What They Neglected to Tell You About Classroom Practice in Graduate School

Harold I. Modell
Physiology Educational Research Consortium, Seattle, Washington
modell@physiologyeducation.org

As a postdoctoral fellow, I had a conversation with my mentor about teaching. He told me that you couldn’t be a good scientist if you were not a good teacher. His justification was that if you couldn’t communicate your research results to others, you couldn’t make a meaningful contribution to your discipline. At that time, teaching, in most faculty’s view, was synonymous with making a good presentation. “Good” classroom teaching was synonymous with “telling the story” through lectures and answering questions from students seeking clarification.

In the mid-1970s, the view of the classroom learning environment began to change. Research focused on how we learn and what “learning” means began to appear in the literature (1). As a result of this and ensuing research, the focus on the classroom environment changed from a teacher-centered, passive learning environment to a learner-centered, active learning environment. Terms such as cooperative learning, collaborative learning, and problem-based learning entered the education vocabulary. The list of terms has continued to grow and now includes team-based learning, flipped classroom, and case-based learning among others. With this classroom evolution, the role of the instructor has changed from being a provider of information and learning opportunities to a facilitator of learning within a learning community. Unfortunately, most graduate programs do not include specific training, other than being a teaching assistant in student laboratories, for this role in the classroom.

So, if I were to enter the classroom as a new instructor today, I would have a number of questions for which I would seek answers to help give me direction for preparing for my classroom experience. I will discuss each of these questions from the perspective of a physiology educator with over 40 years of experience working primarily with medical students. For each question, take a moment to reflect on how you would answer the question before reading my answer.

Question 1: What Kind of Learning Should I Try to Promote in My Classroom?
Many students seem to equate learning with acquisition of information. The goal of their studying seems to be memorizing and recalling information. It is interesting that they take this approach to learning only in school, whereas outside of school they approach their learning in a very different way. In school, their goal is passing exams, which, traditionally, have focused mainly on recalling facts or retelling a “story.” Outside of school, their goal is to use information to solve a problem or complete a task. They engage in what is called “meaningful learning” or “learning with understanding” (3).
If you ask students why they are in school, most, if they are in pre-professional or professional programs, will tell you that they want to be nurses or doctors or other healthcare professionals. Those students taking your course to satisfy distribution requirements may tell you that they want to understand how their bodies work so they can be informed consumers of healthcare services. Notice that each answer describes how they intend to use the information. In my experience, I have not encountered a single student who wanted to acquire enough facts to be a successful contestant on a television game show! If, in fact, the student wants to learn so that she/he can apply the information to solve problems, she/he should be focused on engaging in meaningful learning.

Question 2: How Do Students Engage in Meaningful Learning?
Think about something you learned to do outside of school. It can be anything (e.g., driving a car, learning to knit, buying a house, learning a language, playing a sport, playing an instrument, learning to navigate around a new city). What was the process that you went through to learn this? When faced with this question, students and faculty alike report a similar process. They have an idea (mental model) about what they are trying to learn, either without prior study or with prior study (e.g., reading instructions, doing some background reading, or viewing a video). They then try to do the task (i.e., solving the problem). Based on the success or failure of the trial, they seek additional information or clarification of their knowledge, revise their ideas, and try to do the task again. Students and faculty report that they learned whatever it is by “trial and error.” By calling the process “trial and error,” these learners do not seem to acknowledge the important step of revising their ideas (mental models) based on the outcome of the trial. This is the process by which they have learned to solve problems in their daily lives since they were born (1). We describe this process as building, testing, and refining mental models. It is the process described as “the scientific method.”

Question 3: What is the Instructor’s Role in the Meaningful Learning Process?
We cannot learn for our students. They must do the learning, and they must take responsibility for their own learning (10). So, if we want meaningful learning to occur in our classroom, is it sufficient that we provide resources (information) and learning opportunities (e.g., exercises, workshops) for our students, or do we have more to offer? As physiologists, we have advanced training in making sense of physiological mechanisms and solving physiological problems (e.g., through research). However, there are many instructors of physiology who do not have advanced training in physiology, but these instructors have advanced training in other science disciplines and are, therefore, familiar with the scientific method as a way of knowing. Thus we have much more to offer students than just providing resources and opportunities for learning. Indeed, our classroom can be learner-centered, in which our job is to help the learner to learn (3).

Question 4: What Must I Do to Help the Learner to Learn?
Changing your mindset from providing resources and opportunities to helping the learner to learn changes your whole approach to classroom practice. The focus changes from someone who “instructs” to someone who facilitates. To be a facilitator requires you to interact with the learners to find out what kind of help they need. In some cases, they need some basic information. In these cases, you should provide that information. In other cases, their current mental models may be faulty. In these cases, your job is to first help the student make their current model visible, then help them confront the limitations of their model, and, finally, help them engage in the process of revising their mental model (2). In other cases, students may need help testing their mental models. Again, your job is to model the process of testing their mental models. When fulfilling this role, you become a diagnostician as well as a mentor. You must ask yourself questions like, “What led the student to come to this conclusion?” and “How do I make sense of this mechanism?” Finally, “What question can I ask that will help the learner recognize the limitation of his/her mental model?” This is an iterative process (3). In this process, it is important to help students begin to think about how they think (i.e., engage in metacognition). In doing so, you, as a mentor, model the process of building models of physiological mechanisms and solving physiological problems.

Question 5: How Should I Design Learning Opportunities for My Students?
Physiology is a discipline concerned with mechanisms. As noted earlier, meaningful learning focuses on applying information that is being acquired. The overall goal of a physiology course then is to develop models of physiological mechanisms that can be used to solve physiological problems. The difference between an introductory course and an advanced course is the complexity of the problems to be solved. When designing a course or a learning opportunity, it makes sense to first ask, “What is the problem or problems that the learner should be able to solve at the end of the course or learning exercise?” Stated another way, “How should the student be able to use the content at the end of the learning session?” Thus the first step in designing educational resources is setting educational output objectives or performance goals (3, 5). We can think of the performance goals as the destination for a learning journey.

We now have a learning destination, but what is our embarkation point? We must recognize that students come to our courses with preexisting knowledge (mental models) and that, as they acquire new knowledge, they build on their current knowledge base (1). Aspects of these preexisting mental models may correctly apply to the topic being learned, whereas other aspects may be “faulty” with respect to the current content and accepted models (that is, misconceptions may exist). We can think of this student’s embarkation point as the “input state” (3). So, in our design scheme, our next step is to assess the input state. To do this, we must provide students with a task or ask them questions that will help make their current mental model (ideas) visible to us. In doing so, we also help students make their current mental models visible to themselves. An example of such a task may be to have them close their eyes and focus on their breathing. After several breaths, ask them to describe what they felt and what caused air to flow into the system during inspiration and gas to flow out during expiration.

We now have beginning and ending points for the journey; what remains are the transition steps that will help move learners from where they are to the performance goal. These steps may be a logical progression of questions that lead students to develop a model of the mechanism in question, a task that results in a causal diagram (flow diagram) of the mechanism, a concept map, or other visual organizer of the elements of the mechanism, examination of the system from a particular vantage point (8), a roleplay, or other active learning activity. Finally, we must assess the learners’ ability to carry out the performance goal. One way to do this is to present a perturbation of the model and ask the students to predict the results of the perturbation. (Will a variable value increase, decrease, or not change?) They must also be able to explain the basis for their prediction. Once the students are able to fulfill the performance goal, this destination becomes the embarkation point (input state) for the next performance goal (output state). This iterative process continues until the end of the session or course.

It is important during this process to help students recognize that we learn by building on previous knowledge and that many physiological mechanisms share common principles (4, 7). Hence, because life is cumulative, one question that students should be encouraged to ask is, “Where have I seen this before?” or “How is this like something that I already know?”

Question 6: How Do I Get Students to “Play the Game?”
The “helping the learner to learn” mindset requires the instructor to engage the learners in an interactive dialog. In addition, for students to engage in meaningful learning, they must engage each other in intellectual discussion (i.e., explore each other’s mental models). The challenge is to create a learning environment in which students are willing to share their thoughts. In general, students are reluctant to participate in such activities for a variety of reasons that include the following:

  • Based on prior experience, their expectations are not consistent with the meaningful learning experience; “Just tell me what I need to know to pass the course!” “I’m in competition with my peers.”
  • Contributing factors may involve self-confidence; “I don’t feel comfortable talking in front of groups.”
  • Fear may also play a role; “If I answer a question in class, it must be the right answer. Otherwise I may be ridiculed by the instructor or my peers.”

If the goal is to help the learner to learn, steps must be taken to address the reservations of the students (6). My approach to this challenge is to build a learning community within the classroom (9). Building community promotes a safe learning environment, encourages collaborative learning, provides emotional support among community members, and helps build long-lasting relationships among students and faculty. Although there are many approaches to building community, the necessary steps include the following goals: getting to know the community; setting community learning goals; setting community behavior guidelines; and reinforcing community spirit. All of these steps require discussion within the community. Some faculty argue that using class time to engage in such discussion is not advisable since it takes time away from “delivering the content.” However, the emphasis of community learning is on process (problem solving) rather than information acquisition. Once the learner is familiar with the process, acquisition of new information and incorporating this information into the framework of existing mental models is more efficient than it was in the earlier classroom model.

When time permits, small groups (groups of 4-6 students) develop a mission statement for the course, set learning goals, and set behavioral guidelines. This small group activity is then followed by a community discussion to reach consensus guidelines. When time is at a premium, the course syllabus may include suggested guidelines for community discussion. The following excerpt from a course syllabus illustrates such a statement:

Enrollment in this course entitles you to become a member of a learning community focused on developing the necessary skills and knowledge base to build a foundation for further study in physiology. Membership in this community carries certain rights and responsibilities. Make sure that you read the following statement of Community Rights and Responsibilities. By attending course activities, you agree to be a contributing member of this community.

Statement of Community Rights and Responsibilities
Members of the learning community have the right to expect a supportive learning environment in which they may reach their maximum potential for engaging in meaningful learning. The community should provide academic as well as emotional support for its members in an ethical and professional manner. Members of the community have responsibility for adhering to the practices and guidelines listed below.

  • Each member of the community takes responsibility for his/her individual learning as well as for contributing to the collective learning of the community.
  • Each member of the community arrives to course activities on time and prepared to engage in the topic(s) of the day. Note: Habitual tardiness will be interpreted as showing disrespect for the community and may compromise successful completion of the course.
  • Each member of the community shows respect for other members of the community and for the community learning environment by
    1) using cell phones responsibly during course activities; this includes using phones for texting, viewing e-mail, and accessing the web during breaks only
    2) using computers for engaging in course activities only
    3) refraining from using technology for activities that distract (individually and/or collectively) from the community focus
    4) providing encouragement for all community members to take intellectual risks
    5) sharing ideas and confusion about the topics being discussed
    6) being accepting of and sensitive to community members’ viewpoints
    7) being supportive when nonacademic stresses impact community members’ learning
    8) keeping potentially distracting side conversations to a minimum
    9) sharing concerns regarding the learning community
    10) keeping a sense of humor

Question 7: How Do I Know Whether it is Working?
One advantage of adopting the design scheme that I have described in a learning community setting is that the learning is driven by a series of performance goals (learning outcomes). Because each class period includes the instructor interacting with the learners, the learning environment has a built-in formative assessment component. During the course of this dialog, the instructor continuously assesses the progress of the “journey.” Thus the learning progression is monitored and redirected as needed on a daily basis.

The performance goals also provide the basis for summative assessment. Examinations should be focused on how well the student can do the performance goals. Exam questions may ask students to make predictions about how system variables will change when the system is perturbed and explain the basis for the prediction. Other options include asking students to solve a problem (e.g., predict what will happen to cardiac output, total peripheral resistance, cardiac contractility, and heart rate if mean arterial blood pressure falls suddenly), predict the results of an experiment (e.g., predict how the resting membrane potential of a neuron will change if the relative permeability of the membrane to potassium ions increases), or analyze a case description (e.g., a patient shows signs and symptoms of hypothyroidism; explain what tests you would run and what the expected outcomes of the tests would be to determine the site of pathophysiology in this patient). In each case, the students should be required to explain the reasoning behind his/her prediction. The emphasis of all assessment should be focused primarily on the how the student applied her/his mental model and secondarily on what information has been acquired.

Final Comments
A final advantage of adopting this mindset is that your classroom becomes your laboratory. By being a reflective practitioner, you can gain a wealth of information about how students learn, how they think about physiology, and what challenges they face as they build, test, and refine their mental models. As a result, new research questions come to mind. I encourage faculty to pursue these questions by becoming active in the educational research community. Design experiments that you can conduct in your own classroom or share your ideas and develop collaborative efforts through participation in the Teaching Section of APS, the Human Anatomy and Physiology Society (HAPS), the Society for the Advancement of Biology Education Research (SABER), or similar educationally focused organizations.

My goal for sharing these thoughts is to provide some direction for young faculty who are willing to adopt a “helping the learner to learn” mindset. Although I have not included many specific examples of how to accomplish the goals related to each of the questions that were discussed, specific examples may be found in the appropriate references listed. I invite you to contact me if you seek additional examples or answers to related questions.

References
Bransford JD, Brown AL, Cocking, RR (editors). How People Learn: Brain, Mind, Experience and School (Expanded Edition). Washington, DC: National Academy Press, 2000.

McDermott LC. How we teach and how students learn. Ann NY Acad Sci 701: 9-20, 1993.

Michael JA, Modell HI. Active Learning in Secondary and College Science Classrooms: A Working Model for Helping the Learner to Learn. Mahwah, NJ: Routledge, 2003.

Michael J, Modell H, McFarland J, Cliff W. The “core principles” of physiology: What should students understand? Adv Physiol Educ 33: 10-16, 2009.

Modell HI. Why am I teaching this course? Setting educational objectives for course activities. Ann NY Acad Sci 701: 27-35, 1993.

Modell HI. Preparing students to participate in an active learning environment. Am J Physiol 270 (Adv Physiol Educ 15): S69-S77, 1996.

Modell HI. How to help students understand physiology? Emphasize general models. Adv Physiol Educ 23: 101-107, 2000.

Modell HI. Helping students make sense of physiological mechanisms: the “view from the inside.” Adv Physiol Educ 31: 186-192, 2007.

Modell HI. Steps for building a learning community in a medical physiology course (Abstract). FASEB J 29: 541.4, 2015.

Rogers C, Freiberg HJ. Freedom to Learn (3rd ed.). New York: Macmillan College Publishing, 1994.

 

Harold Modell received his PhD in Physiology in 1971. He soon became interested in physiology education and active learning. This interest led to his developing computer-based simulations of respiratory physiology for student use (1975) and involvement on a national level in activities aimed at improving classroom practice. In 1985-1986, he was instrumental in establishing the Teaching of Physiology Section of the American Physiological Society, and, in 1988, Modell was named the founding editor of Advances in Physiology Education.

In 1989, he gave up bench science research in Respiratory Physiology in favor of educational research and development aimed at improving physiology education at the post-secondary level. Activities in this realm have included research, materials development, and faculty development in local, national, and international settings. In 2004, Modell received recognition for these efforts by being named the Claude Bernard Distinguished Lecturer of the Teaching Section of the American Physiological Society. He continues these efforts as Director of the Physiology Educational Research Consortium, and, until his retirement in 2015, was a faculty member at Bastyr University in Kenmore, Washington.

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