Adv Physiol Educ 40: 93–97, 2016;

doi:10.1152/advan.00137.2015. How We Teach: Classroom And Laboratory Research Projects

Using paper presentation breaks during didactic lectures improves learning of

physiology in undergraduate students
Ahmad Ghorbani1,2 and Kiarash Ghazvini3
1
Pharmacological Research Center of Medicinal Plants, Faculty of Medicine, Mashhad University of Medical Sciences,
Mashhad, Iran; 2Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran;
and 3Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Submitted 8 September 2015; accepted in final form 30 November 2015

Ghorbani A, Ghazvini K. Using paper presentation breaks during di-
dactic lectures improves learning of physiology in undergraduate students.
Adv Physiol Educ 40: 93–97, 2016; doi:10.1152/advan.00137.2015.—Many
studies have emphasized the incorporation of active learning into
classrooms to reinforce didactic lectures for physiology courses.
This work aimed to determine if presenting classic papers during
didactic lectures improves the learning of physiology among un-
dergraduate students. Twenty-two students of health information
technology were randomly divided into the following two groups:
1) didactic lecture only (control group) and 2) didactic lecture plus
paper presentation breaks (DLPP group). In the control group,
main topics of gastrointestinal and endocrine physiology were
taught using only the didactic lecture technique. In the DLPP
group, some topics were presented by the didactic lecture method
(similar to the control group) and some topics were taught by the
DLPP technique (first, concepts were covered briefly in a didactic
format and then reinforced with presentation of a related classic
paper). The combination of didactic lecture and paper breaks
significantly improved learning so that students in the DLPP group
showed higher scores on related topics compared with those in the
control group (P ⬍ 0.001). Comparison of the scores of topics
taught by only the didactic lecture and those using both the didactic
lecture and paper breaks showed significant improvement only in
the DLPP group (P ⬍ 0.001). Data obtained from the final exam
showed that in the DLPP group, the mean score of the topics taught
by the combination of didactic lecture and paper breaks was
significantly higher than those taught by only didactic lecture (P ⬍
0.05). In conclusion, the combination of paper presentation breaks
and didactic lectures improves the learning of physiology.
didactic lecture; learning; paper; physiology
TRADITIONAL DIDACTIC LECTURE is the technique that is often used
to teach impractical lessons at undergraduate medical schools.
Several factors, such as the high volume of course material,
time pressures, and crowded classrooms, make teachers in-
clined to use the didactic lecture technique. However, in this
technique, students are passive listeners and the teacher may
fail to deliver deep learning. In recent years, efforts have been
made to improve the quality of teaching by incorporating
active learning exercises into traditional lectures (13, 23).
Active learning is a student-centered education method that
enhances student engagement, motivates students to learn,
enhances higher-level thinking skills, and increases classroom
satisfaction (1, 19, 21).
Physiology is a difficult course for most medical and
paramedical students because a large number of terms and
Address for reprint requests and other correspondence: A. Ghorbani, School
of Medicine, Mashhad Univ. of Medical Sciences, Mashhad, Iran (e-mail:
ghorbania@mums.ac.ir).
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facts have to be memorized. In addition, it needs problem-
solving ability and knowledge integration for learning com-
plex concepts. Therefore, teachers often use the didactic
lecture technique to present complex concepts and to inte-
grate information from multiple sources. Many studies have
emphasized the incorporation of active learning into class-
rooms to reinforce the didactic lecture technique for phys-
iology courses (6, 17, 23). For example, case-based learn-
ing, problem-based learning, cooperative learning, and con-
ceptual change strategies have been suggested as active
learning approaches (18, 23).
Health information technology (HIT) is one of the fields
where students need to learn medical physiology. However,
students of HIT have a strong focus on electronic medical
record systems and their importance in patient safety (28).
Therefore, they may find it difficult to ascertain the relevance
of basic physiological concepts into their professions. Thus, the
traditional didactic lecture method may not be sufficient to
maintain student motivation and engagement throughout the
class period. On the other hand, topics such as research
methods and applications of research and clinical data are parts
of the curriculum for HIT students, and a combination of
research paper presentation breaks and didactic lecture may
increase their learning motivation. In addition, original re-
search papers have demonstrated how a basic physiological
concept is discovered, and this can help to deepen the learning
of physiology. Therefore, the aim of the present study was to
determine if presenting classic research papers during didactic
lectures improves learning physiology among undergraduate
HIT students.
MATERIALS AND METHODS
Participants and course plan. The present study was conducted
with 22 undergraduate Bachelor of Science students of HIT enrolled
in the physiology course at the Paramedical School of Mashhad
University of Medical Sciences (Mashhad, Iran). Before the study
began, it was approved by the university’s Human Ethics Committee.
The physiology course is a general education course that is required
for all first-year students of HIT and is delivered through traditional
classroom instruction. This course is divided into 17 sessions (2 h for
1 time/wk) and covers the following general topics: membrane phys-
iology and muscle (2 sessions), the nervous system (3 sessions),
gastrointestinal physiology (2 sessions), endocrinology (2 sessions),
the kidneys (2 sessions), the heart and circulation (4 sessions), and
respiration (2 sessions).
Research design. The study was done in weeks 6 –9 of the semester.
In session 6, all 22 students (all women) were randomly divided into
the following 2 groups: 1) students who were taught by the didactic
lecture technique only (control group) and 2) students who received
didactic lectures plus paper presentation breaks (DLPP). In the control
93
How We Teach: Classroom And Laboratory Research Projects
94 RESEARCH PAPER PRESENTATION IMPROVES LEARNING OF PHYSIOLOGY

group, all topics of gastrointestinal and endocrine systems were taught
in the form of didactic lecture using PowerPoint presentation. In the
DLPP group, some topics were presented entirely by the didactic
lecture method (similar to the control group) and some topics were
taught by the DLPP technique (first, concepts were covered briefly in
a didactic format and then reinforced with the presentation of a related
classic paper). In each session, three breaks consisting of 10-min
presentations of an original research paper were included (3 breaks
took 30 min total). While the DLPP group spent 10 min to teach the
METHODS/RESULTS sections of the papers, the control group used this
time for additional didactic teaching (e.g., explanations, examples,
presenting figures, etc.). Table 1 shows the topics and lecture tech-
niques used for teaching the physiology of gastrointestinal and endo-
crine systems. For example, the factors affecting gastric motor activity
were described in detail by didactic lectures for control students. In
the DLPP group, the same factors were taught briefly by didactic
lectures and then the details of the effects of secretin and intestinal
osmolarity on gastric motor activity were discussed in the paper
presentation breaks (using Refs. 6 and 12). For each paper, only the
METHODS and RESULTS sections were presented in summary form.
Students did not read the papers before the class. Both didactic lecture
and DLPP techniques were delivered by the same teacher. The paper
presentation break was an interactive discussion with the students that
involved examples, questions, and student feedback. Examples of the
questions that were discussed about the effect of secretin on gastric
motor activity at the beginning of the paper presentation break
included the following: Why should gastric emptying be regulated by
intestinal factors? Can you suggest a method for determining gastric
motor activity? What is the possible mechanism by which secretin
induces gastric relaxation?
Assessments. To ensure the homogeneity of the two groups, a
pretest was conducted for both groups in session 6 (about gastroin-
testinal physiology) and session 8 (about endocrine physiology).
Pretest questionnaires included multiple-choice questions to test over-
all knowledge regarding gastrointestinal (6 questions) and endocrine
(6 questions) physiology. At the end of session 7 (for gastrointestinal
physiology) and session 9 (for endocrine physiology), a posttest
consisting of questions about both the topics taught by only the
didactic lecture (6 questions) and those taught by the DLPP method (6
questions) was given to assess the learning effectiveness of the two
teaching methods. In addition, at the end of the semester (9 wk after
session 9), the common final exam was given, and the score was
considered for the assessment of 2-mo retention of knowledge. The
questions of the pretest, posttest, and final exam were not identical and
were not very similar to those asked during the paper presentation
breaks. Examples of questions asked on the posttest about topics
taught by only didactic lecture (example 1) and those taught by the
DLPP method (example 2) are shown below:
Example 1: Which of the following is a product of parietal cells?
A. Intrinsic factor
B. Gastrin
C. Pepsinogen
D. Mucus
Example 2: Which action, for gastric acid suppression, is more
effective?
A. Stimulation of the release of gastrin
B. Inhibition of the action of histamine
C. Stimulation of the release of acetylcholine
D. Inhibition of the action of somatostatin
Statistical analysis. The scores obtained for the questions were
compared by a paired t-test for the differences between the pre- and
posttests. Intergroup comparison was done by an unpaired t-test.
Results are presented as means (SD), and P values of ⬍0.05 were
considered statistically significant.
RESULTS
All students were women with an age range of 18 –22 yr old.
There was no significant difference in terms of age between the
control and DLPP groups [19.7 (SD 1.2) and 19.6 (SD 1.2),

Table 1. Topics and lecture techniques used for teaching physiology of gastrointestinal and endocrine systems

Lecture technique
Reference(s) of
Topics Control group DLPP group Paper(s) Used

Session 6
Gastrointestinal physiology
Motor functions of the stomach Only didactic lecture Only didactic lecture
Regulation of gastric motor activity Only didactic lecture Didactic lecture and paper breaks 7, 15
Movements and secretions of bowels Only didactic lecture Only didactic lecture
Emptying of the gallbladder Only didactic lecture Didactic lecture and paper breaks 30
Oxyntic and pyloric glands Only didactic lecture Only didactic lecture
Session 7
Gastrointestinal physiology
Regulation of gastric acid secretion Only didactic lecture Didactic lecture and paper breaks 14, 25
Pancreatic digestive enzymes Only didactic lecture Didactic lecture and paper breaks 3
Composition and functions of bile Only didactic lecture Only didactic lecture
Endocrine physiology
Metabolic effects of GH Only didactic lecture Didactic lecture and paper breaks 24
Effects of GH on cartilage and bone Only didactic lecture Only didactic lecture
Session 8
Endocrine physiology
Regulation of GH secretion Only didactic lecture Didactic lecture and paper breaks 26
Functions of aldosterone Only didactic lecture Only didactic lecture
Regulation of aldosterone secretion Only didactic lecture Didactic lecture and paper breaks 5
Metabolic effects of cortisol Only didactic lecture Only didactic lecture
Anti-inflammatory effects of cortisol Only didactic lecture Didactic lecture and paper breaks 27
Session 9
Endocrine physiology
Regulation of cortisol secretion Only didactic lecture Only didactic lecture
Insulin and its metabolic effects Only didactic lecture Didactic lecture and paper breaks 8, 9
Control of insulin release Only didactic lecture Only didactic lecture
DLPP, didactic lectures plus paper presentation breaks; GH, growth hormone.

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 How We Teach: Classroom And Laboratory Research Projects
RESEARCH PAPER PRESENTATION IMPROVES LEARNING OF PHYSIOLOGY 95

Table 2. Scores of the pretest, posttest, and final exam of 7

students in the control and DLPP groups Control Group

6
Score (From a Total of 12) DLPP Group ###
Control group DLPP group ***
5
Pretest 3.9 (SD 1.4) 3.5 (SD 1.6)
Posttest 7.0 (SD 1.3)† 7.7 (SD 1.0)‡

Post-test score
Percent increase from the pretest 79 120 4
Final exam 5.4 (SD 1.3)* 6.2 (SD 2.1)†
Percent increase from the pretest 38 59
3
Data are presented as means (SD) from 10 (control) and 11 (DLPP)
samples/group. In the control group, all topics were taught in the form of
didactic lecture. In the DLPP group, the same topics were taught by both
2
didactic lectures and paper presentation breaks. *P ⬍ 0.05 vs. the score of the
pretest in the related group; †P ⬍ 0.01 vs. the score of the pretest in the related
group; ‡P ⬍ 0.001 vs. the score of the pretest in the related group.
1

respectively]. All students in the DLPP group completed the 0

pretest, posttest, and final exam. One participant from the
control group was excluded from the study because of not
having completed the posttest and final exam.
As shown in Table 2, the total scores on the pretest in control
and DLPP groups were not significantly different, indicating
that students were relatively homogenous regarding their over-
all knowledge on gastrointestinal and endocrine physiology. In
addition, in the pretest, the scores of topics taught by the
didactic lecture and those by combined didactic lecture and
paper breaks were not significantly different between control
and DLPP groups (Fig. 1).
The scores of the posttest and final exam were higher than
that of the pretest in both the control (P ⬍ 0.05) and DLPP
groups (P ⬍ 0.01; Table 2). Although the percent increase in
the score of the posttest was greater in the DLPP group than in
the control group (120% vs. 79%), the difference in absolute
score [7.0 (SD 1.3) vs. 7.7 (SD 1.0)] did not reach statistical
7
Control Group
6
DLPP Group
5
Pre-test score
DL Topics DLPP Topics
Fig. 2. Effect of paper presentation breaks during DLs on the learning of
physiology as assessed by posttest questions. In the control group, all topics
were taught in the form of DLs. In the study group, the same topics were taught
by DLPP. Data are presented as means (SD) from 10 (control) and 11 (DLPP)
samples/group. ***P ⬍ 0.001 vs. the score of DLPP topics in the control
group; ###P ⬍ 0.001 vs. the score of DL topics in DLPP group.
significance. Similarly, data obtained from the final exam
showed a higher score for the DLPP group [6.2 (SD 2.1)] than
the control group [5.4 (SD 1.3)] in terms of total score related
to the gastrointestinal and endocrine topics. However, the
difference between the two groups was not statistically signif-
icant.
Figure 2 shows that combination of didactic lecture and
paper breaks significantly improved learning, in that students
in the DLPP group compared with the control group showed a
higher score on the paper topics [4.7 (SD 0.6) vs. 3.2 (SD 0.6),
7
Control Group
6 #
DLPP Group
*
5

Final exam score

4
4

3
3

2
2

1
1

0
DL Topics DLPP Topics
Fig. 1. Scores on the pretest from students in the didatic lecture (DL) only
(control) group and those in the DL plus paper presentation breaks (DLPP)
group. The pretest included 12 multiple-choice questions to test overall
knowledge regarding gastrointestinal and endocrine physiology. In the control
group, after the pretest, all topics were taught in the form of DLs. In the study
group, after the pretest, the same topics were taught by DLPP. Data are
presented as means (SD) from 10 (control) and 11 (DLPP) samples/group.
0
DL Topics DLPP Topics
Fig. 3. Effect of paper presentation breaks during DLs on the retention of
knowledge as assessed by final exam questions. In the control group, all topics
were taught in the form of DLs. In the study group, the same topics were taught
by DLPP. Data are presented as means (SD) from 10 (control) and 11 (DLPP)
samples/group. *P ⬍ 0.05 vs. the score of DLPP topics in the control group;
#P ⬍ 0.05 vs. the score of DL topics in the DLPP group.

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How We Teach: Classroom And Laboratory Research Projects
96 RESEARCH PAPER PRESENTATION IMPROVES LEARNING OF PHYSIOLOGY
P ⬍ 0.001]. A comparison of the scores of topics taught by
only didactic lecture and those by combined didactic lecture
and paper breaks showed a significant improvement only for
the DLPP group (P ⬍ 0.001).
Data obtained from the final exam are shown in Fig. 3. In the
DLPP group, the mean score of the topics taught by both
didactic lecture and paper breaks was significantly higher than
those by only didactic lecture [4.1 (SD 1.4) vs. 3.2 (SD 1.4),
P ⬍ 0.05].
DISCUSSION
Traditional didactic lecture in and of itself is a passive
technique for education, and, in recent years, efforts have been
made to improve its quality by incorporating active learning
activities into the technique (13, 23). With this thought in
mind, we hypothesized that the presentation of classic research
papers during didactic lectures improves learning of physiol-
ogy. The results obtained showed that, although the total scores
of the posttest and final exam were not statistically different
between the DLPP and control groups, students in the DLPP
group had a higher score for the topics taught by paper
presentation compared with those by only didactic lectures.
The higher score was observed in both the posttest and final
exam, indicating that paper presentation breaks improved both
learning and retention of information.
Learning of physiology needs problem-solving ability, the
memorization of many facts, and the integration of knowledge
to learn complex concepts. Some previous studies have at-
tempted to replace didactic lectures with different methods,
including case-based, problem-based, and team-based learning
for teaching physiology (16, 6, 10, 22). These methods have
their own benefits and disadvantages. It should be taken into
considered that complete replacement of didactic lectures with
these active learning methods may be difficult, particularly
when the class is crowded and if the education needs the
integration of information from multiple sources to describe
complex concepts. Instead, the incorporation of some brief
active learning activities within didactic lectures can improve
learning efficiency (23). Here, we incorporated a number of
paper presentation breaks within didactic lectures to create a
stimulating learning environment and to improve students’
understanding of the content. This technique can be thought of
as an evidence-based learning approach, and we demonstrated
that it increases student learning. Although we did not quanti-
tatively evaluate satisfaction levels of students, our technique
could hold students’ attention during lectures and participants
showed high levels of interest throughout the paper presenta-
tion breaks.
The use of primary research papers to teach physiology
and pharmacology has been previously suggested by some
authors (2, 4, 12, 20, 29). For example, a paper by Johnson
and Grossman has been used to teach the role of secretin in
the regulation of gastric acid secretion (29). Bauer-Dantoin
and Hanke (2) recommended a paper by Lawton and
Schwartz to teach factors that control the production of the
luteinizing hormone. In addition, Halliday et al. (11) eval-
uated the use of classic papers for teaching basic neurotrans-
mitter pharmacology and reported that it resulted in learning
improvements. Since complete replacement of the didactic
lecture with paper presentation is not possible, particularly
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in large class, we designed a combination of didactic lec-
tures and paper breaks. In each break, a summary of the
METHODS and RESULTS sections of the papers was presented.
Such a use of paper breaks might be a useful technique for
improving learning of difficult topics of physiology and
other biomedical sciences. This technique needs no labora-
tory component, can be adapted to any field of medicine,
and is relatively easy to run in class sessions.
The present study has a few limitations. One limitation is
that each group is limited to only 11 subjects. In our
university, only 20 –25 students are accepted for HIT sci-
ence, and all of them are women. This relatively small
number of subjects might limit the statistical power of the
study, and it is not possible to have a balanced sample
including an equivalent number of women and men. The
other limitation of our research was that learning was
assessed by only multiple-choice questions. In addition, the
number of questions in the pretest, posttest, and final exam
was relatively small. Due to the time restriction in sessions
and limitation of total number of questions in the final exam,
we used only 12 questions about the gastrointestinal and
endocrine systems in each exam. Further studies using
larger numbers of students, more numbers of questions, and
different topics of physiology are warranted to improve the
limitations of this study.
Taken together, the results of the present study suggest that
the combination of didactic lectures and paper presentation
breaks improves the learning of physiology and retention of
information among undergraduate HIT students.
GRANTS
This work was financially supported by Mashhad University of Medical
Sciences Grant 921250.
DISCLOSURES
No conflicts of interest, financial or otherwise, are declared by the
author(s).
AUTHOR CONTRIBUTIONS
Author contributions: A.G. conception and design of research; A.G. per-
formed experiments; A.G. and K.G. analyzed data; A.G. and K.G. interpreted
results of experiments; A.G. prepared figures; A.G. and K.G. drafted manu-
script; A.G. and K.G. edited and revised manuscript; A.G. and K.G. approved
final version of manuscript.
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