Presented By: Anastasia Mashukova, Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine
Co-Authors: Michael Parke, Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine

Purpose
Understanding Autonomic Nervous System (ANS) physiology is essential for grasping the pharmacology of autonomic drugs and the pathophysiological mechanisms of various systemic diseases. However, ANS function is consistently perceived by students as one of the most difficult topics to master. Previously, our pre-clerkship curriculum included two interactive lectures on the fundamentals of ANS function. One was led by physiology faculty, and the other was led by pharmacology faculty. These faculty members also served as experts for a Team-Based Learning session, where students discussed clinical cases associated with ANS dysfunction. Nonetheless, it was evident from academic outcomes and feedback provided in course evaluations that ANS-related content still presented a major challenge. Based on these observations, we set out to improve the sessions specifically dedicated to ANS within our pre-clerkship curriculum.

Methods
To achieve this goal, we incorporated an additional ANS session in the format of a large group interactive discussion. Multiple-choice questions used during the session were specifically designed by physiology and pharmacology faculty with overlapping expertise to address common student misconceptions regarding ANS function. Next, we compared exam and course evaluation scores to the same parameters obtained last year when the session was not delivered.

Results
We found a significant increase (p-value <0.05) in students' performance on the exam questions addressing ANS. Furthermore, we observed improvement in overall course and faculty evaluations. Additionally, students no longer identified ANS as the most challenging part of the course in their comments.

Conclusion
Our results confirm that the incorporation of a large group interactive discussion integrating physiology and pharmacology of the ANS improved academic performance and prompted positive feedback from students. In the future, we plan to implement a similar approach to improve academic outcomes in other content areas of the pre-clerkship curriculum.