part in the survey (Supplementary material). Participation in the survey was voluntary and anonymous.

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