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Table 4 Coding of a representative example of a summative final wiki assessment

From: An innovative pharmacology curriculum for medical students: promoting higher order cognition, learner-centered coaching, and constructive feedback through a social pedagogy framework

Bloom’s Cognitive Taxonomy

Conceptual Framework Elements

Pharmacodynamics Excerpts from a representative Summative Wiki

Remember

- identify, explain, define, recall, recognize, describe

Distribution

“GABA (ɣ-aminobutyric acid) is a neurotransmitter widely distributed within the central nervous system, and represents the major element in neuronal inhibition (Julio-Pieper et al. 2013)...”

Comprehend

- relate, categorize, explain

Evaluate

- searching, supporting, convincing

Drug-Receptor Interactions

Synthesize

- composing, wiki-building

Remember

- identify, explain, define, recall, recognize, describe

Drug-Receptor Interactions

“…There are two main GABA receptors within the brain: GABAA and GABAB. GABAA is the most well-studied of the two. It is a ligand-gated chloride ion channel expressed on the post-synaptic side of the cleft, with orthosteric and allosteric binding sites. With GABA release from the pre-synaptic terminal, and binding to GABAA, the Cl channel is activated and Cl enters the neuron, effectively hyperpolarizing the membrane and increasing the threshold for action potential generation…”

Evaluate

- assess, consider

Drug-Response Relations

Synthesize

- composing, wiki-building

Comprehend

- relate, associate, contrast

Drug-Receptor Interactions

“…Unlike GABAA, GABAB is a G-protein-coupled receptor. GABA signaling here decreases calcium conductance, inhibits cAMP production, increases K+ efflux – the net effect of which will hyperpolarize and reduce the frequency of post-synaptic action potentials (Kumar et al. 2015. Neuropharmacology. 97:414–425)…”

Evaluate

- searching, supporting, convincing

Drug-Response Relations

Synthesize

- composing, wiki-building

Analyze

- appraising

Drug-Response Relations

“…by triggering the inhibitory effects of GABAergic neurons in the central nervous system, the GABA added to Dream Water could potentially exert anxiolytic and myorelaxant effects (Richard and Foster 2003; Chou et al. 2008; Mazzoli et al. 2010)…”

Evaluate

- hypothesizing

Synthesize

- composing, wiki-building

Bloom’s Cognitive Taxonomy

Conceptual Framework Elements

Pharmacokinetics Excerpts from a representative Summative Wiki

Remember

- explain, recall, describe

Elimination – Metabolism & Excretion

“…After exerting its function within the synaptic cleft, GABA experiences reuptake, whereby the presynaptic terminal and surrounding supporting glia cells reabsorb it in an exchange with sodium. The GABA which is reabsorbed by the neuron can be reused, while the GABA reabsorbed by the glia is metabolized to succinic semialdehyde and must be regenerated by GAD. (Cherlyn et al. 2010; Femenía et al. 2012)…”

Comprehend

- relate, associate, contrast

Evaluate

- searching, supporting, convincing

Synthesize

- composing, wiki-building

Comprehend

- relate, associate, contrast

Absorption

“…Exogenously administered GABA, as in the case of Dream Water, would be subject to the challenges of absorption, distribution, metabolism, and excretion, as any exogenous substance is. GABA’s capacity to traverse the blood-brain barrier (BBB) is controversial (Boonstra et al. 2015). The bulk of evidence supports the impermeability of BBB to GABA, although Boonstra et al. (2015) report that “BBB permeability to GABA could diminish with increasing age.” In addition, mouse model studies have demonstrated evidence of GABA-facilitated transport across the BBB; however, measurements of GABA efflux were 17x greater than GABA-facilitated influx (Kakee et al. 2001). The presence of equivalent GABA transporters in the human blood-brain barrier has yet to be established. Moreover, Knych et al. (2015) demonstrated in a horse animal model that exogenous oral GABA – with a half-life of 25 min, bioavailability of 9.8%, and urine concentration peaking at 3 h – had no discernable behavior effect. This means that half of the given GABA had been metabolized within 25 min, and that of all of the GABA administered, only 9.8% was available as active within the body. Given that no behavioral changes where seen with exogenous oral GABA, but was with IV, it appears that it did not appreciably enter the cerebrospinal fluid to exert its effects…”

Apply

- applying, judging

Bioavailability

Evaluate

- searching, supporting, convincing

Distribution

Synthesize

- composing, wiki-building

Elimination – Metabolism & Excretion

Elimination – Clearance & Half-life

Apply

- judging, determining

Drugs and the Blood-Brain Barrier

“…Therefore, the ultimate benefit of the GABA added to Dream Water may be in question. A Phase I clinical trial to study exogenous GABA in humans is currently recruiting participants (https://clinicaltrials.gov/ct2/show/NCT01917760)…”

Evaluate

- assessing, concluding

Peripheral Restriction of Drugs

Synthesize

- composing, wiki-building

  1. Coding of a single, representative example of a summative final wiki assessment with respect to Bloom’s cognitive taxonomy and pharmacological conceptual framework elements