Using systems modeling to facilitate undergraduate physiology student learning and retention of difficult concepts

Physiology concepts, such as acid-base balance, may be difficult for students to understand. Systems modeling, a cognitive tool, allows students to visualize their mental model of the problem space to enhance learning and retention. We performed a within-subjects three-period randomized control comparison of systems modeling versus written discussion activities in an undergraduate asynchronous online Anatomy and Physiology II course. Participants (<i>n</i> = 108) were randomized to groups with differing treatment orders across three course units: endocrine, immune, and acid-base balance. Participants demonstrated content understanding through either constructing systems modeling diagrams (M) or written discussion posts (W) in a MWM, MMW, or WMM sequence. For each of three units, student performance was assessed on 6 standardized multiple-choice questions embedded within a 45-question exam. The same 6 questions per unit, 18 questions in total, were again assessed on the 75-question final exam. The groups demonstrated no significant difference in performance in the endocrine unit exam [mean difference (MD) = -0.036]. However, the modeling group outperformed the writing group in the immune unit exam (MD = 0.209) and widened the gap in the acid-base balance unit exam (MD = 0.243). On the final exam, performance was again higher for the modeling group on acid-base balance content, as mean difference increased to 0.306 despite the final exam content for acid-base balance being significantly more difficult compared to other units [modeling: <i>F</i>(2) = 29.882, <i>P</i> < 0.001; writing: <i>F</i>(2) = 25.450, <i>P</i> < 0.001]. These results provide initial evidence that participation in systems modeling activities may enhance student learning of difficult physiology content as evidenced by improved multiple-choice question performance.<b>NEW & NOTEWORTHY</b> Physiology educators often intuitively utilize systems thinking and modeling while teaching difficult concepts. Guiding students in development of their own systems modeling skills by enhancing their visualization of their mental model of the problem space may improve performance on multiple-choice test questions.