T-GEM for cardiovascular physiology

A commonly cited conceptual challenge in medical education is cardiovascular physiology. This seems to be a consistent finding at different educational levels (Mikkila-Erdmann, 2012). If applying the T-GEM model (Khan, 2010)to teaching this, I would organize it as follows:

  1. I would provide some background content information, such as the definition of cardiac output, mean arterial pressure, heart rate, and systemic vascular resistance (total peripheral resistance)
  2. Have the students pair up and access the following simulator: https://ilearn.med.monash.edu.au/physiology/Cardiovascular/index.html 
    • on the Home tab, have the students look at the relationship between cardiac output, mean arterial pressure, and heart rate
    • have students generate a relationship between the above variables (by seeing what happens to these variables during different activities)
  3. Based on this relationship, have students predict what will happen to these variables with postural change
  4. Have students run the postural change simulation and evaluate the relationship
  5. Have students review their initial predictions and compare to the relationship that was observed through the simulation.
    • ask students to modify their initial predictions/relationships based on new data.


I think this method will offer students a chance to challenge their conceptual models by simulation and make modifications as needed. In trying to find software for TGEM in the medical context, I ran into a significant challenge. This is because a lot of medical simulations were for clinical skills or other technical skills improvement, and not for the purposes of understanding certain phenomena. But I do think this is a great way to learn and really understand concepts in a deeper more meaningful way (compared to the superficial rote memorization that is still common in medical education). I hope that simulations that examine concepts in my field become more readily available as time goes on.



Khan S. New Pedagogies on Teaching Science with Computer Simulations. J Sci Educ Technol. 2010;20(3):215-232. doi:10.1007/s10956-010-9247-2.


Mikkilä-Erdmann M, Södervik I, Vilppu H, Kääpä P, Olkinuora E. First-year medical students’ conceptual understanding of and resistance to conceptual change concerning the central cardiovascular system. Instr Sci. 2012;40(5):745-754. doi:10.1007/s11251-012-9212-y.


  1. Hi Momoe,

    I think that your plan certainly offers medical students a chance to deepen their conceptual understanding of cardiovascular physiology that extends beyond the traditional confines of rote memorization. I was wondering if there were particular guiding questions that you feel would benefit students in working through your T-GEM plan, and what would the collaboration and feedback opportunities look like within the context of medical education?

    I’m surprised to hear that there are few options that exist for medical students to learn through simulations that examine concepts; it seems to me that these are tremendous missed opportunities!

    Thanks for your post,

    – Allen.

  2. For this particular T-GEM, I would ask them questions about the effects of angle on the various parameters such as cardiac output and mean arterial pressure. I would ask them to reflect on their prior understanding of the relationship and whether this changed with degree of angulation of the patient.

    I was actually really surprised too. Until I started looking, I never realized that concept based simulations were hard to find. Perhaps I’m looking in the wrong place, but most of what I can find is to improve clinical or technical skills such as incubating a patient, delivering a baby etc.

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