Integrative Metabolism: An Interactive Learning Tool for Nutrition, Biochemistry, and Physiology

By Gale Carey

Metabolism is a dynamic, simultaneous, and integrative science that cuts across nutrition, biochemistry, and physiology. Teaching this science can be a challenge. The use of a scenario-based, visually appealing, interactive, computer-animated CD may overcome the limitations of learning one pathway at a time and engage two- and four-year college students in a deep understanding of integrative metabolism.

etabolismchemical reactions in the human body that stash away birthday cake as fat on the hips, convert scrambled eggs into a protein in the liver, or transform chemical energy into fuel for exercising musclesis a topic that integrates nutrition, biochemistry, and physiology. I teach this topic each fall to upperlevel science students at the University of New Hampshire and typically do so the way I have been taughtone metabolic pathway at a time. And typically, by the midpoint of the course, pathways covered on exams 1 and 2 have been long forgotten and replaced by this weeks metabolic pathway. This is not uncommon; the amount of information about metabolic pathways can be overwhelming (Schultz 2005). But teaching intermediary metabolism

within a physiological framework, in combination with technology, has been shown to facilitate effective student learning and retention of metabolic pathways (Schultz 2005; Watford 2003). So I wondered: could I develop a technology tool that would not only place metabolic pathways within the context of everyday activities, but also reveal metabolism as it operates in the body (integrated, simultaneous, and dynamic) rather than as it appears on a PowerPoint slide (linear, step-wise, and static)? Technology provides the opportunity to incorporate active, deep, and self-regulated learning into the sciences (Azevedo 2005; Snyder 2001). Computer-based learning environments have been shown to provide scaffolding for deep inquiry and refine strategies of metacognition (Graesser, McNamara,

and VanLehn 2005; Teoh and Neo 2007). For example, using technologyenabled active learning to teach electromagnetism, Dori and Belcher have increased their students conceptual understanding and retention of electromagnetic phenomena (Dori and Belcher 2005a, 2005b; Dori et al. 2007). So I set out to use technology to help students see the metabolic pathways that reside in the liver versus the brain versus the fat tissue. I wanted them to see that metabolic pathways operate 24/7with some very active while others are asleep. I wanted them to interact with the pathways, making informed guesses about the activity of these pathways depending on what they chose to eat for breakfast. Using Gagnes nine events of instruction (Gagne, Briggs, and Wager 1992) and the notion that natural learning is goal directed, failure driven, and case based, I created a computer-animated, interactive learning tool for teaching integrative metabolism.

Methodology Creating the integrative metabolism tool

The tool was created with two overarching principles: (1) that it empha-

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size the simultaneous and integrated nature of metabolism and (2) that it be engaging. To engage students, I wanted a multimedia approach: video, animation, graphics, music, text, interactivity, and voice. For content, I chose to focus on carbohydrates, from their entrance into the body (eating) to their exit (metabolism to carbon
FIGURE 1 Which breakfast did each student eat? Users are prompted to choose a breakfast from the waitresss tray and drop it onto a students photo.

dioxide). I envisioned a drill-down approach, in which the user could go from broad (eating) to deep (allosteric regulation of a regulatory enzyme) or anywhere in between, using a table of contents. And I envisioned flexibility, in which the user could see the impact of their food choices at both the broad and deep levels.

In collaboration with the medical illustration and design team at Link Studio (Baltimore, MD) and using Gagnes nine events of instruction (see Table 1), we created the tools architecture and navigational flow and designed the 144 screens that would comprise the final product. During this time, 29 University of New Hampshire students participated in two user tests to identify the optimal look, feel, design, and navigation of the interface (see note).

Using the tool

FIGURE 2 Users can watch the digestion of a chosen breakfast into carbohydrate, fat, and protein.

The users attention, grabbed quickly with music and color, is focused on the learning objectives of the tool, thereby addressing the first two of Gagnes events of instruction (see Table 1). Next, the user is presented with four video vignettes of typical, college-age students. Each vignette ends with the student at a different level of energy. A waitress appears on-screen with four breakfast choices; the user is asked to guess which breakfast meal the student ate two hours earlier by dragging and dropping a breakfast meal icon onto the students picture and then receives text and audio feedback about his or her selection (see Figure 1; Table 1, Event 6). Next, the user follows the digestion of his or her chosen breakfast, the absorption of glucose from the breakfast into the bloodstream, the hormonal response of the body to the change in blood glucose, the metabolic pathways that utilize glucose in liver or adipose tissue, the rate-limiting enzymes for each metabolic pathway, and the mechanisms that controlled the rate-limiting enzymes of the metabolic pathway of interest (see Figures 2 and 3; Table 1, Events 3, 4, and 5). This fantastic voyage approach provides a colorful experience for the user, utilizing eye-appealing computer graphics, catchy music, and upbeat voiceover (available in sound and/or text). Along the journey from mouth to molecules, the user is asked to make predictions by dragging and dropping icons (see Table 1, Event 6).
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At any point in the journey, the user can change breakfasts and see the impact of his or her choice, even at the molecular level (see Table 1, Event 9). Last, queries are sprinkled throughout the tool that test the users ability to transfer knowledge to a new situation, and the user is provided with immediate feedback (see Table 1, Events 7, 8, and 9). For example, students are asked to choose one of three blood glucose curves that best represents absorption of glucose from a sugar-coated cereal rather than a high-fiber cereal.

Evaluating the tool

Evaluation of the tool was driven by three questions: Is the tool welldesigned for student use? Does the tool improve immediate comprehension? Does the tool promote deep comprehension? The evaluation was conducted with three audiences using formative and summative surveys, exam scores, and journals. The first audience was an Anatomy and Physiology class in a two-year community college setting (represented as 2 Year in subsequent sections and figures). Students (n = 7) were
TABLE 2 Student user quotes.
It really helped to see the visual process of what I was learning. It allows you to see how each process fits into the big picture. It helped me understand how all the concepts and pathways fit together and work with each other. It tied together loose ends and gave me another varied way to study. It made learning fun. Its an autocorrect system where you immediately know if you dont understand a concept. It forces you to give answers, make a decision, and have the opportunity to be wrong. It allowed me to be engaged with what I was learning.

presented with three class sessions on metabolism, asked to use the CD outside of class to strengthen their understanding of metabolism, and asked to complete a summative survey. The second audience was a Teaching Science class at the University of New Hampshire (represented as Sci. Ed. in subsequent sections and figures). Students (n = 14) met for three 30-minute class sessions. The first two sessions were dedicated to discussion of glucose metabolism. After the second session, students were randomly assigned to one of two groups (CD users or text users, n = 7 per group)
TABLE 1

and provided with either the CD or text material. Students were asked to study a list of knowledge questions and one analytical essay question, as defined by Blooms taxonomy, using either the CD or text in preparation for an exam the following week. At the third session, students completed an exam (26 knowledge questions and the same analytical essay question) that assessed their understanding of glucose metabolism and then were asked to complete a summative survey. The third audience was my Nutritional Biochemistry class at the University of New Hampshire (represented as

Gagnes nine events of instruction (Gagne, Briggs, and Wager 1992).

Event number 1 2 3 4 5 6 7 8 9 Event description Gain attention Inform learners of the objectives Stimulate recall of prerequisite learning Presenting the content Providing learning guidance Eliciting the performance Providing feedback Assessing performance Enhancing retention and transfer

FIGURE 3 Does your breakfast increase or decrease the major metabolic pathways of the liver? Users can go deeper into each pathway to learn the details.

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4 Year in subsequent sections and figures). Students (n = 70), all of whom were majoring in nutrition or animal sciences, were given the CD at the outset of the semester. All were asked to use the CD outside of class and complete a summative survey at the end of the semester; a total of 57 surveys were returned. This research was approved by the University of
FIGURE 4 Students rate the tools design features from low (1) to high (5). Sci. Ed. = students enrolled in a Teaching Science class; 2 Year = students in an Anatomy and Physiology class at a 2-year community college; 4 Year = students in a Nutritional Biochemistry class at a 4-year university.
Design and navigation vs. other science CDs. Sci. Ed. 4 Year 2 Year 1 2 3 4 5 1 2 3 4 5 Is the CD easy to navigate?

New Hampshire Institutional Review Board #3286. The summative survey consisted of 21 questions. Fourteen questions asked the student to circle the appropriate number on a 1-to-5 Likert scale accompanied by three verbal anchors (1 = most negative response, 3 = average, 5 = most positive response). For example, the verbal anchors for Is

the Integrative Metabolism CD easy to navigate? were 1 = very difficult, 3 = typical, and 5 = very easy. Seven questions asked the student to check either yes or no; for example, As a result of using the CD, has your comfort with scientific terminology improved? Mean + standard deviation for each question was calculated for the three audiences.

Is design layout uncluttered? Sci. Ed. 4 Year 2 Year 1 Low 2 3 4 5 High

Is the music appealing?

1 Low

4 High

FIGURE 5 Percentage of students responding Yes to questions addressing the tools three learning objectives. Sci. Ed. = students enrolled in a Teaching Science class; 2 Year = students in an Anatomy and Physiology class at a 2-year community college; 4 Year = students in a Nutritional Biochemistry class at a 4-year university.
After using the CD, are you better informed to make personal nutrition choices? Sci. Ed. 4 Year 2 Year 0 20 40 60 80 100 0 20 40 60 80 100 0 20 40 60 80 100 After using the CD, do you have a deeper understanding of why liver enzymes are influenced by breakfast? After using the CD, has your comfort with science terminology improved?

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The 26 knowledge questions on the exam for the Sci. Ed. class consisted of 13 fill-in-the-blank questions (e.g., The ______(pick an organ) can make glucose while the ______(pick an organ) can burn glucose for energy) and 13 matching questions (e.g., The product of this enzyme is glucose). The analytical essay question was How does the liver ensure that glucose is metabolized after you eat a high carbohydrate meal, yet it is synthesized while you are sleeping? Please explain this from the perspective of liver metabolic pathways and enzymes. Students were asked to please provide an answer to this question with as much detail as you can muster. I graded the exam with the students name and group assignment listed at the top of the page. Because I was not blinded to either piece of information, this could have introduced unintended bias into the grading. Mean scores for the knowledge and essay questions were calculated as mean + standard deviation, and scores for CD users versus nonusers were compared via t-test, with P < .05.

FIGURE 6 Percentage of students responding Yes to questions addressing the tools three learning objectives. Sci. Ed. = students enrolled in a Teaching Science class; 2 Year = students in an Anatomy and Physiology class at a 2-year community college; 4 Year = students in a Nutritional Biochemistry class at a 4-year university.
Sci. Ed

4 Year

2 Year 0 20 40 60 80 100

FIGURE 7 Students rate the tools ability to provide motivation to learn. Sci. Ed. = students enrolled in a Teaching Science class; 2 Year = students in an Anatomy and Physiology class at a 2-year community college; 4 Year = students in a Nutritional Biochemistry class at a 4-year university.
Sci. Ed

Results and discussion Is the tool well designed for student use?

4 Year

2 Year 1 2 3 4 5

The mean student rating for the CDs design, navigation, and music is shown in Figure 4. Note that verbal anchors were presented with responses 1, 3, and 5 on the surveys, as described in Methods, but for ease of presentation Figure 4 uses Low and High. The mean design scores ranged from 3 to 4.3. There was significant variability in the responses, however, and this variability was as high for the large sample (4 Year, n = 56) as it was for the smaller samples (Sci. Ed. and 2 Year, n = 7 for each). The three learning objectives for the CD were to improve a students ability to (1) make informed, personal nutrition choices; (2) achieve a deep understanding of the bodys metabolic biochemistry; and (3) become comfortable with scientific terminology. When students were queried for their opinion
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No, not at all

Yes, very much

FIGURE 8 Number of correct answers on 26 knowledge questions for CD users versus nonusers (all were Sci. Ed. students).
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# Correct (max=26)

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CD Users

Nonusers

Integrative Metabolism
FIGURE 9 Students rate the tools ability to reinforce understanding of intermediary metabolism concepts. Sci. Ed. = students enrolled in a Teaching Science class; 2 Year = students in an Anatomy and Physiology class at a 2-year community college; 4 Year = students in a Nutritional Biochemistry class at a 4-year university.
Sci. Ed

as to whether these objectives were achieved (answering yes or no), an average of 84% of students responded yes (see Figure 5).

Does the tool improve immediate comprehension?

4 Year

2 Year 1 2 3 4 5

No, not at all

Yes, very much

FIGURE 10 Percentage of students who answered Yes to the question After using the tool, could you follow the rate of a breakfast that wasnt presented, like oatmeal with raisins? Sci. Ed. = students enrolled in a Teaching Science class; 2 Year = students in an Anatomy and Physiology class at a 2-year community college; 4 Year = students in a Nutritional Biochemistry class at a 4-year university.
Sci. Ed

An average of 87% of students felt that the tool was useful for their learning (see Figure 6) and that the CD provided above average motivation to learn (see Figure 7). However, there was no significant difference in scores on the knowledge questions in the exam administered to the Sci. Ed. class, although the small sample size limits the interpretation of this finding (see Figure 8). It is interesting to note, however, that the standard deviation reflects substantial variation in the scores of the CD versus text users (12.0 + 7.9 vs. 11.9 + 3.0, respectively). Again, although the small sample size renders limited interpretation of these data, the variation suggests that among the CD users, some students may have benefited from using the CD whereas others did not and were left without printed material to use as back up.

4 Year

Does the tool promote deep comprehension?

2 Year 0 20 40 60 80 100

FIGURE 11 Score on a 4-point synthetic, integrative essay question for CD users versus nonusers (all were Sci. Ed. students). *indicates significant difference from Nonusers, P < .05.
4

Points (max=4)

CD Users

Nonusers

CD users in all classes were of the opinion that the tool was average or above in reinforcing their understanding of intermediary metabolism concepts (see Figure 9) and felt that it enhanced their ability to transfer knowledge to new situations (see Figure 10). The most striking finding was that, despite the limited sample size, the CD users in the Sci. Ed. class had a significantly higher score on the analytical essay question compared with the nonusers (see Figure 11). Of the seven CD users, two had extensive detail in their answers, were able to describe metabolic pathways accurately, and used the language of metabolism appropriately; two had less detail but the overall concepts were intact and language of metabolism was used appropriately; and three had generalized answers
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Integrative Metabolism
with intact concepts but lacking detail. None of the answers contained errors in content. In contrast, in the nonusers group, none of the answers contained metabolic pathway or enzyme details, one used the language of metabolism appropriately, and four had significant errors in content. Although it is well accepted that computers alone do not invoke learning (Stanton, Porter, and Stroud 2001; Steinberg 2000) and that problem-based active learning is crucial (Schultz 2005), computer animation can promote learning while it engages students (see Table 2). This project suggests that the use of a visually appealing, interactive, computer-animated tool grounded in case-based scenarios and Gagnes nine events of instruction may promote deep understanding of integrative metabolism. Replacing shallow knowledge of metabolic pathwaysmemorized names of enzymes and metaboliteswith deep comprehension about that pathways regulation and enhancing a students ability to apply this understanding to new and practical situations are consistent with the National Science Education Standards and teach for depth of understanding rather than recall of scientific facts. Although instructors who teach biochemistry from a nutrition or metabolic perspective may not have the resources or inclination to customdevelop such a tool, the use of existing web-based, interactive animations can be useful alternatives for engaging students in a deep understanding of integrative metabolism. these exciting tools may be useful adjuncts to the integrative teaching efforts of science educators. n Acknowledgments
I am grateful to the National Science Foundation for Educational Materials Development Grant 147223 that funded this project; to Michael Linkinhoker and Aline Lin of Link Studio for giving professional life to my ideas; to Terri Winters; to Mike Giordano and Joe Danahy of the University of New Hampshire Academic Technology team for their unwavering support in the early phases of this project; and to George Carey for his technical help, emotional support, and keen guidance that made working on this project so enjoyable. Visualization in science education, ed. J.K. Gilbert, 187216. Dordrecht, the Netherlands: Springer. Dori, Y.J., E. Hult, L. Breslow, and J.W. Belcher. 2007. How much have they retained? Making unseen concepts seen in a freshman electromagnetism course at MIT. Journal of Science Education and Technology 16 (4): 299323. Gagne, R.M., L. Briggs, and W. Wager. 1992. Principles of instructional design. Fort Worth, TX: Harcourt Brace Jovanovich. Graesser, A.C., D.S. McNamara, and K. VanLehn. 2005. Scaffolding deep comprehension strategies through Point&Query, AutoTutor, and iSTART. Educational Psychologist 40 (4): 225234. Schultz, E. 2005. A guided discovery approach for learning metabolic pathways. Biochemistry and Molecular Biology Education 33 (1): 17. Stanton, N.A., L.J. Porter, and R. Stroud. 2001. Bored with point and click? Theoretical perspectives on designing learning environments. Innovations in Education and Teaching International 38 (2): 175182. Steinberg, R.N. 2000. Computers in teaching science: To simulate or not to simulate? Physics Education Research, American Journal of Physics Supplement 68 (7): S37S41. Snyder, K. 2001. An assessment of the role of computer technology in the classroom (ERIC Document Reproduction Service No. ED 453727). Teoh, B.S., and T. Neo. 2007. Interactive multimedia learning: Students attitudes and learning impact in an animation course. The Turkish Online Journal of Educational Technology, 6 (4): article 3. Watford, M. 2003. The urea cycle: Teaching intermediary metabolism in a physiological setting. Biochemistry and Molecular Biology Education 31 (5): 289297. Gale Carey (gale.carey@unh.edu) is a professor in the Department of Molecular, Cellular and Biomedical Science at the University of New Hampshire in Durham.

Note
The design and all of the elements, including the animations and menus, were created in Macromedia Flash. The artwork was created in Adobe Illustrator with modifications made in Flash. A professional voice artist recorded the voiceover while the music was purchased as stock tracks from a sound studio. University of New Hampshire provided the digital video. Flash was then used as a compositing program to combine all of the elements including the illustration, video, photography, music, voice-over and programming. Actionscript, a native Macromedia Flash scripting language, and XML were used to integrate all of the interactive components.

References
Azevedo, R. 2005. Using hypermedia as a metacognitive tool for enhancing student learning? The role of self-regulated learning. Educational Pyschologist 40 (4): 199209. Dori, Y.J., and J.W. Belcher. 2005a. How does technology-enabled active learning affect undergraduate students understanding of electromagnetism concepts? The Journal of the Learning Sciences 14 (2): 243279. Dori, Y.J., and J.W. Belcher. 2005b. Learning electromagnetism with visualizations and active learning. In

Conclusion

A scenario-based, integrative, computeranimated learning tool that extends student learning beyond the knowledge category of Blooms taxonomy may be useful for engaging two- and four-year college students in a deep understanding of metabolism that integrates nutrition, physiology, and biochemistry. Websites, publishers online learning centers, and CDs bundled with textbooks that provide
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