Statement of the Problem

How Do We Deal With the Knowledge Explosion?
The knowledge explosion is alive and well in pharmacology, similar to most other scientific disciplines. Textbooks are increasing in length, with smaller font sizes, and the number of available drugs is expanding every year. Medical educators are faced with the dilemma that, no matter how well a course is taught, students can only learn a fraction of what is "covered". A large fraction of what students learn is by rote memorization, resulting in surface learning that is typically sufficient for passing an upcoming exam, but results in poor long-term retention or "meaningful learning". There are many in the scientific community who feel that the current focus on learning of "facts" and "content" has resulted in increasing levels of content overload, and a negative impact on understanding of basic concepts and principles in pharmacology.^[1]

Concept Inventories For Assessment of Learning Gain
A similar situation was addressed in undergraduate physics in the 1990's. Physicists were able to come together and develop a universal agreement on what core concepts all entry-level undergraduate physics students should know. This led to the development of the first of many assessment instruments - the Force Concept Inventory (FCI), which had a profound impact on reforming physics education. The FCI was used in a pre-course / post-course method to assess the increase in learning gain that students achieve following a given undergraduate physics course. The FCI was also used to compare different teaching methods to see if they produced significantly different learning gains.

Concept Inventories Reveal Differences in Efficacy of Different Teaching Methods
In 1998 Hake published a study of the use of the FCI in 62 introductory physics courses enrolling 6542 students. Included in the study were 14 "traditional" courses (n=2084 students), and 48 courses (n=4458 students) which made substantial use of "active learning" methods. The learning gain for traditional courses was roughly 20% (0.23+/-0.04)(std dev). In sharp contrast, courses using active learning methods showed an average improvement of nearly 50% (0.48+/-0.14)(std dev), almost 2 standard deviations greater learning gain compared to traditional courses. These results clearly demonstrated three important findings:

1. the FCI was a useful instrument for assessment of learning gains
   
2. instruction focused on active learning pedagogy (e.g. involving heavy use of in-class peer discussion of concept-related questions) produced significantly superior learning outcomes
   
3. standard lecture-based instruction was not sufficient to bring most students to a level of concept mastery independent of the lecturer. Data obtained from programs with both inspired & engaging lecturers, as well as less motivating lecturers attained the same level of student conceptual understanding (Hake, 1998). These results are consistent with the conclusion that "only lecture" reinforces "only memorization" (Klymkowsky et al., 2003). These findings have led to many additional studies confirming that active learning produces superior learning outcomes compared to traditional lecture design (e.g. Crouch & Mazur, 2001). There is also a limited amount of available data indicating that the use of active learning pegagogy significantly enhances long-term retention (Francis et al., 1998; Cortright et al., 2003; Halpern & Hakel, 2003).
   
   

Concept Inventories in Other Disciplines
Due in part to the successful use of the FCI in reforming undergraduate physics, many groups of educators have come together to identify the core principles or "concepts" of their respective disciplines. As a result, at present there are multiple scientific disciplines that have either developed, or are actively working to develop their own "concept inventories" for measuring conceptual learning in their respective fields. These fields include (so far): Astronomy, Basic Biology, Calculus, Chemistry, Computer Science, Engineering, Genetics, Geoscience, Microbiology & Immunology, Molecular Life Sciences (Biochemistry & Molecular biology), Natural Selection, Physiology (undergrad) & Statistics.

Summary
At present concept inventories have not been developed for the "graduate level" basic & clinical science disciplines in medical education. The Concepts in Medical Pharmacology wiki is intended to foster the development of a consensus on what "core concepts in pharmacology" all medical students should have mastered prior to graduation (and ideally should still remember ~5 years later). Once there is a consensus on core concepts, we can work to construct a Pharmacology Concept Inventory, which can be used to better assess conceptual learning in our various educational settings.

References

1. ↑ The same problem described here has been recently raised concerning the field of physiology education by Michael et al. Adv Physiol Educ 33:10-16, 2009

• Cortright RN, Collins HL, Rodenbaugh DW, DiCarlo SE: Student retention of course content is improved by collaborative-group testing. Adv Physiol Educ 27(3):102-108, 2003.
  
• Crouch CH and Mazur E: Peer instruction: ten years of experience and results. Am J Physics 69:970-977, 2001.
  
• Francis GE, Adams JP, Noonan EJ: Do they stay fixed? Physics Teacher 36:488-490,1998.
  
• Hake RR: Interactive-engagement versus traditional methods: a six-thousand-student survey of mechanics test data for introductory physics courses. Am J Phys 66(1):64-74,1998.
  
• Halpern DF, Hakel MD: Applying the science of learning to the university and beyond. Teaching for long-term retention and transfer. Change 35(4) July/August: 36-41,2003.
  
• Karpicke JD, Roediger HL: The critical importance of retrieval for learning. Science. 319:966-968, 2008.
  
• Klymkowsky MW, Garvin-Doxas K, Zeilik M: Bioliteracy and teaching efficacy: what biologists can learn from physicists. Cell Biol Educ 2:155-161,2003.