Use of Integrated Metabolic Maps as a Framework for Teaching Biochemical Pathways in the Pre-clinical Medical Curriculum

Abstract

Introduction: The Larner College of Medicine has steadily transitioned to primarily active learning-based instruction. Although evaluations praise session formats, students often highlight difficulties in synthesizing preparatory materials to integrate biochemical pathways. A student/faculty collaboration led to the development of interactive metabolic maps that illustrate pathways and link to a broader framework of metabolism.

Methods: A review of the session materials identified relevant biochemical pathways, and for each pathway, we created a fillable visual diagram to highlight the interactions between all substrates, enzymes, and cofactors. Implementation of the metabolic maps began for first-year medical students in fall 2022. Evaluation data included standard student session evaluations (Likert scale and qualitative comments) and a survey specific to the metabolic maps.

Results: After implementing the maps, student ratings of biochemistry/metabolism session materials significantly improved (3.2 ± 1.04 to 4.3 ± 0.87, p < 0.001), and students made positive comments about their effectiveness. Most students (77.8%) used the metabolic maps to aid in studying biochemistry content for exams and found the metabolic maps important for integrating information about metabolic pathways. The median performance on metabolism-specific questions was higher, although not statistically significant (69.23 to 77.28, ns).

Discussion: The implementation of integrated metabolic maps improved student satisfaction of biochemistry/metabolism session materials. Limitations include confounding factors related to student population differences and other simultaneous curriculum changes. Implementing interactive visual aids to integrate metabolism pathways and concepts is applicable to any medical curriculum, and other longitudinal topics may benefit from this type of curricular framework.

Supplementary information: The online version contains supplementary material available at 10.1007/s40670-024-02073-1.

Keywords: Active learning; Integrated mapping; Medical biochemistry; Metabolism; Visual diagram.

Fig. 1

Ratings of biochemistry session materials and importance for integrating metabolism concepts. a Data were collected from session evaluations for the years indicated, and values represent the average Likert score ratings of specific biochemistry session materials in block 2. **p < 0.0001 by Student’s t test; n = 62–63 students/class. b Survey data were collected from students in fall 2023 regarding use and importance of the metabolic maps. Shown are % respondents in each of 5 importance categories, n = 54 students

Fig. 2

Student performance on biochemistry exam questions showed a positive, but not significant trend after implementing metabolic maps. a Points represent average student performance on individual questions and b boxes represent the 95% confidence interval for individual student performance. Questions mapped to biochemistry objectives in the year before vs. after implementing metabolic maps. Horizontal lines represent the median. Differences were not significant by unpaired Student’s t test