Advancing Nephron Physiology Education in Medical Curricula with an Interactive Manipulative: Validation Study

Background: Renal physiology, including the intricate processes of secretion and absorption across various nephron segments, remains a challenging subject for medical students, often leading to difficulties in mastering key concepts such as ion movements. To bridge these educational gaps, we had previously developed a hands-on Nephron Manipulative ( https://doi.org/10.1152/advan.00087.2013 ) designed to improve retention of renal physiology through active learning techniques. Building on our previous work, our current study updates the previous paper based nephron manipulative into a digital format, broadens its utility to clinical settings and integrates additional data collection to evaluate its impact on long-term learning outcomes. Objective: Our aim is to validate the updated digital nephron manipulative by evaluating knowledge acquisition of medical students in both short-term and long-term settings. Hypothesis: The updated digital nephron manipulative will enhance medical student’s understanding, retention and application of renal physiology concepts compared to traditional lecture based teaching methods. Methods: The previous paper-based nephron manipulative has been upgraded to a digital, user-friendly PowerPoint tool designed for active student engagement. Learners interact by dragging and positioning electrolytes and molecules onto their corresponding transporters within each nephron segment. Medical students participated in pre, post and long-term manipulative quizzes. The pre-manipulative quiz served as a baseline assessment and an introduction into key concepts while the post-quiz addressed any potential misconceptions. The long-term survey was applied a year later to the same cohort of students. The control group was composed of students who responded to the survey without using the manipulative. The quiz included 13 knowledge questions and 3 questions on user satisfaction and suggestions for improvement. Initial data collection was conducted during a teaching session in the first year renal physiology block at Virginia Tech Carilion School Of Medicine. A second data collection aimed at assessing long term can retention was conducted the following year during the medical students’ second year renal pathology block. Results: Twenty first-year medical students participated in the initial data collection, engaging with the digital manipulative and completing the associated quizzes. Analysis of the first set of collected data revealed a statistically significant improvement in knowledge (p=0.017), with correct responses increasing from 64.2% to 71.9% following the manipulative activities. Student feedback reported a better understanding of the course material and appreciation for the interactive nature of the tool. Results from the second data collection revealed that students who participated in the manipulative had a 69% correct response rate while the control group had a correct response of 60%. Conclusion: Our findings highlight the effectiveness of the updated digital nephron manipulative in promoting immediate knowledge improvement, long term knowledge retention as well as high levels of student satisfaction. This enhanced educational tool has demonstrated its ability to simplify complex nephron physiology concepts and support medical students’ understanding. The success of this manipulative for nephron physiology education as well as its easily customizable design makes it a useful tool to teach other complex concepts in nephrology. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.