A Systematic Integrated Approach to Teaching in the Health Sciences

An Interinstitutional Symposium: Curricula for the 21st Century.  

Department of Medical and Research Technology, University of Maryland, The Donaldson Brown Conference Center, Port Deposit, MD. November 13 –15 1998


                Marguerite E. Neita, Ph.D., MT(ASCP)

                Associate Professor

                Department of Clinical Laboratory Science/ Division of Allied Health Sciences

                College of Pharmacy, Nursing and Allied Health Sciences

                Howard University, Washington DC


        Abstract:   Junior professional phase students in the 2+2 program need to develop and use those skills that will ensure their advancement in the type of curriculum that involves the solution of complex problems, and in the competitive job-market of the 21st century. Proficiency in skills such as critical thinking, problem solving, integrating and applying information, are often not well developed in many students.  In addition, the volume of information that must be covered means that professors and instructors cannot adequately convey to the students everything they need to know using the traditional "chalk and talk" teaching method.

        In an effort to develop the students’ mastery of important learning skills, two first semester professional level courses, Urinalysis & Body Fluids and Clinical Immunology, were redesigned to incorporate active learning strategies, computer assisted instruction (CAI), and aspects of the Writing Across the Curriculum (WAC) program sponsored by the Department of English at Howard University.

        Evaluation of the outcome of the project will consist of pre- and post- use assessment of the process, determination of the students’ willingness to use the learning skills in other courses, and the students’ examination results.  It is anticipated that incorporating these strategies into the curriculum will enhance students’ comprehension of complex material and their ability to analyze and apply the information learned.   The Howard University Fund for Academic Excellence provided financial support for the project.  




        As we approach the 21st century, changes in curriculum design and teaching strategies become increasingly important as students and faculty attempt to meet the challenges of succeeding in the information age. In addition, many junior professional phase students in the 2+2 program in the Department of Clinical Laboratory Sciences at Howard University, are often at a disadvantage as they attempt to apply previously successful learning methods to a curriculum which requires the comprehension of large volumes of information, the application of concepts, and the solution of complex problems.  As a result, the initial semester of the professional phase of the program can be a frustrating one for both students and faculty.  In an attempt to address some of these problems, two first-semester, junior level pre-professional courses were redesigned to include components that facilitate the development of necessary skills and enhance student learning. 



        Preparing today’s students to be successful performers in the coming century is a formidable challenge for the clinical laboratory science educator.  They must educate the student to cope with large volumes of information and help them to develop techniques for translating this information into innovative solutions for complex problems.  In addition, they must assist the students to become adept at written and verbal communication (Table 1).

Table 1. Skills for the 21st Century 

         critical thinking


      interpretation and application of information

     creativity and curiosity

     written and verbal  communication 



In response to these demands the educator must design curricula that engage and challenge the student,  address the various learning styles of  the individual student, and meet the changing needs of the workplace.

        Awareness that students possess varying learning styles presents a challenge to the instructor who must try to tailor instructional models to accommodate the different learners.  Many classifications of these different ways of learning currently exist.  These include the basic delineations of auditory, kinesthetic, and visual learning styles. Twenty to thirty percent are auditory learners who remember what is heard;

40% are visual learners who need to see and manipulate material in order to remember basic information, and the remainder are kinesthetic learners who learn best through touch, feel, and movement (1).  These proportions of learning styles apparently change throughout the early educational years and a more relevant classification for the college student may be based on the approaches outlined by Claxton and Murrell in 1987 (2).  In this work the authors discuss several approaches to learning that are observed in college students including the classification by Schmek that students are either “deep, elaborative," or “shallow, reiterative” processors of information.  These authors contend that students can be encouraged to break their habitual method of learning if instructional models are organized to encourage the “deep, elaborative” form of thinking by requiring ongoing comprehension and analysis of information rather than a regurgitation of facts. 

         Today’s curriculum must therefore be attractive and engaging;  it must address the solution of relevant and authentic problems, develop the ability of the student to work collaboratively, and encourage students to become “deep, elaborative” thinkers  and critical analyzers of information.   The redesign of two clinical laboratory science courses attempted to integrate the needs of the students and faculty by addressing the objectives outlined in Table 2.


Table 2.  Course Objectives


         improve student writing

         introduce active  learning strategies

         incorporate different styles of learning

         improve student performance


Both courses incorporated aspects of the Writing Across the Curriculum (WAC) program, active learning strategies, and computer-assisted instruction (CAI).



        The writing-across-the-curriculum (WAC) program was established at Howard University, in 1991, under the auspices of the English Department of the College of Arts and Sciences. The aim of a Writing Across the Curriculum (WAC) course is two fold.  It is designed to improve students' writing ability, especially their professional writing (learning to write), through a series of pre-writing and writing exercises, and to improve their reading, comprehension, critical, analytical, and problem solving skills (writing to learn).  Each year teachers from various disciplines, such as math, physics, history, and physical education, volunteer for a series of workshops offered in the English Department.  These workshops prepare teachers to teach a WAC course and include the collaborative revision of class syllabi to meet the Guidelines for Teachers of Writing-Intensive Courses in the Disciplines.  After approval of the revised syllabi, courses are assigned a 700-WRTG level number (e.g., 572-709- 01, Clinical Immunology-WRTG).  Writing-intensive WAC courses have two Freshman English prerequisites, and meet the third writing requirement (Technical Writing) for the Department of Clinical Laboratory Science.  Class size is limited to 20 students per class to facilitate the teacher’s response to student assignments, and an individual instructor may teach only one WAC course per semester.  Clinical Immunology was the designated WAC course.   In Clinical Urinalysis and Body Fluids, however, the option to use selected aspects of the WAC program without having the class officially designated a WAC course was exercised as both courses are taught by the same instructor in the fall semester of the junior year.  Urinalysis and Body Fluids contains only one element of the WAC program, the laboratory notebook.

Clinical Immunology-WRTG

        The Clinical Immunology course in the Department of Clinical Laboratory Science was originally developed to teach basic immunologic principles in combination with serologic applications.  With the rapid development of the science of immunology and its increasing application to all areas of medical diagnostics, involvement in the course can be a daunting task for both students and instructor.  Students need to be able to grasp the basic concepts, to become motivated to seek information on their own, and to handle problem-solving activities. Students also must learn to write well professionally and to adhere to the  guidelines of format, word limit, and content for their academic discipline.   As future health care providers, they will also disseminate information to the public and must learn to do so in a format that is concise and easily understood.

        The course was redesigned to include writing components such as pre-writing strategies (journal notebooks), laboratory notebooks, and a formal case-report on a specific immunological disorder.  Included in these exercises are various stages of drafting and review (including peer-review).  Writing assignments are evaluated based on organization, clarity of expression, grammar, and spelling, as well as the demonstration of a clear understanding of the immunological concepts involved.

The Journal:

        Each student is required to keep a bound notebook in which entries are made.  The journal allows the student to be as creative as they want, although ideas must be organized in a coherent fashion and must be based on the course material and class presentations. Unlike conventional journals, however, topics are assigned, and the length of each entry is limited to a minimum of one handwritten page, with a maximum of two pages.  The assigned topics include summaries of class concepts, new vocabulary terms, definitions, abstracts and analogies of the students’ choice to educate specific audiences (lay person, school children, clinic patients) about a particular topic (Table 3).  Since keeping abreast of new developments is a requirement of many professional disciplines, summaries of three current articles in immunology from newspapers,

Table 3.  Examples of Journal Assignments

                 summarize class concepts

                 analogies for various lay audiences


                 summarize current article for lay audience

                 develop product advertisement

                 design laboratory test and write product information



magazines, or journals (written or electronic) are assigned throughout the semester.  Copies of the original articles are submitted with the summary, which must be written in language a layperson could understand.

In addition students are encouraged to make relevant written comments on class discussions, to assess the strengths and weaknesses of the presentations of the professor, to ask questions, and to make comments on specific areas of the subject matter that are problematic to them 

        In order to handle the paper work, all journal entries are graded from a holistic perspective.  Entries are evaluated on the basis of a general impression of the content, arrangement, and style and grades are assigned as seen in Table 4.  Entries which receive an F may be rewritten and resubmitted for a maximum upgrade of B.

Table 4.     Holistic Grading of Journal Assignments


A    (15%) outstanding

B      (10%) good

C      (7.5%) adequate

F      (2.5%) unsatisfactory


The Laboratory Notebook:

        The laboratory notebook trains students to fulfill another scientific requirement, the provision of a clear and accurate written record of procedures, results and discussion.  The particularly common and egregious habit of writing results and doing calculations on scraps of paper or paper towels is actively discouraged.  Instead, students are taught to treat the laboratory notebook as an integral part of each laboratory exercise in which the pre-lab write up prepares them for the exercise, and where results are entered during each laboratory session. Laboratory notes should consist of the elements listed in Table 5 (3). The conclusion and discussion should be based on the laboratory results and accompanied by a brief discussion of their clinical significance.

Students are encouraged to record any problems encountered during the procedure and comment on their effect on the results with recommendations for avoiding similar problems in future laboratory exercises.


Table 5.  Elements of The Laboratory Notebook


               introduction and theory

                 materials and supplies


                 results and calculations

                 conclusion and discussion


The Case - Report:

        The readily available array of immunological case studies are valuable tools for teaching the application of  immunologic principles to the cause and treatment of immunologal disorders.  Many are suitable for preparation of the case-report.  Each student is assigned a case study with relevant laboratory results for review and analysis. The student then prepares a written case-report for submission to the scientific or medical community.  The case-report must contain the elements outlined in Table 6.


Table 6.     Elements of the Case Report


         an abstract (150 words or less)

         the introduction

         review of the literature

         laboratory results and analysis

         discussion of the results



        To assist the student in planning and completing this writing assignment, a timeline is developed for completion and submission at each stage of the process.  Each component is graded to ensure that students adhere to the timeline (Table 7) .   One of the most useful elements of the case report, and the first to be submitted, is the annotated bibliography.  This bibliography consists of the citation and a brief summary of each article to be used in the final paper and provides the instructor with one mechanism for reducing plagiarism, and for assessing the amount of  legitimate research done by each student .  Students are permitted to change no more than two references when the final paper is submitted.  The final paper must adhere to specific limitations of length and style.  Students may select a reference style from any journal of laboratory medicine, medicine or immunology (e.g. Immunology Today, Clinical and Diagnostic Immunology, Clinical Laboratory Science); a copy of the journal style must be submitted with the first draft of the paper.


Table 7.                 Timeline  and Grading Scheme for  Student Case Report

assignment of case     Sept.04

annotated bibliography     20%    Oct. 10

outline  10%      Nov. 03

first draft     20%    Nov. 14

peer review   Nov .19

final paper  50%    Dec. 04


Student Resources:

        It is beyond the scope of an instructor in this type of WAC course to teach writing skills that should have been learned in prior English classes.  To assist those students who need additional help with persistent problems,  the WAC program at Howard University has several support services available to the student. These include a Writing Center where students can find software to help them with issues such as planning the paper and proofreading skills.  Tutorial assistance is also available to students by referral from their WAC instructor.  Tutors do not edit the student’s writing, but will assess the student’s writing deficiencies, assist with solutions to a variety of problems, including lack of organization and incorrect grammar, and evaluate the student’s progress.  Students may also access an electronic grammar tutorial through the English Department’s web site.

        Both courses (Clinical Immunology-WRTG and Clinical Urinalysis and Body Fluids) contained the next two components of the project, active learning strategies and computer-assisted instruction (CAI).



        The active learning component was designed to encourage students to actively participate in the learning process by using critical reading, comprehension, and questioning activities. Students are initially asked to evaluate the strengths and weaknesses in their study habits by completing and analyzing a self-assessment questionnaire (4).  Exercises to encourage the use of active learning strategies were selected from the book by Metzler and Palau,  Acquiring Critical Thinking Skills (5).  Students were expected to read, outline, and develop learning issues from textbook assignments with the use of specific learning objectives.  Each class session began with a brief review of the chapter outline, a discussion of student learning issues and an attempt to answer questions generated by the student issues.  In addition, each student was required to prepare and use a personal study guide (PSG) for each examination.  The PSG is submitted on the day of the examination, and students are given a series of questions to help them evaluate the effectiveness of the study guide.



        Computer assisted instruction  (CAI) is an excellent resource for the kinesthetic and visually oriented learner, and is useful for all students as review material, auto-tutorials, an adjunct to lectures, and as a training tool.  Funds obtained from the President’s Fund for Academic Excellence at Howard University enabled the department to purchase several sets of computer software for use by the students (Table 8).  Students were expected to view these materials on their own time and complete all required programs by the end of the semester.  Questions specifically from the software programs were included in final examinations to ensure that students were held accountable for any information covered in the program that may have been omitted in lecture.



Table 8. Software Purchased for Computer Assisted Instruction (CAI)



         Electrophoresis Tutor                               


         Immunology Interactive CD-Rom       

         Urinalysis Tutor

         CD-Rom Instructional for Sperm Morphology





        Evaluation of the success of the model is to be based on pre-and post- use evaluations of the process, a questionnaire which asks the participants to evaluate each aspect of the model, and consideration of  student comments.   Complete analysis of the data is still in progress, but some generalizations can be made.

        After some initial resistance, the students seemed to accept the writing components of the class favorably.   They were delighted with the more creative writing assignments; in particular those assignments that involved group participation.  Students also expressed their satisfaction with the case-report activities, especially the peer review.  Students felt that their writing skills were better and, with few exceptions, the final case-reports were excellent and the overall quality of student writing had improved.  From the instructor’s perspective the WAC component was also the most useful and rewarding. Commonly occurring errors as well as specific misconceptions were more easily discerned and corrected before an examination, thereby allowing the students a greater possibility of improving their grades.  The active learning component was the most negatively received by the students and resulted in the most frustration for the instructor.  Most students considered the exercises “a waste of time”, and “busy work”, however, a few commented that they benefited from the production, use, and evaluation of the study guide which helped to provide a focus for their studying.  In a class of 15 students, only one expressed dissatisfaction with the computer software programs which she described as ‘boring”.  Interestingly, this student considered herself a visually oriented learner!  When the evaluation process is completed, the model will be modified and refined to better meet the needs of the students and instructor.



1.     Farwell, Terry.,  Visual, Auditory or Kinesthetic:  Which is Your Child? http://familyeducation.com/article/0,1120,4-605,00.html

2.     Claxton, Charles S., and  Murrell, Patricia H., Learning Styles:  Implications for Improving Educational Practices.  ASHE-ERIC Higher Education Report No.4 Washington D.C.: Association for the Study of Higher Education, 1987.

3.     Boyer, Rodney F., Modern Experimental Biochemistry.2nd Ed., The Benjamin Cummings Publishing Company, Inc., CA., 1993.

4.     Twining, James E., Strategies for Active Learning.  Allyn and Bacon, MA. 1991

5.     Metzler, Marilyn and Palau, Susan M., Acquiring Critical Learning Skills. W.B. Saunders Co., PA., 1996.



WAC Presentations:

A Systematic Integrated Approach to Teaching in the Health Sciences.  An Interinstitutional Symposium: Curricula for the 21st Century.   Department of Medical and Research Technology, University of Maryland, The Donaldson Brown Conference Center, Port Deposit, MD. November 13 –15 1998

Innovative Writing Strategies in The Health Sciences: Considerations for Preparing the Course Syllabus.  Guest Speaker, Department of Integrated Healthcare Dinner Meeting, Anne Arundel County Community College, December 15, 1999

Improving Learning Outcomes Through Writing Across The Curriculum.  Baltimore City Community College Faculty Development Day, Gaare Auditorium, BCCC.   January 22, 2002


 Neita, M.E., A Strategic Integrated Approach to Teaching in the Health Sciences. Proceedings The 1998 Interinstitutional Symposium: Curricula for The 21st Century. Department of Medical and Research Technology, University of Maryland, Baltimore MD.pp23 –28, 1999.