May 5th, 2017
Embracing Online Education: A Brief Personal Reflection

I would like to state upfront to all the loyal PECOP readers that I am not a blogger, nor am I an active participant in many social media venues and I do not Tweet! So when I was trying to decide what to write about I made a list of concerns that I face as a faculty member at a regional state university in the Midwest. My ideas included topics like life-work balance, burn-out, anti-science/academic sentiments, student retention, academic standards and institutional budget concerns. The list of possibilities was great, but this list seemed too negative for a career I truly do enjoy. I would like to instead speak briefly of a place that I have found refuge from many of the topics mentioned above. That refuge is the administration of an online Principles of Biology course.

I find it strange myself to consider how a person who may seemingly possess the characteristics of a social media Luddite, would want to get involved with and indeed embrace the world of online education. So I will list and briefly reflect on three areas that drew me to online education: love of learning; love of teaching; and accessibility.

Love of learning

I derive deep pleasure from learning new things and even reviewing those things that I already know.  After all, who would ever tire of learning and teaching about the structure and function of the mitotic spindle, the sarcomere, or how an action potential occurs or how a whole embryo forms from a single cell!  These cellular structures and their functions are so beautiful and amazing, that I really enjoy revisiting them again and again, each time adding a few new details to my lecture notes.  I also appreciate hearing others talk about subjects outside of biology, such as history and philosophy. One important venue I use for learning new things takes place in my car, during my daily commutes.  I listen to courses from The Great Courses series produced by the Teaching Company, lectures and talks from iBiology, hhmi/BioInteractive, various Ted talks, and individual posted lectures that can be found through a quick search on Google. Some of my favorites are bookmarked for easy retrieval or in the case of the Teaching Company courses, I actually own.  So what keeps me going as a faculty member through the periods of burn-out and meeting the daily requirements of academic life is the joy of learning and putting together a package of information and materials that students can use to learn about the subject as well or even just tweaking that material so students may learn it better.

Love of teaching

How can this love of learning get transferred from faculty to students in a way that also encourages students to become lifelong self-learners?  Can students really be taught to be lifelong self-learners? And, if so, what pedagogical methods are best suited to reach this goal? I have already discussed how I enjoy listening to educational lectures, but I would argue that the enjoyment of listening is not sufficient enough to learn the material.  In preparing for a lecture or to oversee meaningful active learning experiences, one is not simply able to listen to a great lecture and then be able to teach the material to students, expecting them to walk away and be able to apply that content in a meaningful way.

How then do faculty prepare to teach? Even if you are a fan of lecturing, most faculty members would agree that a fabulously well-delivered lecture, even a short one, is the result of hours of reading, reflection, writing, and repeating each of these!  I see this as the elephant in the room: that a great lecturer is really a great learner.  Thus, while it is quite enjoyable to hear a great lecture, it does not mean that the attending students are learning in a manner that creates lasting behavioral changes. This is in contrast to someone who has already engaged with the material. Even before I started teaching online, I had started assigning more readings, reflective writing assignments, and oral presentations from students in all my classes. When students now ask me every semester,” Do I really need to buy/rent the textbook?”  I say yes AND you must also read it and bring it with you to every class, as if your life …I mean your grade depends on it!


I have briefly reflected above on my love of learning and my love of teaching. And I try to model for my students, the skills I use to learn new material, such as reading the text, reflecting and writing on the material, as well as presenting the material to others during class through presentation and in accessing learning through quizzes and examinations. But do you have to be in the same classroom to teach this way? I have found the answer to be no. I have had the enlightening experience to see that I can assign the same readings, provide many of the same online resources for reflection and practice, and have regular meaningful interactions and quality controlled proctored assessments online through webcasting software such as Zoom with my online students as I have had with my face to face students. Online education at its best is more than simply posting content and assessments over a learning management system.  Depending on software and internet availability, I can be anywhere, the student can be anywhere, and we can still have a scheduled, meaningful face-to-face interaction. In fact, I am often finding the interactions with my online students to be more meaningful and memorable than the ones in my face to face classes. As I continue this adventure in online education, I hope to continue to be able to take my classroom on the road so to speak. Maybe the car in my daily commutes (especially with the advent of self-driving vehicles) will become “my classroom”, instead of where I merely arrive.

In summary, when the daily grind of academic duties and responsibilities gets me down and feeling negative, I have a place I can go and do what I enjoy most about academia, prepare and deliver material for students anytime and anyplace.

A short list of my favorite online lecture resources for the lifelong self-learner in us all

Melissa A. F. Daggett is an Associate Professor of Biology at Missouri Western State University, St. Joseph, MO. Melissa received her Ph.D. in Physiology and Cell Biology at The University of Kansas, Lawrence, KS and completed post-doctoral work in gene regulation and sex determination at The University of Kansas Medical Center, Kansas City, KS. Melissa currently teaches Principles of Biology (both face to face and online), plus two senior undergraduate/graduate level courses in Developmental Biology and Molecular Cell Biology. She has also taught courses in Animal Physiology, Microbiology and Environmental Science. She is currently interested in expanding opportunities for course based undergraduate research experiences in all her courses; especially those projects related to environmental toxicology and development.

April 5th, 2017
What makes a good teacher?

I was intrigued to read this PECOP blog post on what makes a good teacher from December 2016. The post recommends that we reflect on our teaching at the end of the semester, and begin the process of understanding our teaching perspectives through the Teaching Perspectives Inventory. What makes a good instructor is something that is extremely relevant to me, because teaching happens to be my job and my passion.

I was recently prompted to think about this very question as I made contact with my former secondary school in Liverpool, U.K about being featured as a former pupil of theirs (I feel more than slightly uneasy about being featured together with John Lennon however!). I was stimulated to think about my former teachers and what I had learned from their teaching. I left the school over 20 years ago but can to this day recall specific teachers, moments in class, and things I learned inside and outside the classroom. Certainly, that’s the kind of learning I’d like my students to have 20 years after I’ve taught them!

As I reflect on the teaching that I had, several aspects popped out to me.

A love of teaching: My best teachers clearly loved teaching students. They enjoyed interacting with students, creating a rapport with us, which made the subject matter come to life and facilitated our engagement with the material. I have come to the realization that perhaps the most important aspect of teaching is to enjoy connecting with your students in order to create an effective learning environment. The saying of “they won’t care what you know until they know that you care” is somewhat cliché but it has a lot of truth to it. As a soccer coach in my spare time, I frequently reflect on the fact that if you don’t like kids, you shouldn’t coach youth soccer. In the same way, our teaching is unlikely to be as effective as it could be if we don’t like interacting with our students and enjoy teaching them.

Meeting students at their level: My English literature teacher taught us Pride & Prejudice, a text that many in my class found somewhat boring. My teacher perceived the boredom, and attempted to understand why it could be perceived as boring to my classmates. He then adapted his teaching to this in order to emphasize why the text was important. He attempted to bring the text to his students and make it relevant to them, rather than merely expecting students to engage, understand and enjoy the text automatically.

Adaptable: The best lesson I ever had was a history lesson. My teacher was a few minutes late, and as we all sat inside the classroom waiting for him, a dispute arose amongst two students in the class. The teacher came into the classroom and upon encountering the dispute, proceeded to set up a court to judge the basis of the evidence of the ‘crime’, as an example of the history of trials and determining justice. I have no idea if that was his intended lesson, but I was in awe of how the teacher adapted his lesson so perfectly to something that had just happened in the class. It is a reminder to me to be observant and adapt to issues that our students may be experiencing.

Practical: One of the most salient things I learned came from a teacher who was supervising me as I visited potential colleges. We were looking for somewhere to eat dinner one evening, and as we walked past various eating establishments, he gave me the advice of “never eat in an empty restaurant”. This has stuck with me ever since and I apply it frequently when deciding where to eat. It was practical advice on something that I had never before considered, and the ‘light bulb’ lit up for me. Reflecting on this, I see our role as teachers to help our students see beyond the immediate – to analyze and think critically about what we see with our eyes, and to help them consider what things mean. Finally, what we teach them must also be practical and relevant.

From these reflections, I have come to the realization that a good teacher is someone who is able to adapt to where our students are in terms of the knowledge that they come with, and take them to higher levels of learning that they cannot get to on their own.

What is your definition of a good teacher?


Hugh Clements-Jewery PhD is currently Visiting Research Associate Professor and M1 Course Director in Physiology at the University of Illinois College of Medicine in Rockford, IL, starting in November 2016. Prior to moving to the University of Illinois, he taught medical physiology at the West Virginia School of Osteopathic Medicine from 2007 to 2016. He is a certified trainer-consultant in Team-Based Learning.

March 31st, 2017
The Surprising Advantages Retrieval Practice

Retrieval practice,  retrieval __________,    _________ practice,  testing effect……wuh?!?!

Retrieval practice simply means to actively recall information following exposure (e.g., studying). Because tests are a particularly common and effective means by which to prompt the retrieval of specific pieces of information, the learning benefits of retrieval practice are also known as the testing effect. That is, effective tests can do more than simply assess learning; they can strengthen learning by prompting retrieval. It is important to clarify that the key to the testing effect is the retrieval and not the test per se. Therefore, the testing effect pertains to not only traditional assessments like tests and quizzes, but also to free recall. So, silently answering questions in your mind (e.g., self-testing) is an example of testing that promotes learning.

Landmark study by Roediger and Karpicke in 2006a

Figure 1. Repeated testing lead to better long-term recall when compared to repeated studying. Roediger and Karpicke, 2006a.

Although the testing effect has been described by studies that date back more than a century, researchers and articles often cite a 2006a study by Roediger and Karpicke as the source of renewed interest in the strategy and effect. In that study, the investigators asked three groups of undergraduates to read passages that were about 250 words long. One group of students learned the passages by studying (i.e., reading) them four times (SSSS group). A second group learned the passages by studying them three times and then completing a test in which they were prompted to retrieve information from the passages (SSST group). The last group studied the passages just one time and then performed the retrieval test three times (STTT group). All three groups were given a total of 20 minutes to learn each passage, following which their retention was assessed via free recall either 5 minutes or 1 week later. As you can see in Figure 1, there was a modest advantage with the SSSS strategy, as well as a modest disadvantage with the STTT strategy, immediately after learning the passages. However, the exact opposite pattern was observed one week later, as the STTT group’s recall scores were about 5% higher and 21% higher than those of the SSST and SSSS groups, respectively. The results of this study demonstrated that testing/retrieval practice can be a powerful means of improving long-term memory. These advantages to long-term recall have subsequently been confirmed by many different researchers and investigations (see Roediger and Butler 2011; Roediger and Karpicke, 2006b for review).

Retrieval practice and the ability to make inferences; it isn’t just about simple recall

Figure 2. Retrieval practice resulted in higher scores on verbatim and inferential questions. Derived from Karpicke and Blunt, 2011.

One might be concerned that retrieval practice is just a form of drill and practice that merely teaches people to produce a fixed response to a specific cue. Karpicke and Blunt (2011) addressed this concern by comparing the effects of retrieval practice and concept mapping on meaningful learning, which includes the ability to draw conclusions and create new ideas. The investigators chose concept mapping for this comparison because it known to promote elaborative (i.e., complex) learning. In one experiment, one group of students learned a science text by repeatedly reading (i.e., studying) it, another group studied the text and then used it create a concept map, and a third group studied and then recalled the text two times. The total amount of time the concept mapping and retrieval practice groups were given to learn the text was standardized. The students returned the following week and completed a short-answer test that included both questions that could be answered verbatim from the text and questions that required inferences. As is displayed in Figure 2, the retrieval practice strategy resulted in superior scores on not just the verbatim questions, but also on the inference questions. That is, the advantages of retrieval practice extended beyond simple recall and to meaningful learning. These findings are supported by numerous other investigations (see Karpicke and Aue, 2015 for review), including a subsequent study by the same authors (Blunt and Karpicke, 2014).

Okay, so retrieval practice has been shown to enhance recall and meaningful learning, but does it work with the types of information that are relevant to APS members?

Figure 3. The testing strategy resulted in superior performance on both sections of the six month assessment. Derived from Larsen, Butler and Roediger, 2009.

Yes………numerous studies support this claim. One notable example was a study by Larsen, Butler and Roediger (2009) in which two groups of medical residents first attended lectures on the treatments of both status epilepticus and myasthenia gravis. Immediately after the lectures, and then again about two and four weeks later, the residents studied (i.e., read) a review sheet pertaining to the treatment of one of those diseases and they completed a retrieval test that included feedback on the other treatment. Roughly six months after the lectures, the residents completed a final assessment that covered the treatment of both diseases. As you can see in Figure 3, the testing strategy resulted in scores that were about 11% and 17% higher than those associated with the studying strategy on the status epilepticus and myasthenia gravis sections, respectively. It is also worth noting that the overall effect size pertaining to those differences was large (Cohen’s d = 0.91). The same group of researchers went on publish similar findings with groups of first-year medical students (Larsen et al, 2013). In that follow-up study, a testing-based strategy produced superior recall and greater transfer of learning of four clinical neurology topics six months after the students first encountered them.

Our lab has also recently published numerous studies with relevant materials, and we observed several advantages with retrieval practice compared to more commonly-used reading and note-taking learning strategies. For example, we found that retrieval-based strategies resulted in superior recall of exercise physiology (Linderholm, Dobson and Yarbrough, 2016) and anatomy and physiology course information (Dobson and Linderholm, 2015a; Dobson and Linderholm, 2015b), including information that consisted of concepts and terminology that were previously unfamiliar to the students (Dobson, Linderholm and Yarbrough, 2015). We have also observed advantages to independent student learning that resulted in higher scores on course exams (Dobson and Linderholm, 2015a), as well as to the ability to synthesize themes from multiple sources (Linderholm, Dobson and Yarbrough, 2016), which is a skill that requires higher orders of cognition.

Just give me the take home messages.

  • Dozens of studies have demonstrated that retrieval practice can promote superior recall and meaningful learning when compared to more commonly-used strategies like reading. (Karpicke and Aue, 2015; Roediger and Butler, 2011; Roediger and Karpicke, 2006b).
  • Although some studies have provided evidence that essay and short answer (SA) questions can lead to a greater testing effect than multiple choice (MC) questions (Roediger and Karpicke, 2006b; Butler and Roediger, 2007), a recent study by Smith and Karpicke (2014) indicated that MC and SA questions are equally effective.
  • Multiple repetitions of retrieval practice promote more learning than a single retrieval event (Roediger and Butler, 2011; Roediger and Karpicke, 2006b)
  • The benefits of retrieval practice are enhanced if learners receive feedback after they retrieve (Roediger and Butler, 2011; Roediger and Karpicke, 2006b).

Great, but how do you apply retrieval practice in the classroom?

  • Summative assessments. Tests prompt retrieval, so one way to incorporate more retrieval practice into your classes is to have your students complete both more exams and more cumulative exams.
  • Formative assessments. There are numerous reasons to use low-stakes assessments like quizzes instead of tests. Quizzes may be just as effective at prompting retrieval, and they provide valuable feedback about performance to both instructors and students, but they typically elicit less anxiety and encourage less cheating. Suggested applications include starting class meetings with a short quiz that prompts students to retrieve information that will be developed during the lecture and/or end class meetings with a short quiz to get students to retrieve the important take home messages of the lecture.
  • In-class retrieval assignments. A great way to break up the monotony of lectures is to have students complete retrieval assignments during class meetings. For example, have individuals or groups of students retrieve information and then present it to the rest of the class.
  • Encourage students to use retrieval practice outside of class. One of the greatest benefits of retrieval practice is that it easy to use; all one needs to do is to recall information from memory. I encourage my students to use retrieval practice by first presenting to them some of the evidence of its effectiveness (described above), and then by suggesting some methods they may use to employ the strategy that (e.g., take turns quizzing or teaching fellow students, quiz one-self, or simply freely recall portions of the information). Again, it is important to emphasize that multiple retrieval events are more beneficial, and that each or most of those should include feedback. For example, have students study then retrieve then study again to receive feedback, etc.


  1. Dobson JL, Linderholm T, Yarbrough MB. Self-testing produces superior recall of both familiar and unfamiliar muscle information. Advances in Physiology Education 39: 309-314, 2015
  2. Dobson JL and Linderholm T, The effect of selected “desirable difficulties” on the ability to recall anatomy information. Anatomical Sciences Education 8: 395-403, 2015.
  3. Dobson JL, Linderholm T. Self-testing promotes superior retention of anatomy and physiology information. Advances in Health Sciences Education 20: 149-161, 2015.
  4. Butler AC, Roediger HL. Testing improves long-term retention in a simulated classroom setting. European Journal of Cognitive Psychology 19: 514-527, 2007.
  5. Blunt JR, Karpicke JD. Learning with retrieval-based concept mapping. Journal of Educational Psychology 106: 849, 2014.
  6. Dobson JL, Perez J, Linderholm T. Distributed retrieval practice promotes superior recall of anatomy information. Anatomical Sciences Education DOI: 10.1002/ase.1668, 2016.
  7. Karpicke JD, Aue, WR. The testing effect is alive and well with complex materials. Educational Psychology Review 27: 317-326, 2015.
  8. Karpicke JD, Blunt JR. Retrieval practice produces more learning than elaborative studying with concept mapping. Science 331: 772-775, 2011.
  9. Larsen DP, Butler AC, Roediger HL. Repeated testing improves long-term retention relative to repeated study: A randomized controlled trial. Medical Education 43: 1174-1181, 2009.
  10. Larsen DP, Butler AC, Lawson AL, Roediger HL. The importance of seeing the patient: Test-enhanced learning with standardized patients and written tests improves clinical application of knowledge. Advances in Health Sciences Education 18: 409-25, 2013.
  11. Linderholm T, Dobson JL, Yarbrough MB. The benefit of self-testing and interleaving for synthesizing concepts across multiple physiology Advances in Physiology Education 40: 329-34, 2016.
  12. Roediger HL, Butler AC. The critical role of retrieval practice in long-term retention. Trends in Cognitive Sciences 15: 20-27, 2011.
  13. Roediger HL, Karpicke JD. Test-enhanced learning: Taking memory tests improves long-term retention. Psychological Science 17: 249-255, 2006.
  14. Roediger HL, Karpicke JD. The power of testing memory: Basic research and implications for educational practice. Perspectives in Psychological Science 1: 181-210, 2006.
  15. Smith MA, Karpicke JD. Retrieval practice with short-answer, multiple-choice, and hybrid tests. Memory 22: 784-802, 2014.

John Dobson is an Associate Professor in the School of Health and Kinesiology at Georgia Southern University. John received his M.S. and Ph.D. in Exercise Physiology at Auburn University. Although most of his research has focused on the application of learning strategies that were developed by cognitive scientists, he has also recently published articles on peripheral neuropathy and concussion-induced cardiovascular dysfunction. He teaches undergraduate and graduate Anatomy and Physiology, Structural Kinesiology, Exercise Physiology, Cardiovascular Pathophysiology courses. He has been an active member of the American Physiological Society since 2009, and he received the Teaching Section’s New Investigator Award in 2010 and Research Recognition Award in 2011.


March 8th, 2017
Boredom, the Evil Destroyer of Motivation vs. Inquiry, the Motivation Maker

Students have an innate desire to learn and more learning takes place when doing rather than when listening. (4)  This begins in pre-school and kindergarten when children have fun while learning by playing with blocks, coloring, drawing, etc.  This is their first experience with active learning.  But then as education progresses through grade school, high school and college, something bad happens.  That is, fun learning activities are slowly replaced with often very boring listening activities filled with inane factoids, and consequently, students often become disinterested.  The disinterest is seen in the form of poor class attendance, and the lack of motivation is palpable through continual yawns, bobbing heads, and walking to the back of the classroom and looking at student laptops to see how many are streaming Netflix or shopping for shoes.  As educators that take part in this process, we actively destroy their innate desire to learn.  We do not do this intentionally, as all of us want our students to learn as much as possible.  However, with the ever increasing and endless mountain of information, we cannot teach them everything, and often feel that we should be actively teaching, rather than letting them actively learn. (3)  Thus, after hours, days and years of sitting in class “listening”, the traditional “sage on the stage” can slowly chip away at the inner desire to learn.  But, if this internal motivation can be decreased by boring activities, can it also be increased by fun or intriguing activities?


As educators, we hold an awesome power that has the potential to inspire and increase student motivation.  Student-centered learning activities that include but are not limited to collaborative group testing, inquiry-based learning, team-based learning and laboratory exercises (5) provide students with the opportunity to apply their minds, to have fruitful discussions with their peers (2) and to see and appreciate the complex beauty that science and medicine are.  If we can provide our students with learning activities that open their imaginations and make them feel excitement, we can actively increase their innate desire to learn, and improve their chances of success. (1)  In doing so, the awesome potential power that we hold can become fully realized in the form of life-long learners.



  1. Augustyniak RA, Ables AZ, Guilford P, Lujan HL, Cortright RN, and DiCarlo SE. Intrinsic motivation: an overlooked component for student success. Adv Physiol Educ 40: 465-466, 2016.
  2. Cortright RN, Collins HL, and DiCarlo SE. Peer instruction enhanced meaningful learning: ability to solve novel problems. Adv Physiol Educ 29: 107-111, 2005.
  3. DiCarlo SE. Too much content, not enough thinking, and too little fun! Adv Physiol Educ 33: 257-264, 2009.
  4. Freeman S, Eddy SL, McDonough M, Smith MK, Okoroafor N, Jordt H, and Wenderoth MP. Active learning increases student performance in science, engineering, and mathematics. Proc Natl Acad Sci U S A 111: 8410-8415, 2014.
  5. Goodman BE. An evolution in student-centered teaching. Adv Physiol Educ 40: 278-282, 2016.



Robert A. Augustyniak is an Associate Professor and Physiology Discipline Chair at Edward Via college of Osteopathic Medicine- Carolinas Campus, Spartanburg, SC. Rob received his Ph.D. in Physiology at Wayne State University School of Medicine, Detroit, MI, and subsequently completed a post-doctoral fellowship at the University of Texas Southwestern Medical Center, Dallas, TX. A cardiovascular physiologist by training, his studies have focused on the blood pressure regulation during exercise and in heart failure and hypertensive states. In 2009, Rob became a founding faculty member at Oakland University William Beaumont School of Medicine where he began to focus on the scholarship of medical education. These research interests continued to grow when he moved to Spartanburg, SC in 2013. He is profoundly interested in how medical student motivation impacts learning and in finding best practices in teaching and assessment that can increase motivation. For the past several years, he has been and continues to be active within the leadership of the APS Teaching Section.

January 16th, 2017
Critical thinking or traditional teaching for Health Professions?

“Education is not the learning of facts but the training of the mind to think”- Albert Einstein”

A few years ago I moved from a research laboratory to the classroom. Until then, I had been accustomed to examine ideas and try to find solutions by experimenting and challenging the current knowledge in certain areas. However, in the classroom setting, the students seemed to only want to learn facts with no room for alternative explanations, or challenges. This is not the way a clinician should be trained- I thought, and I started looking in text books, teaching seminars and workshops for alternative teaching methods. I quickly learned that teaching critical thinking skills is the preferred method for higher education to develop highly-qualified professionals.

Why critical thinking? Critical thinking is one of the most important attributes we expect from students in postsecondary education, especially highly qualified professionals in Health Care, where critical thinking will provide the tools to solve unconventional problems that may result. I teach Pathophysiology in Optometry and as in other health professions, not all the clinical cases are identical, therefore the application and adaptation of the accumulated body of knowledge in different scenarios is crucial to develop clinical skills. Because critical thinking is considered essential for patient care, it is fostered in many health sciences educational programs and integrated in the Health Professions Standards for Accreditation.

But what is critical thinking? It is accepted that critical thinking is a process that encompasses conceptualization, application, analysis, synthesis, evaluation, and reflection. What we expect from a critical thinker is to:

  • Formulate clear and precise vital questions and problems;
  • Gather, assess, and interpret relevant information;
  • Reach relevant well-reasoned conclusions and solutions;
  • Think open-mindedly, recognizing their own assumptions;
  • Communicate effectively with others on solutions to complex problems.

However, some educators emphasize the reasoning process, while others focus on the outcomes of critical thinking. Thus, one of the biggest obstacles to proper teaching of critical thinking is the lack of a clear definition, as observed by Allen et al (1) when teaching clinical critical thinking skills. Faculty need to define first what they consider critical thinking to be before they attempt to teach it or evaluate student learning outcomes. But keep in mind that not all students will be good at critical thinking and not all teachers are able to teach students critical thinking skills.

The experts in the field have classically agreed that critical thinking includes not only cognitive skills but also an affective disposition (2). I consider that it mostly relies on the use of known facts in a way that enables analysis and reflection of conventional and unconventional cases for the future. I have recently experimented with reflection in pathophysiological concepts and I have come to realize that reflection is an integral part of the health professions.  We cannot convey just pieces of information based on accumulated experience, we have to reflect on it. Some studies have demonstrated that reflective thinking positively predicted achievement to a higher extent than habitual action. However, those may not be the key elements of critical thinking that you choose to focus on.

How do we achieve critical thinking in higher education and Health Professions? Once we have defined what critical thinking means to us, it must be present at all times when designing a course, from learning objectives to assignments. We cannot expect to contribute to development of critical thinking skills if the course is not designed to support it. According to the Delphi study conducted by the American Philosophical Association (3), the essential elements of lessons designed to promote critical thinking are the following:

  1. “Ill structured problems” are those that don’t have a single right answer they are based on reflective judgment and leave conclusions open to future information.
  2. “Criteria for assessment of thinking” include clarity, accuracy, precision, relevance, depth, breadth, logic, significance, and fairness (Paul & Elder, 2001).
  3. “Student meaningful and valid assessment of their own thinking”, as they are held accountable for it.
  4. “Improving the outcomes of thinking” such as in writing, speaking, reading, listening, and creating.

There are a variety of examples that serve as a model to know if the course contains critical thinking elements and to help design the learning objectives of a course. However, it can be summarized in the statement that “thinking is driven by questions”. We need to ask questions that generate further questions to develop the thinking process (4). By giving questions with thought-stopping answers we are not building a foundation for critical thinking. We can examine a subject by just asking students to generate a list of questions that they have regarding the subject provided, including questions generated by their first set of questions. Questions should be deep to foster dealing with complexity, to challenge assumptions, points of view and the sources of information. Those thought-stimulating types of questions should include questions of purpose, of information, of interpretation, of assumption, of implication, of point of view, of accuracy and precision, of consistency, of logic etc.

However, how many of you just get the question: “Is this going to be on the test?”. Students do not want to think. They want everything to be already thought-out for them and teachers may not be the best in generating thoughtful questions.

As an inexperienced research educator, trying to survive in this new environment, I fought against the urge of helping the students to be critical thinkers, and provided answers rather than promoting questions. I thought I just wanted to do traditional lectures. However, unconsciously I was including critical thinking during lectures by using clicker questions and asking about scenarios with more than one possible answer. Students were not very happy, but the fact that those questions were not graded but instead used as interactive tools minimized the resistance to these questions. The most competitive students would try to answer them right and generate additional questions, while the most traditional students would just answer, no questions asked. I implanted this method in all my courses, and I started to give critical thinking assignments. The students would have to address a topic and to promote critical thinking, a series of questions were included as a guide in the rubric. The answers were not easily found in textbooks and it generated plenty of additional questions. As always, it did not work for every student, and only a portion of the class probably benefited from them, but all students had exposure to it. Another critical thinking component was the presentation of a research article. Students had a limited time to present a portion of the article, thus requiring analysis, summary and reflection. This is still a work in progress and I keep inserting additional elements as I see the need.

How does critical thinking impact student performance? Assessment

Despite the push for critical thinking in Health Professions, there is no agreement on whether critical thinking positively impacts student performance. The curriculum design is focused on content rather than critical thinking, which makes it difficult to evaluate the learning outcomes (5). In addition, the type of assessment used for the evaluation of critical thinking may not reflect these outcomes.

There is a growing trend for measuring learning outcomes, and some tests are used to assess critical thinking, such as the Classroom Assessment Techniques (CAT), which evaluate information, creative thinking, learning and problem solving, and communication. However, the key elements in the assessment of student thinking are purpose, question at issue, assumptions, inferences, implications, points of view, concepts and evidence (6). Thus, without a clear understanding of this process and despite the available tests, the proper assessment becomes rather challenging.

Another issue that arises when evaluating students critical thinking performance is that they are very resistant to this unconventional model of learning and possibly the absence of clear positive results may be due to the short exposure to this learning approach in addition to the inappropriate assessment tools. Whether or not there is a long term beneficial effect of critical thinking on clinical reasoning skills remains to be elucidated.

I tried to implement critical thinking in alignment with my view of Physiology.  Since, I taught several courses to the same cohort of students within the curriculum, I decided to try different teaching techniques, assessments and approaches at different times during the curriculum.  This was ideal because I could do this without a large time commitment and without compromising large sections of the curriculum. However, after evaluating the benefits, proper implementation and assessment of critical thinking, I came to the conclusion that we sacrifice contact hours of traditional lecture content for a deeper analysis of a limited section of the subject matter. However, the board exams in health professions are mostly based on traditional teaching rather than critical thinking. Thus, I decided to only partly implement critical thinking in my courses to avoid a negative impact in board certification, but include it somehow as I still believe it is vital for their clinical skills.



  1. Allen GD, Rubenfeld MG, Scheffer BK. Reliability of assessment of critical thinking. J Prof Nurs. 2004 Jan-Feb;20(1):15-22.
  2. Facione PA. Critical thinking: A statement of expert consensus for purposes of educational assessment and instruction: Research findings and recommendations [Internet]. Newark: American Philosophical Association; 1990[cited 2016 Dec 27]. Available from:
  3. Facione NC, Facione PA. Critical thinking assessment in nursing education programs: An aggregate data analysis. Millbrae: California Academic Press; 1997[cited 2016 Dec 27].
  4. Paul WH, Elder L. Critical thinking handbook: Basic theory and instructional structures. 2nd Dillon Beach: Foundation for Critical Thinking; 2000[cited 2016 Dec 27].
  5. Not sure which one
  6. Facione PA. Critical thinking what it is and why it counts. San Jose: California Academic Press; 2011 [cited 2016 Dec 27]. Available from:






Lourdes Alarcon Fortepiani is an Associate professor at Rosenberg School of Optometry (RSO) at the University of the Incarnate Word in San Antonio, Texas. Lourdes received her M.D. and Ph.D. in Physiology at the University of Murcia, Spain. She is a renal physiologist by training, who has worked on hypertension, sexual dimorphism and aging. Following her postdoctoral fellowship, she joined RSO and has been teaching Physiology, Immunology, and Pathology amongst other courses. Her main professional interest is medical science education. She has been active in outreach programs including PhUn week activities for APS, career day, and summer research activities, where she enjoys reaching K-12 ad unraveling different aspects of science. Her recent area of interest includes improving student critical thinking.


December 26th, 2016
Good Teaching: What’s Your Perspective?

Are you a good teacher? 

What qualities surround “good teachers? 

What do good teachers do to deliver a good class?

The end of the semester is a great time to critically reflect on your teaching.

For some, critical reflection on teaching is prompted by the results of student course evaluations. For others, reflection occurs as part of updating their teaching philosophy or portfolio.  Others use critical reflection on teaching out of a genuine interest to become a better teacher.  Critical reflection is important in the context of being a “good teacher.”

Critical reflection on teaching is an opportunity to be curious about your “good teaching.”  If you are curious about your approach to teaching I encourage you to ponder and critically reflect on one aspect of teaching – perspective.

Teaching perspectives, not to be confused with teaching approach or styles, is an important aspect on the beliefs you hold about teaching and learning.  Your teaching perspectives underlie the values and assumptions you hold in your approach to teaching.

How do I get started?

Start by taking the Teaching Perspectives Inventory (TPI).  The TPI is a free online assessment of the way you conceptualize teaching and look into your related actions, intentions, and beliefs about learning, teaching, and knowledge.  The TPI will help you examine your views about and within one of five perspectives:  Transmission, Apprenticeship, Developmental, Nurturing, and Social Reform.

What is your dominant perspective?

The TPI is not new.  It’s been around for over 15 years and is the work of Pratt and Collins from the University of British Columbia (Daniel D. Pratt and John B. Collins, 2001)(Daniel D. Pratt, 2001).  Though the TPI has been around for a while, it is worth bringing it up once more.   Whether you are a new or experienced teacher, the TPI is a useful instrument for critical reflection on teaching especially now during your semester break!  Don’t delay.  Take the free TPI to help you clarify your views on teaching and be curious.



Teaching Perspectives Inventory –

How to interpret a teaching perspective profile –

Daniel D. Pratt and John B. Collins. (2001). Teaching Perspectives Inventory. Retrieved December 01, 2016, from Take the TPI:

Daniel D. Pratt, J. B. (2001). Development and Use of The Teaching Perspectives Inventory (TPI). American Education Research Association.




Jessica M. Ibarra, is an Assistant Professor of Applied Biomedical Sciences in the School of Osteopathic Medicine at the University of the Incarnate Word. She is currently teaching in the Master of Biomedical Sciences Program and helping with curriculum development in preparation for the inaugural class of osteopathic medicine in July 2017. As a scientist, she studied inflammatory factors involved in chronic diseases such as heart failure, arthritis, and diabetes. When Dr. Ibarra is not conducting research or teaching, she is mentoring students, involved in community service, and science outreach. She is an active member of the American Physiological Society and helps promote physiology education and science outreach at the national level. She is currently a member of the Porter Physiology and Minority Affairs Committee; a past fellow of the Life Science Teaching Resource Community Vision & Change Scholars Program and Physiology Education Community of Practice; and Secretary of the History of Physiology Interest Group.


December 12th, 2016
The Real World – A Philosophical Analysis?

Silhouette of coming businessman in doorway with shadow

“The world is too much with us; late and soon,

Getting and spending, we lay waste our powers”—thus, Wordsworth over two centuries ago, bemoaned man’s disconnect from the natural world and meaningful lives. Universities these days are exhorted to prepare students for the “real world”. But what that “reality” is, puzzles me.


In one sense, there is a depressing soul-numbing banality to our daily lives. As the Fool told Jacques, “From hour to hour, we ripe and ripe/And then, from hour to hour, we rot and rot;/And thereby hangs a tale.” Surely we do not need Universities to teach students to cope with that tedium—picking out the best buys from a selection of toilet paper or tooth pastes, parking cars, changing diapers, filing tax forms and other drearies (to coin a word). The ‘real world” is one where many trudge through their working days longing for the weekends when they can begin to live. We always ask people how their weekends went, not their week. Do we need courses in coping with tedium or preparing for the weekend?


We could of course, prepare them for other realities. Beyond death and taxes, there are other certainties, the “resonant lies” that Auden warned us about in his Ode to Terminus. That our students will find themselves in a thicket of lies in the real world is more than certain. We can prepare them well by giving them the right tools. In the sciences, much is made of critical appraisal where students are taught to assess peer-reviewed articles and analyze publications. That is all well and good, but the more dangerous lies have rarely been subject to peer review. They lie buried elsewhere in the minutes of Committee meetings, confidential reports etc. I think it was David Halberstam in his brilliant analysis of the Kennedy administration, who noted the significance of selective “minuting” in skewing decisions. Perhaps an interdisciplinary or trans-disciplinary mandatory course in “Institutional Lying” can be very useful.


Philip Larkin found himself in a church where he mused on what would become of such sacred spaces, “In whose blent air all our compulsions meet/ Are recognized, and robed as destinies.”  To me, the University much like a church, is a sacred space, where one melds the richness of the past with the exuberance of the future. It is that richness of the real world that we can pass on to our students, not just its banalities.


I am a basic biologist and most, though not all, of my courses deal with biological mechanisms that underly the very marrow of our existence, the stuff we are made of, so to speak. The words and concepts, I use, (receptors, inverse agonists, G-proteins, allosteric modulators, constitutive activities etc.), may seem a trifle arch but these can, and have, made their way from bench to boardroom and beyond. In addition, our daily lives, loves, behaviors, misbehaviors stem from responses to such molecules.


None of what I teach may help my students deal directly with their quotidian vicissitudes; in a deeper sense though, they may realize that underlying all their actions, their fears, hopes, loves and despairs are molecular interactions whose mysteries have been probed and defined by their own species adding to the rich tapestry of human expression and creativity. We are, ourselves, part of that wonderful world that Wordsworth wanted us to be in touch with.  Truly the unknown psalmist got it right when he said “Oh Lord, How manifold are Thy works! In Wisdom has thou made them all: the earth is full of thy riches”

What better way for a university to fulfill its role than opening the windows to their students to that wonderful world, the REAL one?





P.K. Rangachari is currently Professor (Emeritus) of Medicine at McMaster University. Depending on the emphasis placed, that word emeritus could imply he has much merit, none whatsoever or only in cyberspace. He has a medical degree (M.B.B.S. 1966) from the All-India Institute of Medical Sciences, New Delhi, India and a Ph.D. (Pharmacology) from the U. of Alberta (1972). He drifted into medical school due to a bureaucratic blunder that derailed his efforts to become an organic chemist. However he was lucky. He had great teachers in the basic sciences and so after graduation, he left his stethoscope behind and began a peripatetic existence moving from lab to lab in several continents, finally landing up at McMaster University in Canada, some thirty plus years ago.
P.K. Rangachari’s experimental research focused on the effects of inflammatory mediators on ion transport in smooth muscles and epithelia. He has taught students in undergraduate science, liberal arts, nursing, medicine, physiotherapy and pharmacy. He has sought to bridge the two cultures (the sciences and the humanities) by designing interdisciplinary courses or encouraging students to express their learning through more creative outlets such as framing conversations, writing reviews and plays. He is blessed that he is blissfully ignorant so he can wake up each day convinced that there is so much more to learn. His students fortunately help him in that regard.



November 21st, 2016
May I Cut In? – A Short Dance With Social Media

1 hour, 43 minutes.  Per day.  In the United States, ~10% of a person’s waking hours are spent on social media.  And, you’d be hard pressed to find a college student who doesn’t use social media as 90% of adults between 18-29 years old use some form of it.  It’s a tremendous online environment in which people spend considerable amounts of time – a promising place for educators to expand their repertoire for teaching.

Now, some may consider it “crazy” that social media influences the way people think (about politics, for example), but it certainly has the power to affect the way we feel (for good or ill).  It also seems to increase student interest in a subject near and dear to my heart – physiology.

So, earlier this year, I experimented with social media during my block of a large (~330 undergraduate students), upper-division course on integrative cellular physiology.  This class was principally lecture-based with the online portal for the course only used for distributing slides/notes, administering quizzes, and tracking grades.

Browsing through the science education literature, I found a number of articles evaluating the benefits and burdens of using social media in the classroom.  After some reading, I decided I needed to test the waters myself and get a better sense of how to use social media as a tool to improve learning.

But, why even bother with social media?

  1. Location, location, location. I wanted to go where the students were (digitally).
  2. Beyond the lecture hall. By extending the learning environment past the walls of the classroom, I hoped to get students thinking more about physiology outside the isolated microcosm of the lecture (whether they’re standing in line at Starbucks, checking status updates during lunch, or sneaking a peek to clear the notification bubble on their app).
  3. Build rapport. If I engaged students in an online locale they were familiar with, I could help erode some of the barriers (fear of speaking in class, an “intimidating” professor, etc.) that tend to inhibit communication between teacher and student.
  4. Cultivate a sense of community. I wanted to take advantage of a hub that would help foster the formation of friendships and study groups.  I also hoped to provide a curated online environment for students to help each other with the course material – a community of learners.
  5. “Go online,” they said. “It’ll be fun,” they said.  I saw an opportunity for myself to grow as an educator, and I wanted to challenge myself by wrestling with a tool I had yet to add to my teaching kit.

Which social media venue, though?  

A Facebook group.  Facebook has the largest active user base of social media platforms (192 million active users in the US), it’s in the top 3 most visited sites in the US, and it’s the social media site with which I have the most experience.

social media meme


Soon, I began to have feelings of self-doubt and trepidation as an onslaught of questions started rolling in.

Would students be willing to participate?  What about students who had chosen to avoid Facebook?  How many points would I need to assign to get them to buy in?  Would students have concerns about their instructor potentially seeing their Facebook profiles?  Would other privacy issues arise such as online student-to-student harassment?  How frequently would I need to post to keep students interested?  What kind of material would I post?  How would I compose posts to make them “effective”?  How would I evaluate participation and engagement?

Well, some of these questions can only be answered in execution, so I looked at this endeavor as an exploratory, two month “pilot study” and pressed on.

I announced the Facebook group during the first lecture in my block of the course, explained that it was completely optional (no associated points), listed some of the benefits (that I perceived) of joining it, and told them that all supplementary materials posted to the group would also be posted on the course website (if they didn’t have/want Facebook).  The first prompt I gave them on the Facebook group was a question I had found on an 8th grade test from 1912:

“Why should we study physiology?”

Immediately after lecture ended, I whipped out my smartphone and checked on the group.  About 30 students had joined.  This was encouraging, but really… I was hoping for more.  With less than 10% of the class on board, I began to regret not offering more carrot.

Over the next week, the students trickled in.  It climbed to 40.  60.  80.  By the end of my block two months later, 108 students had joined the group.  Close to a third of the class, which (considering I made it optional) was a success.

Ah, but were students actually participating? 

In order to get an overview of this, I turned to marketing analytics for social media.  Likes, shares, and comments are the marketing currency for businesses in this realm.  I think it’s much the same for educational purposes, though the value you assign to each currency for their contribution to “engagement” rating may differ.

Regardless, I used the website to give me metrics for my Facebook group. is free and quite a nice tool (despite some bugs).  The image below shows the kind of data it provides, which includes:



  1. Summary for number of unique contributors (post authors, commenters, and likers)
  2. Timeline showing activity for the group in graphical format (posts, likes, and comments).
  3. Breakdown of the types of posts that have been made (photos, videos, links, statuses, and events). also allows you to analyze posts to see which had the highest engagement ratings (which is done by summing data for likes/shares/comments for each post).



Of my posts, those that included videos were the highest rated followed by ones containing photos.  The second highest rated post for the group was from a student who posted a photo that related to a topic we were covering in class.  Perhaps unsurprising, visual content is the best bet for engagement.  Pure text-based posts and links were not very popular.

Additionally, summary stats ranking each visitor can be viewed.  This is useful for finding students in the group who are the most active or who are generating the most engaging posts.  This “visitor rating” takes into account received likes, shares, comments, and comment likes and submitted likes, posts, and comments.  The comparison between the two (received versus submitted) is what measures as “karma”.



On top of all this, each set of data can also be exported as CSV or XLS files for analysis.

That said… did this actually have a positive impact for learning physiology?

Yes, I believe so.  Based on comments from students (directly asking them or through course evaluations), using the Facebook group got them more engaged with the material.  Students seemed to like the online dynamic.  They felt that it showed that I cared about interacting with them and facilitating a different avenue for them to ask questions.

It also gave me a chance to share interesting tidbits about physiology with students without having to shoehorn them into lecture.  Social media is definitely well-designed for “hey, look at this cool thing” kind of communication.  Often, it’s those tidbits that tend to stick and motivate students to dig deeper on their own.

But, did using social media make an appreciable difference for their exam grades?

Given the way I carried out my “pilot study”, determining that with confidence is trickier.  However, students who simply joined the Facebook group scored a few percentage points higher on the block exam.  Since the group was optional, though, those who took part may represent students who usually take more initiative in their learning.

While my approach to trying out social media was a little messy, I thought it was an extremely valuable experience.  I’ve found that fumbling around is often the best way to learn.  I may still have two left feet, but I’m not going to find the rhythm without stepping onto the dance floor.

Sources for social media usage statistics:

  • Kemp, Simon. “Special Reports: Digital in 2016.” We Are Social, 27 Jan. 2016,
  • Perrin, Andrew. “Social Media Usage: 2005-2015.” Pew Research Center – Internet, Science & Tech, 8 Oct. 2015,





Scientist, teacher, and all-round geek, John Kanady earned his PhD in Physiological Sciences from the University of Arizona.  He is currently a postdoctoral trainee in Dr. Janis Burt’s laboratory at the University of Arizona.  His research involves looking at how cells communicate with each other via proteins called connexins and what that communication means for cell function.  He serves as Postdoctoral Councillor for the Arizona Chapter  of the American Physiological Society where he strives to advance the three pillars of the organization: teaching, research, and outreach.  You can follow him on Twitter @JDKPhD



November 14th, 2016
The Benefits of Having Nontraditional Age Students in Your Classes

If asked the traditional age of a college student, most people would answer between 18-22 years old. While for many colleges this is accurate, at our college we have some students that are above the age of 22, and designated nontraditional age students (Nontrads). These students are enrolling at an older age for several reasons. Some have had other careers, and finally mustered up the courage to start fulfilling their dream of getting a college degree. These students could also be the first in their family to go to college, and are designated First Generation students. Others started college at the traditional age, and then stopped attending (stopped out). The reasons for stopping out vary, and could be for academic reasons, financial instability, or family obligations. Some are transfer students that work full time, have been taking one or two courses a semester at a community college, and are now moving on to a four year college. A fourth group are military veterans. These students served in the military for several years and are now just beginning their college careers. A final group are students who earned a Bachelor’s degree at a traditional age, had a career, and are now back to take prerequisites for graduate or professional school.

The course where I see the greatest mix of all these students is in Principles of Biology I & II. These are the required courses for first year science majors on our campus. In a room full of students, the Nontrads can sometimes make up 20% of the class enrollment. This provides a unique environment that I really enjoy. While some of the Traditional age students might be intimidated at first to have an older student sit next to them, as the professor standing in the front of the room I have a different perspective. What I see when I look at the Nontrads is typically someone who is engaged from the first day of class, and ready to get to work. These students have had life experiences, and they know without a doubt that the college classroom is where they want to be at this point in their lives.  They are focused and want to get the most out of this experience. Usually a Nontrad is the first to answer my questions, or raise their hands on the very first day of class. For me that first day experience is very important for all the students and getting them past the barrier of participating in class is important. Having a Nontrad start off right away by participating is a joy and the beginning of forming a community that is open to discussions. I encourage their engagement and this leads to more positive interactions. These interactions benefit the Nontrad as they may be a bit uncertain about starting college at an older age and getting the reassurance from the professor early helps ease their minds while building their confidence. It is no surprise that the Nontrads are the students whose names I learn first and then call on them by name (Student A). One pitfall is that they will start answering every question I ask, and to gently discourage this I will say to the entire class “Now Student A cannot answer all the questions, come on folks who wants to answer this question?” This allows me to get different students involved in the class without discouraging others.

Another unique quality found in the Nontrad student population is that they are not concerned about the test. Everyone knows what I mean by this, students that only want to understand and perhaps memorize information that they will be tested on in a few weeks. The Nontrads want to understand what they are learning at a deeper level and they find connections to the material that most of the Traditional students would not initially make. They bring their life experiences into the classroom and it benefits everyone. Some of our students want to go on to careers in health care (PA, MD, OD), and I often have Nontrads in the class who are currently working part time (or full time) as paramedics, emergency medical technicians (EMTs), or they were a medic in the military. They bring in real life examples of some of the principles that we are going over in class. I love to hear these stories as they bring the concepts to life for the entire class. These stories benefit all of us as they capture the attention of the students, engage them, and also provide me with yet another example of the concept we are discussing.

For the Traditional age student, the Nontrads are often active mentors to them in the classroom. During a break in class I will see the Nontrad explaining concepts to the Traditional age student sitting next to them. If the Traditional age student is receptive to this mentoring it will continue to occur throughout the semester. Being mentored by a Nontrad benefits the Traditional age student as they will then understand the material at a deeper level and any misconceptions can be addressed during class time. Mentoring benefits the Nontrad as they gain confidence in their knowledge.  Because of this positive experience some of the Nontrads will become tutors in our tutoring center the following year.

I enjoy sharing stories about the Nontrads who have had interesting lives before they came to our college and will share a few favorites with you. One was a diamond broker, and then a massage therapist, before majoring in science. She will earn her Ph.D. in Biochemistry next year. Our commencement speaker last year was a plumber, who became a member of Phi Beta Kappa and won the Beta Chapter award for the highest GPA at our university.  He is now in an MD-Ph.D. program. Our biology program award winner for the previous year was a diesel engine mechanic, who had attended every community college in the state before switching his focus to science. He is now in his first semester of a Ph.D. program in microbiology. The final example I will share is of our convocation speaker a few years ago. He told family and friends he did not need college, as he was going to be a rock star. After getting married, having two children, and realizing he did need college, he came to us after getting an Associate’s degree at a community college. He earned his Bachelor’s degree with a 4.0 GPA and is now in his second year of dental school. Having Nontrad students in the classroom benefits them, their classmates, and their professors. I am continually grateful they have decided to attend our college and look forward to having them in my classes in the future.



Patricia A. Halpin is an Assistant Professor in the Life Sciences Department at the University of New Hampshire at Manchester (UNHM). Patricia received her MS and Ph.D. in Physiology at the University of Connecticut. She completed a postdoctoral fellowship at Dartmouth Medical School. After completion of her postdoc she started a family and taught as an adjunct at several NH colleges. She then became a Lecturer at UNHM before becoming an Assistant Professor. She teaches Principles of Biology, Endocrinology, Cell Biology, Animal Physiology, Global Science Explorations and Senior Seminar to undergraduates. She has been a member of APS since 1994 and is currently on the APS Education committee and is active in the Teaching Section. She has participated in Physiology Understanding (PhUn) week at the elementary school level in the US and Australia. She has presented her work on PhUn week, Using Twitter for Science Discussions, and Embedding Professional Skills into Science curriculum at the Experimental Biology meeting and the APS Institute on Teaching and Learning.

October 31st, 2016
Closing the Circle: How being faculty at a liberal arts college made me a better medical physiologist

Happy Halloween!

As I look back upon my career as a faculty member at both a liberal arts college and several medical schools, I’ve come to the realization that this holiday is not a bad analogy for some things we all are familiar with—surprises both good and bad, sometimes a little scary… and at the journey’s end, a reflection of our perceived world and ourselves.pumpkinghosts

Example:  20 years ago last month, I started my first faculty position as an Assistant Professor of Biology at a small liberal arts college. Walking into that first classroom on the first day of classes was pretty frightening, because I did not know it all. As a graduate of a medical-level physiology Ph.D. program I had a solid background in the teaching of physiology, having taught it in lecture and/or lab to students in dental hygiene, nursing, dental, medical, and graduate programs. But I’d never taken gross anatomy or histology. So in that first Anatomy and Physiology class I was going to have to be an “expert” in both topics to students who had no reason to think I wasn’t.  The horror of it all to me.

I spent a good deal of my first semester staying one week ahead of the students in those weak areas.  In the next semester, it was Microbiology in which I was deficient. I had only taken one undergraduate microbiology course 14 years before, and unlike anatomy or histology there had been little cross-learning of this topic with physiology in graduate school, so I was on my own. I had help of course, including experienced faculty and excellent teaching resources that came with the textbooks. But it was a long way out of my comfort zone.  In fact, it was downright frightening!  As the years went by, I put on many other hats, some of which were better fits than others. I taught general biology, biochemistry, genetics, cell biology, and personal health, among other courses offered to a dozen biology majors and a few hundred non-majors.  From being trained as a Physiologist, I had become a Biologist.

So what were the lessons I learned at this liberal arts college? The first was this:  That it is possible to teach what many medical schools of the day would have been considered an insane teaching load of 16-20 contact hours with students per week instead of 16-20 contact hours per year. Second, it is not necessary to be THE expert on a topic in order to teach it well. Third, to achieve this adequacy required being very flexible and willing to learn new things. For example, while I couldn’t actually replace an ecologist in the planning and leading of field trips, I could teach enough of the basic principles to satisfy the needs of students in a Biology II class. This involved working with the ecologists on the staff, even following them into the field to see and experience how they looked at the biological sciences. The final lesson I learned, though I learned it late, was that there are always opportunities to be a scientist. That not all research takes place in the laboratory or the clinic. That being a teacher and being a scientist need not be an either-or career choice. That the principles of science could be applied to the science and art of teaching itself.

After several years at this liberal arts college, I made the life-changing decision to start medical school on a part-time-student-part-time-teacher basis, at a Caribbean location.  While I never did get an M.D., my faculty experience at this medical school led to other full time faculty positions at both allopathic and osteopathic medical schools. And out there, working up from smaller medical schools to larger ones, I learned still more.  For two years before I joined my current institution, I taught medical physiology from 8-10 a.m. five days a week, assisted in the anatomy lab another four hours, and lectured in a premedical prep course for another 8-10 hours per semester. Completely unlike anything I had done before, I had to teach a medical physiology course three times per year as the sole instructor.  By necessity I relearned physiology as an entire discipline to a level close to what I’d known as I was finishing up my first year as a graduate student. I became able to teach any physiology topic at the medical level with little to no advance prep, again adequately but not necessarily at the research specialist level. The flip side was that as the only physiologist, there was essentially no time off for anything else including travel, conferences, or research.

From this experience I learned that it is possible to be a sole medical physiologist with the same teaching load as that taught at the undergraduate level. If necessary, one can have at least 14 contact hours per week to medical students and an additional 1-2 hours over several weeks each semester to premedical students and still teach well. I firmly believe that had I not had seven years of teaching experience as a multidisciplinary biologist at the undergraduate level, I would have found it much harder be able to teach all aspects of physiology at the medical level at such an intense pace. Just as I had had to do at the liberal arts college, I worked 16-18 hour days that first semester to stay two weeks ahead of the students. Each semester after that I worked 12 hour days to try to keep up with the demand of keeping lecture content and other materials updated, write 75 new exam items every three weeks, and perform all the other duties required of an associate professor at a tiny school. Along the way I finally overcame the self-concept built in from graduate training that I was an “endocrine physiologist” or a “reproductive physiologist” or a “gastrointestinal physiologist” or any other specialist physiologist based on the research I was doing. And in so doing I did acquire a specialty after all… I became a specialist at being a “generalist” whole-body physiologist, as well as a specialist in physiology education!

It was these specialties, honed from the lessons in adaptability first learned at the liberal arts college, which I brought to both my current medical school and to an osteopathic medical college in the United States. But my lessons weren’t done. Both of these medical programs use an integrated curriculum, which was far different from anything I had experienced before.  Prior to helping design the integrated curricula of both schools, I had never had significant teaching-level interactions with either histologists, biochemists, pathologists, or clinical medicine faculty despite our having been colleagues for years.  Now not only was I going to interact with them, I was going to have to be able to discuss pathology with medical students with enough competency to help explain how the physiology dovetailed into it and both of them into clinical conditions/presentations.  I was going to have to do the same thing with microbiology, anatomy, histology, biochemistry, and pharmacology to appreciate the whole-system approach to medical education.

So once again, I dove into the new challenges of adapting to this integrated organ-system driven curriculum.  For the first time, I came to understand across several organ systems how the clinical medicine was driven by pathology and that driven by the four foundations of gross anatomy, microanatomy, physiology, and biochemistry. But the focus of any integrative approach would always be first and foremost the clinical aspect of these four foundations in disorders and compensations because that’s what our students were ultimately trying to master. Bringing the balance in teaching the appropriate level of physiology in such a systems-based curriculum while ultimately keeping the clinical focus was a challenge I had never before faced.

And this is what brings me back almost full circle to my days as a young assistant professor at a tiny liberal arts school.  Instead of having teaching resources located in a set of supplements to a textbook, I have access to several specialists in each discipline, all of whom are focused on the same tasks for their respective fields.  And yet, in a curious sort of way I have become a Biologist again, albeit a medical biologist.

To illustrate this, I’ll give a short example.  At my current institution we have a curriculum in which organ systems are split into a first-or-second semester component and a third-or-fourth semester component.  In one lecture I deliver in second semester Endocrine Systems, I deliver a significant portion of the basic science content for the hypothalamus and pituitary gland.  In the initial preparation for this lecture, I incorporate materials prepared by our module’s microanatomist (a neuroscientist by training) and from our module’s pathologist which mentions those pathologies most appropriate for students at this level to learn.  When I then stand before the class as the lecture presenter, I deliver not only physiology content but this other content as well.  As I do so, I am reminded of those times so many years ago now when I was just as far out of my field, delivering the details of dense connective tissue to biology majors, the presentation of viral gastrointestinal disorders to nursing students, or the principles of public health to non-majors.

The story is the same really.  We are all alike now, the physiologists of the undergraduate and the medical teaching world.  We have much to share with one another, and much to learn from one another.  And you know, that’s not really a scary thought at all.  Happy Halloween anyway.



Bruce Wright is a professor in the Department of Physiology at Ross University School of Medicine in the Commonwealth of Dominica, West Indies.  Bruce received his doctorate in Physiology from Louisiana State University Health Sciences Center in New Orleans.  Following two postdoctoral fellowships he taught at Thomas University in Thomasville, GA.  He also taught at the Medical College of the Americas in St. Kitts and Nevis, West Indies, the University of Sint Eustatius School of Medicine in the Netherlands Antilles, West Indies, and the Alabama College of Osteopathic Medicine in Dothan, AL.  Bruce has been a regular member of the APS for 22 years, most of those with the Teaching section as his primary affiliation. Bruce has served as Treasurer/Events and Awards Coordinator of the APS Teaching of Physiology Section since 2015.  He has presented work at EB and the APS ITL on APS learning objectives, novel teaching strategies and item objective formats, integrated curriculum design and implementation, and challenges in preserving physiology content in integrated curricula.