Research Article

Blues for the lecture theatre - the pharmacology songbook

¹Ewen MacDonald and ²Jarmo Saarti

¹Department of Pharmacology & Toxicology and ²University Library, University of Kuopio, P.O. Box 1627, 70211 Kuopio, Finland

Date received: 17/03/06             Date accepted: 18/04/06

In 2005, we were able to digitally record the so-called pharmacology songbook; a set of songs with lyrics devoted to pharmacological topics. A CD was prepared entitled The Beta-blocker Blues and its contents are now all freely available in mp3 format from our web page (Ewen MacDonald & friends, 2005). The web page also contains the lyrics and videos. These songs can be used to spice up a lecture; not only do they also describe certain aspects of basic pharmacology in a humorous manner, they also provide students with easy-to-grasp illustrations of difficult concepts (e.g. the problems associated with prophylactic use of risk-reducing medications in large numbers of people, most of whom will never suffer the actual disease). We examined whether students could learn basic pharmacology knowledge simply by listening to a CD with the songs. After listening to the CD on the weekend prior to the start of their pharmacology course, our novice students more than doubled their performance on a multiple-choice examination (from a pre-CD score of 30% up to 65% after the CD; p<0.001). We conclude that these "pharmacological blues" are a useful teaching resource for basic pharmacology students.

Introduction

Some years ago, in an attempt to quieten down the lecture theatre at the start of the actual lecture, it was decided to play a short piece of music with lyrics appropriate to the up-coming content. The hope was that students would be sufficiently curious about the music and the lyrics on display that they would terminate their chatter. In fact, this strategy did work and proved to be a sophisticated alternative to loud coughing from the lecturer or straightforward demands for silence. However, finding suitable lyrics for every lecture proved at first difficult, and later impossible, when the course moved on to topics not normally included in the repertoire of modern popular songwriters.

Rather than going back to the authoritive demands for silence, one of the authors (EMD) started to write lyrics appropriate to the up-coming lecture. The first such song was entitled The Beta-blocker Blues and gradually over the years, a body of material was created which could be called “the pharmacology songbook”. The response of the students to incorporation of the songs into lectures has been very positive; often students would mention the songs as one of the highlights of the course and spontaneously state how helpful they were in remembering pharmacological facts.

It seemed intuitive to us that students would find music to be an effective way of learning. We all remember the lyrics of popular songs of our youth, the so-called soundtracks of our lives. Pre-school children are taught almost exclusively via musical nursery rhymes (Trehub & Trainer, 1988) but by the time the kindergarten students reach university, music is no longer a mode of instruction, though most students spend large parts of their spare time listening to music and much of their money on festival tickets. While, the incorporation of music into a lecture may be considered as a gimmick, it was our belief that this could well be an alternative teaching method, helping our students to learn some basic pharmacological facts. There are only a few relevant citations on this topic. In one study, medical students showed better recall of anatomical details if these were sung rather than spoken (Panksepp and Bernatzky, 2002) and in the 1970s in Loyola University, Illinois, medical students were introduced to different types of personality disorders via the lyrics from popular songs (Egan, 1977). This study was designed to determine whether students could actually learn some basic pharmacological facts simply by listening to the words and music of our "pharmacological blues".

Material and methods

In 2005, it became possible to record these songs in a professional studio so that they could be made available in digital form not only to our own students but via our musical lecture web page to students and teachers of pharmacology all over the world (Table 1; Ewen MacDonald & friends, 2005). When the songs became available in digital format, it was possible to examine whether, in fact, students could learn useful pharmacological knowledge simply by listening to the songs a few times.

The effectiveness of the music was tested in four different student populations; second year medical students (n=12); second year pharmacy students (n=10) and graduate chemistry students enrolled in a basic pharmacology course (n=8). None of these students had received any formal lessons in pharmacology and the CDs were distributed on the week prior to their introduction to the subject. The final student group consisted of fourth year pharmacy students (n=10). All of these fourth year students had completed basic pharmacology instruction; had spent at least six months working in a community pharmacy and were now starting advanced courses.

Table 1 The titles of the songs in the pharmacology songbook with a summary of their salient points (Titles are linked to mp3 versions of the songs).

There were two similar multiple choice exam questions, called here exam A and exam B. Each exam consisted of 13 multiple choice questions (one correct answer from five options) on topics covered by the song lyrics. Students were invited to the department to pick up their copy of the CD and at that time completed one exam. They were instructed to answer all of the questions, if they did not know the answer, then they should try to guess the answer. They were asked to listen to the CD at least once, preferably also reading the lyrics (printed on a booklet inside the CD cover). At the start of the course on the next week, the students were given the second exam during a break in the first day’s lectures. This was arranged such that if they had answered exam A before, they now were given exam B and vice versa. Fourth year pharmacy students simply came to the departmental office at some point in the next week and took the second exam.

A two-tailed paired Student’s t-test was used to compare the performance of each individual student before and after listening to the CD. The difficulties of exams A and B were compared with unpaired Student’s t-test and differences between different student populations were compared by ANOVA with Scheffe’s test to compensate for multiple comparisons. In all tests, a p-value less than 0.05 was considered statistically significant.

Results

All of the student groups improved their performance after listening to the CD (Fig. 1). Before listening to the CD, the novice pharmacology students (i.e. the second year medical and pharmacy students plus the graduate chemists) had average scores around 30% (26% chemists; 30% medics; 32% pharmacists), slightly better than the 20% that would be achieved on a pure chance basis. Their initial scores were all statistically worse (p<0.01) than the fourth year pharmacy students who achieved a mean score of 58%. After listening to the CD, all but one of the students improved their performance. This meant that all of the novice groups at least doubled their average scores (54% chemists; 72% medics; 66% pharmacists). Though the best scores were achieved by the fourth year pharmacy students (84% correct), their post-CD scores were not statistically better than those achieved by the second year students.

Figure 1 The effectiveness of the CD as a teaching resource. Results are means ± s.e. mean. All student groups improved after listening to the CD (* = p<0.05; ** = p<0.01; Student's paired t-test) (## = p<0.01; significantly different from all novice student groups; Scheffe's test). Above each column is the proportion of students who would have "passed" the examination i.e. obtained a score of at least eight questions correct out of a total of thirteen.

Another way to interpret these results is to examine how many would pass the exam. Our second year students are offered mid-term exams with similar types of multiple-choice questions and a pass mark of 60% (i.e. in our exam that would mean eight out of thirteen questions correct). Using this criterion, none of the novice students would have passed prior to listening to the CD, but after listening, two out of every three would have passed. All of the fourth year pharmacy students would have passed the exam after listening to the CD.

The two exams had equal degrees of difficulty (scores for novice students taking exam A were 30% ± 3% compared to 28% ± 3% for those taking exam B first). However, we did note that certain questions were answered correctly more than would be expected on a pure chance basis (i.e. one correct out of five). The medical students were aware that seborrhoea was greasy skin and the graduate chemists and the second year pharmacy students most often knew what the pKa value referred to and the sites in the gastrointestinal tract favouring absorption of a weak acid.

Discussion

All but one of our students had better test scores after listening to the CD than their original efforts. The single student whose performance deteriorated (a graduate chemist) admitted that though she had played the CD, she had used it to lull her baby to sleep and she herself had not really paid careful attention to the lyrics. The questions in the quizzes related to basic pharmacology but were focussed around topics covered by the lyrics. Thus, students were asked about the side effects of beta-blockers, corticosteroids, dementia medications i.e. topics covered in the Beta-blocker Blues; Moonface Blues and Alzheimer Blues. The questions were arranged on areas which would be examined in the final exam; our fourth year students who had already taken and passed the course, scored significantly better in the pre-CD course than the pharmacology novices i.e. they already knew the side effects of beta-blockers and corticosteroids etc. However, even these advanced students improved their performance after listening to the CD. For example, the more complex questions such as which receptor is blocked by yohimbine (mentioned in the Potentol Rag) or the mechanism of taxanes (described in the song Cancer Chemotherapy) were answered correctly by the advanced students (but not the novices) after listening to the CD. These questions were too esoteric for the novice students; the lyrics on their own were not sufficient to clarify these difficult concepts to students only embarking on pharmacology studies. In contrast, there were questions which even the novice pharmacy students could answer correctly before listening to the CD, such as the meaning of the pKa value (described in the song Messrs H & H).

Humour is also an important element of most of these songs; if they are to be effective, students have to listen and if they do not find the songs amusing and interesting, they will not waste their free time listening to them. It could be argued that the time could be better spent reading the textbook, but students already spend hours revising for examinations, reviewing lecture material and preparing for seminars etc. The songs are a true alternative to this hard work and most students said that they had listened to the CD a couple of times, not simply the single time requested in the instructions. As one student stated in his/her course critique "Anything at all which lightens the burden of this heavy course is to be welcomed. It is much easier to remember facts when they are associated with pleasurable events". Another student remarked "I find these songs extremely useful especially for remembering the side effects of drugs - it is so easy to learn by listening to music".

Most of our songs are written as blues, which proved to be a very suitable medium. The lyrical structure of the blues is sufficiently flexible to allow a variety of permutations, students are well acquainted with blues music and perhaps most importantly, the demands on the vocalist are not excessive, though blues aficionados, such as the music critic of a Finnish blues magazine, may disagree (Walamies, 2005). The blues has an honourable history as a flexible teaching tool; some of its greatest exponents such as Blind Willie Johnson and Reverend Gary Davis sang the blues to preach the Gospel; in our own profane way we are continuing that tradition.

There are many ways that these songs can be incorporated into lectures. They can be downloaded in mp3 format from the web page (Ewen MacDonald & friends, 2005) and inserted directly into a PowerPoint presentation (using ‘insert’ > ‘movies and sounds’ > ‘sounds from file’). Lyrics to all songs are available as PDF files from this same site and there are also some simple videos of the band performing the songs. In addition to spicing up individual lectures by inclusion of an appropriate musical interlude, we have devoted an entire hour to performing the songs live in conjunction with an interactive quiz. This has proved to be extremely memorable and it is our belief that the use of this form of “edutainment” can help students cope with the stresses of studying today (Guthrie et al, 1998). Students develop a positive attitude to our course; fun should not be an offence or offensive (Howarth-Hockey and Stride, 2002). It is essential to find ways to make a task like learning a fact-filled subject such as pharmacology less of a chore and more of a pleasurable experience.

Acknowledgements

This project was supported financially by the North Savo Cultural Foundation. We thank Pekka Mustonen; Jukka Nissinen; Tuomo Salo; Seppo Örmälä and Juha Hirvaskero for their musical contributions to the CD and Tommi Kupiainen and Arvo Halme, the sound engineers in the recording studio of Savonia Polytechnic, for their assistance. We acknowledge the help of Pasi Karvonen in the Learning Centre of the University of Kuopio for his expertise in making the web page from where this material can be downloaded.

Communicating author Ewen MacDonald, Senior Assistant Department of Pharmacology & Toxicology,University of Kuopio, P.O. Box 1627, 70211 Kuopio, Finland: Tel +358 17 162400; Fax +358 17 162424; Ewen.Macdonald@uku.fi

References

Egan W.H. (1977) Teaching medical student psychiatry through contemporary music. Journal of Medical Education 52, 851-853

Ewen MacDonald & friends (2005) Beta-blocker blues and other blues for the lecture theatre. http://www.oppi.uku.fi/opk/video/ujbb/ (accessed 16 March 2006)

Howarth-Hockey G. and Stride P. (2002) Can medical education be fun as well as educational? British Medical Journal 325, 1453-1454

Guthrie E., Black D., Bagalkote H., Shaw C., Campbell M. and Creed F. (1998) Psychological stress and burnout in medical students: a five-year prospective longitudinal study. Journal of the Royal Society of Medicine 91, 237-243

Panksepp J. and Bernatzky G. (2002) Emotional sounds and the brain: the neuro-affective foundations of musical appreciation. Behavioural Processes 60, 133-155

Trehub S. and Trainer L.J. (1988) Singing to infants: lullabies and play songs. In Advances in Infancy Research, ed Rovee-Collier C., pp 43-77. Greenwich, CT, USA: Ablex

Walamies V. (2005) Ewen MacDonald & Friends - Beta-blocker Blues (CD reviews). Blues News (5), 51-52 (in Finnish)