Building and Breaking the Cell Wall in Four Acts: A Kinesthetic and Tactile Role-Playing Exercise for Teaching Beta-Lactam Antibiotic Mechanism of Action and Resistance †
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Authors:
John Popovich1,
Michelle Stephens1,2,‡,
Holly Celaya1,2,‡,
Serena Suwarno1,2,‡,
Shizuka Barclay1,2,‡,
Emily Yee1,2,‡,
David A. Dean2,3,‡,
Megan Farris1,2,‡,
Shelley E. Haydel1,2,4,*
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Received 28 August 2017 Accepted 10 November 2017 Published 26 January 2018
- ©2018 Author(s). Published by the American Society for Microbiology
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[open-access] This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-NoDerivatives 4.0 International license (https://creativecommons.org/licenses/by-nc-nd/4.0/ and https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode), which grants the public the nonexclusive right to copy, distribute, or display the published work.
- *Corresponding author. Mailing address: Biodesign Institute Center Immunotherapy, Vaccines and Virotherapy, 1001 S. McAllister Avenue, Tempe, AZ 85287-7501. Phone: 480-727-7234. Fax: 480-727-0599. E-mail: [email protected].
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‡ These authors contributed equally to the manuscript.
Abstract:
“Building and breaking the cell wall” is designed to review the bacterial cell envelope, previously learned in lower-division biology classes, while introducing new topics such as antibiotics and bacterial antibiotic resistance mechanisms. We developed a kinesthetic and tactile modeling activity where students act as cellular components and construct the cell wall. In the first two acts, students model a portion of the gram-positive bacterial cell envelope and then demonstrate in detail how the peptidoglycan is formed. Act III involves student demonstration of the addition of β-lactam antibiotics to the environment and how they inhibit the formation of peptidoglycan, thereby preventing bacterial replication. Using Staphylococcus aureus as a model for gram-positive bacteria, students finish the activity (Act IV) by acting out how S. aureus often becomes resistant to β-lactam antibiotics. A high level of student engagement was observed, and the activity received positive feedback. In an assessment administered prior to and two months after the activity, significant improvements in scores were observed (p < 0.0001), demonstrating increased understanding and retention. This activity allows students to (i) visualize, role play, and kinesthetically “build” the cell envelope and form the peptidoglycan layer, (ii) understand the mechanism of action for β-lactam antibiotics, as well as how gene acquisition and protein changes result in resistance, and (iii) work cooperatively and actively to promote long-term retention of the subject material.
References & Citations
Supplemental Material
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Appendix 1: Pre- and post-assessment quizzes for fall 2015, 2016, and 2017, Appendix 2: Mini-lecture and discussion presentation, Appendix 3: Photos of required props and active learning classroom, Appendix 4: Detailed instructions for instructors, Appendix 5: Photo demonstration of the activity, Appendix 6: Schematic representation of the activity, Appendix 7: Complete exam questions, Appendix 8: Student satisfaction survey
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Abstract:
“Building and breaking the cell wall” is designed to review the bacterial cell envelope, previously learned in lower-division biology classes, while introducing new topics such as antibiotics and bacterial antibiotic resistance mechanisms. We developed a kinesthetic and tactile modeling activity where students act as cellular components and construct the cell wall. In the first two acts, students model a portion of the gram-positive bacterial cell envelope and then demonstrate in detail how the peptidoglycan is formed. Act III involves student demonstration of the addition of β-lactam antibiotics to the environment and how they inhibit the formation of peptidoglycan, thereby preventing bacterial replication. Using Staphylococcus aureus as a model for gram-positive bacteria, students finish the activity (Act IV) by acting out how S. aureus often becomes resistant to β-lactam antibiotics. A high level of student engagement was observed, and the activity received positive feedback. In an assessment administered prior to and two months after the activity, significant improvements in scores were observed (p < 0.0001), demonstrating increased understanding and retention. This activity allows students to (i) visualize, role play, and kinesthetically “build” the cell envelope and form the peptidoglycan layer, (ii) understand the mechanism of action for β-lactam antibiotics, as well as how gene acquisition and protein changes result in resistance, and (iii) work cooperatively and actively to promote long-term retention of the subject material.

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Author and Article Information
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Received 28 August 2017 Accepted 10 November 2017 Published 26 January 2018
- ©2018 Author(s). Published by the American Society for Microbiology
-
[open-access] This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-NoDerivatives 4.0 International license (https://creativecommons.org/licenses/by-nc-nd/4.0/ and https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode), which grants the public the nonexclusive right to copy, distribute, or display the published work.
- *Corresponding author. Mailing address: Biodesign Institute Center Immunotherapy, Vaccines and Virotherapy, 1001 S. McAllister Avenue, Tempe, AZ 85287-7501. Phone: 480-727-7234. Fax: 480-727-0599. E-mail: [email protected].
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‡ These authors contributed equally to the manuscript.
Figures
Student satisfaction survey responses. Twenty-seven participating students rated their satisfaction of the activity and their self-reflected learning gains. Chi-squared analysis of grouped positive (strongly agree and agree) and grouped negative (neutral, disagree, and strongly disagree) responses revealed significant (p = 0.0091) satisfaction and perceived learning gains associated with the activity. For the complete survey questions, see Appendix 8 .

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FIGURE 1
Student satisfaction survey responses. Twenty-seven participating students rated their satisfaction of the activity and their self-reflected learning gains. Chi-squared analysis of grouped positive (strongly agree and agree) and grouped negative (neutral, disagree, and strongly disagree) responses revealed significant (p = 0.0091) satisfaction and perceived learning gains associated with the activity. For the complete survey questions, see Appendix 8 .
Comparison of the pre-assessment (PRE) and post-assessment (POST) quiz scores, (A) separated by semester and (B) combined. Students were administered a quiz in a pre-/post-activity manner, with the average (±SEM) scores for each semester displayed. POSTa indicates that the post-assessment quiz scores from the student co-authors were eliminated from the data analysis. ****p < 0.0001; two-way ANOVA, Fisher’s LSD test.

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FIGURE 2
Comparison of the pre-assessment (PRE) and post-assessment (POST) quiz scores, (A) separated by semester and (B) combined. Students were administered a quiz in a pre-/post-activity manner, with the average (±SEM) scores for each semester displayed. POSTa indicates that the post-assessment quiz scores from the student co-authors were eliminated from the data analysis. ****p < 0.0001; two-way ANOVA, Fisher’s LSD test.
Comparisons of individual questions in the pre- and post-assessments in (A) fall 2015, (B) fall 2016, (C) fall 2017, and (D) combined fall 2015, 2016, and 2017 semesters. Students were administered a quiz in a pre-/post-activity manner, with the average (±SEM) percentage for each question displayed. POSTa indicates that the post-assessments from the student co-authors were eliminated from the data analysis. *p < 0.05, **p < 0.01, ***p < 0.001 ****p < 0.0001; two-way ANOVA, Fisher’s LSD test.

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FIGURE 3
Comparisons of individual questions in the pre- and post-assessments in (A) fall 2015, (B) fall 2016, (C) fall 2017, and (D) combined fall 2015, 2016, and 2017 semesters. Students were administered a quiz in a pre-/post-activity manner, with the average (±SEM) percentage for each question displayed. POSTa indicates that the post-assessments from the student co-authors were eliminated from the data analysis. *p < 0.05, **p < 0.01, ***p < 0.001 ****p < 0.0001; two-way ANOVA, Fisher’s LSD test.