Physiology is considered a challenging discipline in most Health Science studies. Psychology students in particular usually consider physiology as a less relevant part of their professional training even though it provides an essential scientific understanding of the biological processes underlying human behavior and cognition (Vanags et al., 2012; Lloyd et al., 2019). Understanding physiology entails successful comprehension, integration and application of several complex concepts (Rehan et al., 2016). The very nature of the discipline, the way it is taught and the student’s preconceptions have all been described to contribute to this perceived intrinsic difficulty (Michael, 2007; Slominski et al., 2019). Finding new pedagogical strategies for teaching physiology to psychology students is thus important to enhance their understanding of the biological underpinnings of human behavior and to foster interdisciplinary connections within the Health Science field.

The ability to make predictions about how external and internal changes affect the state of a biological system is central to physiology (Zohar, 1995). Active methodologies are defined by educational researchers as any activity that ‘involves students in doing things and thinking about the things they are doing’ by engaging them cognitively and meaningfully with the materials (Bodemer and Ploetzner, 2004; Goodman et al., 2018), leading to a better understanding of complex ideas and mastering difficult skills (Chi, 2009). Research suggests that active teaching methodologies with multiple and interactive external interactions are required for effective students’ engaging students (Bodemer and Ploetzner, 1998). It has been discussed that those who actively relate sources of information are able to create mental representations that are more coherent when it comes to content application than those who do not make these connections (Cakir, 2008; Anwar, 2019). Under this perspective, for learning to be effective, students must develop the capacity to evaluate and use information. New concepts that fit within preexisting mental structures are better retained and understood.

All this suggest that students would be better able to handle with difficulties if they actively engage in the cognitive processes required to build connections amongst separate information pieces (Hopper, 2016). This will not only help in their learning but for physiology teaching in particular, it may be an opportunity for them to handle with difficulties in understanding. Anwar states that in active learning: “students’ participation differs from more traditional learning environments in their level of participation and collaboration.” Hopper (2016) emphasizes that “the more students participate in activities that are designed to improve learning and competence development (such writing, evaluating, synthetizing, analyzing, and thinking) the more competent they will become.” Thus, active learning pedagogies help to develop and assess mental models which need to be used in order to understand newly introduced concepts (Graffam, 2007). This in turn enables students to generate new ideas which go beyond the learning material (Chi and Wylie, 2014).

In recent decades, the importance of teaching basic sciences such as Physiology in an integrated manner has been emphasized (Sánchez et al., 2020; Tun et al., 2020). This advocates for a clinical perspective to be included from the initial formative years to better equip students with the ability to navigate the complexities of psychology. This is especially true for laboratory classes which represent a major step in most Health Science curricula. Different methodologies such as activity-based learning (ABL) and problem-based learning (PBL) have been previously used in integrated curricula. PBL is a methodology in which the starting point is a problem that enables students to develop a hypothesis and identify their own learning needs. PBL is typically taught using small groups (usually around 8–10 students) with a tutor who guide students to keep on track of learning objectives of the task (Trullàs et al., 2022). PBL methodology obtained a high level of satisfaction, especially among students (Trullàs et al., 2022).

Using PBL methodologies can thus help to better engage Psychology students in learning physiology concepts, especially in relation to more real case scenarios. Integration of laboratory classes into the PBL framework has been shown to significantly improve understanding, leading to the development of critical thinking and other major competences (Matsuo et al., 2011; Azer et al., 2013). By providing coherence and contextualization of the laboratory classes, this approach enable students to gain a deeper understanding of the content (Hammerness, 2006; Canrinus et al., 2019). Based on this approach, we have recently introduced workstation learning activities (WSLA) as an active methodology where the students organized in groups of 5–6 students rotate across different stations to work in an integrated manner the basic scientific aspects of a particular clinical case (González-Soltero et al., 2017). We demonstrated its effectiveness in more interactive and constructive knowledge for medical students (Sánchez et al., 2022). Such a framework may be particularly useful to teach practical aspects of Physiology to psychology students, as well.

Here, we investigate the effectiveness of integrating Physiology teaching with PBL-based laboratory classes by evaluating the impact on academic performance and students’ perception in the first year of the Psychology undergraduate program. Our hypothesis is that students in which the laboratory classes are contextualized into PBL develop a better knowledge as compared to those who did not have the experience. To address this hypothesis, we developed a pilot study using a PBL-oriented clinical case on Parkinson’s disease using WSLA as an example. We compare a first group (academic year 2018–2019) in which laboratory classes were taught separately from the clinical case with an experimental group (year 2019–2020) for which laboratory classes were contextualized into the PBL and transformed into Integrated Laboratory Classes (ILCs) (Azer et al., 2013). Our study demonstrates the value of ILCs for learning, and highlight the strategies used by students for knowledge integration of theoretical concepts.

In this work, we evaluated quantitatively if ILCs impact positively the academic performance of Physiology in first year students of psychology. Our findings show that no significant differences were obtained in the final grade for the subject. However, there was significant improvement of the score of the theoretical block of Cohort 2 students, where laboratory physiology classes were integrated and contextualized into the clinical case. Interestingly, we also found that academic results of the ILCs were significantly lower than for non-integrated laboratory classes. These results may suggest that ILCs are more challenging for students to accomplish than the non-integrated practical lesson. In spite of this difficulty, analysis of the students’ perception on questionnaires confirmed the value they give to ILCs for learning and highlight their strategies for knowledge integration of theoretical concepts.

Experimental psychologist Robert Bjork, advocates for the so-called “desirable difficulties” as learning strategies which require learners to exert an appropriate effort when learning something new. It has been demonstrated that these activities tend to result in enhanced learning (van Merriënboer et al., 2006; Bjork and Bjork, 2011; Lange and Costley, 2018; Kinsey, 2023). In curricular programs which include these planned difficulties, proper scaffolding must be embedded in the design via retrieval cues to facilitate learning the relationship between task difficulty and deep learning has been also described in the context of Health Education (Nelson and Eliasz, 2023).

Strategies to incorporate ‘desirable difficulty’ in health education include retrieval practice, spaced practice, and interleaved practice (Bjork and Bjork, 2011; Kinsey, 2023). In addition to the difficulty of the activities, it has been described that it is important to space out the day of the exam, since there are differences in remembering the concepts if the time interval until the exam is not well scheduled (Dobson, 2011). Students of cohort 1 and 2 took the exam being equally spaced and under the same conditions (structure and duration of the exam). In spite of this, the students get better results in the theoretical block having experienced ILCs. Analysis of the questionnaires confirmed this interpretation. This suggests that there was a positive impact of ILCs in spite of their difficulty, which resulted from knowledge integration at a more constructive level.

The counterintuitive idea that more difficult learning processes can enhance learning outcomes supports our results. The ILCs is a learning activity where retrieval practice is included through questions for learners to probe their knowledge. These results suggest that students learn more significantly and are able to recall better the information they learnt through ILCs. Our results add to previous reports demonstrating that retrieval practice enhances the ability to evaluate complex physiology information (Dobson et al., 2018).

In this experience we use five clinical cases each based on a clinical scenario, a description of the patients, and various situations that students must solve in groups, working in an integrated manner through different learning activities. Health Science professionals are expected to integrate content that is traditionally taught in isolation, and this may be particularly challenging in the context of psychology. When combined, active and integrated learning approaches result in an enriched learning environment which encourages students to apply knowledge to real-world scenarios and develop critical thinking skills. By doing so, students are better equipped to understand complex problems, to analyze clinical situations, and to make informed decisions in their future practice (Wood, 2003; Hmelo-Silver, 2004; Lujan and DiCarlo, 2006; Gleason et al., 2011; Parmelee et al., 2012; Thistlethwaite et al., 2012; Tayce et al., 2021; Topperzer et al., 2022). This is especially important for psychology students in order to develop their clinical competences. Our results confirm that 60% of the students consider that clinical cases helped them understand the physiology subject (question 7). Nearly all of them (94.7%) agreed that the ILCs were instrumental for understanding physiological concepts (question 6) consistent with previous experience (Azer et al., 2013).

Contextualization of the clinical case for Psychology students is crucial. All the clinical cases the students had to work with, were real. The protagonist of each case develops an illness related to the psychological and emotional domain, which naturally attracted the interest of psychology students. By feeling that the content they are studying comes close to their professional world, students gain motivation and engagement (Guilherme Guedert et al., 2022). Consistently, our results demonstrate that students better recalled relationship with the clinical cases when remembered minor details around the narrative than the academic content of the clinical case (question 8). This supports the idea that episodic and emotional cues associated to learning can influence extrinsic motivation (Schunk, 2008). Such strategies may act to stimulate health science students toward academic performance, wellbeing and satisfaction in their professional career (Leadbeatter and Gao, 2018).

As for any pilot study, there may be some potential limitation. Our study focused on a particular cohort with a limited sample. Studies in education are usually limited by factors such as the teaching load, institutional policies and logistical constrains. Future studies would include the implementation and evaluation of integrated laboratory classes in other programs and courses with a longitudinal design. Active learning methodologies seldom reach the laboratory component of basic science courses losing an important chance to provide a better learning experience for students that may be less inclined toward laboratory work.

In summary, our study supports that using active learning methodologies to teach laboratory classes within an attractive clinical context has a positive impact on learning and on the overall student’s experience. Moreover, ILCs are perceived as a motivating strategy by students which facilitates the understanding of complex physiological concepts. Using real clinical scenarios make students feel the content closer to their professional future and enhances engagement in their own learning process. This pilot study suggests that the ILCs help to retain core physiology content and it can be considered as a learning activity worth implementing in the Health curricula and in particularly in Psychology teaching.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by the Ethics Committee from the European University of Madrid (CIPI/18/060). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

BG: Conceptualization, Investigation, Supervision, Writing – original draft, Writing – review and editing. JS: Formal analysis, Investigation, Methodology, Writing – review and editing. BN-G: Data curation, Investigation, Writing – review and editing. ML: Investigation, Methodology, Writing – review and editing. MR: Formal analysis, Investigation, Methodology, Writing – review and editing.