Imaginative and colorful elaboration affects views and comments for recorded video in acid-base physiology.

Physiology concepts are often student-perceived as difficult because of low knowledge transfer or background, inability to focus on what is most important, and difficulty visualizing concept elements. Elaboration is a learning science strategy that uses learning-enhanced additions, constructions, or generations to improve mastery of novel material by leveraging the mental cues available for recall and application. Elaboration appears to be especially helpful for neurodivergent students. To connect acid-base balance and disorders to something vivid and memorable, we developed a gnome hat color elaboration that is based on pH indicator strips - where red is acidic, blue is basic, and yellow-green is neutral. Acidosis was defined as the process of gnomes making red hats and implements and alkalosis as gnomes making blue hats and implements. Blood "battle grounds" were drawn with pH <7.35 and >7.45 for acidemia and alkalemia, respectively. The plasma neutral space (pH 7.35-7.45) denotes yellow-green gnomes' habitat. This slightly basic starting point is unfair from the red gnome viewpoint and escalates acid-base tensions. This elaboration can then be layered over acid-base classification tools, such as acid-base boxes (Dietz, Adv Physiol Educ, 35(4):454-5, 2011), where the three gnome groups populate either inside the box (yellow-green), left of the box (red), or right of the box (blue). Over the years, we have adapted the box limits to correspond to the normative laboratory values for HCO3 - and PCO2 used in national board exams (USMLE, COMLEX, etc.). Naming an acid-base disorder then becomes a quick visual of gnome hat color, where names are derived when a second gnome emerges outside of the box - e.g., one red hat gnome for pH and another for HCO3 - is metabolic acidosis. Compensation can also be identified, if the opposite color hatted gnome emerges out of the other side of the box. Based on data using USMLE Physiology© hosted by Lecturio™, which provided a convenience sample free from the power biases associated with respondents being direct, graded students of either author, 32% of polled respondents specifically mentioned gnomes helping them to learn, recall, or apply acid-base information. Additionally, 57% specifically noted that the approach was clear, easy to follow, and recallable, often comparing it to their other acid-base balance learning experiences. Of the 14 hosted acid-base physiology podcasts, the gnome-based approach layered with the acid-base box received 2- to 8-fold more comments than other podcasts. Overall, podcasts were well received with 96% of respondents rating 4-5/5 stars (91% were 5/5 stars). It is difficult to identify the amount of variance accounted for by the gnome hat approach, but having nearly 1/3 of students mention this approach in non-mandatory, non-coerced, open-ended feedback means that for some it was vivid and memorable. There appears to be a potential for imaginative and colorful concept elaboration efficacy in physiological education, even when the elaboration may seem a bit over-the-top and simplistic.