Research Article

Technological and Traditional Drawing Approaches Encourage Active Engagement in Histology Classes for Science Undergraduates
Barbara Cogdell1, Ben Torsney2, Katherine Stewart2 and Robert A. Smith1
School of Life Sciences, University of Glasgow; 2School of Mathematics and Statistics University of Glasgow.
1

Date received: 2/8/2011

Date accepted: 21/12/2011

Abstract In order to promote more active engagement of science undergraduates in histology practical classes some technology-based innovations were introduced. First, an interactive pre-lab tutorial was set up using an electronic handset voting system, where guidance on tissue analysis was given. Second, a web-based resource where students could access photomicrographs of tissues, practice formative assessment tasks and review the information from the pre-lab was produced. When the impact of the innovations was evaluated. Both were received very favourably by the students and they improved the general perceptions of the course. In both the pre-lab and web resource it was emphasised to the students that they should make sketches of the photomicrographs. Our hypothesis was that drawing would strongly enhance the students engagement with the practical material and that they would observe the photomicrographs more thoroughly if they drew them. This idea was confirmed as the students who drew achieved significantly higher scores (p-values in all cases <0.05) in their subsequent practical assessments. In 2004, for example, their percentage scores exceeded those of the students who did not draw by between 5.9% and 18.6%. Drawing was always a part of histological courses in the past and our study illustrates that, although introducing new technology may be beneficial, traditional teaching methods should not be rejected without careful consideration. Keywords: Histology, education, evaluation, Personal Response System, web-based resource, computer assisted learning

Introduction
The practical teaching of histology in universities has undergone a major revision over the past decade. The traditional method, where students spent many hours analysing prepared microscope slides and recording their observations by producing labelled drawings (Cotter, 2001; Jacyna, 2001), is a luxury that can no longer be afforded. Large student numbers and lack of resources such as staff, equipment, funding, space and time have necessitated the introduction of alternative methods. The modern trend in histology is to use computer-aided learning and virtual microscopy (Bloodgood and Ogilvie, 2006; Cotter, 2001; Paulsen et al., 2010; Sandberg, 2003). Virtual microscope technologies have been widely described (Glatz-Krieger et al., 2006; Harris et al., 2001; Heidger et al., 2002; Kumar et al., 2004; Mills et al., 2007; Triola and Holloway, 2011) and students are positive towards their use (Harris et al., 2001; Kumar et al., 2006; Mills et al., 2007). A number of studies have evaluated student performance using these new technologies, and in general students achieve similar or better results than those taught using conventional microscopy (Husmann et al., 2009; Koch et al., 2009; Krippendorf and Lough, 2005; Scoville and Buskirk, 2007; Triola and Holloway, 2011). None of these studies examined
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whether students made drawings while studying with the new technologies, or whether this impacted student performance. In 1996, a basic one-semester 10 credit histology course, Human Tissues in Health and Disease was introduced in year 2 at the University of Glasgow following a major reorganisation of biology teaching. The course is available to any of our 600 qualified science students, and is generally well received, by the (typically) between 250 and 350 students enrolled upon it. The resources provided for the course are restricted to on average 1200 a year to cover all running costs including hourly-paid staff and student handouts. Students normally study 50 credits of other courses alongside this one and so the practical time allocated to the course was restricted to two 2 hour laboratory sessions which meant that elaborate practical work was not possible. The practicals introduced aimed to enable recognition of normal morphology at the microscopic level and to compare this with that of pathological specimens. Appreciation of the different stains used in tissue preparation, and identification of the four basic tissue types - epithelial, connective, nerve and muscle was also stressed. Initially, high quality photomicrographs were selected and organised on poster-boards together with text describing their most salient features. The poster-boards were divided into two sets of seven, with each set displayed for a whole week for each practical. During that time the students studied the photomicrographs and expanded their knowledge-base from that delivered in the lecture course. They were free to attend whenever they wished during the week and could spend as much time as they wanted and many returned on more than one occasion. Demonstrators were available at advertised periods during the week to answer any student queries. Posters are not the ideal way to teach histology, since students do not learn the practical skill of using a microscope. The area of study and magnification are also selected for them. Even so, poster-boards do have a number of advantages: They are a convenient way to display carefully selected, high quality micrographs. Unlike slide shows, students may spend as long as they wish on the material. Many students can attend the lab at the same time. Students are not hampered by being unable to use a microscope correctly. Poster-boards do not require a special laboratory. The practicals do not need intensive staffing, and require minimal technical support. Once produced the posters are inexpensive to maintain. The poster-boards alone however, proved less effective than we hoped as demonstrated by the poor student feedback during the initial years after their introduction. For instance, course evaluation questionnaires and staff-student committee meetings revealed that a large number of students spent much time copying down all the text rather than focussing on the images, which detracted from the practical and reduced the level of satisfaction. Typical responses suggested that: Practicals incredibly dull, The laboratories were a bit boring and that they took hours and hours. Clearly there was a need to improve the practicals. Unfortunately the only way to acquire good interpretive skills is by careful observation of examples of tissues which takes time and effort, in order to determine similarities and differences. Poster-boards promoted superficial learning and produced a very passive learning style (surface learning). It is our hypothesis that students study histology better when they actively engage with the practical material, and in particular make drawings. We therefore modified the delivery of histology by incorporating two new technological innovations, namely an interactive pre-lab tutorial using a handset voting system and a web-based resource, into our basic course to
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address the issues of engagement and encourage drawing. A major part of the web-based resource incorporates guidance on how to get the most from the practical sessions in order to improve the learning experience, with emphasis on the advantages of making drawings or sketches thereby encouraging close observation of the material. This paper describes these innovations and how their effectiveness was evaluated.

Methods
Handset voting systems in the pre-lab session In 2000, a pre-lab tutorial session was introduced on how to prepare for the practical sessions. The lecturer projected slides and encouraged an analytical approach to study by reviewing the main features of the tissues and asking relevant questions on each. The class proved very reluctant to respond, and even if a few students did attempt to answer, the majority remained silent. Fortunately, in 2002, the Universitys Psychology Department piloted the use of electronic voting systems in lectures (Draper and Brown, 2004), which provided a means of involving all students (Caldwell, 2007; Kaye and Lesage, 2009). Handset technology facilitated the conversion of the pre-lab session into an interactive Ask the Audience format as used in the television program Who wants to be a Millionaire? (Cogdell and Smith, 2004; Smith and Cogdell, 2006) and ensured that students actively engaged in this pre-lab session. The system currently used is the Interwrite Personal Response System available from eInstruction-Banxia Software. It consists of radio-based handset transmitters resembling small TV remotes, which are distributed to the students as they enter the lecture theatre. The receiver plugs into a USB port of a computer onto which the Interwrite software has been installed. The setting up of the equipment can be completed in less than 5 minutes. The software allows integration of the response system with PowerPoint. A photomicrograph can thus be projected together with an appropriate multiple choice question, and the students votes collected by the same programme. The students responses are anonymous. Anonymity is important as it encourages reluctant students to answer without fear of ridicule from the lecturer or fellow students. It takes about two minutes for an audience to vote and so typically between 10 and 20 questions can be asked in a session. Once the votes have been collected, the number choosing each option is displayed in a bar chart on the screen. If the students answer correctly the lecturer can continue with the next question, while if students select an incorrect option he can explain why this is wrong. Likewise students receive instantaneous personal feedback of where they stand in relation to the rest of the class.

Web-based resource
In 2001, advice about the merits of making drawings was linked to the Learning Resources page on the course website, prior to the laboratory sessions, in order to encourage students to interact more with the material presented in the laboratory sessions. The following web pages were available: 1. Introduction to practical sessions 2. Why are posters used? This gives the aims of the practicals, and details of why posters are used to present the material. 3. How to get the most out of your practical session? This advises on the format and how best to approach the practicals. 4. Tips for making sketch drawings from posters

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5. Example of a sketch made from a photomicrograph. This is a deliberately simple drawing so as not to discourage those students lacking drawing skills. This is important as lack of skill may prevent the use of this learning technique (Freeman et al., 2002). The sketch is fully labelled however, as this is an important skill to develop.) 6. Tissue analysis guidelines and notes on stains. This includes the major stains encountered on the course and which tissues or tissue components they highlight. The benefits of making sketches were also stressed during the pre-lab sessions. By using the website and attending the pre-lab session therefore students obtained information about the practical beforehand and were better prepared about what to expect. During the 2002-2003 session we received an award from the University of Glasgows Learning and Teaching Development Fund, which enabled us to significantly develop the website by adding the text from both practicals and the photomicrographs from the second practical together with other self help material. The second lab was chosen since previously the students had found it more difficult. This strategy also meant we could compare the reaction to practical 2 and its improved web resource with that to practical 1. Each photomicrograph was scanned and loaded into an individual web page together with its corresponding text. Pages were made of the photomicrographs as small thumbnails which were linked to the corresponding full size image. Another page for each board contained both text and thumbnails linked to the full sized images. A third page was made with just the text. An index page was used for ease of navigation with links to the three pages for each poster board. In the first two years that the micrographs were available, we were concerned that the students would just download these and spend little time actually in the practical. For this reason we only mounted the text before the practical so that students could print this for use in the laboratory, rather than wasting time merely copying it from the boards. Instead they were encouraged to take a more active strategy in making sketch drawings, and benefit from instruction from available staff, thereby improving their learning potential in the laboratory session. At the end of the week in which the practical ran, all photomicrographs were added to the website for revision purposes. In later years all the material was available at the beginning of the practical. The second part of the resource allowed the students to carry out self-assessment exercises on their abilities to identify tissues. The exercises included: Labelling a photomicrograph (figure 1a), where students could compare their answer with the example provided. Assessing examples of good and bad drawings. A series of examples of drawings were scanned so that students could to test their skills in assessing these (figure 1b). A link was made to a page with the same drawings including corrections and labels added by staff. They were then asked to grade and rank the drawings in order of merit. Another link gave a brief staff commentary on each drawing together with the grade allocated (figure 1c). Thus the students could compare their own assessments with the opinions of the staff. The emphasis was that drawing skills were not being assessed but the ability to represent the salient features of the photomicrographs and label them correctly. An example of the type of written assessment at the end of practical 2 for students to use as a self test.

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a)

Section 1 (20 minutes): Assessment exercise

Study this micrograph of sectioned trachea carefully. Make a sketch diagram, and add labels precisely by using straight arrows. [CORRECT LABELLING]: Labels to be added:
Mucosa Submucosa Adventitia C-shaped cartilage Glandular secretory endpieces Perichondrium Goblet Cells Adipocytes

b)
Examples of students' sketches of the trachea Look at these sketches and decide if they were correctly labelled. Click here for [CORRECT LABELLING] Also decide if they are good representations taking into account the scale of the various structures. Click here [MARKED SKETCHES] to see how they were marked.

c)
Staff feedback on student sketches The ranking of the sketches from excellent to awful is:

EDBACF

Sketch A was given a score of 5. Probably the best drawing of the six to scale and looks like the actual micrograph. Apart from the odd crossed line, it is very presentable. However, its labels let it down no matter how good it is, if a diagram is badly labelled it is not helpful. The marker remains unconvinced that the student knew exactly where the submucosa should be unclear label. Take care in labelling if you want to get good marks on this exercise.

Figure 1 Examples of pages from the web resource: a) the start of the assessment exercise; b) two students sketches for other students to evaluate; and c) staff feedback on a students sketch. The labels to be added referred to at the bottom of figure 1a are the same as the labels shown on figure 1b beside the students sketches.

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Assessment of practicals
When the module was introduced, the first practical was assessed by a short-answer quiz and the second by writing a brief summary of the material on one of the poster boards. The quiz was easy for staff to mark, but it encouraged superficial learning since it could be completed by quickly scanning the boards for the answers and not really studying the micrographs in depth. The written answer gave practice in writing, but often resulted in the students focussing on one board and ignoring the others. In both of these exercises there was also evidence that some students copied from each other, or from the internet. Consequently both the revised assessments are now completed under exam conditions to avoid the possibility of plagiarism. Since 1998, practical 1 has been assessed by a visual test. This consists of projecting slides of the photomicrographs and asking questions in a four option multiple choice format. Identifying the various tissues in health and disease encourages the students to look more carefully at the photomicrographs. The assessment of practical 2 is written under exam conditions and consists of a drawing and labelling exercise, some short answer questions and a longer written section in the form of make notes about some aspect of the material on the poster boards. In designing the assessments we attempted to include as wide a range of tasks as possible. However these assessments have to conform to the standard of other equivalent course assessments in our faculty. We also had to consider the available resources taking into account the ease of marking.

Methods of evaluation
A variety of measures, all in agreement with the Glasgow University ethical policy at the time the data were collected, were used to evaluate the course and the innovations as they were introduced. Each session staff-student committee meetings were held at which the student representatives were directly asked about the innovations. Anonymous end of course evaluation questionnaires were handed out to all students during the final course exam each year. This ensured a very high return rate of an average of 90 ( 8 st.dev.) %. These questionnaires were used for course monitoring in all level 2 courses in our faculty, so the questions were generic, but with space for the student to provide a written comment. In addition students were asked about the handset voting system at end of pre-lab sessions. From 2001-2004 inclusively all students were also contacted by e-mail giving a link to an anonymous more targeted web-based questionnaire. The return rate was much lower at 21 (18 std) %, both because of the timing of the questionnaire (after the course had finished) and because completion involved opting-in during the students own time. Finally, questions were asked on the front page of the response forms for the assessment of practical 2. This front page was then detached from the rest of the script before allocation to the markers. These questions asked if students used the website resource, whether they made drawings during the practicals, and how long they spent on each practical. The answers involved circling yes or no or the number of hours. Accompanying the questions was a statement saying:
We are evaluating how students learn material from photomicrographs, so that we can improve the course practical sessions. Please circle your answers to the questions below. Your answers will in no way affect the marks you are given for this assessment.

Students results in their final exam and course work assessments were monitored to ascertain whether any changes resulted from our innovations. The final marks and the assessment marks were also examined for relationships with the answers to the questions on the response forms of the assessment of practical 2. In particular we examined whether performance in the
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practical assessment of students who made drawings of the photomicrographs was better than those who did not draw. The number of hits on the web resource was also recorded to monitor its usage. The data from 2004, 2005 and 2006 were analysed statistically to see if the students that made drawings or sketches of the photomicrographs performed better in their practical assessments than those who did not. The three years were analysed separately. The students scores in the assessments of practical 1 and practical 2 were grouped according to whether or not the students made drawings from the poster-boards or website. All the distributions of the scores over each of the years were tested for normality (using Kolmogorov-Smirnov tests), and the assumption of normality was justified in each case. Two sample t-tests were then used (as the data was normally distibuted and suitable for parametric tests) to determine any significant difference in the sample means of the scores for those students that drew and those that did not in the two practicals. A 2-way ANOVA (run as a general linear model as the data were unbalanced) tested the main and interaction effects of whether the students made drawings of the material on the poster-boards and/or the web resource. The relationship between the students scores and time they spent on the practicals either using the poster-boards or the web resources, or both was determined using scatter plots and Pearsons correlation coefficients.

Results
Outcomes of using handsets The pre-lab sessions using handsets have successfully run for several years now with almost full attendance. Recently in Glasgow student numbers at lectures has declined generally, with sometimes less than half the class present, so this is a very positive additional outcome. The students gave very favourable and perceptive responses to evaluations of the use of the handsets. The voting system was used at the end of the pre-lab session to ask: What was for you the balance of benefit versus disadvantage from the use of the handsets in the pre-lab tutorial session? . Typically 90% of the students responded that they either definitely benefited or that the benefits outweighed any disadvantages from their use. The anonymous web-based questionnaire included open ended questions, such as What do you consider were the benefits, if any, of using the handsets for the students/lecturers? Below are some of the typical answers:
Made sure you paid attention since you had to submit an answer. Also helped see how you were doing compared to rest of group. Students could be interactive and lecturers get instant results of questions and class percentages. You had to give the answer that you thought was right - if you got it wrong it wasnt embarrassing because you werent giving the answer verbally. It gave you an idea of the knowledge you already had before the test and it definitely added a fun element!

Another question asked about the disadvantages. Most students said there were none, although a few commented on the setting up process.

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The lecturing staff concluded that the use of the handsets enhanced the pre-lab tutorial session in that students appreciated the photomicrographs and were better placed to identify the various tissues and cell types in the laboratory. Students were encouraged to make judgements and become actively engaged in the material in a way which otherwise would not have been possible.

Effects of web-based advice

Following the introduction of the initial web-based resource in 2001 which gave advice on how to make sketches, many students made drawings of the material rather than just copying down the text verbatim. This was in marked contrast to the previous year when virtually none of the students attempted any type of drawing. The number of times that students accessed the webbased resource was monitored. In the first year there were 421 hits at the time of the practical, making it the most visited departmental website during this period. The students were asked in the web-based questionnaire if they had viewed the material on the resources page and over the four years 2001 to 2004 an average of 90% responded that they had done so. Students were seen with copies of the web pages in the practical, and in particular the Guidelines for Tissue Analysis. The students also responded that they found the advice given by the web-based resource helpful. Data from the web-based questionnaire in 2003 showed that of the 130 respondents: 87% responded favourably to the general advice on the posters, 75% found the drawing suggestions beneficial; and 93% found the notes on stains helpful or very helpful. The course representatives on the staff-student committee meeting confirmed that the check list and information on stains were useful and said it was good to know the standard of drawing and that they had been encouraged to make their own drawings and accurately label them. In the first year, 2003, that all the text and photomicrographs were available on the website, over 1000 hits (an average of approximately 4 visits per student) were recorded on the poster index page prior to the second practical assessment. In 2004 students were asked if they had used the web material for practical 1 and/or practical 2. Table 1 shows that only 4 students did not use the web material in either practical: their mean scores at the end of the course were poor at 42% compared to those of the class as a whole 61%. There were 8 students who did not look at the web material in practical 2 and the mean of their scores, 45%, differed significantly from those who accessed material in both practicals (t = 2.49, df = 205, p=0.014). Although the scores for those who did not use the web material for practical 1 were also lower, they were not significantly different from those who looked at the material in both cases. This might be expected since the photomicrographs were only available in the second practical.
Table 1 The numbers of students who used the material on the website in practical 1 (P1) and in practical 2 (P2) in 2004 together with their scores for the course.

All 246 61% 18%

Number of students Mean final score Standard deviation

Looked at web for P1 and P2 199 62% 19%

Did not use web for P1 43 58% 18%

Did not use web for P2 8 45% 18%

Did not use any web material 4 42%

21%

In their end of course evaluation in 2003, 92 out of 266 students chose to make a written comment. Of these, 24 students specifically said that the practical 2 web material was good and very helpful. This was considered very positive as the evaluation form only has space for

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a single comment and these comments might cover any aspect of the course. There were also many fewer negative comments about the practicals. When the course first ran in 1996, 41 had complained about the practicals. Following the introduction of the pre-lab tutorial with handsets and with the initial web resource, there were still similar numbers of unfavourable comments. These comments could be split into two groups. The first type noted that the practicals were too long or contained too much information. The numbers in this group were 21 and 31 for 2001 and 2002 respectively. The second group of negative comments, with 19 and 11 responses, were statements like dull, tedious, not helpful and pathetic. By 2005, when the photomicrographs were on the website the number of comments of the first type dropped to 7, and of the second type were 8. The ratings for the two practicals from the end of course evaluation were the same in 2001 and 2002, as shown in figure 2, but in 2003 they increased by nearly 20% in the excellent/good category for practical 2 compared with practical 1.
Students rating of practical sessions
70%

Practical 1 Practical 2 2003

Percentage of students

60% 50% 40% 30% 20% 10% 0%

2001

2002

po or

po or

ex ce lle nt /g oo d

ex ce lle nt /g oo d

ex ce lle nt /g oo d

er y

er y

po or /v

po or /v

Figure 2 Students ratings of the practical sessions as determined from the end of course evaluations for years 2001 and 2002 prior to putting the photomicrographs onto the website and for 2003 after introduction of the web resource for practical 2.

In the staff-student committee meeting in 2003 students commented that having the photomicrographs on the website was brilliant, and excellent, and in 2005 that they liked having the slides on the web in addition to the practical sessions as they were able to spend extra time in the library taking notes and reviewing the slides because they were posted on the web. The examples of the good and poor drawings by previous students were good because they instructed you about how to draw a good picture to represent the micrographs. In the web questionnaire 68% of students printed the text of the poster-boards (Table 2) thereby reducing the time spent writing in the laboratory and, 60% printed the thumbnails, which would be useful as memory aids although it is not possible to see all the detail that can be seen in the photomicrographs. Printing all the photomicrographs was discouraged as this would be expensive and time consuming, although just under a third of the students claimed to have done this.

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po or /v

er y

po or

Table 2 Table shows the students responses to the question Which of the following did you print? about items included on the web resource.

Responses to the question: Which of the following did you print? Yes No Total All Some None Total a) Text P2 82 39 121 68% 32% 75 50 125 b) Thumbnails 60% 40%

c) Photomicrographs

d) Example of assessment

34 28 57 119

29% 24% 48%

52 23 50 125

42% 18% 40%

Time spent on the practicals The students were asked in the web questionnaires, and in the assessment of the second practical, how much time they spent on the practicals. In the years following the introduction of the photomicrographs on the website they were asked to distinguish between time spent on the poster-boards in the laboratory as opposed to how much time they spent on the website. An initial descriptive analysis found that the students spent roughly the same amount of time on each practical in the two years prior to putting the photomicrographs on the web resource: on average 3.8 hours for practical 1 and 3.9 hours for practical 2. In the three following years they spent an average of 3.6 hours on practical 1 and 4.5 hours in total on practical 2. The latter resulted from 1.6 hours viewing the poster-boards in the laboratory and 2.9 hours on the web resource (figure 3). This was reassuring as we had noticed that the students were spending much less time in the laboratory looking at the poster-boards in practical 2, and we were concerned that they were just accessing the website and then considering that they had done the practical. The data in figure 3 actually suggest the opposite with students prepared to spend more time studying the photomicrographs once they were available as a website resource.
Average time spent (hours)
5 4 3 2 1 0 P1 (88) 2001, 02 P2 (88) 2001, 02 P1 (404) 2003, 04, 05 Looking at website P2 (404) 2003, 04, 05 Viewing posters in lab

Practical sessions

Figure 3 Time spent by students doing practicals before and after photomicrographs for practical 2 (P2) were put onto the website. The numbers in brackets represent the numbers of students responding. Volume 19: June 2012 www.bioscience.heacademy.ac.uk/journal/vol19/beej-19-2.pdf

A correlation analysis revealed positive relationships between the amount of time spent working on the material on the poster-boards in the laboratory for practical 1 and the scores in the assessment of practical 1 in both 2005 (r = 0.243, p = 0.000) and 2006 (r = 0.354, p = 0.000). Likewise, significant positive relationships between the amount of time spent on the material on the web resources of practical 2 and the scores in the assessment of practical 2 were also detected in 2005 (r = 0.262, p = 0.000) and 2006 (r = 0.372, p = 0.000). Also in 2006 the amount of time spent on the material on the poster-boards in the laboratory for practical 2 and the assessment scores showed a positive relationship (r = 0.167, p = 0.010). Although all the photomicrographs for practical 2 were available on the web resource, students still valued the opportunity to ask the staff any questions they might have on the material. Therefore overall, the more time the students studied the photomicrographs the better the scores they achieved.

Drawing
Data from all three years showed that making drawings of the photomicrographs whether from the poster-boards or web resource led to higher scores in the practical assessments as illustrated in figure 4 (showing data from 2006). The box plots in figures 4a and 4b show that students who drew from the poster-boards in the laboratory in both practicals have higher mean scores than those who did not make drawings in each case. The pair of box plots in figure 4c shows that those who made drawings from the web resource in practical 2 had higher mean scores than those who did not. Figure 4d shows that students in practical 2 who drew from both the poster-boards and the web resource had the highest mean scores while those that drew from neither had the lowest.

Figure 4 Box plots showing the students scores in their practical assessments grouped according to whether they made drawings (Y) or did not make drawings (N) from a) poster-boards in practical 1; b) poster-boards in practical 2; c) web resource in practical 2; and d) poster-boards and/or web resource. The numbers besides the plots are the mean scores for each group.

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The analysis of the data showed that there were significant differences in the mean scores between students who made drawings and those who did not. In each case the mean scores of students making drawings were higher. Table 3 shows the percentage increases in the mean scores for three groups of students in two of the years analysed. Each interval is a positive range confirming evidence of a higher percentage score among those who drew from posterboards or web resources compared to those who did not. In 2004, for example, the percentage scores of those who drew from the web resource in practical 2 exceeded that of those who did not by somewhere between 5.9% and 18.6%. Table 3 also shows the p-values from twosample t-tests. These are all <0.05 and so the increases in the scores are significant.
Table 3 The percentage increase in the means, followed by confidence intervals for the improvement in scores produced by students who made drawings over those who did not. The table also displays the p-values obtained from two-sample t-tests.

Comparison
Drew from poster boards in P1 versus did not

Improvement in Scores (2004)

(5.6%, 15.5%)

P-value (2004)
0.000

Improvement in Scores (2006)

(1.7%, 11.3%)

P-value (2006)
0.008

Drew from poster boards in P2 versus did not

(4.6%, 17.6%)

0.001

(2.9%, 16.0%)

0.005

Drew from web resource in P2 (5.9%, 18.6%) versus did not

0.000

(1.3%, 16.1%)

0.022

When the scores of individual students for the two practicals are compared, the scores changed according to whether drawings are made or not (figure 5). In the groups of students who did the same in both practicals, i.e. either drew in both or drew in neither practical, roughly equal numbers of students improved their scores or did worse. However in the group of students who did not draw in the first practical, but then drew in the second, more students improved their scores than decreased their scores. On the other hand, the grades of more than twice as many students that drew in the first practical but not in the second, went down in the second assessment than went up.
100% 80% 60% 40% 20% 0% NN (73) NY (98) YN (119) YY (193)

Percentage of students

grade went up stayed the same grade went down

Figure 5 Change in grades from practical 1 to practical 2 related to whether they drew in the practicals. The data was obtained from 2004 and 2005. The numbers in brackets is the number of students in each case. NN = drew in neither practical; NY = drew in second practical only; YN = drew in first practical only; and YY = drew in both practicals. Volume 19: June 2012 www.bioscience.heacademy.ac.uk/journal/vol19/beej-19-2.pdf

Discussion
The main finding of our study is that students who made drawings performed better than those who did not. A similar benefit of learning by drawing has been described for young children learning letters and adults learning unknown graphic characters such as Arabic letters (Longcamp et al., 2005; Longcamp et al., 2008; Naka, 1998; Naka and Naoi, 1995). Those who repeatedly copied the characters memorised them more effectively than those who just studied them visually. Similar benefits of other forms of active engagement have been widely discussed, for examples see Prince (2004) and Wood (2009) The students gave more favourable reactions to the practicals following the introduction of the handsets and the web resources. Using these innovations can help motivate students and encourage them to spend more time studying the material in the practicals. The use of the personal response system also increased attendance. We have shown that students who spend more time studying the practical material do better, so any innovations that encourage this are worthwhile. It is interesting to consider that the practice of making drawings has been commonplace since the introduction of histology into medical curricula in the second half of the nineteenth century (Cotter, 2001; Jacyna, 2001). Although the merits of drawing have never been properly investigated, it has always been accepted as good practice. This study confirms that this approach actually works. Finally, it is important to remember that, even when introducing new technology which may be beneficial, traditional teaching methods must not be forgotten.

Acknowledgments
This project was supported by a grant from University of Glasgows Learning and Teaching Development Fund. Part of this study was presented by one of the authors (BC) at the Effective Learning in the Biosciences conference held in Edinburgh in June 2011. Communicating author
Dr Barbara Cogdell, School of Life Sciences, College of Medical, Veterinary and Life Sciences, West Medical Building, University of Glasgow, University Avenue, Glasgow G12 8QQ. Email: Barbara.Cogdell@glasgow.ac.uk tel: 141 330 2805

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