This article describes the following aspects of teaching biochemistry in undergraduate health courses: objectives, number of hours, time in which the subject is studied, selection of content, teaching strategies, and evaluation methodologies used. Fifty-three courses distributed in 13 areas within the health field and offered by 12 institutions were analyzed for this matter. An exploratory research was developed, with data obtained from documentation analysis, form completion, and interviews with teachers involved. For the analysis of data, both quantitative and qualitative approaches were used. The analysis of teaching plans for the subjects under investigation shows that their inclusion in the curriculum occurs early in the professional education. The subject focus is intradisciplinary, and there is a great diversity in terms of number of hours, even if one looks at the same professional field. There is a tendency to standardize objectives, centralizing the teaching in “biochemical knowledge,” which is frequently not related to the specific proposal of professional education. We also noticed that there is a certain degree of similarity in the contents, even though some specific content is seen in the courses of dentistry and veterinary medicine. From the value given to lectures, one could see an evidence of transmission of pre-established content. Thus, there seems to be a need to stimulate the use of more active learning methodologies. As for evaluation, this study suggests an increased emphasis on the formative approach to assessing students.
Health professionals must have sound knowledge about the basis of the organization of living beings. Curricular contents should include knowledge about people and society in multiple aspects to allow for a deeper understanding of health-disease process. Therefore, according to the specificity of each course, one should take into account theoretical and practical knowledge related to molecular and cellular basis of physiological and pathological processes, as well as processes relative to the functioning of the human body. In this context, biochemistry is an important area of knowledge in the basic cycle of professional education.
The teaching of biochemistry presents some specific features: an extensive list of terminology (names of compounds, enzymes, and metabolic pathways), the need for a high level of abstract thinking, the overload of ever-changing information, and the rather early inclusion of biochemistry courses in curricula. Many authors discuss the challenges of teaching biochemistry in different health courses. In Brazil, the need for specific contents and teaching strategies are some of the issues that arise in academic meetings.
In the Brazilian educational system, health courses (medicine, nursing, dentistry, pharmacy, nutrition, physiotherapy, veterinary medicine, biomedicine, speech therapy, physical education, chiropractics, occupational therapy and ophthalmic technology) are all undergraduate courses. This article reports an investigation and analysis of the teaching of biochemistry in different undergraduate health courses in universities in São Paulo, Brazil.
Fifty-three undergraduate courses in the area of health, from 12 different universities in São Paulo were analyzed. These universities are responsible for the education of professionals in 13 different areas: biomedicine (3), physical education (1), nursing (8), pharmacy (6), physiotherapy (11), speech therapy (1), medicine (3), veterinary medicine (4), nutrition (5), dentistry (8), chiropractics (1), occupational therapy (1) and ophthalmic technology (1). Taking into account that some universities offer the same course more than once, the total number of groups analyzed was 93, distributed in morning, afternoon, and evening classes, as well as for full-time students.
Some of the structural characteristics of the subject of biochemistry (i.e. number of hours, period in the curriculum in which the course is offered, teaching strategies, and theory-practice link) were determined from questionnaires applied to teachers and from the analysis of course plans, using a quantitative approach. Data relative to subject objectives, evaluation methodology, and content were analyzed both qualitatively and quantitatively.
RESULTS AND DISCUSSION
In most curricula (85%), biochemistry was taught in the first year of courses. In the curricular timetable for the undergraduate course of pharmacy, as well as in two of three courses of biomedicine, the subject was taught from the second year of studies onward (15%). In two of the courses, the number of hours of biochemistry was divided into four semesters (4%); in 31 courses, it was divided into two semesters (58%); and in 20 courses, one semester (38%).
Analysis of the average number of hours in the different courses demonstrated that there were three levels of distribution. Whereas the courses of biomedicine, pharmacy, and medicine had an average of 200 h, the courses in nutrition, dentistry, chiropractics, and veterinary medicine varied between 100 and 160 h. All the others (physical education, nursing, physiotherapy, speech therapy, ophthalmic technology, and occupational therapy) had an average of 60 h (Fig. 1).
Nonetheless, if one considers the same undergraduate courses in different institutions, one will notice a great discrepancy in the number of hours allotted to the teaching of biochemistry. This is the case, for example, in the courses of medicine and pharmacy in which the average time is of 207 h but whose number of hours actually varies between 135 and 272 h, for the medical course, and between 119 and 320 h for the pharmaceutical course. An important variation was also noticed in the courses of biomedicine, nutrition, and veterinary medicine. The courses of dentistry, nursing, and physiotherapy, however, tend to present a more homogeneous number of hours in the universities analyzed.
Analyses of objectives highlighted in the teaching plans showed that there is a homogenizing tendency, in which the same objectives are repeated in different courses. The designing of learning objectives can involve three different aspects: the cognitive aspect, which encompasses knowledge, ideas and mental skills; the psychomotor aspect (or abilities), which is associated with the actions and procedures; and the affective aspect (also called attitudinal), whose concern is the learning of attitudes and values .
Sixty percent of teaching plans showed that proposed objectives focused exclusively on cognitive aspects, with an emphasis on the understanding of content and its applicability in specific situations. Thirty-four percent focused on the development of abilities besides the learning of theoretical concepts. These emphasized practical activities in laboratories. Only 10 courses (20% of the total number of courses analyzed), took into account the affective realm, valuing critical-scientific vision, autonomous studying habits, ability to work in groups, and problem solving strategies. In any case, only seven (14%) of the courses investigated took into consideration all three dimensions of educational objectives.
Mehler  comments that, in the biochemistry context, although the idea of defining objectives to be reached prior to the definition of the means to achieve them is evident, this logic is not always taken into account when planning the teaching per se. Some subject plans described the relationship between biochemistry learning and understanding of other basic subject contents, which are essential to professional education. Forty-two percent of subjects showed an explicit commitment, with the teaching linked to the understanding of pathologic processes. Only 24% of courses showed objectives linked to the specific process of education of a health professional.
In general, contents listed in course plan were similar no matter which undergraduate course was analyzed, including properties of energy-rich compounds, chemical structure, as well as amino acid and protein metabolisms, carbohydrates and lipids, enzymes, vitamins, and hormonal action. Differences were seen in terms of the sequence and depth in which they were taught. Thirty-one of the 53 courses (59%) analyzed had, at the same time, topics pertaining to molecular biology of the gene.
Practical contents students were to work on in laboratory activities were described in only 30% of plans, despite having been offered in 70% of courses. The most common themes to be developed were: features of amino acids, proteins and carbohydrates, doses of total lipids and triglycerides in serum, determining glycemia, fractionating plasma proteins, factors that interfere in an enzymatic reaction, pH determination, and use of indicators.
Choice of contents and their sequencing in biochemistry were established by means of different parameters from teacher to teacher: models experienced, curricular organization of the course, group decision between professors based on the needs of the specific profession, and the level of previous knowledge students may have brought to the course. Twenty-five (47%) courses showed a sequence of contents based on the structural characteristics of the main biomolecules, the mechanism of enzymatic action, followed by cellular metabolism.
Mehler  states that such a course structure has been criticized for not arousing students' interest because the courses cover structural topics too early, at a point when the students are unable to see the applicability of the theory in real life. The structural characterization of each biomolecule, followed by the studies of metabolism and introduction to regulatory mechanisms (enzymes, coenzymes, and hormones) at the end of the course was the sequence adopted in 36% of courses.
Specific biochemistry contents applied to a specific professional education were pointed out in some areas, namely, in veterinary medicine, the metabolism of ammonotelic, ureotelic, and uricotelic animals, rumen, meat, milk and honey biochemistry; in dentistry, topics pertaining to salivary composition, the process of caries formation, and bone and teeth mineralization; and in physiotherapy, general aspects of metabolism and muscular functioning. The depth to which each content is approached will vary according to the undergraduate area and to the level of previous knowledge the students might have. Despite controversies, one sees that the choice of content is guided according to a tendency to have teaching centered in biochemical knowledge, and some courses will emphasize this more than others. Such is the case with medicine, biomedicine, pharmacy, dentistry, and veterinary medicine. In other courses, content tends to be simplified and homogenized.
Feldberg  recognizes the difficulty in selecting topics that are relevant but criticizes the excessive concern with teaching the whole scope of content because the rushed and superficial approach to teaching the subject tends to diminish students' interest. He considers that allowing for the development of abilities as well as learning to take place to be of greater importance than the coverage of content. According to Wood , although the content taught is excessive, it is difficult to delimit the type of knowledge that is relevant, which strategy should be used to enhance learning, and how to integrate this knowledge with that of other subjects studied.
The choice of procedures and pedagogical resources used to teach biochemistry must be coherent with the objectives that one seeks to achieve and with a view that leads to learning. Fifty-one of 53 courses taught at the undergraduate level in the universities of São Paulo described the teaching strategies used in their course plans. The procedures can be seen in Fig. 2. The variety of procedures used shows that there is a predominance of lectures (92%), followed by laboratories/practicals (75%), seminars (47%), and exercises in problem solving (43%). The frequency of lectures emphasizes the cognitive dimension, which is predominant in the course objectives of plans analyzed.
Carrol , a professor at the Biochemistry Department of the University of London, comments that lectures can be a sound teaching resource as long as they present a coherent organization, a clear exposition of ideas pronounced well enough for the audience to hear, and appropriate pedagogical material.
An absolute predominance of theoretical activities was noticed, with fewer practical activities. A greater amount of hours given to the training of abilities was noticed in the following courses: biomedicine, pharmacy, dentistry, and veterinary medicine (approximately 30%). Two of the eight nursing courses and six of the 11 physiotherapy courses offered practical activities. One of the three medicine courses, on the other hand, was solely theoretical. Also, courses in the areas of physical education, occupational therapy, ophthalmic technology, and speech therapy did not offer practical lessons.
Stimulating reasoning about the content taught was pointed out as a strategy in some course plans. This was to occur by means of participatory lectures, exercises, group discussions, and case studies. Torres  recognizes that most courses overload students with information in the hope that they will be able to remember and apply it to solve problems in their professional lives. He considers that there is a need to allow the students to develop their problem-solving capacity and the ability to identify which piece of information is necessary to solve each problem.
Rosing  highlights that not all teaching activities result in a learning process if this is understood as construction of knowledge and development of abilities with practical applicability. He also emphasizes that one needs to teach in a way that enhances self-guided learning, promotes active information search, and knowledge creation.
The course plans analyzed seemed to prioritize the assessment of students' learning without mentioning teaching/lecturers' assessment. Evaluation should be understood as a teaching-learning monitoring process involving the institution, the curriculum, the teachers and the students. We noticed a great variety of tools used in the subjects studied (Fig. 3).
Tests were the main assessment tools and were used in all subjects (100%). Twenty percent of all courses had the test as the only means of assessment. Reports on practical classes and exercise solving were also used. Written examination, seen as the only assessment instrument, was criticized by some teachers. They also showed concern about writing test questions that assess something other than the sole retention of content by students, besides demonstrating their care with the designing of objective questions. Some consider the oral examination an opportunity for interaction that allows for the identification and correction of possible deficiencies.
Souza , studying the several theories about evaluation published in Brazil, observed that there is a tendency to value the technical dimension, which emphasizes the classifying purpose of tests. She also calls our attention to the need to consider the students' performance as a consequence of teaching.
The diagnostic aspect of evaluation, used both to identify the student's previous knowledge and to guide subject planning, was not mentioned as a common practice in the subjects whose plans were analyzed. Wood  considers that an ideal practice would be to seek to determine the level with which students enter the course of biochemistry, especially in terms of knowledge of chemistry and biology. One could not avoid noticing that it is common to have an introductory lesson to familiarize students with these concepts. This lesson is prepared and delivered in 20% of courses analyzed and is based on concepts that the teacher considers to be important, to help students recall previous knowledge.
Most evaluation practices seek to measure students' performance and pass or fail students based on the course and the exam. Teachers involved in this investigation not only showed understanding that this is a traditional means of assessment, but also were willing to improve their evaluation practice.
A great heterogeneity was noticed in the number of hours used to teach the subjects analyzed. This difference occurred not only among the undergraduate courses but also among the institutions analyzed. In many cases, the definition of hours does not follow discussion pertaining to the meaning of the content taught. Instead, power relationships in academic environments, departmental legitimacy, and also the importance given to certain teachers in terms of production of knowledge can determine the amount of time given to a certain subject .
Objectives formulated for biochemistry in different courses demonstrate a degree of homogeneity that values theoretical-conceptual aspects of the subject. There is a similarity of contents with a lack of specificity for different undergraduate courses. There is also a tendency to an intradisciplinary focus to teaching, as well as the kind of teaching that is centered in the biochemical knowledge.
One could not help noticing the emphasis of teaching by transmission, evidence of which can be seen in the predominance of lectures and in a lack of strategies that value active learning. Professional education requires more than learning content. In order to assess this education, it is necessary to go beyond the possibilities that examinations allow for, and honoring evaluation as a means to help students learn rather than simply a tool for measuring the students' performance.
The articulation of biochemistry teaching with all other phases of professional education must be stimulated to encourage clarity in terms of biochemical knowledge, its objectives, and the means to make this otherwise abstract content into something of concrete use. This clarity is crucial not only because of hour division, but also for the overall course planning. New studies should be completed in this matter to support the planning and implementation of the teaching of biochemistry in different fields of professional work.