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More than a Module of Autonomic Function Tests: Student Perceptions of a Skill-Based Physiology Elective

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Title: More than a Module of Autonomic Function Tests: Student Perceptions of a Skill-Based Physiology Elective
Language: English
Authors: Dhiren Punja (ORCID 0000-0001-5962-9792), Akash Tomar (ORCID 0000-0003-0557-9229), Sucharita Sambashivaiah
Source: Advances in Physiology Education. 2026 50(1):232-243.
Availability: American Physiological Society. 9650 Rockville Pike, Bethesda, MD 20814-3991. Tel: 301-634-7164; Fax: 301-634-7241; e-mail: webmaster@the-aps.org; Web site: https://www.physiology.org/journal/advances
Peer Reviewed: Y
Page Count: 12
Publication Date: 2026
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Student Attitudes, Medical Students, Physiology, Elective Courses, Competency Based Education, Experiential Learning, Instructional Effectiveness, Relevance (Education), Foreign Countries, Medical Education, Gamification, Case Method (Teaching Technique), Theory Practice Relationship, Seminars, Student Evaluation
Geographic Terms: India
DOI: 10.1152/advan.00167.2025
ISSN: 1043-4046
1522-1229
Abstract: Autonomic function testing (AFT) is crucial for assessing autonomic nervous system integrity and diagnosing dysautonomia. However, AFT remains underrepresented in undergraduate physiology curricula worldwide. Limited evidence exists on how structured, skillbased AFT modules influence medical students' perceptions of learning within a competency-based framework. This study evaluated third-year medical students' perceptions of a structured AFT elective emphasizing experiential learning and faculty-guided skill acquisition and designed to bridge theoretical knowledge with clinical application. Ten third-year medical students participated in a 2-wk AFT elective combining lectures, hands-on testing, student presentations, and clinical case discussions. We employed a mixed-methods approach using structured questionnaires with 5-point Likert-scale items and open-ended questions. Quantitative data were analyzed descriptively, whereas qualitative responses underwent thematic analysis. Students reported uniformly high satisfaction across domains, including clarity of objectives (4.83 ± 0.22), clinical relevance (4.93 ± 0.10), and hands-on sessions (4.81 ± 0.18). The pretest-posttest analysis following the first lecture showed significant improvement (mean difference 1/4 2.75, P 1/4 0.0017). Thematic analysis revealed seven major themes: experiential learning, theory-practice integration, faculty engagement, student seminars, Objective Structured Clinical Examination (OSCE) assessment, curriculum expansion, and clinical preparedness. We conclude that integrating AFT electives within competency-based medical education (CBME) frameworks can enhance engagement, reinforce physiology-clinic integration, and stimulate student interest in underrepresented domains such as autonomic testing. This pilot provides a replicable model for embedding experiential learning into undergraduate physiology education.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1497608
Database: ERIC
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  Value: <anid>AN0192623349;apu01mar.26;2026Apr01.05:47;v2.2.500</anid> <title id="AN0192623349-1">More than a module of autonomic function tests: student perceptions of a skill-based physiology elective </title> <sbt id="AN0192623349-2">INTRODUCTION</sbt> <p>Autonomic function testing (AFT) is crucial for assessing autonomic nervous system integrity and diagnosing dysautonomia. However, AFT remains underrepresented in undergraduate physiology curricula worldwide. Limited evidence exists on how structured, skill-based AFT modules influence medical students' perceptions of learning within a competency-based framework. This study evaluated third-year medical students' perceptions of a structured AFT elective emphasizing experiential learning and faculty-guided skill acquisition and designed to bridge theoretical knowledge with clinical application. Ten third-year medical students participated in a 2-wk AFT elective combining lectures, hands-on testing, student presentations, and clinical case discussions. We employed a mixed-methods approach using structured questionnaires with 5-point Likert-scale items and open-ended questions. Quantitative data were analyzed descriptively, whereas qualitative responses underwent thematic analysis. Students reported uniformly high satisfaction across domains, including clarity of objectives (4.83 ± 0.22), clinical relevance (4.93 ± 0.10), and hands-on sessions (4.81 ± 0.18). The pretest-posttest analysis following the first lecture showed significant improvement (mean difference = 2.75, P = 0.0017). Thematic analysis revealed seven major themes: experiential learning, theory-practice integration, faculty engagement, student seminars, Objective Structured Clinical Examination (OSCE) assessment, curriculum expansion, and clinical preparedness. We conclude that integrating AFT electives within competency-based medical education (CBME) frameworks can enhance engagement, reinforce physiology-clinic integration, and stimulate student interest in underrepresented domains such as autonomic testing. This pilot provides a replicable model for embedding experiential learning into undergraduate physiology education. NEW & NOTEWORTHY This study presents a holistic systematic evaluation of an autonomic function testing (AFT) elective integrated into undergraduate medical education. We demonstrated that hands-on AFT training achieves high student satisfaction and enhances clinical confidence in the diagnosis of dysautonomia. The AFT teaching and assessment framework offers a replicable model for other institutions seeking to implement skill-based AFT electives. The findings of the study address a critical gap in medical education, where AFT remains underrepresented despite its growing clinical importance.</p> <p>Autonomic dysfunction affects millions globally and is implicated in a wide spectrum of clinical disorders, including diabetic autonomic neuropathy, postural orthostatic tachycardia syndrome (POTS), Parkinson's disease, and vasovagal syncope ([<reflink idref="bib1" id="ref1">1</reflink>], [<reflink idref="bib2" id="ref2">2</reflink>]). These conditions often manifest with subtle and nonspecific symptoms demanding both clinical suspicion and a thorough understanding of autonomic physiology for accurate diagnosis and management.Autonomic function testing (AFT), including heart rate variability (HRV) analysis, the Valsalva maneuver, and tilt-table testing, plays an important role in assessing the functional integrity of the autonomic nervous system (ANS) ([<reflink idref="bib3" id="ref3">3</reflink>]). Early identification of autonomic abnormalities can guide timely intervention and improve patient outcomes.Despite its recognized clinical importance, AFT remains underrepresented in undergraduate medical education ([<reflink idref="bib4" id="ref4">4</reflink>]). Surveys of European neurology curricula indicate limited exposure to autonomic testing procedures, with most training focused on theoretical lectures and lacking practical integration ([<reflink idref="bib5" id="ref5">5</reflink>]). Similarly, studies in medical education indicate that teaching of autonomic dysfunction is often restricted to neuroanatomy and theoretical concepts, with few active learning resources available ([<reflink idref="bib6" id="ref6">6</reflink>]). Advocacy groups and reports from residency programs have also emphasized persistent knowledge gaps in autonomic medicine that have prompted the development of targeted continuing education initiatives to improve clinical competence in this domain ([<reflink idref="bib7" id="ref7">7</reflink>]).A lack of structured, hands-on learning opportunities may hinder students' preparedness to interpret physiological data and understand autonomic disorders. This gap persists even as competency-based medical education (CBME), adopted in countries including India, emphasizes early clinical exposure, interdisciplinary integration, and active learning approaches ([<reflink idref="bib8" id="ref8">8</reflink>]).Kolb's experiential learning theory ([<reflink idref="bib9" id="ref9">9</reflink>]) provides a strong conceptual basis for bridging this divide, promoting the transition from passive knowledge acquisition to active clinical reasoning through authentic experiences. Evidence from simulation-based and active learning interventions demonstrates improved engagement and knowledge retention compared with traditional didactic methods ([<reflink idref="bib10" id="ref10">10</reflink>]), though such approaches remain underutilized in autonomic physiology and diagnostic testing.To guide effective curricular innovation, it is essential to explore how medical students perceive the educational value and clinical relevance of clinically integrated physiology electives. Although some studies have examined student perceptions of active learning and clinical skills modules ([<reflink idref="bib14" id="ref11">14</reflink>], [<reflink idref="bib15" id="ref12">15</reflink>]), evidence specific to autonomic physiology remains limited, underscoring the need for systematic evaluation of such initiatives.In response to these needs, our department developed a 2-wk AFT elective for third-year medical students within the CBME framework. The elective combined foundational lectures, student-led seminars, faculty-supervised practical sessions, case-based data interpretation exercises, objectively structured skill assessments, and a gamified digital module to enhance engagement and learning. The aim was to provide students with both theoretical knowledge and hands-on training in assessing autonomic nervous system (ANS) function with simple equipment and to guide them in interpreting the results of relevant AFT tests. Structured faculty training ensured consistency in teaching and assessment.This study evaluated students' perceptions of the educational value, clinical relevance, and feasibility of an experiential, clinically integrated AFT physiology module and explored its influence on learner engagement and perceived preparedness for clinical reasoning.</p> <hd id="AN0192623349-3">Research Question</hd> <p>How do third-year medical students perceive the educational value and clinical relevance of a structured AFT elective within a competency-based curriculum?</p> <hd id="AN0192623349-4">Objectives</hd> <p>1) To implement a 2-wk skill-based AFT elective integrating theoretical physiology with clinical application through hands-on training, case-based learning, and gamification.2) To evaluate students' perceptions of the elective's educational value, faculty engagement, and perceived effectiveness of experiential learning strategies with a validated survey tool.</p> <hd id="AN0192623349-5">MATERIALS AND METHODS</hd> <p></p> <hd id="AN0192623349-6">Study Design and Setting</hd> <p>This study employed a convergent parallel mixed-methods design combining quantitative Likert-scale data with qualitative thematic analysis of open-ended responses to evaluate students' perceptions of a structured, skill-based AFT elective module delivered within the competency-based medical education (CBME) framework. The elective was conducted over 2 wk, between February and March 2025, from 2 to 5 PM each day in the Department of Physiology.</p> <hd id="AN0192623349-7">Participants</hd> <p>Ten third-year MBBS students enrolled in the elective via the institutional elective allocation system. All participants had previously completed theoretical coursework on autonomic physiology in their first year but had no prior experience observing or performing autonomic function tests.</p> <hd id="AN0192623349-8">Faculty</hd> <p>All faculty involved in the elective possessed at least 6 years of experience working in the autonomic function testing laboratory of a physiology department. The two principal trainers, who led lectures, seminars, and AFT demonstration and interpretation sessions, completed the "Autonomic Disorders Certification Program—Knowledge to Practice" offered by the Department of Physiology at St. John's Medical College (SJMC), Bengaluru. This program was intended to equip health care professionals with the knowledge and practical skills required for accurate autonomic function testing, analysis, and clinical reporting. The program consisted of an online theory component delivered via live lectures covering the autonomic nervous system divisions, neurotransmission mechanisms, and autonomic pharmacology, pathophysiology of dysautonomia along with the various methods of diagnosis and management of autonomic disorders, noninvasive cardiovascular and sudomotor recording techniques, and the performance and interpretation of orthostatic, adrenergic, cardiovagal, and sudomotor tests. The in-person practical module at the Department of Physiology, SJMC, involved demonstrations of standard AFTs, supervised hands-on training, and the analysis and interpretation of AFT results.Before the elective's implementation, the two principal trainers conducted structured faculty preparation sessions covering the learning objectives, standardized procedural instructions, ethical and safety protocols, and the Objective Structured Clinical Examination (OSCE) assessment rubric. Calibration exercises were also held to ensure interrater reliability, involving practice OSCE stations, mock student interactions, and scoring discussions before actual assessments.</p> <hd id="AN0192623349-9">Overview of the Elective</hd> <p>The elective was designed to integrate foundational physiology concepts with clinical applications using a combination of interactive, student-centered learning modalities. Its structure and syllabus are summarized in Supplemental File S1. The learning objectives, along with their corresponding learning domains and levels of Bloom's taxonomy addressed in the elective, are presented in Table 1. The elective consisted of five major components:</p> <p>Table 1. Learning objectives of the AFT elective</p> <p> <ephtml> <table><thead><tr><th>Learning Objectives</th><th>Domains of Learning (K/S/A)*</th><th>Bloom's Taxonomy Level</th></tr></thead><tbody><tr><td><p>Explain autonomic nervous system anatomy and physiology</p></td><td><p>K</p></td><td><p>Understand</p></td></tr><tr><td><p>Identify normal vs. abnormal AFT values</p></td><td><p>K</p></td><td><p>Apply</p></td></tr><tr><td><p>Recognize contraindications for AFT procedures</p></td><td><p>K</p></td><td><p>Understand</p></td></tr><tr><td><p>Understand pathophysiology of common autonomic disorders</p></td><td><p>K</p></td><td><p>Analyze</p></td></tr><tr><td><p>Perform Valsalva maneuver, deep breathing test, SVC, postural stress test</p></td><td><p>S</p></td><td /></tr><tr><td><p>Interpret AFT results in clinical context</p></td><td><p>K</p></td><td><p>Analyze</p></td></tr><tr><td><p>Demonstrate proper patient positioning and safety protocols</p></td><td><p>S</p></td><td /></tr><tr><td><p>Diagnose POTS, orthostatic hypotension, and other dysautonomias</p></td><td><p>K</p></td><td><p>Evaluate</p></td></tr><tr><td><p>Integrate AFT findings with clinical presentation</p></td><td><p>K</p></td><td><p>Analyze</p></td></tr><tr><td><p>Generate differential diagnoses for autonomic dysfunction</p></td><td><p>K</p></td><td><p>Evaluate</p></td></tr></tbody></table> </ephtml> </p> <p>The table shows the learning objectives mapped to the corresponding learning domains and levels of Bloom's taxonomy. *K, knowledge; S, skills; A, attitude. AFT, autonomic function testing; POTS, postural orthostatic tachycardia syndrome; SVC, sustained voluntary contraction.</p> <hd id="AN0192623349-10">Foundational lectures.</hd> <p>Short (45–60 min) interactive sessions revisited autonomic nervous system (ANS) physiology and its clinical correlations. Lecture handouts were provided. All lecture materials were developed using evidence-based content from current autonomic medicine guidelines and peer-reviewed literature.</p> <hd id="AN0192623349-11">Student seminars.</hd> <p>Participants delivered short, faculty-moderated presentations (20 min + 5 min Q&A). Sessions were moderated by faculty, involving immediate feedback, rubric-based scoring (Supplemental File S2), and discussions following the presentation to address misconceptions. Topics were assigned randomly to students 3 days before their presentations.</p> <hd id="AN0192623349-12">Hands-on skill training.</hd> <p>These sessions were conducted in the AFT laboratory of the Department of Physiology (Fig. 1). The AFT laboratory is equipped with the following standardized equipment: PowerLab 15T (ADInstruments) with LabChart 8 software, MLT004/ST grip force (AD Instruments), automatic blood pressure apparatus (SunTech), and tilt table (Ostrich–L&K). Students rotated through small-group workstations (5:1 student-to-faculty ratio) to observe and perform core AFT procedures (33% of total contact time) The hands-on training was structured into two categories:</p> <p></p> <p>PHOTO (COLOR): Figure 1. Images from the autonomic function testing (AFT) laboratory showing the hands-on demonstration area (A), instruments used for heart rate variability (HRV) and AFT analysis (B), and the head-up tilt table (C).</p> <hd id="AN0192623349-13">Faculty demonstration and performance of skills by students.</hd> <p>These included:•Valsalva maneuver using standardized 40 mmHg pressure for 15 s with continuous ECG monitoring.•Timed deep breathing test following the standardized protocol of 6 breaths/min for 1 min.•Sustained voluntary contraction (SVC) at 30% of maximum voluntary contraction for 2 min.•Postural stress test [lying-to-standing blood pressure (BP)/heart rate (HR) changes] parameters at baseline, immediately upon standing, and at 1 and 3 min.</p> <hd id="AN0192623349-14">Faculty demonstrations only.</hd> <p>Separate sessions were conducted for more elaborate procedures requiring specialized equipment and enhanced safety protocols: These included:•Tilt-table test (70° for 30 min, continuous cardiovascular monitoring).•HRV analysis (15 min, time and frequency domain).Both procedures were performed on healthy volunteers. Students actively participated in data collection and interpretation. Safety protocols included continuous faculty supervision, availability of emergency equipment, preprocedural screening for contraindications, and immediate session termination for any adverse reactions. All procedures followed standardized protocols based on published guidelines from the American Autonomic Society and International Federation of Clinical Neurophysiology ([<reflink idref="bib3" id="ref13">3</reflink>]).</p> <hd id="AN0192623349-15">Clinical case-based discussions.</hd> <p>Using anonymized AFT datasets from real patients (with institutional approval), students under faculty guidance interpreted test findings, identified autonomic dysfunction patterns, and linked results to clinical presentations. A structured interpretation format (Fig. 2) guided diagnostic reasoning and interpretation.</p> <p></p> <p>PHOTO (COLOR): Figure 2. Autonomic function testing clinical report format. BP, blood pressure; bpm, beats per minute; DBP, diastolic blood pressure; HR, heart rate; RR int, R-R interval; SBP, systolic blood pressure.</p> <hd id="AN0192623349-16">Gamified learning component.</hd> <p>In collaboration with Elsevier ClinicalKey, a digital module was created that included matching games, case quizzes, and interactive question rounds (Fig. 3) to reinforce procedural and conceptual knowledge.</p> <p></p> <p>PHOTO (COLOR): Figure 3. Snapshots from the gamified autonomic function testing (AFT) learning module. A: learning material shown to students before starting the gamified module. B: round 1: match the dysautonomia with symptoms. C: video to understand blood pressure regulation after round 1. D: round 2 start screen: questions on autonomic function testing. E: round 2: match the autonomic function test with image shown. F: round 3 start screen. G: final complete screen after all rounds.</p> <p>Students were required to complete the module over a 3-day period at their own pace. Students completed reflective feedback after the activity.</p> <hd id="AN0192623349-17">Assessment Methods</hd> <p></p> <hd id="AN0192623349-18">Pretest-posttest.</hd> <p>A 10-item multiple-choice questionnaire (MCQ) assessing previous autonomic physiology knowledge and immediate knowledge gains was administered at the end of the first lecture. The tests also helped faculty identify and address students' foundational knowledge gaps in autonomic physiology. The pretest and posttest had identical MCQs.</p> <hd id="AN0192623349-19">Objective Structured Clinical Examination.</hd> <p>Students were evaluated through a structured Objective Structured Clinical Examination (OSCE) consisting of five timed stations (5 min per station plus 1-min transitions): Valsalva Maneuver, Timed Deep Breathing Test, Sustained Voluntary Contraction with Blood Pressure Response, Recording Relevant Clinical History and Setting Up an Autonomic Function Test, and Postural Stress Test/Lying-to-Standing Test (Fig. 4). Each station included standardized simulated patient scenarios assessed by faculty using validated checklists [content validity index (CVI) = 0.94] developed by two experts with ≥6 years of autonomic testing experience (Supplemental File S3). The faculty assessors in the OSCE stations were not involved in training the students. Students performed for 3 min per station, followed by 2 min of immediate verbal formative feedback provided directly by the evaluator, during which students could seek clarifications.</p> <p></p> <p>PHOTO (COLOR): Figure 4. Objective Structured Clinical Examination (OSCE) stations used for assessment in the elective. 1) Valsalva Maneuver; 2) Hand Grip Dynamometer; 3) Deep Breathing Test; 4) Lying-to-Standing Changes in Blood Pressure and Heart Rate.</p> <p>For standardization, stations were conducted consecutively in a single laboratory. Students performed tests serially, with each participant serving as the subject for the next, and were instructed not to assist peers. Faculty evaluators completed a 2-h rater calibration session before the OSCE, achieving high interrater reliability (Cohen's κ = 0.82) to ensure consistent scoring.</p> <hd id="AN0192623349-20">Evaluation of AFT datasets.</hd> <p>Students received two anonymized AFT datasets from real clinical cases (modified for education with institutional approval). They independently interpreted each case in 15 min, using the structured clinical report format from teaching sessions (Supplemental File S4) without reference materials, to assess authentic skills. Comprehensive written feedback with correct interpretations and error explanations was provided within 24 h.</p> <hd id="AN0192623349-21">Feedback Evaluation</hd> <p>The feedback questionnaire was developed based on Kirkpatrick's four-level model, focusing on Level 1 (reaction) and Level 2 (learning) outcomes ([<reflink idref="bib16" id="ref14">16</reflink>]). Development involved a literature review, expert panel assessment, content validity testing (CVI = 0.92 by 3 physiology education experts), and pilot testing with five postgraduates to confirm face validity. The final 45-item Likert-scale instrument (1–5) covered domains such as objective clarity, engagement, teaching effectiveness, hands-on training, clinical relevance, and assessment, alongside 16 open-ended questions for qualitative insights (Supplemental File S5). Internal consistency was excellent (Cronbach's α = 0.97).</p> <hd id="AN0192623349-22">Data Collection</hd> <p>After final assessments, students completed the questionnaire via Microsoft Forms in a private setting, with 30 min allocated and technical support available.</p> <hd id="AN0192623349-23">Data Analysis</hd> <p>Likert-scale data were entered into Excel and analyzed descriptively, calculating mean scores per item and domain to quantify students' perceptions. Open-ended responses were analyzed thematically with Braun and Clarke's six-phase approach in 2021 ([<reflink idref="bib17" id="ref15">17</reflink>]). Two researchers independently coded the data to enhance credibility and reduce bias, achieving intercoder reliability of κ = 0.85. Codes were systematically organized into themes, which were iteratively refined for coherence and representativeness. Data integration followed a convergent parallel mixed-methods design, with separate analyses merged during interpretation via joint display tables to identify areas of convergence and expansion.</p> <hd id="AN0192623349-24">Ethical Considerations</hd> <p>Approval was obtained from the Institutional Ethics Committee (IEC1: 194/2025). Participation in the feedback process was voluntary, with informed and written consent and assurances of confidentiality, anonymity, and nonimpact on academic standing. Data were securely stored and reported only in aggregate form.</p> <hd id="AN0192623349-25">RESULTS</hd> <p>All ten third-year medical students who participated in the AFT elective submitted complete feedback forms. The cohort comprised four males and six females, with ages ranging from 20 to 22 yr.A total of eight students participated in both the pretest and posttest assessments of the first lecture.The mean score improved significantly from 5.25 (SD = 1.91) pre test to 8.00 (SD = 1.31) post test, with a mean increase of 2.75 points [<emph>t</emph>(<reflink idref="bib7" id="ref16">7</reflink>) = 4.92, <emph>P</emph> = 0.0017] (Table 2).</p> <p>Table 2. Results of the pre- and posttest conducted after the first didactic lecture</p> <p> <ephtml> <table><thead><tr><th>Test (<italic>n</italic> = 10 students)</th><th>Mean Score</th><th>Standard Deviation</th><th><italic>P</italic> Value (paired <italic>t</italic> test)</th></tr></thead><tbody><tr><td><p>Pretest</p></td><td><p>5.25</p></td><td><p>1.91</p></td><td /></tr><tr><td><p>Posttest</p></td><td><p>8.00</p></td><td><p>1.31</p></td><td><p>0.0017</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>P</emph> value < 0.05 considered significant.</p> <hd id="AN0192623349-26">Quantitative Feedback Analysis</hd> <p>Students rated each domain of the elective, using a five-point Likert scale (1 = strongly disagree, 5 = strongly agree). Table 3 summarizes mean attitude scores (average of each category) of Likert responses.</p> <p>Table 3. Category level mean attitude scores of the Likert-scale questionnaire</p> <p> <ephtml> <table><thead><tr><th>Feedback Categories of the Likert Questions</th><th>Mean Attitude Score (out of 5)* in <italic>n</italic> = 10 students</th></tr></thead><tbody><tr><td><p>Overall session feedback and session-specific feedback</p></td><td><p>4.86</p></td></tr><tr><td><p>Perception of OSCE stations</p></td><td><p>4.68</p></td></tr><tr><td><p>Perception of analysis and interpretation of AFT results</p></td><td><p>4.63</p></td></tr><tr><td><p>Feedback on student seminars</p></td><td><p>4.92</p></td></tr><tr><td><p>Quality of hands-on sessions</p></td><td><p>4.81</p></td></tr><tr><td><p>Clinical application and conceptual understanding</p></td><td><p>4.93</p></td></tr><tr><td><p>Overall rating</p></td><td><p>4.65</p></td></tr></tbody></table> </ephtml> </p> <p>Scores are maximum out of 5. *Each feedback category comprised multiple Likert-scale items. The table presents the average of the mean item scores for the category, calculated on a five-point Likert scale (1 = strongly disagree to 5 = strongly agree), where higher values indicate more positive student perceptions. AFT, autonomic function testing; OSCE, Objective Structured Clinical Examination.</p> <p>All participants (100%) reported they would recommend the elective to peers, and the overall elective rating was 9.3/10.</p> <hd id="AN0192623349-27">Qualitative Findings: Thematic Analysis of Student Feedback</hd> <p>Seven core themes emerged from analysis of open-ended responses (Fig. 5): Experiential Learning and Hands-On Training, Integration of Theory with Clinical Practice, Faculty Teaching Methods, Student Seminars, Evaluation and OSCE Design, Curriculum Coverage and Topic Suggestions, and Overall Impact on Clinical Understanding. These themes illustrate key educational strengths and areas for improvement (Table 4).</p> <p></p> <p>PHOTO (COLOR): Figure 5. Themes generated from the thematic analysis of students' descriptive responses. OSCE, Objective Structured Clinical Examination.</p> <p>Table 4. Representative student quotes illustrating each theme from the open-ended component of the feedback</p> <p> <ephtml> <table><thead><tr><th>Theme</th><th>Representative Student Quotes</th></tr></thead><tbody><tr><td><p>1. Experiential Learning and Hands-On Training</p></td><td><p>"I enjoyed being both a subject and observer during the Tilt Table Test—it made the concept so much more real. I could understand from the patient's perspective." "Doing the HRV analysis ourselves helped me understand the variability far better than just reading about it." "I loved the practical component. It made learning fun and gave me clarity about real clinical procedures." "I was not aware of the various factors leading to autonomic dysfunction and also about various autonomic tests before this elective was conducted".</p></td></tr><tr><td><p>2. Integration of Theory with Clinical Practice</p></td><td><p>"Seeing how AFT findings relate to real diseases like Parkinson's, diabetes mellitus, and orthostatic hypotension made the physiology finally click." "The clinical correlation discussions were eye-opening—they helped me understand why these tests actually matter." "I feel more confident now applying theory to patient care after this elective."</p></td></tr><tr><td><p>3. Faculty Teaching Quality and Methods</p></td><td><p>"The faculty were amazing—they explained everything so clearly and were always open to questions." "I appreciated how approachable and enthusiastic the instructors were during sessions." "The demonstrations by the faculty were very effective—I could grasp even complex concepts easily."</p></td></tr><tr><td><p>4. Student Seminars: Value and Limitations</p></td><td><p>"Seminar preparation strengthened old physiology concepts and helped understand the classes that followed"."The student seminars were good for participation, but sometimes I wished there was more depth or faculty input." "Some sessions felt rushed or unclear, especially when peers weren't confident in the topic." "It was a good platform to speak and listen, but could be better with structured feedback."</p></td></tr><tr><td><p>5. Evaluation and OSCE Design</p></td><td><p>"The OSCE was truly practical—it tested what we had actually learned, not just theory." "Having to perform the tests on real subjects rather than a manikin has been the best part of the assessment." "I liked the hands-on aspect of the OSCE, but the time felt a bit short for some stations especially the postural test." "The assessors at some stations were more interactive than others—standardization would help."</p></td></tr><tr><td><p>6. Curriculum Coverage and Topic Suggestions</p></td><td><p>"I wish we could've gone into more detail on things like QSART and rare autonomic syndromes." "Would love a follow-up module or research elective on HRV." "The content was good, but maybe add more on ECG interpretation in autonomic disorders."</p></td></tr><tr><td><p>7. Overall Impact on Clinical Understanding</p></td><td><p>"This elective helped me think like a clinician, not just a student memorizing facts." "Now I can actually interpret AFT results and understand what's going on in autonomic failure." "It made me more confident in diagnosing conditions that I used to find confusing."</p></td></tr></tbody></table> </ephtml> </p> <p>AFT, autonomic function testing; HRV, heart rate variability; OSCE, Objective Structured Clinical Examination; QSART, quantitative sudomotor axon reflex test.</p> <p>Students valued experiential learning and clinical integration but noted variability in seminar quality, with some presentations lacking depth despite high engagement. A strong interest in curricular expansion was evident, with requests for advanced topics such as quantitative sudomotor axon reflex test (QSART), ECG interpretation, and rare autonomic disorders. Several students expressed enthusiasm for follow-up electives and research opportunities.</p> <hd id="AN0192623349-28">Integrated Mixed-Methods Findings</hd> <p>Convergence of quantitative and qualitative data revealed strong alignment between high satisfaction scores and dominant thematic patterns (Table 5). For example, top ratings for "hands-on sessions" (mean 4.81) directly corresponded with qualitative emphasis on experiential learning, whereas slightly lower OSCE ratings (mean 4.68) paralleled comments regarding station variability. The consistency of findings across both data types underscores the reliability of the conclusions and the educational value of integrating experiential methods in physiology instruction.</p> <p>Table 5. Integration of quantitative and qualitative findings</p> <p> <ephtml> <table><thead><tr><th>Theme</th><th>Quantitative Score(s) Average Scores on Likert Responses</th><th>Interpretation/Integration</th></tr></thead><tbody><tr><td><p>1. Experiential Learning & Hands-On Training</p></td><td><p>Hands-on AFT: 5.0 HRV and AFT understanding: 5.0 Equipment explanation: 5.0</p></td><td><p>Practical exposure was central to engagement. High scores align with strong student enthusiasm for active learning over theory alone.</p></td></tr><tr><td><p>2. Integration of Theory with Clinical Practice</p></td><td><p>Clinical relevance: 4.9 Application of basic science: 4.7 Relevance of clinical cases: 5.0</p></td><td><p>The elective effectively bridged textbook learning with clinical relevance, enhancing diagnostic reasoning.</p></td></tr><tr><td><p>3. Faculty Teaching Quality & Methods</p></td><td><p>Faculty teaching: 4.7 Demonstration clarity: 4.9 Faculty guidance: 4.6</p></td><td><p>Faculty clarity and approachability enhanced learning and created a positive learning environment.</p></td></tr><tr><td><p>4. Student Seminars: Value and Limitations</p></td><td><p>Seminar relevance: 5.0 Seminar clarity: 4.8 Critical thinking in seminars: 4.9</p></td><td><p>Despite high scores, qualitative data revealed issues in consistency and depth, suggesting the need for more structured oversight.</p></td></tr><tr><td><p>5. Evaluation & OSCE Design</p></td><td><p>Usefulness of assessment: 5.0 OSCE rubric clarity: 5.0 Time per station: 4.6</p></td><td><p>Students appreciated real-life assessment formats, but variability in timing and assessor engagement needs addressing.</p></td></tr><tr><td><p>6. Curriculum Coverage & Topic Suggestions</p></td><td><p>All content areas rated ≥4.8</p></td><td><p>Students expressed interest in advanced, niche content, indicating potential for elective expansion or follow-up modules.</p></td></tr><tr><td><p>7. Overall Impact on Clinical Understanding</p></td><td><p>Clinical understanding of AFT: 5.0 Final elective rating: 9.3/10</p></td><td><p>The elective improved students' confidence and readiness to apply knowledge clinically, aligning with CBME goals.</p></td></tr></tbody></table> </ephtml> </p> <p>The first column lists the 7 major themes that emerged from the thematic analysis of the open-ended responses. The second column reports corresponding quantitative feedback scores (mean Likert ratings out of 5) relevant to each theme. The third column offers an interpretive synthesis, highlighting how quantitative ratings align with, reinforce, or contrast with qualitative insights. AFT, autonomic function testing; CBME, competency-based medical education; OSCE, Objective Structured Clinical Examination.</p> <hd id="AN0192623349-29">DISCUSSION</hd> <p>This mixed-methods evaluation of a 2-wk AFT elective for third-year medical students provides valuable insight into the clinically relevant modules in physiology. The integration of hands-on practice, clinical correlations, and structured assessment created a rich learning environment that resonated with learners both cognitively and affectively. The findings underscore the value of incorporating such integrative and applied modules into undergraduate medical education, especially in areas such as autonomic physiology that are often underrepresented in standard curricula.</p> <hd id="AN0192623349-30">Experiential Learning and the Impact of Hands-on Training</hd> <p>Experiential learning emerged as a defining strength of the AFT elective, with hands-on training consistently rated as the most impactful component (mean attitude score = 4.86). Students reported that active participation in procedures such as the tilt-table test, heart rate variability (HRV) analysis, deep breathing test, Valsalva maneuver, and postural stress test was the most engaging and conceptually clarifying aspect of the course. Alternating roles as both test subjects and testers provided a unique, multidimensional perspective that deepened conceptual understanding, enhanced real-time data interpretation, and evoked affective responses such as "I understood the patient's perspective," thereby fostering empathy and clinical insight.Consistent with prior studies highlighting the value of active learning in clinical education ([<reflink idref="bib12" id="ref17">12</reflink>], [<reflink idref="bib13" id="ref18">13</reflink>]) these findings underscore the importance of sustaining and expanding experiential components to maximize course effectiveness, deepen learning, and strengthen student engagement.</p> <hd id="AN0192623349-31">Integration of Theory with Clinical Applications and Relevance</hd> <p>The effectiveness of the elective in integrating foundational physiological principles with real-world clinical practice addresses a fundamental challenge in medical education ([<reflink idref="bib18" id="ref19">18</reflink>]). This was reflected in high quantitative ratings for topic relevance to clinical practice and the integration of basic science with clinical application. Students consistently reported that the course helped them connect textbook concepts with clinical cases such as Parkinson's disease, diabetic neuropathy, and orthostatic hypotension, thereby deepening their understanding of autonomic dysfunction and its diagnostic implications. This approach directly supports the development of analytical clinical reasoning skills, a recognized gap in traditional undergraduate medical curricula ([<reflink idref="bib19" id="ref20">19</reflink>]).Thematic analysis reinforced these findings, with students highlighting how the course helped them relate physiology to patient care. Comments such as "The clinical correlation discussions were eye-opening—they helped me understand why these tests actually matter" and "I feel more confident now applying theory to patient care after this elective" indicate successful knowledge transfer and the development of early clinical competence, particularly the ability to link physiological mechanisms to patient symptoms.By analyzing actual AFT findings within a diagnostic framework, learners were able to translate abstract theory into meaningful clinical insight. Students reported high confidence in interpreting AFT results and diagnosing dysautonomias (mean attitude score = 4.8 for both). Students noting that they were introduced to AFT for the first time through this course underscore its potential to spark career exploration in underrepresented areas such as autonomic physiology.</p> <hd id="AN0192623349-32">Faculty Teaching Quality and Methods</hd> <p>Faculty quality and mentorship emerged as critical determinants of student satisfaction, with students consistently praising the teaching team for their clarity, enthusiasm, and supportive demeanor. High teaching effectiveness ratings were supported by thematic feedback describing instructors as approachable and open to discussion, which enhanced motivation and comprehension.The significant improvement in pre- to posttest scores (mean increase from 5.25 to 8.00) highlights the immediate impact of structured didactic teaching, while the use of pre- and posttesting also reinforced key concepts and promoted self-reflection among students.Demonstration-led teaching and small-group discussions allow complex concepts to be explained in simple, relatable terms, fostering an environment that encourages inquiry and engagement ([<reflink idref="bib20" id="ref21">20</reflink>]). Statements such as "The demonstrations by the faculty were very effective—I could grasp even complex concepts easily" captured how instructor enthusiasm and modeling of clinical reasoning directly influenced learner engagement, underscoring the pivotal role of skilled facilitators in translating complex physiological principles into clinically meaningful knowledge. To ensure that this strength remains consistent independent of individual faculty characteristics, best practices could include structured faculty orientation sessions, standardized teaching guidelines, periodic instructor evaluations, and continuing development programs. For AFT electives in medical education, faculty with a background in physiology or neurophysiology, particularly those experienced in autonomic testing or related laboratory work, can effectively lead sessions. A core faculty group with advanced training or certification in AFT may serve as mentors for others, supporting capacity building through peer teaching and periodic skill enhancement workshops.</p> <hd id="AN0192623349-33">Student Seminars: Value and Limitations</hd> <p>Peer-led seminars encourage self-directed learning, ownership of content, and peer teaching. They enhance understanding and confidence through independent research and knowledge sharing, skills vital to lifelong learning in medicine ([<reflink idref="bib14" id="ref22">14</reflink>]). The elective seminars were highly rated for engagement and relevance (mean attitude score = 4.92). Students appreciated the opportunity to present, noting that it helped them recall prior concepts and prepared them for subsequent classes. However, qualitative feedback revealed variability in preparation and content quality. Comments such as "Some sessions felt rushed or unclear, especially when peers weren't confident in the topic" and "The student seminars were good for participation, but sometimes I wished there was more depth or faculty input" captured concerns that some sessions were less comprehensive than faculty-led discussions, indicating a need for greater structure and support. This aligns with prior evidence that peer-led teaching is most effective when supported by standardized templates and formative feedback ([<reflink idref="bib21" id="ref23">21</reflink>]).To enhance both engagement and academic rigor, future implementations should include preapproval of presentation slides, comprehensive resource lists, clear preparation rubrics, and faculty moderation, creating a hybrid model that maintains student autonomy while ensuring depth, accuracy, and consistency.</p> <hd id="AN0192623349-34">Evaluation and OSCE Design</hd> <p>The Objective Structured Clinical Examination (OSCE) assesses applied knowledge, procedural competence, and clinical reasoning goals often unmet by traditional written assessments. The AFT OSCE was intended to mirror real-world clinical scenarios by using a practical, scenario-based challenge that requires knowledge application under realistic time constraints.The OSCE was praised by students as a robust and authentic assessment method, achieving a mean attitude score of 4.68. Comments such as "The OSCE was truly practical—it tested what we had actually learned, not just theory" and "Having to perform the tests on real subjects rather than a manikin has been the best part of the assessment" highlighted perceived authenticity and content alignment.The structure of the OSCE reinforced learning while offering a practical, scenario-based challenge. Students raised concerns about inconsistencies in examiner expectations and time allocation, with most issues occurring at one station of the lying-to-standing test as commented in a quote, "I liked the hands-on aspect of the OSCE, but the time felt a bit short for some stations especially the postural test", leading to dissatisfaction and timing problems. This issue likely arose because the postural test inherently requires more time than the other stations. Examiner variability also persisted despite 2-h calibration sessions, with students noting that "The assessors at some stations were more interactive than others—standardization would help."Whereas these challenges highlight areas for improvement, they also offer valuable insights for refining OSCE implementation. Recommended strategies include pilot-testing station timing with representative student groups, implementing standardized examiner training and scripts to ensure consistent interactions, ensuring realistic timing, incorporating peer observation and faculty oversight during assessments, and establishing real-time contingency protocols with ongoing evaluation to maintain fairness, authenticity, and educational impact ([<reflink idref="bib22" id="ref24">22</reflink>], [<reflink idref="bib23" id="ref25">23</reflink>]).</p> <hd id="AN0192623349-35">Curriculum Coverage and Topic Suggestions</hd> <p>The students highly rated the breadth and clarity of the existing curriculum (mean attitude scores > 4.8), acknowledging its strong alignment with learning objectives and relevance to clinical practice. However, qualitative feedback reflected a desire for deeper engagement with advanced or specialized topics in autonomic physiology. Quotes such as "I wish we could've gone into more detail on things like QSART and rare autonomic syndromes" and "Would love a follow-up module or research elective on HRV" encapsulated suggestions for additional content including advanced AFTs (QSART, thermoregulatory sweat test), ECG interpretation, rare autonomic disorders, and expanded links to pharmacology and clinical management.Several students expressed enthusiasm for follow-up electives or research opportunities, particularly in areas such as HRVs and diagnostic advancements, highlighting the elective's potential as a springboard for further inquiry. This eagerness for enriched content aligns with contemporary trends in personalized medical education, where electives are designed to cater to diverse interests, career trajectories, and scholarly pursuits ([<reflink idref="bib21" id="ref26">21</reflink>]). These insights suggest that offering tiered or modular extensions of the elective could effectively address varying levels of learner curiosity and promote self-directed exploration.</p> <hd id="AN0192623349-36">Gamification Success and Digital Engagement in Revisions</hd> <p>Specific student feedback on the gamified learning activity revealed a strong preference for formats that made learning feel less like traditional studying and more like an enjoyable, engaging process. Responses such as "It did not feel like I was studying, and I was actually interested in the games" and "It makes learning about AFT more interesting" may reflect the positive impact of gamification on motivation and attention. The combination of interactive formats and immediate feedback likely contributed to better knowledge retention, with the gamified component serving not only as a revision tool but also as a motivational driver, reinforcing the value of integrating playful, learner-centered strategies in medical education.</p> <hd id="AN0192623349-37">Overall Impact on Clinical Understanding</hd> <p>A strong final elective rating (9.3/10) and consistently positive qualitative feedback confirmed that the module succeeded in transforming abstract physiological principles into tangible, clinically relevant skills. This aligns well with the goals of competency-based medical education, which emphasizes real-world application and early career insight as part of holistic student development. This study builds on literature advocating for experiential and integrated learning in health profession education ([<reflink idref="bib13" id="ref27">13</reflink>], [<reflink idref="bib20" id="ref28">20</reflink>], [<reflink idref="bib24" id="ref29">24</reflink>], [<reflink idref="bib25" id="ref30">25</reflink>]), but it is among the first to focus specifically on AFT education. It responds to the gap in exposure to autonomic testing and related clinical conditions, despite their relevance in cardiology, neurology, and internal medicine. The survey approach provides both quantitative validation of student satisfaction and qualitative insights into the mechanisms driving successful learning outcomes, with quotes mentioning "This elective helped me think like a clinician, not just a student memorizing facts" and "It made me more confident in diagnosing conditions that I used to find confusing."The integration of Likert-scale responses with thematic feedback offers a multidimensional understanding of the effectiveness of an elective. This convergent mixed-methods approach enabled a more comprehensive understanding of students' perceptions of the AFT elective, capturing not only measurable satisfaction scores but also the underlying experiences and insights that shaped them. Whereas the quantitative data confirmed high overall satisfaction, the qualitative analysis revealed deeper narratives about learning preferences, emotional engagement, and unmet needs. Thus, experiential, clinically linked, and learner-centered modules can transform preclinical physiology from a theoretical subject into an engaging discipline.</p> <hd id="AN0192623349-38">Educational Implications and Institutional Guidance</hd> <p>These findings support several evidence-based curricular innovations: <emph>1</emph>) curricular integration: AFT modules could be integrated within foundational physiology modules to increase engagement and long-term retention; <emph>2</emph>) assessment innovation: the successful OSCE format suggests potential for broader implementation of performance-based assessments in physiology education; <emph>3</emph>) faculty criteria for training and development for AFT: the importance of faculty teaching quality highlights the need for training in experiential learning methodologies; and <emph>4</emph>) scalability: the modular design allows adaptation to different institutional contexts and resource availability for deeper exploration of niches and critical areas such as autonomic testing.</p> <hd id="AN0192623349-39">Challenges and Solutions to Incorporate Electives in Medical School Timetables</hd> <p>The integration of experiential learning in medical curricula faces structural challenges. Medical school timetables are often saturated with mandatory coursework, leaving little flexibility for electives, while faculty frequently balance teaching with research and clinical obligations. Nevertheless, small but deliberate strategies may help overcome these barriers. For instance, experiential learning can be embedded within existing physiology sessions by converting a portion of didactic hours into case-based or practical activities, thereby avoiding the need for additional contact time. Faculty workload concerns may be alleviated by providing standardized teaching materials and adopting team-teaching models. Such measures may facilitate the wider adoption of manageable experiential learning practices without overburdening faculty or disrupting curricula while still preserving the benefits of hands-on, clinically relevant education.</p> <hd id="AN0192623349-40">Limitations and Future Research Directions</hd> <p>Some limitations in our study warrant consideration. The small sample size (<emph>n</emph> = 10) and single-institution design limit generalizability. Although this represents a limitation, similar educational intervention studies in medical education often use comparable sample sizes (ranging from 8 to 15 participants) for in-depth survey analysis ([<reflink idref="bib26" id="ref31">26</reflink>]). This sample size is appropriate for thematic saturation in qualitative analysis and descriptive statistics for quantitative outcomes ([<reflink idref="bib27" id="ref32">27</reflink>]). Second, a short-term feedback collection may not capture long-term retention or application in clinical settings, and the lack of a control group precludes causal attributions regarding intervention effectiveness compared with traditional teaching methods. Finally, the pretest-posttest was conducted only after the first lecture to assess baseline knowledge and immediate gains; however, a more comprehensive overall assessment across the elective could have offered broader insights.Future studies should address these limitations through multi-institutional designs, longer follow-up periods, objective knowledge assessments, longitudinal tracking of knowledge retention and clinical application, cost-effectiveness analysis, and correlation studies linking elective participation with clinical rotation performance in relevant specialties.</p> <hd id="AN0192623349-41">Conclusions</hd> <p>This study evaluated a short autonomic function testing (AFT) elective developed within a competency-based physiology curriculum and found it to be a well-received and effective educational experience. The elective, which combined lectures, student-led seminars, hands-on procedural sessions, case-based discussions, and gamified learning, helped students connect basic physiological concepts with their clinical applications. Students described the module as engaging and relevant, emphasizing that the opportunity to perform and interpret AFT procedures made complex concepts easier to understand. Faculty enthusiasm and individualized feedback were identified as key factors that supported learning and motivation. The elective also appeared to strengthen diagnostic reasoning and generate new interest in lesser-known aspects of physiology such as autonomic testing.Although the study involved a small cohort from a single institution, the consistent positive feedback suggests that short, structured, and experiential modules can meaningfully enhance how students learn and apply physiology. Embedding similar skill-based learning experiences within existing curricula may help make preclinical education more interactive, clinically relevant, and aligned with the goals of competency-based medical education.</p> <hd id="AN0192623349-42">SUPPLEMENTAL MATERIAL</hd> <p>Supplemental File S1: https://doi.org/10.6084/m9.figshare.30571001.</p> <p>Supplemental File S2: https://doi.org/10.6084/m9.figshare.30571040.</p> <p>Supplemental File S3: https://doi.org/10.6084/m9.figshare.30571049.</p> <p>Supplemental File S4: https://doi.org/10.6084/m9.figshare.30571052.</p> <p>Supplemental File S5: https://doi.org/10.6084/m9.figshare.30571055.</p> <hd id="AN0192623349-43">DATA AVAILABILITY</hd> <p>Source data are available to verified researchers upon request by contacting the corresponding author.</p> <hd id="AN0192623349-44">ACKNOWLEDGMENTS</hd> <p>We thank all the students who participated in this study and acknowledge Elsevier ClinicalKey for support in developing the gamified learning module.</p> <hd id="AN0192623349-45">DISCLOSURES</hd> <p>No conflicts of interest, financial or otherwise, are declared by the authors.</p> <hd id="AN0192623349-46">AUTHOR CONTRIBUTIONS</hd> <p>D.P. and S.S. conceived and designed research; D.P. and A.T. performed experiments; D.P. and A.T. analyzed data; D.P. and A.T. interpreted results of experiments; A.T. prepared figures; A.T. drafted manuscript; D.P., A.T., and S.S. edited and revised manuscript; D.P., A.T., and S.S. approved final version of manuscript.</p> <ref id="AN0192623349-47"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Sánchez-Manso JC, Gujarathi R, Varacallo MA. 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  Data: <searchLink fieldCode="AR" term="%22Dhiren+Punja%22">Dhiren Punja</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-5962-9792">0000-0001-5962-9792</externalLink>)<br /><searchLink fieldCode="AR" term="%22Akash+Tomar%22">Akash Tomar</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-0557-9229">0000-0003-0557-9229</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sucharita+Sambashivaiah%22">Sucharita Sambashivaiah</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Advances+in+Physiology+Education%22"><i>Advances in Physiology Education</i></searchLink>. 2026 50(1):232-243.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: American Physiological Society. 9650 Rockville Pike, Bethesda, MD 20814-3991. Tel: 301-634-7164; Fax: 301-634-7241; e-mail: webmaster@the-aps.org; Web site: https://www.physiology.org/journal/advances
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 12
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+Students%22">Medical Students</searchLink><br /><searchLink fieldCode="DE" term="%22Physiology%22">Physiology</searchLink><br /><searchLink fieldCode="DE" term="%22Elective+Courses%22">Elective Courses</searchLink><br /><searchLink fieldCode="DE" term="%22Competency+Based+Education%22">Competency Based Education</searchLink><br /><searchLink fieldCode="DE" term="%22Experiential+Learning%22">Experiential Learning</searchLink><br /><searchLink fieldCode="DE" term="%22Instructional+Effectiveness%22">Instructional Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Relevance+%28Education%29%22">Relevance (Education)</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+Education%22">Medical Education</searchLink><br /><searchLink fieldCode="DE" term="%22Gamification%22">Gamification</searchLink><br /><searchLink fieldCode="DE" term="%22Case+Method+%28Teaching+Technique%29%22">Case Method (Teaching Technique)</searchLink><br /><searchLink fieldCode="DE" term="%22Theory+Practice+Relationship%22">Theory Practice Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Seminars%22">Seminars</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Evaluation%22">Student Evaluation</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22India%22">India</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1152/advan.00167.2025
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1043-4046<br />1522-1229
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Autonomic function testing (AFT) is crucial for assessing autonomic nervous system integrity and diagnosing dysautonomia. However, AFT remains underrepresented in undergraduate physiology curricula worldwide. Limited evidence exists on how structured, skillbased AFT modules influence medical students' perceptions of learning within a competency-based framework. This study evaluated third-year medical students' perceptions of a structured AFT elective emphasizing experiential learning and faculty-guided skill acquisition and designed to bridge theoretical knowledge with clinical application. Ten third-year medical students participated in a 2-wk AFT elective combining lectures, hands-on testing, student presentations, and clinical case discussions. We employed a mixed-methods approach using structured questionnaires with 5-point Likert-scale items and open-ended questions. Quantitative data were analyzed descriptively, whereas qualitative responses underwent thematic analysis. Students reported uniformly high satisfaction across domains, including clarity of objectives (4.83 ± 0.22), clinical relevance (4.93 ± 0.10), and hands-on sessions (4.81 ± 0.18). The pretest-posttest analysis following the first lecture showed significant improvement (mean difference 1/4 2.75, P 1/4 0.0017). Thematic analysis revealed seven major themes: experiential learning, theory-practice integration, faculty engagement, student seminars, Objective Structured Clinical Examination (OSCE) assessment, curriculum expansion, and clinical preparedness. We conclude that integrating AFT electives within competency-based medical education (CBME) frameworks can enhance engagement, reinforce physiology-clinic integration, and stimulate student interest in underrepresented domains such as autonomic testing. This pilot provides a replicable model for embedding experiential learning into undergraduate physiology education.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2026
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1497608
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1497608
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      – Type: doi
        Value: 10.1152/advan.00167.2025
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 232
    Subjects:
      – SubjectFull: Student Attitudes
        Type: general
      – SubjectFull: Medical Students
        Type: general
      – SubjectFull: Physiology
        Type: general
      – SubjectFull: Elective Courses
        Type: general
      – SubjectFull: Competency Based Education
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      – SubjectFull: Experiential Learning
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      – SubjectFull: Instructional Effectiveness
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      – SubjectFull: Relevance (Education)
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      – SubjectFull: Foreign Countries
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      – SubjectFull: Medical Education
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      – SubjectFull: Gamification
        Type: general
      – SubjectFull: Case Method (Teaching Technique)
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      – SubjectFull: Theory Practice Relationship
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      – SubjectFull: Seminars
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      – SubjectFull: Student Evaluation
        Type: general
      – SubjectFull: India
        Type: general
    Titles:
      – TitleFull: More than a Module of Autonomic Function Tests: Student Perceptions of a Skill-Based Physiology Elective
        Type: main
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            NameFull: Dhiren Punja
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            NameFull: Akash Tomar
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            NameFull: Sucharita Sambashivaiah
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              M: 01
              Type: published
              Y: 2026
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            – Type: issn-print
              Value: 1043-4046
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              Value: 1522-1229
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              Value: 50
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