Chemistry for the Allied Health Students Donald H. Williams Hope College, Holland, MI 49423
The content of the chemistry course for the allied health student has been a concern of many educators for a long time. We struggle with it a t Hope College and not just because we desire to have the same course serve both the allied health student and the student not majoring in a physical science. Serving more than one audience is a problem, but it is overshadowed by changes in the professionalism of nursing students, a move that is bringing about tough new evaluation of such courses by nursingeducators. Smillie et al. have raised suswicions that the science courses reauired in a wrenursing p;ogram are chosen in a haphazard manner (1): Here I review the recent educational literature for insights about this course so that any review of it can proceed on an informed basis. I believe this examination will help make the case for the importance of this course when its content and awwroach are sound. This course is also important because the group of students that it reaches is a significant proportion of the chemistry enrollments on many campuses. The review that follows. as it unfolds. will sueeest stronelv that we teach for the studknt's next course, for%he stude& likely intended occupation or for a certifying examination. These are worthy sources of guidance for the content of such a course. but I believe that we should be teachine bevond such goals. We must impart an appreciation of, a n d a "Hense about", chemistry. We, as chemists, are best qualified to do so, but first the review. This and related educational journals have long given ample heed to the content of this chemistry course. Reviewing educational writings over the last dozen years reveals a trend calling for the teaching of more biochemistry and the use of applied examples in this course. The call for attention to biochemically significant substances as lecture examples was made by Stanitski and Sears in 1975 (2). Takacs et al., resnondine to a needs survev. .. called for attention to chemical instrumentation and automation in a continuing education course for waramedical oersonnel (3). In 1976. Jones clearly laid out ihe varied peiagogical challenges in such a course and found interesting relevance hv centering the course around a patient's hospital chart (4j. ~ r e c h e t t eand Farina reported in 1979 that their wrogram, which emphasized an integrated clinical approach, ;educed attrition by permitting the student an early professional commitment ( 5 ) .Ahmed called for the removal of any doubts about the appropriateness of biochemistry and biological chemistry for such students by describing asubsequent course in which he used clinical correlation conferences that included pharmacists and dieticians (6).But Genvea and Callewaert asked i~isrructors10 review rhe llalance betwen hasicconccptsand I~rolth-relaredawvlicati,ms in 1983 (7). 'l'hev" argued for keeping many &sic topics yet drastically deemphasizing theoretical and auantitative aowroaches; for example, thev are unsure why we teach the p;icedures for balancikg redok equations. In 1979 the Executive Committee of the Division of Chemical Education established a Task Force on Chemical Education for Health Professionals. Their report was published in 1984 and focused on the syllabus for a one-semester chemistry course for allied health professionals (8).I t was written by Trehlow, Daly, and Sarquis and called for relevance in the examples, sensitivity for the student, and the need for communication with those teaching subsequent courses which
the first chemistry course serves. The article contains a list of topics to he covered without forcing the order. I t does not suggest the time to be given to particular topic, rather it is a model, a framework on-which we are to build. Some reports have suggested that somewhere the graduates of our programs must acquire increased mathematical proficiency (9,10). Another study notes that, to date the technical competence of baccalaureate nurses is not significantly higher than that of two-year, diploma nurses, a t least by one measure, a measure which involves following directions and performing simple numerical calculations (11). Yet, a student's aptitude for math seems to be the key to successful performance in our chemistry courses (12,13) and to passing the tests of state examining boards (14). Still another sensible source of advice for our courses would seem to come from an investigation of the current state board examination of nurses for their content of chemical principles. These tests are decidedly different from the A.C.S. exams for our particular courses. I studied three common review works which exist for students preparing for those examinations taken shortlv after comnletion of BSN degree (15-1 7). They reveal precibus little, ifany, chemistry. The study exercises and sample questions that are of a technical nature are mostly all medical. Students are repeatedly asked to second-guess lab reports. interwret svmotoms. and verify the judgments made h i others. ~ h clos&t k the material comes to being chemical in nature is bv using terms like pH, oxygenate, sodium-free, glucose tolerance, and other terms commonly classified as heing used in biological chemistry. I t is as if the BSN graduates are to be "mini-physicians" in terms of their technical knowledge. The largest amount of material is anatomical and physiological. A significant amount of the material covered is psychological, socioloeical. oreanizational. and designed tomeasuri communic a h ' s k i k While a sound foundation in chemistry makes the terms less foreign to astudent of whvsioloev. nearlveverv .. bit of the chemistry and every chemical term covered in standard review text could be picked uw from a thoroueh physiology course. What is expected is n i t biochemistry a s a chemist or a molecular biologist means it, but rather all that is called for is hiological chemistry, chemistry of biology. This is one important aspect of our student's needs. Since nearly all our students, especially those in the allied health field, will take a t least one course in hiolom, it seems appropriate to examine the chemical principlesneeded for biology courses as well. My examination of 18 texts, mostly first-course biology texts, but including some physiology texts, was very revealing. Thelist of topicsaided by chemical foundations included all those on the list generated by the Chemical Education Task Force (8).It also included other topics. Yet no textbook was without an error in the chemistr; being pesented. This pejorative statement may be somewhat subjective, but when one realizes that the chemistry used in these texts is oversimplified and overgeneralized my statement becomes understandable and reasonable. Those of us not just baptized, but bathed, in chemistry know the shortcomings of "purified" and boiled down chemical principles. Some of the errors were significant, for example: optically active carbonyl carbons, three-bonded carbons, ions without charges, and energy terms heing incorrectly used. It is especially important to note the larger, comprehen-
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sive general biology textbooks in which there are often more than 250 pages of what can only he described as chemistry. Some have as many as 30 more pages devoted to the structure and replication of DNA. Often the material is extensive enough to include discussions of entropy, free energy, and equilihrium constants derived from simplified rate equations. Amazinelv. some textbooks move from atoms throueh DNA to socioiiology very quickly, demonstrating a definse nhilosouhical nosition without offerine much in the wav of i n y ca;eats. kommonly carbon atoms are assumed to he tetrahedral while others are somehow planar, without any theoretical rationalization. At least three separate observations stand out in the analysis of biology textbooks and the hoard examination review hooks. (1) The approach is that of reductionism; seldom are integrations made. The whole is never more than the simple sum of its Darts. In fact. it often seems to he less. since some parts are devalued. (2) The chemistry is there oniy so that its terms can be used more freelv. The student miaht acquire the vocabulary by rote memolization rather than by uiderstanding. (3) Much of the chemistry we teach, or that an encyclopedic textbook includes, is never explicitly dealt with or used. I t seems to exist to serve as a hurdle, a basis of exclusion for those students less intellectually inclined. But chemistry teachers know that the chemistry can he comprehended and will facilitate the learning of, appreciation of, and understanding of all the science material to follow. We also know iust how basic and central chemistrv is to manv aspects of Gfe. And this is why I feel so strongly chat chemists must effectivelv teach this material includine its affective aspects. In some ways we are left with the impression that chemists must make their material relevant with very realistic cases and examples taken from material that the student may later face. I feel that there are sufficient examples in the world the student has already encountered. The toughest part of the problem arises when the chemistry heing huilt upon is complex, riddled with exceptions and complications, yet is treated by others as heing simple. The problem is real and uhiauitous. Furthermore. if re~etitionis still reaarded asasoundpedagogic principle then it behooves those in later courses to build upon and use the appropriate material from previous ones in order to facilitate the student's memory Drocesses. Doine- so would further integrate the material. . This all adds importance to our topic selection hut even more to our approach. We must choose the material of greatest utility, of lasting importance, and we must present it so that it will not he easily forgotten. The very human tendency to pass on that which we know best, or that which currently concerns our minds most, must he resisted. Likewise we must not equate unforgettable presentations withunforgettahle material. Just what material and what auuroach will satisfy all the constraints that face us is a difficiit matter as is obvious from all the papers that have addressed it. For me, the topics are suggested below; the approach is one of repetition, drill, and relationships. The best instructor makes the material clear, not simple, and a t least awakens the students sensitivitv to the subtle. the interrelatedness of material and the need to acquire understanding. The enduring parts of our course and its presentation seem to come in five parts. (1) The facts will outlive the theories. Structure and reactivity are fundamental. They will both he rememhered better if continuously related. I t will matter little exactly how we rationalize which atoms are tetrahedral and which are planar. But one seldom forgets, if shown, the reactivity of chlorine, or the inflammability of ether. (2) The material presented that will he best remembered is that which is huilt upon material the students already know as opposed to that which they may sometime see. Whenever possible the laboratory exercises and demonstrations must concretely illustrate what is heing taught to 708
Journal of Chemical Education
facilitate our huildine of more comnlete understandines and lasting memory. ~ e w i m ~ o r t a nthen c e must he placedon the laboratory experiments chosen. This is easily justified in our empirical discipline. (3) The language of allscience is mathematical and no language is learned without continual usage (18). (4) We must he student-friendly as some computer programs are called user-friendlv. The terms of chemistw leaiily become discernible after careful approach is taken. The approach must undo the rather natural xenophobic tendency of many and the approach must correct the mistaken popular image of chemists, humbling, white-coated eggheads existing to generate toxins and failing grades. That is, a positive attitude will open a student's mind. (5) Finally, some specific, topical suggestions are offered as heing fundamental and of lasting utility. (a) If the student is ever to think atomically, the gas laws and the kinetic molecular theory are well suited for our syllabus. (h) For the most part students find that while most things are well put toeether. some do not mix a t all. Bonds, hond'types, and inter "holec: ular" forces must he understood: therefore, electronic structures must he taught. 1.ewisconfigurations willgon long way towarddoina that. Klerrron pair n~pulsionnfinish it. Hybridization is not the answer. i c ) ~ c i dand base concepts, if presented in the broadest of approaches, will allow many other principles to follow logically. Here equivalents, moles, and concentration units come to mind as well as insights about buffers and titrations. (d) With life depending upon so many delicate balances, i t does not seem hard to present equilihrium concepts. The language of kinetics is not far removed hut separate. (e) Inasmuch as this is often the only course students have in the ~ l a thoroueh . h.v s i c a sciences. discu4on ol energy, and esperially light energy, is wnrranted. r r I l.Educ. 1984.23.57. Uneisl. C. R. Wodswuilh's Rmiaru olNurrin8: Wadsrorth: Monterey, CA, 1985. Carapao. I,.: Kellock, A.: Schnakel. P.;Smalls, S.; Sutton, L. Ramon's Holu to Prepore /OF the Nolionol Council olLic.nriire Eraminiltion /or Registwed Numes; Barran'. Edocstion Series: Woudhurg, NY, 1983. Dvorak, E. M.:Kane,M. T.; Laskevich. L. A,: Showalte?, R. E. T h e N o f i o ~ l C o u n c i l Lirnnaure Examination for Reairirred N w s e s ; Chicago Review: Chicago. 1982. Hueherl. R. J. J. Chem. Educ. 1985.62, 129.
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Number 8
August 1987
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