Question of the Month: Should A & P Content Be "Retaught?"

UM Review RN, ASN, RN · Jan 31, 2005

I recall doing a lot of memorizing for A&P. While my memory for the information was excellent and I got A's, I had trouble really grasping the import of twitching frog's legs in relation to cardiac dysrhythmias. I couldn't understand how diabetes worked or how to treat it no matter how many times I read the material and stood on my head to figure it out until a nursing teacher explained it in my last semester of school. It took years for me to understand how a patient third-spaced and why they were really quite dry when they appeared anything but.

And don't get me started on ABGs. :stone

A concise review brought me past that into gaining some understanding.

Therefore, I vote yes to "re-teaching." We all have those "gaps" in our education.

llg, PhD, RN · Jan 31, 2005

I think the "answer" lies in not treating the issue as a black and white issue -- an all or nothing, yes or no situation. Right now, it seems as if your question is "to reteach or not to reteach" and yet in your examples, there are many subtleties and possibities that don't fall neatly into those 2 dichotomous categories. Find new ways of framing the questions and new possible answers and solutions appear.

For example, on paper, the students come to you having already taken A&P. However, you state that some students are taking the course concurrently and therefore have NOT yet taken the course prior to taking your class. You also state that the A&P course does not cover all of the material that needs to be covered. In these instances, your inclusion of A&P content is not reteaching -- because it is truly new material for your students. Perhaps there needs to be either a clarification within your program or the stricter enforcement of current guidelines as to the sequence of classes and the required content in each. By letting these things get "fuzzy," the school creates a need for reteaching that should not exist. Stop enabling students to NOT LEARN the content when they are supposed to learn it. If students are showing up in your class without the preparation they are supposed to have -- solve that problem at its source instead of turning your class into a remedial review.

Another twist might be to further clarify which aspects of the content are taught in A&P and which aspects of similar content are taught in nursing courses. For example, A&P probably includes basic information about the heart, but NOT information on the needs of patients with heart problems. The nursing instructor would focus on the effects of the heart condition on the patient and the types of care that the patient would need. Learning materials might include some A&P material, but it would be looked at from a different angle -- not from the angle of learning about the heart, but rather from the angle of understanding it's effect on the patient and the needs for nursing care. In your class, the student would develop a greater understanding of the heart through re-examining the heart while considering the needs of heart patients.

Unless the nursing instructor is supposed to be teaching A&P, that instructor should be looking at that material from a nursing perspective, using a nursing lens -- and that should (if properly done) make it a different class from the orginal A&P class and therefore NOT be a reteaching of the same material. If the nursing instructor finds himself/herself actually reteaching the same material in the same way, then that is the sign of a problem that should be corrected. Either there was something wrong with the original A&P course -- or the nursing instructor is failing to add the nursing perspective and new material to the "follow-up" course that is supposed to be building upon the first course.

Just my $.02,

llg

purplemania, BSN, RN · Jan 31, 2005

I agree that review is often necessary to get the class to the same level of understanding. This also helps the student identify areas needing attention. But I also think the student should be responsible and accountable for learning, and that re-teaching is not the best option. All the courses need to build on one another. Hard call, though, when the student looks at you with blank stares.

pmchap · Feb 1, 2005

Another way to consider the question is - how many times does a student get taught something before they learn it.... and then how many times do you need to learn something before you understand it. From my archives of memory - memorizing 101 different muscle and nerve names to get through my A&P exam did nothing other than get me through my exam.... It was only while scouting (while and undergrad) during a hip operation and observing muscle tissue being opened up and the ball being measured and placed did the understanding of the of the functional value sound muscle tissue about a joint really hip home.

I am not saying that we only learn through personal exeriences - but I am saying that until we as teachers are able to give relavance to our material - students will not truely understand the information. In Highschools you teach a topic at least 3 times before the majority of students grasp it - with tertiary students we expect that students will have a higher vested interest in ther learning - but this will still be limited by the percieved relevance of the information to the student. (ie a student will take the attitude that the doc orders the med and I give it - provided it is a legal and valid order - until the student understands their role as a patient advocate mandates that they understand why and if that ordered med is appropriate for the patient.

So to the original theme - should you reteach A&P - the answer is open ended - but yes some material presented initially will inevitably be retught to ensure student learning has occured.

(In a clinical setting you don't presume someone can do a catheterization because they are an RN - they must first show that they are capable)

sfamom04 · Feb 1, 2005

There seems to be great controversy afoot as to whether "old content" (especially anatomy and physiology) should be "retaught" in nursing curriculum.
Arguments against "reteaching" include:
Adult students should be self-motivated and actively participating in their educational process. As such, adult learners need to be held accountable for what they should have learned in another class or term. If they do not understand or haven't grasped "old" content, then it is their responsibility to seek out remediation/ support systems such as on-campus tutoring or computer-assisted instruction. The classroom is not the place for remediation.
The Education Consultants with the NC BON are advising nurse educators in our state not to reteach content, due to the tremendous time constraints and to reduce the burden of additive curricula. Anatomy and physiology, for example, is a co-requisite in our ADN program, and they are requesting us not to reteach it. If we must reteach previous material, then we lose precious time to teach new material. Compliance with this approach can be extremely difficult for instructor and student alike, especially with the more challenging content, such as fluid and electrolytes, or the cardiac system. Teachers who are complying with this approach are prefacing a new unit by instructing students to review the anatomy and physiology content for that unit before coming to class.
I tend to disagree with this position. I believe the effective classroom teacher needs to develop a clear understanding of what the students know before proceeding with planned instructional activities. I believe that it is imperative for educators to assess the overall level of our students and begin where they are. It's like taking aim at a bullseye. The effective instructor must be right "on target" with the students while lecturing and truly be "reaching" and "engaging" the audience.
As such, I always include a section on A & P with my lectures, because the students simply need this review to understand where I am going in the lecture. Most of the time, this is just a quick review. Otherwise, adult learner or not, they are just lost. Just because they have had the A & P course in the past and passed it with a "C" average, doesn't mean they truly understand the information. I cannot take that for granted. Also, the way our ADN schedule runs, students in the first year are still taking their anatomy courses and may not have been exposed to the particular subject matter yet. Many students do take as many non-nursing courses as possible before they get into the program, but this cannot be taken for granted. Also, the A & P teacher (as truly wonderful and excellent as he is) always tends to conveniently "run out of time" every year before teaching reproductive A & P :imbar . So this is entirely new content for the students which we must teach in detail.
I can see both sides of this argument and I would like to hear your opinions or advice. If an instructor is not "reteaching," I would like to hear how this is being successfully done without "losing" half the class.
Thanks! Awaiting your thoughts on this matter... :)

I definitely think that they need to review. I had a teacher for A&P 2 that never got to a lot of things. Such as reproductive. I got an A out of the class but by the time I get into the nursing program I will definitely need a refresher.

smk1, LPN · Feb 1, 2005

i am still just a student (currently in A&P 2nd of 3 semesters), but why not put together a small review packet of A&P info to review (like a sheet of the terms, anatomy etc..) that could be useful for review for each lecture exam. Or better yet do a little scouting and see if there is a good review book that you could "recommend" as part of the books needed for the program. Find pg numbers in it that you can type onto your lecture notes to remind students to go over certain items for review. I am looking at a year long gap after finishing A&p, before i start my RN program and while I definitely will review, it is hard to know what sort of things you need to keep fresh for an entire year. (blood and CSF tracings, names of sulci, foramina and events at a cholinergic synapse and such or what? :uhoh21: )(Along with the fact that school still goes on with other prereqs while you wait. :rolleyes: ) Another Idea is perhaps to record what you would lecture on regarding A&P on tape for the different units, and label them and have a few copies available in the library for viewing or check-out. This way it is still up to the students to be responsible for the A&P info you want them to know, and you won't take class time away discussing it, yet you know you have been fair in providing the information you want the students to learn. (We had a psych prof do this and as a supplement it was a great tool for his students.)

NPTeacher · Feb 1, 2005

Wow - so we aren't the only ones with this problem! Our school is a 2 + 2 program where they do their first two years someplace else, then transfer to us for the final two years of nursing school. We are located on a medical science campus, so we don't offer all of the prerequisite courses - including basic a & p. Unfortunately, the courses offered at the local and state colleges and universities vary greatly - so our students come in with a w-i-d-e range of knowledge related to such courses as A & P. However, I have SO much to already teach, that I tell them day one that I am NOT going to spend my time in a 3 or 5 hour course reteaching what they have already had in 2 4-hour courses. I tell them to pull out their A&P books and to BE SURE that they know the A&P of the "system of the day" because if they don't know where it is, or what it does, they certainly can't examine or treat it!

llg, PhD, RN · Feb 1, 2005

I went to nursing school (generic BSN program) many years ago -- and didn't take a non-nursing A&P course as a pre-requisite course. It wasn't a pre-req. The nursing school had it's own courses in the sophomore year that combined the essentials of anatomy, physiology, pathophysiology, nutrition, and pharmacolgy into 2 integrated courses. That way, we never wasted time memorizing bones and muscles, chemicals, etc. in ways that were not useful to nurses. All of the material was presented in ways that emphasized their use for patient care. When students take those courses outside the department of nursing, a lot of time is invested learning material from a perspective that is not necessarily helpful for the nurse. We received the material in a way that promoted its relevance to our chosen profession and practical application.

I still think that is the best way to teach that content. Unfortunately, that is not always possible in 2 + 2 programs and/or ADN programs.

llg

Maxs · Feb 14, 2005

Well, I loved science classes, that's where I got all my A's from (a turbocharger for my GPA cause they were 5 semester hour each). I also tutored in these courses to some of my collegues. I found out that even though it was easy for me to grasp the material, it wasn't as easy for my friends. You can say it will take them days to figure every new function (physiology & anatomy) or rule/laws (chemistry & biology) in science courses. So, reteaching may sort of aggravate some staff members who have set such courses as prerequisites before admission (basically a curriculum). If reteaching is to take place, then I am sure that the students who highly posses in science courses will be preferred in admission to Nursing Schools. (good for me, but I am not selfish). I don't think that's mutual because there are people who are book smart (they know how to crack a test).

The solution is; you don't have to reteach it, but you can make text books that are viable and contain only the necessary information (this will be impossible for all nursing textbooks because of all the laws and regulations required by the government to be listed in their textbooks, maybe that's why they make text books that have 6.23 x 10 to the 23rd power of pages). As you can see, the instructors are very limited in time (very critical). This should make it clear that the instructors cannot review science materials due to the time limit (and mainly that's not their major). I am sure some nursing instructors are as creative as any chemistry, math, biology and english(one) teacher I have encountered with.

Even when you take organic chemistry, you first review inorganic on the first chapter, so the same applies with biology and etc. If nursing teacher's do not want to reteach, then they should make handouts (you don't have to go over the handout) of the materials that students must know in order to understand the preceding work.

Then instructers have to be compassionate about what they teach, and mainly make their students aware of what they want them to know inside out (even if it's 6.23 x 10 to the 23rd power of pages of work), it atleast gives your students confidence, which has a factor that can be multiplied at 6.23 x 10 to the 23rd power strength. So basically here is how it should go in order to satisfy both parties.

For instance, if chapter three is about the cardiac treatment, medication, diseases & etc, there should be a chapter two prior to chapter three reviewing the structure and function of the heart, mainly focusing on the parts you want the students to know. I know I got a carried away a little and I apoligise, but this is the only way to let some of the instructors (I can't stand the guts of those who think they're all thaaaaaat)! know, how we as students should be tought. Rhyme = Put some nut and gut together. LOL!

Sincerely,

Maxs

Maxs · Feb 14, 2005

Another way to consider the question is - how many times does a student get taught something before they learn it.... and then how many times do you need to learn something before you understand it. From my archives of memory - memorizing 101 different muscle and nerve names to get through my A&P exam did nothing other than get me through my exam.... It was only while scouting (while and undergrad) during a hip operation and observing muscle tissue being opened up and the ball being measured and placed did the understanding of the of the functional value sound muscle tissue about a joint really hip home.
I am not saying that we only learn through personal exeriences - but I am saying that until we as teachers are able to give relavance to our material - students will not truely understand the information. In Highschools you teach a topic at least 3 times before the majority of students grasp it - with tertiary students we expect that students will have a higher vested interest in ther learning - but this will still be limited by the percieved relevance of the information to the student. (ie a student will take the attitude that the doc orders the med and I give it - provided it is a legal and valid order - until the student understands their role as a patient advocate mandates that they understand why and if that ordered med is appropriate for the patient.
So to the original theme - should you reteach A&P - the answer is open ended - but yes some material presented initially will inevitably be retught to ensure student learning has occured.
(In a clinical setting you don't presume someone can do a catheterization because they are an RN - they must first show that they are capable)

No offense, but I bet your one hella of an instructor.

carolynd · Feb 21, 2005

It has been my experience that many students need to refresh their A & P yet the curriculum is already so full I frequently see reteaching as unnecessary. I have found a focused worksheet to be helpful. Most nursing textbooks have a chapter on A & P prior to the system and that can be assigned as a part of the student reading which is not covered specifically in class. One thing for sure - we simply can't teach it all and still be effective - students must be responsible for previously learned material.