Category Archives: Core Concepts & Competencies

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.


The art of revamping an Introductory Biology course (and curriculum) around Vision & Change

blue cycling arrowsWhen Vision & Change: A Call to Action was published and distributed, University of Alaska Anchorage (UAA) Biology department (like many other departments across the country) answered the call. The rubrics for Vision and Change gave people a means to evaluate one’s department and how student instruction occurred. This led to great discussions on what needed to be remodeled within our courses and curriculum. This was good. The previous UAA Introductory Biology course had a 20% withdrawal rate and (by estimates only) an additional 20% of students who would not succeed in the course (D or F grade). If we wanted to increase retention in the major and increase the diversity of people pursuing a biological sciences undergraduate education, something needed to be done.

I want to take this opportunity to spend a bit of time on our process; not simply because I am excited about the positive changes that are happening at our biology department, but to share our brief story in hopes to hear from others.

The problem – UAA had a 2 semester introductory biology (survey based) course that had, in some instances, 40% reduction of students for each semester.

Our solution – Create a 1 semester laboratory/experiential learning introductory biology course (Principles and Methods of Biology; BIOL A108) that is founded on the principles laid forth in Vision and Change.

What does this really look like, other than a lot of work?

The basic flow is to have 3, 5-week (10 sessions) modules within the semester, which focus on three core concepts: evolution, information flow, and structure and function. These modules are tied together by principles of the scientific method and student led experiments. Each module has a different content lead instructor. The unifying instruction is led by a lab coordinator that follows the theme of scientific method to ensure students are practicing and utilizing each part of the scientific method throughout the duration of the course.

  • Module 1 focuses heavily on observation, creating and testing hypotheses, finding and using credible sources, and creating basic graphs for communication purposes.
  • Module 2 continues to build on observation, creating and testing hypotheses, creating graphs, and adds the component of applying the collected data into a greater context using credible sources.
  • Module 3 takes the components of modules 1 and 2 and asks the students to interpret their data using credible sources.

These modules culminate at the end of the course by having the students present a hypothetical experiment based on a current biologically relevant observation.

This course set up requires a large amount of group work and coordination among the students. We encourage discussions through specific assignment prompts and ask the students to present their data (6 times) as a group (they switch group members for each module). Presentations are assessed on flow of information, clarity of information, and accuracy of information. We include concept quizzes (3 per module), but no high stakes exams. There are a series of assignments that are formative to allow instructor feedback to be incorporated into summative assignments (presentations and experimental write ups).

Is it working? – We’ve tracked these changes with pre/post tests and student retention rates. Initial data show 96% of students passed (defined as a C or better grade) with a withdrawal rate of 2% in the first semester (Fall 2015). Data from the current semester (Spring 2016) suggest a similar trend. A second goal of the program revision was to increase student learning and engagement about the process of the scientific method; in this our data suggest we were successful. Within one month of BIOL A108, students have improved their use of the scientific method to tackle challenging biological questions and core concepts. Preliminary assessment data show 96% of BIOL A108 students can create and use hypothesis statements correctly. Additionally, BIOL A108 student pre/post data indicate a 25% improvement in their comprehension of Mendel’s principles.

These changes have required a lot of work by many people; including learners from all levels. Transparent communication between instructors and students have been paramount to our initial success. This communication includes informing the students that the changes within the course structure are based on discipline based educational research and is founded by using current data from evidence-based teaching to shape the course.

Additional data that we are collecting include student demographics and end of semester student perception surveys. I hope to gather information regarding how this course is perceived by students and their personal successes as scientists. Why would we care about our student demographics? Anchorage, Alaska has three high schools in the top ten diversity ranking of high schools. A majority of our students enrolled in UAA’s biological science degree program are from the Anchorage and greater Alaska area. Collectively, if we want to increase the diversity of people trained in the biological sciences; UAA’s biological sciences program is one place to start. Maybe our course redesign will help others with their curricular transformations.

I am really interested in learning about how other departments and programs have remodeled their courses following the guidelines of Vision and Change, and what outcomes they are tracking. Let’s share ideas and materials within the LifeSciTRC and PECOP resources!



Aguirre, K. M., Balser, T. C., Jack, T., Marley, K. E., Miller, K. G., Osgood, M. P., & Romano, S. L. (2013). PULSE Vision & Change Rubrics. CBE-Life Sciences Education, 12(4), 579-581.

Brewer, C. A., & Smith, D. (2011). Vision and change in undergraduate biology education: a call to action. American Association for the Advancement of Science, Washington, DC.

Brownell, S. E., & Kloser, M. J. (2015). Toward a conceptual framework for measuring the effectiveness of course-based undergraduate research experiences in undergraduate biology. Studies in Higher Education, 40(3), 525-544.

Farrell, Chad R. (2016). “The Anchorage Mosaic: Racial and Ethnic Diversity in the Urban North.” Forthcoming chapter in Imagining Anchorage: The Making of America’s Northernmost Metropolis, edited by James K. Barnett and Ian C. Hartman. Fairbanks, AK: University of Alaska Press

Hanauer, D. I., & Dolan, E. L. (2014). The project ownership survey: measuring differences in scientific inquiry experiences. CBE-Life Sciences Education13(1), 149-158.
PECOP rachael hannah


Rachel Hannah is an Assistant Professor of Biological Sciences at University of Alaska, Anchorage. Helping people become scientifically literate citizens has become her major career focus as a science educator. As a classroom and outreach educator, Rachel works to help people explore science so they can apply and evaluate scientific information to determine its impact on one’s daily life. She is trained as a Neurophysiologist and her graduate degree is in Anatomy and Neurobiology from the University of Vermont College of Medicine. Recently, Rachel’s research interests have migrated to science education and how students build critical thinking skills.

Description of an Innovative Undergraduate Human Biology Program


The series of PECOP blogs has provided many examples of the positive changes that biology educators are making in what we teach and how we facilitate student learning. I would like to share a new program that was developed by a faculty team at Bastyr University.

We responded to the call for changes in biology education by developing an undergraduate program in integrated human biology that was launched in 2012. We used backwards design and competencies recommended in Scientific Foundations for Future Physicians: Report of the AAMC-HHMI Committee as a foundation to develop a progressive, premedical curriculum. The program competencies also align well with the AAAS/NSF Vision and Change core concepts and competencies. The IHB program competencies are listed in Table 1. We are continuing to use the program competencies and PULSE Vision and Change rubrics in our work to improve assessment at both the course and program level.

Table 1. Integrated Human Biology Program Competencies
Use mathematics and quantitative reasoning appropriately to describe or analyze natural phenomena.
Demonstrate understanding of the scientific process and describe how scientific knowledge is developed and validated.
Demonstrate understanding of basic physical principles and apply these principles to living systems.
Demonstrate understanding of basic principles of chemistry and apply these principles to living systems.
Demonstrate knowledge of how the 4 categories of biological molecules contribute to the structure and function of cells.
Demonstrate an understanding of the link between structure and function at all levels within a living organism: molecular, microscopic, and macroscopic.
Explain how internal environments are maintained in the face of changing external environments.
Demonstrate an understanding of the theory of evolution by natural selection.
Demonstrate an understanding of the biological basis for human behavior.
Demonstrate an understanding of the connection between the human organism and the biosphere as a whole.
Communicate effectively within and between scientific disciplines and with nonscientists.

Integrated Human Biology Program Highlights

  • The program includes a series of integrated human biology courses that require that students apply core concepts at multiple levels of complexity from cell and molecular to organismal in the context of organ systems.
  • Students are also required to apply physical principles from physics courses to biological systems in the integrated human biology series and through a parallel biophysics series.
  • The curriculum includes a required bioethics course and elective courses that require students to examine the applications of science to world problems.
  • Courses are team-taught by a group of faculty from different sub-disciplines who collaborate to create course materials and exams.
  • Classes are organized so that students are active participants.
  • Competencies are assessed in courses in a variety of ways including projects, presentations, papers, and exams.
  • All laboratories require students to participate in inquiry-based activities.
  • A majority of IHB students have completed a research project and presented their work at a University Research Symposium.
  • Student surveys have demonstrated that students appreciate the integrated approach to learning.
  • The first class graduated from the program in 2014, and a majority of those students have entered medical school or are working in research.

Have you developed or revised a program or curriculum in response to initiatives aimed at improving life sciences education?  Please share your experiences and recommendations.

Lynelle Golden is Goldena broadly trained physiologist who currently serves as Professor and Dean of the School of Natural Health Arts and Sciences at Bastyr University near Seattle Washington. She has more than 20 years of experience teaching junior/senior level physiology for biology majors and anatomy and physiology for allied health, nutrition and exercise science students. Her experience at Bastyr also includes teaching integrated case studies and physiology courses for medical students. While at Bastyr, Lynelle has been actively involved in curriculum development and revision. She has been a member of the teaching section of the American Physiological Society since 1986, and she currently serves as Chair of the Programming Committee for the APS Teaching Section. Lynelle earned an M.S. and a PhD in Life Sciences/Physiology from the University of Tennessee, Knoxville, and she completed postdoctoral research in Cardiovascular Diseases at the University of Alabama at Birmingham.

Developing and Assessing Mastery Competencies in Physiology

Dr. Benjamin Bloom is most widely remembered for his role in developing and writing The Taxonomy of Educational Objectives (Bloom, 1956) for the cognitive domain. In his later years Bloom shifted his focus to the concept of mastery learning, believing that students who learn only a portion of the required material would be unable to advance appropriately (Bloom, 1974). The concept of mastery has gained a foothold in disciplines where complete comprehension and understanding of the material is needed. For example, this is widely used in the military where fighter pilots are required to master material rather than simply gain a passing score. It would seem that, for the medical student, important concepts in physiology demand this same attention. Medical students who gain a passing score but failed to master basic principles will find it difficult, if not impossible, to develop the more advanced critical skills required when diagnosing and treating a patient’s condition.

Educators must also consider the learning environment when addressing these issues.  In a recent book, The Narcissism Epidemic: Living in the Age of Entitlement, (Twenge & Campbell, 2013) researchers highlighted the inability of students to self-evaluate their knowledge and understanding. Many claimed to know authors, painters, and factual information even though the individuals and events never existed. The authors relate this to the syndrome of, “everyone-gets-a-trophy” mentality where mediocrity is rewarded. Claiming to know the words of the Star-Spangled Banner is easy while seated in the bleachers — performing it solo in the middle of the gym floor is a different matter. Learning to work as part of a medical team is a very important attribute; however, diagnosis and treatment requires competencies including individual critical thinking skills and knowledge.  Just as the Air Force finds it important for a student pilot to achieve mastery — we should require students to master basic competencies before placing patients’ lives in their hands.

Pedagogical techniques such as team-based learning, problem-based learning, and the flipped classroom approach provide opportunities to teach both content and critical thinking skills with a student-centered approach. Enhancing these techniques so that students will have the opportunity to master these important competencies is an essential part of our task as educators. This same logic can be applied to our educational system at all levels. Anders Ericsson’s results have demonstrated that 10 years or 10,000 hours of deliberate practice is required to become an expert.  This strongly suggests that we should stress mastery of important competencies during the K-12 years and continue this focus in undergraduate college courses (Ericsson, 1990).  The importance of emphasizing such learning techniques is reemphasized in the more recent book, Talent is Overrated (Geoff, 2010).

Teaching content specific critical thinking is difficult and assessing mastery is even more challenging—but one worthy of our unified attention. Questions we should answer include:

1) what content and critical thinking skills should be mastered at each level of training?

2) what are the most appropriate pedagogical techniques for each student group?

3) how can we most appropriately assess mastery of these competencies?

Answers to these and related questions will not come easily and small successes will most likely materialize during the journey that will alter the route we take to reach the final destination.  Thus physiology educators and their colleagues in particular need to continue to be working on how to help various levels of students learn competencies and how to assess their mastery.





Herb Janssen received his baccalaureate degree from Midwestern State University. He later was awarded a Masters of Education at Texas Tech University. His doctorate degree in Physiology was obtained at Texas Tech University Health Science Center-Lubbock. After finishing his degree, he became Director of Research in the Department of Orthopaedic Surgery at TTUHSC. His physiology teaching activities have included presentations to students taking undergraduate animal physiology, engineering students, allied health students, medical students, graduate students, residents and fellows.
Herb Janssen’s interest in education started during his undergraduate years where he completed a K-12 teaching certificate. This training proved most useful when he became the assistant chair in orthopedics surgery and was instrumental in designing class activities for the physiology program. Herb remains involved in K-12 education through activities with local school districts. He serves on advisory boards for several health magnet schools in the local area. He also provides presentations to physiology classes in these advanced high schools.
He has received a number of teaching awards from students and colleagues over his teaching career. In 2012 he received the Master Teacher Award from IAMSE and was named the Arthur C Guyton Educator of the Year in 2014.


Creating Core Concepts in Animal Physiology

What happens if you put together a group of instructors who teach animal physiology and ask them to generate core competencies for their particular sub-discipline?  Well, Dee Silverthorn found out when we assembled ourselves in her workshop on Core Competencies at last summer’s APS Institute on Teaching and Learning in Bar Harbor, Maine.   What our group produced in that short session was a list of distinctive core concepts in animal physiology that we believe are essential for student learning in animal physiology (see Table 1).  It is important to note that these concepts are fundamentally applicable to the teaching and learning of ALL of physiology and are most easily distinguished through the study of comparative animal physiology.  By using a comparative approach toward these core concepts, students can be successful in their learning.

Table 1.  Core Concepts in Animal Physiology















Motivated by this rationale, our group has begun to elaborate and fill in our original brainstormed list.  Following the pattern set by AAAS/Vision and Change (2011) and AAMC/HHMI SFFP (2009), we’ve used our core concepts to produce a matching set of student competencies.  For each competency we have created specific learning objectives that would demonstrate student level mastery of concepts in different areas of animal physiology.  We have started to unpack some of the concepts (e.g. tradeoffs) into their constitutive ideas and sub-concepts (see Table 2). We have also begun to examine the introductory chapters of commonly used textbooks in animal physiology to determine the extent to which these concepts are presented and explained.  All of this has involved an interactive collaboration among instructors who teach animal physiology to a diverse group of students in a variety of educational settings.  And it all got its start during a 60-minute workshop at the APS ITL!

Table 2. Core Concept of “Trade-Offs” Unpacked

















APS ITL – Animal Physiology Group

Beth Beason-Abmayr (Rice University)                      Patricia Halpin (Univ. New Hampshire)

Jason Blank (Cal Poly San Luis Obispo)                      Kerry Hull (Bishop’s University)

Sydella Blatch (Stevenson University)                        Patricia Schulte (Univ. British Columbia)

Bill Cliff (Niagara University)                                        Alice Villalobos (Texas A&M)


Have we missed major concepts/competencies that faculty expect from their animal physiology students? Please share your comments and questions below.





Patricia Halpin is an Assistant Professor of Biology and the University of New Hampshire at Manchester. She teaches Principles of Biology, Cell Biology, Animal Physiology, Medical Terminology, Biotechnology & Society, and Diseases of the 21st Century. She also teaches in the summer EXCELL program at UNHM for middle and high school English language learners. Her current research focus is on adding technology and active learning to her teaching as well as bringing science to elementary and middle school students. Patricia is a LifeSciTRC Scholar, PECOP Fellow, and a member of the American Physiological Society (APS). She serves on the APS Education Committee and is active in the APS Teaching Section.