July 9th, 2018
Why do you teach the way that you do?

Have you ever stopped to think about why you do something the way that you do it? We educators are often very good at describing what we do or have done. I was recently reviewing some CVs for a teaching position; all the CVs were replete with descriptions of what content was taught in which course at which institution. However, I feel that we educators often fail to capture why we teach in a certain way.

 

 

In my extra-curricular life, I am an educator on the soccer field in the form of a coach. Through coaching education, I have been encouraged to develop a philosophy of coaching. This is a description of why I coach the way I do. To develop a coaching philosophy, coaches should think about three central aspects (see: https://www.coach.ca/develop-a-coaching-philosophy-in-3-easy-steps-p159158 for more details):

 

  1. Purpose: why do you coach?

  2. Leadership style – what methods do you use to coach? Are you more ‘coach-centered’ or more ‘player-centered’ in your approach? Or somewhere in between? Why?

  3. Values: what is most important to you? How does it affect the way you coach?

 

If ‘coach’ is replaced by ‘teach’ or ‘teacher’ in the above list, and ‘player’ is replaced by ‘student’, we can use this framework to develop a philosophy of teaching. I have found that putting ‘pen to paper’ in forming a philosophy helps to crystallize your beliefs about teaching that may have been seemingly random, disparate thoughts previously. It can be insightful to synthesize your beliefs about teaching, as it provides some structure and guidance when planning future teaching.

 

It is time to nail my colors to the mast. I teach because I want to help my students be successful diagnosticians in their profession (medicine) and understand why their patient’s bodies are responding in the way that they do in order to help them treat them effectively. I do believe in the benefit of having an expert instructor, especially when you have novice students, so I am probably more teacher-centric than is the current fad. However, I don’t like lectures for the most part, because from my perspective, lectures principally focus on information transfer rather than using and applying the important information. This is not to say that lectures are all bad, but I prefer ‘flipped classroom’ methods that require students to gather the necessary knowledge before class, and then during class, demonstrate mastery of material and apply it to clinical scenarios (with the aid of the instructor). But, that’s me. What about you?

 

If you are applying for positions that will require teaching, having both a teaching philosophy and a teaching portfolio will provide the appropriate evidence to the search committee about how you plan to teach.  The following resources might be useful to you:

Preparing a Teaching Portfolio http://www.unco.edu/graduate-school/pdf/campus-resources/Teaching-Portfolio-Karron-Lewis.pdf

Writing Your Teaching Philosophy https://cei.umn.edu/writing-your-teaching-philosophy

  Hugh Clements-Jewery, PhD is currently Visiting Research Associate Professor at the University of Illinois College of Medicine in Rockford, Illinois. He teaches medical physiology in the integrated Phase 1 undergraduate medical curriculum at the University of Illinois College of Medicine. He is the College-wide leader for the Circulation-Respiration course. He has also recently taken on the role of Director of Phase 1 curriculum at the Rockford campus.
June 25th, 2018
Why I’m a Clicker Convert

Recently I was faced with a teaching challenge: how to incorporate active learning in a huge Introductory Biology lecture of 400+ students. After searching for methods that would be feasible, cost effective, and reasonably simple to implement in the auditorium in which I was teaching, I came up with clickers. Our university has a site license for Reef Polling Software which means I wouldn’t add to the cost for my students—they could use any WiFi enabled device or borrow a handset at no cost. I incorporated at least 4 clicker questions into every class and gave students points for completing the questions. 10% of their grade came from clicker questions and students could get full credit for the day if they answered at least 75% of the questions. I did not give them points for correct answers because I wanted to see what they were struggling to understand.

I’m now a clicker convert for the following 3 reasons:

  • Clickers Increase Student Engagement and Attendance

In a class of 400+, it is easy to feel like there is no downside to skipping class since the teacher won’t realize you are gone. By attaching points to completing in-class clicker questions, about 80% of the class attended each day. While I would like perfect attendance, anecdotally this is much better than what my colleagues report for similar classes that don’t use clickers. Students still surfed the internet and slept through class, but there was now more incentive to pay a bit of attention so you didn’t miss the clicker questions. In my opinion, getting to class can be half the battle so the incentive is worth it. In my small classes I like to ask a lot of questions and have students either shout out answers or vote by raising their hands. Often, students won’t all vote or seem to be too embarrassed to choose an answer. I tested out clickers in my small class and found an increased response rate to my questions and that I was more likely to see the full range of student understanding.

  • Clickers Help Identify Student Misconceptions in Real Time

Probably the biggest benefit of clickers to my teaching is getting a better sense of what the students are understanding in real time. Many times I put in questions that I thought were ‘gimmes’ and was surprised to see half the class or more getting them wrong. When that happens, I can try giving them a hint or explaining the problem in a different way, having them talk with their group, and then asking them to re-vote. Since I don’t give points for correctness, students don’t feel as pressured and can focus on trying to understand the question. I’m often surprised that students struggle with certain questions. For instance, when asked whether the inner membrane of the mitochondria increases surface area, volume, or both, only half of the students got the correct answer the first time (picture). Since this is a fundamental concept in many areas of biology, seeing their responses made me take time to really explain the right answer and come up with better ways of explaining and visualizing the concept for future semesters.

  • Clickers Increase Student Learning (I hope)

At the end of the day, what I really hope any active learning strategy I use is doing is helping students better understand the material. To try to facilitate this, I ask students to work in groups to solve the problems. I walk around the class and listen while they solve the problem. This can help me get an idea of their misconceptions, encourage participation, and provide a less scary way for students to ask questions and interact with me. While working in groups they are explaining their reasoning and learning from each other. Interspersing clicker questions also helps to reinforce the material and make sure students stay engaged.

I’m convinced that clickers are helping to improve my teaching and students seem to agree. Of the 320 students who filled out course evaluations one semester, 76 included positive comments about clicker questions. Here are two of my favorites:

“I like how we had the in-class clicker questions because it made me think harder about the material we were learning about in that moment.”

“I enjoyed doing the clicker questions. If the class disagreed with something she would stop and reteach the main point and hope we would understand. That was really helpful on her part.”

I would be remiss if I didn’t end by thanking the many researchers who have studied how to incorporate clickers into your class to maximize learning. I decided to try them after hearing Michelle Smith talk at the first APS Institute on Teaching and Learning and highly recommend seeing her speak if you have the chance. If you only want to read one paper, I suggest the following:

Smith, Michelle K., et al. “Why peer discussion improves student performance on in-class concept questions.” Science 323.5910 (2009): 122-124.

I hope you will comment with how you use clickers or other strategies to engage large lecture classes. For more resources I’ve found helpful designing my classes click here.

Katie Wilkinson, PhD is a newly minted Associate Professor of Biological Sciences at San Jose State University. She completed her undergraduate work in Neuroscience at the University of Pittsburgh and her PhD in Biomedical Sciences at the University of California, San Diego. She was an NIH IRACDA Postdoctoral Fellow in Research and Scientific Teaching at Emory University. At SJSU her lab studies the function of stretch sensitive muscle proprioceptors. She teaches Introductory Biology, Vertebrate Neurophysiology, Integrative Physiology, Pain Physiology, and Cardiorespiratory Physiology to undergraduate and masters students.
June 15th, 2018
Medical Physiology for Undergraduate Students: A Galaxy No Longer Far, Far Away

The landscape of medical school basic science education has undergone a significant transformation in the past 15 years.  This transformation continues to grow as medical school basic science faculty are faced with the task of providing “systems based” learning of the fundamental concepts of the Big 3 P’s: Physiology, Pathology & Pharmacology, within the context of clinical medicine and case studies.  Student understanding of conceptual basic science is combined with the growing knowledge base of science that has been doubling exponentially for the past century.  Add macro and microanatomy to the mix and students entering their clinical years of medical education are now being deemed only “moderately prepared” to tackle the complexities of clinical diagnosis and treatment.  This has placed a new and daunting premium on the preparation of students for entry into medical school.  Perhaps medical education is no longer a straightforward task of 4 consecutive years of learning.  I portend that our highest quality students today, are significantly more prepared and in many ways more focused in the fundamentals of mathematics, science and logic than those of even 30 years ago.  However, we are presenting them with a near impossible task of deeply learning and integrating a volume of information that is simply far too vast for a mere 4 semesters of early medical education.

 

To deal with this academic conundrum, I recommend here that the academic community quickly begin to address this complex set of problems in a number of new and different ways.  Our educators have addressed the learning of STEM in recent times by implementing a number of “student centered” pedagogical philosophies and practices that have been proven to be far more effective in the retention of knowledge and the overall understanding of problem solving.  The K-12 revolution of problem-based and student-centered education continues to grow and now these classroom structures have become well placed on many of our college and university campuses.  There is still much to be done in expanding and perfecting student-centered learning, but we are all keenly aware that these kinds of classroom teaching methods also come with a significant price in terms of basic science courses.

 

It is my contention that we must now expand our time frame and begin preparing our future scientists and physicians with robust undergraduate preprofessional education.  Many of our universities have already embarked upon this mission by developing undergraduate physiology majors that have placed them at the forefront of this movement.  Michigan State University, the University of Arizona and the University of Oregon have well established and long standing physiology majors.  Smaller liberal arts focused colleges and universities may not invest in a full majors program, but rather offer robust curricular courses in the basic medical sciences that appropriately prepare their students for professional medical and/or veterinary education.  Other research 1 universities with strong basic medical science programs housed in biology departments of their Colleges of Arts and Sciences may be encouraged to develop discipline focused “tracks” in the basic medical sciences.  These tracks may be focused on disciplines such as physiology, pharmacology, neuroscience, medical genetics & bioinformatics and microbiology & immunology.  These latter programs will allow students to continue learning with more broad degrees of undergraduate education in the arts, humanities and social sciences while gaining an early start on advanced in depth knowledge and understanding of the fundamentals of medical bioscience.  Thus, a true undergraduate “major” in these disciplines would not be a requirement, but rather a basic offering of focused, core biomedical science courses that better prepare the future professional for the rigors of integrated organ-based medical education.

 

In the long term, it is important for leaders in undergraduate biomedical education to develop a common set of curriculum standards that provide a framework from which all institutions can determine how and when they choose to prepare their own students for their post-undergraduate education.  National guidelines for physiology programs should become the standard through which institutions can begin to prepare their students.  Core concepts in physiology are currently being developed.  We must carefully identify how student learning and understanding of basic science transcends future career development, and teach professional skills that improve future employability.  Lastly, we must develop clear and effective mechanisms to assess and evaluate programs to assure that what we believe is successful is supported by data which demonstrates specific program strengths and challenges for the future.  These kinds of challenges in biomedical education are currently being addressed in open forum discussions and meetings fostered by the newly developed Physiology Majors Interest Group (P-MIG) of the APS.  This growing group of interested physiology educators are now meeting each year to discuss, compare and share their thoughts on these and other issues related to the future success of our undergraduate physiology students.  The current year will meet June 28-29 at the University of Arizona, Tucson, AZ.  It is through these forums and discussions that we, as a discipline, will continue to grow and meet the needs and challenges of teaching physiology and other basic science disciplines of the future.

Jeffrey L. Osborn, PhD is a professor of biology at the University of Kentucky where he teaches undergraduate and graduate physiology. He currently serves as APS Education Committee chair and is a former medical physiology educator and K12 magnet school director. His research focuses on hypertension and renal function and scholarship of teaching and learning. This is his first blog.
June 13th, 2018
BOOK REVIEW: Teach Students How to Learn: Strategies you can incorporate into any course to improve student metacognition, study skills, and motivation

I recently had a conversation with my son who teaches high school math and computer science at a Catholic college-prep girls high school in San Jose, CA about how his students did not realize that they were learning from his innovative standards-based teaching approach.  We had already discussed how mindset has a big impact on student learning at an early age; how K-12 students are not taught appropriate study skills for future educational experiences; and how students do not understand how they learn.  Thus, I went out looking for resources to help him deal with these learning issues.  By searching on Amazon, I found the book Teach Students How to Learn:  Strategies You Can Incorporate Into Any Course to Improve Student Metacognition, Study Skills, and Motivation by Saundra Yancy McGuire with Stephanie McGuire (ISBN 978-1-62036-316-4) which seemed to be just what we wanted.  Dr. McGuire taught chemistry and has worked for over 40 years in the area of support for teaching and learning.  She is an emerita professor of chemical education and director emerita of the Louisiana State University Center for Academic Success.  Her daughter Stephanie is a Ph.D. neuroscientist and performing mezzosoprano opera singer who lives in Berlin, Germany.

The book has interesting and self-explanatory chapters about Dr. Saundra McGuire’s own evolution as a teacher (and as a chemistry major I could really relate to her story), discussions about why students don’t already know how to learn when they come to college, what metacognition can do for students to help them become independent learners, how to introduce Bloom’s taxonomy and “the study cycle” to students, how to address student growth vs. fixed mindset status, and how both faculty and students can boost motivation, positive emotions, and learning.  The study cycle learning strategy proposed and used by Dr. McGuire over the years involves five steps for the students: preview before class, attend class and take meaningful notes, review after class, study by asking “why, how, and what if” questions in planned intense study sessions and weekend reviews, and assess their learning by quizzing or planning to teach it to others.  Especially helpful for teachers are the actual presentations as three online slide sets and a sample video lecture (styluspub.presswarehouse.com/Titles/TeachStudentsHowtoLearn.aspx), and a handout summarizing the entire process that Dr. McGuire uses to introduce her learning strategies to groups of students in as little as one 50-minute class period.  Throughout the book, there are summary tables, examples, activities, and success stories about students who have incorporated the learning strategies.

In Appendix D of the book (pp. 176-177), Dr. McGuire includes a handout entitled “Introducing Metacognition and Learning Strategies to Students: A Step-by-Step Guide” for the 50 minute session.

An abbreviated version of the 15 steps are repeated here:

  1. Wait until the students have gotten the scores of their first test back.
  2. Don’t tell the class in advance that there will be a presentation on learning strategies.
  3. Evaluate student career goals by clickers or show of hands at beginning of session.
  4. Show before and after results from other students.
  5. Define metacognition.
  6. Use exercise to show the power of various learning strategies.
  7. Ask reflection questions, like “What is the difference between studying and learning?
  8. Introduce Bloom’s taxonomy.
  9. Introduce the study cycle as way of ascending Bloom’s.
  10. Discuss specific learning strategies like improving reading comprehension (active reading) and doing homework as formative assessment.
  11. Discuss reasons students in the class may or may not have done well on the first test.
  12. Ask students how different the proposed learning strategies are to the ones that they have been using.
  13. Ask students to commit to using at least one learning strategy for the next few weeks.
  14. Direct students to resources at your campus learning center.
  15. Express confidence that if students use the learning strategies they will be successful.

Currently all of the students that I teach are either advanced undergraduate students planning to go to professional schools or graduate students, so that my current students do not have mindset or motivational issues and have mostly learned how they study best.  However after sharing this book review with you, I have convinced myself that I cannot give up my book to my son when he comes to visit next month and I will need to go and buy another one.  I hope that this book will help you facilitate the learning of your students too!

Barb Goodman received her PhD in Physiology from the University of Minnesota and is currently a Professor in the Basic Biomedical Sciences Department of the Sanford School of Medicine at the University of South Dakota. Her research focuses on improving student learning through innovative and active pedagogy.
May 28th, 2018
Why Teaching? Why a Liberal Arts school?

Why Teaching? Why at a Liberal Arts school? These are two questions that I am often asked. I used to give the standard answers. “I enjoy working with the students.” “I didn’t want to have to apply for funding to keep my job.” “A small, liberal arts school allows me to get to know the students.” But more recently those answers have changed.

A year or so ago, I returned to my undergraduate alma mater to celebrate the retirement of a biology faculty member who had been with the school for almost 50 years. As I toured the science facilities—which had been updated and now rival the facilities of many larger research universities—I reflected on where I had come from and how I came to be a biology professor at a small liberal arts school in Iowa.

I was born and raised in the suburbs of Harrisburg, Pennsylvania. In fact my parents still live in the house they purchased before I was born. My parents valued education and believed it was their job to provide their three children with the opportunity to go to college. Because there were three of us, it was expected that we would attend college in Pennsylvania. At that time, the way to learn about colleges was to go to the guidance counselor’s office or to sift through all of the mailings that came to the house. One of the schools I chose to visit was Lebanon Valley College (LVC),  a small, private, liberal arts institution in Annville, PA (central Pennsylvania). LVC had a strong biology program but my reasons for choosing LVC were I liked the campus, the school was neither too big nor too small, and it was far enough from home but not too far from home. That is how I ended up at LVC.

I was a biology major, pre-med my entire four years at LVC. The biology department at LVC was fantastic. The professors had high expectations, held students to these high expectations, and helped the students to reach those expectations. The professors gave me a solid background in the sciences and opportunities to work in a lab. Both the knowledge I gained and the lab experiences I had allowed me to succeed as a scientist. However, during my journey at LVC, I found that there was more to me than being a biology major or a Pre-Med student. From the beginning of my time at LVC, my professors saw something in me that I could not and chose not to see. My professors saw a person who loved to learn, a person who loved to explore, and a person who loved to share information. They saw an educator, a leader, and a communicator. But regardless of what they saw or what they said, I had to find these elements on my own and for myself.

 

During my time at LVC, I did not understand what the liberal arts meant or what the liberal arts represented. Back then if you had asked me if I valued the liberal arts, I probably would have said I have no idea. Even when I graduated from LVC, I did not realize the impact that my liberal arts education would have on me. It is only now when I reflect on my time at LVC that I can appreciate and value the impact that my liberal arts education had on the achievement of my goals. It was the courses that were required as a part of the liberal arts program and the professors who taught them that made me a better scientist. The writing and speech classes provided the foundation for my scientific communication skills that continued to develop after graduation. It was in these classes that the professors provided constructive feedback which I then incorporated into future assignments. The leadership, language, literature, philosophy, and art courses and professors provided opportunities to develop my ability to analyze, critique, and reflect. The religion courses taught me that without spirituality and God in my life, there was little joy or meaning to what I accomplished. The liberal arts program provided me with skills that were not discipline specific but skills utilized by many academic fields. These courses allowed the person who loved to learn, the person who loved to explore and ask questions, and the person who loved to share information to flourish. These courses taught me to value all experiences as opportunities to learn and to become a better person. Lebanon Valley College, through the people I met and the education I received, put me on the path to finding the elements that form my identity.

After graduation from LVC, I explored. I accepted a position as a research technician in a laboratory where I remained for three years. During that time, I improved my science skills, but I also had the opportunity to use and improve those other abilities I learned at LVC. After three years, I decided I wanted to go to graduate school. I loved asking new questions, performing experiments, and the feeling I had when an experiment worked and provided new information. I also liked working with students. I loved sharing information and guiding students through the process of learning. I applied to graduate school, was accepted, earned my Ph.D, and then completed two postdoctoral fellowships. My graduate advisor and postdoctoral advisors were supportive of me and allowed me to teach in addition to my research. After two successful postdoctoral fellowships, I had to decide where to go next. I chose teaching and I chose Clarke University. I chose teaching and specifically Clarke because I wanted to go back to my roots. I wanted to take the knowledge and skills I had attained and share them. I chose Clarke University because I saw similarities between it and LVC. I chose Clarke University because of its liberal arts heritage and its focus on the students.

Now, 10 years later, I am a guide for a new generation of students at Clarke University. While there are so many differences between my generation and this generation, I still see similarities. I see students eager to come to class so they can learn. I see students excited when they understand a difficult concept. I see students who want to make a difference in this world. I do not know what a student would say if I asked them if they valued their liberal arts education or me as their teacher. My guess is that many of them are just like I was and do not know what the liberal arts represent. Some might even say they do not value the liberal arts or the professors. I can only hope that one day, when the students I teach reflect on their undergraduate careers, they can recognize and appreciate the influence Clarke University, the liberal arts program, and their professors had on them. I know that without my professors and without my liberal arts experience at Lebanon Valley College, I would not be me—the educator, the scientist, the author, the leader, the life-long learner. Nor would I be me—the mother, the wife, the daughter, the sister, the friend, the colleague. Lebanon Valley College and my liberal arts education helped me become the person I am today.

Melissa DeMotta, PhD is currently an Associate Professor of Biology at Clarke University in Dubuque, IA. Melissa received her BS in biology from Lebanon Valley College. After working for three years at Penn State’s College of Medicine in Hershey, PA, she received her PhD in Physiology and Pharmacology from the University of Florida in Gainesville. Following postdoctoral fellowships at the University of Arizona and Saint Louis University, Melissa joined the Biology Department at Clarke University. Melissa currently teaches Human Physiology and Exercise Physiology to physical therapy graduate students and undergraduates. She also enjoys teaching non-majors life science courses as well.
May 14th, 2018
An Academic Performance Enrichment Program for Struggling Students

Pharmacy schools nationwide are currently experiencing a decline in admission applications and an increase in the number of academically struggling students in their programs. Thus, schools of pharmacy are not only searching for effective ways to increase enrollment of qualified candidates but are also focusing on the development of programs to improve academic performance and retention of enrolled students.

 

Our students struggle academically for a number of reasons:

  1. personal issues such as those involving jobs or family,
  2. mental disorders or conditions such as attention deficit disorder, anxiety, or depression,
  3. lack of academic skills,
  4. deficiencies in prerequisite knowledge, and/or
  5. lack of motivation and discipline to meet the requirements necessary to succeed in a rigorous professional degree program.

Some students may be helped by resolving the underlying personal or medical issues.  For the others, we have developed an academic performance enrichment program (APEP) aimed to improve academic skills (e.g. study skills, time management skills), comprehension of course material, metacognition, discipline and accountability with the overall goal to decrease course failures and to improve retention.

During the first year of our Pharm.D. curriculum, students complete a two-semester (10-unit) integrated biological sciences course sequence (BSI I & II) which integrates biochemistry, cell biology, physiology, and pathophysiology.  The summative assessments include 4 exams and a comprehensive final in each semester. Formative assessments include worksheets and assignments, which are not submitted to the instructor, and various in-class active learning activities. BSI is the course in which the first year pharmacy students struggle the most. BSI is a prerequisite for most other advanced courses, so it is required to pass in order to complete the program in 4 years. Furthermore, a failure in BSI I is highly predictive of a student struggling throughout the program. Thus, developing a means to improve academic performance is imperative to facilitate success. Historically, we have found that traditional one-on-one or small-group peer-tutoring did not lead to significant improvements in academic performance or course failure rates. Feedback from the peer-tutors revealed that tutees did not adequately prepare for the tutoring sessions and were passive participants in the tutoring process.  We have also observed that most of the students struggle in BSI and the first year pharmacy curriculum due to lack of academic skills and/or lack of motivation and discipline to implement the skills rather than difficulty in understanding course content. Therefore, the APEP includes academic skills training and student accountability to be active participants in the tutoring process.

The APEP is comprised of structured group tutoring sessions which are 1.0-1.5 hours twice per week, led by graduate assistants (2nd year pharmacy students).  At the beginning of each week, the students are emailed instructions as to what to prepare and expect for the sessions that week.  They are asked to develop a 15-question multiple choice quiz from the specified BSI material and to complete worksheets or assignments that coincide with each BSI course lecture note set. At each session, the students exchange and complete the quizzes followed by discussion of wrong answers among each other.  The students then complete various activities which may include drawing specific diagrams, flowcharts, or pathways that were assigned to learn for the session. The students are expected to complete the drawings from memory and then work together to fill in any missing information. The graduate assistants discuss active study methods most effective for learning the particular course content, along with the importance of continuous self-testing. We have observed that linking the discussion of study methods to specific material is more effective than giving general study skills advice, which low performing students often ignore and/or do not know when or how to apply.  Each session also includes a question and answer period where the students can ask questions for clarification and the graduate assistants ask higher order questions to probe their level of understanding. The students submit their quiz grades, completed worksheets, and drawings to the graduate assistants in order to track attendance and preparedness for the sessions.  Procrastination and the underutilization of active studying techniques are common among our low performing students; the completion of the assignments in preparation for and during each session is aimed to prevent these unfavorable habits.  To improve metacognition we have incorporated two activities. Before each BSI exam, the APEP students predict the grade they will receive based on their self-perceived preparedness and understanding of the material.  After each exam, they are required to meet with the course instructor to review the questions that they missed and then to write a paragraph with their insights as to why they earned the grade and what they plan to do differently to improve on the next exam. In the BSI course, all students are encouraged to meet with the professor to review their exam; however, the lower performing students often do not follow through. Thus, we have made it a required piece of the APEP.

Students with an average BSI course grade below 73% at any point during the semester are required to attend the APEP sessions until their course grade exceeds 73% (<69.5% is a failing grade). Most of the students attend the sessions and complete the required tasks without being pressed. However, a small percentage require further enforcement which includes a meeting with the Director of the APEP and the Assistant Dean of Academic Affairs. Typically, such a meeting leads to improved engagement in the APEP. So far, only 1 student out of 35 who have participated in the APEP has continued to skip required sessions.

The APEP was implemented in the fall semester of 2017. Preliminary data indicate that the program is effective for improving academic skills and performance. The failure rate in BSI I decreased by 36% compared to the previous two years. For those who entered the program after performing poorly on an exam, the APEP was deemed effective to improve performance on the following exam.  For example, 80% of the students who were required to join the APEP after Exam 1 improved on Exam 2, while only 29% of the students who scored between 74-79% on Exam 1 (and not required to attend the APEP) improved on Exam 2.  86% of the students in the APEP after Exam 2 improved on Exam 3, compared to 54% of the comparative group who did not attend the APEP. 65% of the students in the APEP after Exam 3 improved on Exam 4, compared to 38% in the comparative group. 78% of the students in the APEP after Exam 4 improved on Exam 5 (comprehensive final exam), compared to 36% in the comparative group.  We do not know yet if the APEP was effective at reducing the failure rate in BSI II, since the semester is still in progress.

According to a survey, the majority of APEP attendees believed that the program helped:

  1. to improve study skills by incorporating more active studying techniques,
  2. to prevent procrastination of studying,
  3. to study with more intent by having quizzes and assignments to complete for each APEP session,
  4. to improve understanding of the course material and
  5. to identify course content that they did not fully understand.

A program such as this requires active engagement to be effective; what you put into it, you get out of it. 68% of the APEP students believed that they came to each session as prepared as they should have been.  The biggest struggle has been to find an effective means to increase this number to closer to 100%.  The APEP will continue to evolve as we strive to meet the 100% mark and to reduce the failure rate even further.

Amie Dirks-Naylor is Professor and a member of the founding faculty at Wingate University School of Pharmacy in North Carolina where she teaches the basic sciences to the first-year pharmacy students. She earned her Ph.D. in Exercise Physiology (minor in Biochemistry and Molecular Biology) from the University of Florida, her M.S. from San Diego State University, and B.S. from the University of California, Davis.  She completed her post-doctoral research at Stanford University School of Medicine in the department of Radiation Oncology.  Her current research interests include mechanisms of adverse drug effects involving oxidative stress and apoptosis, physiological effects of lifestyle modifications, and the scholarship of teaching and learning.
April 23rd, 2018
Thoughts from the Future

 

 

April 23, 2028

 

Dear Dave Harris of 2018,

It has been a long time my friend, in fact 10 years.  I have plenty of good news to share with you, which may be shocking or expected!

First, I am happy to inform you that the past decade has been extremely good for your Philadelphia Eagles!  After winning Super Bowl LII in 2018, they have gone on to win 3 more with Carson Wentz running new “Philly Specials” year after year!  Tom Brady finally retired after he dropped another wide-open pass in Super Bowl LV.  However, the biggest surprise for you may be that the Cleveland Browns won Super Bowl LV!

I am also happy to tell you that the educators survived the Great Medical Education Transformation of the 2020s! I knew that you saw this coming around 2015, but the speed at which the Transformation occurred was mind-blowing for many faculty!  We lost a few good “soldiers” in the process when they failed to adapt their educational views and styles, but as of now, medical education has never been better and there have been substantial improvements in patient safety and outcomes!  I am sharing some of the changes with you to prepare the faculty of the future!

One of the first recognizable changes was the manner in which students approached medical school curricula.  Even during your time, schools saw drastic reductions in class attendance and student engagement with the formal curriculum.  The millennial students were used to obtaining information how they wanted and immediately when they wanted.  Recording of lectures led to students remaining at home so that they could double speed your voice to sound (you have no idea how they describe you!), allowed them to view these lectures at midnight in their pajamas, and gave them the ability to stop and take notes.  Many faculty mistook this as student disengagement and tried to “force” them into class by making mandatory sessions or increasing the frequency of assessments. However, students responded by stating that some sessions were a “waste of time” and “took time away from studying for Step 1”.  They continued to vote with their feet and migrate away from the classroom!

However, what caught most faculty of your time off guard was the use of external resources outside of your own curricular items.  The emergence of the “hidden curriculum”!  Students were presented with alternative options such as Anki, Sketchy Medical, Osmosis, First Aid, Khan Academy and Pathoma to name a few!  At first faculty were unaware and put up a staunch resistance.  It was even postulated by some that the core curriculum of basic science could be delivered as a shared Medical Curricular Ecosystem (Le and Prober) that would help reduce redundancy in medical schools.  This caused an imbalance in the galaxy and many of the upset faculty tried to prevent this from coming. However, many astute faculty quickly realized that it was already there!!  At that point the faculty rebel forces decided to become proactive instead of reactive!

Town hall meetings, focus groups, and interviewing revealed many weaknesses in the medical school schema to date.  Faculty struggled to realize that the millennial students grew up with the internet and basically a cell phone attached to their hand.  Finding content was not an issue for them and what faculty discovered was that much of the content delivered in lectures was identical to what could be viewed in a video in 8 minutes.  They also discovered that students grew up in a world where everyone was connected through social media and available almost 24 hours a day!  They expected responses from their friends on a chat within seconds!  After all, how many people sleep with their cell phone next to them?  Faculty also discovered in these town halls that the generation valued work/life balance and anything that was deemed inefficient cut into this time that they could be doing something else.  Through these important meetings, faculty also discovered that students were excellent at recalling facts and regurgitating knowledge. However, when asked to apply that knowledge to a problem, the students went back to recalling the facts. Students had mistaken memorizing for learning!  And many faculty had mistaken learning for telling!  Some faculty reflected back and actually admitted that we may have enabled the behaviors with our constant barrage of standardized tests of knowledge!

At least, the good news is that this led to some drastic changes in medical education!  Gross anatomy has been severely trimmed down in an effort to focus on clinically relevant anatomy for undifferentiated medical students. Gross anatomy dissection is reserved for students interested in a surgical career as an elective.  Much of that experience of cutting through muscle layers and isolating each artery, nerve and vein, and picking through layers of fat to get there has been replaced by complex computer programs that help students visualize the anatomy in 3D!  Since ultrasound is currently available to any physician through their phone, more emphasis of anatomy related to ultrasound aspects has been a focus of instruction.  For many of the pathological or anatomical variations, 3D printing has allowed for much cheaper and better alternatives for learning.  Everything is currently related to clinical medicine and focuses on key concepts that are necessary to master as opposed to “knowing” everything!  However, the changes did not stop there!

Much of the basic physiology content knowledge is now presented to the students in alternative ways using directed, short videos or providing references.  The class time has been reserved for higher level threshold concepts where students are placed in situations in which misconceptions and dangerous reasoning can be identified and corrected.  Simulations and standardized patients (robots) have become common place where students have to integrate what they were learning in Doctoring courses with real life physiology.  Students enjoy the safe environment and as faculty discovered the role of affect in cognition, they quickly realized that this was a time efficient pedagogy.  Faculty have discovered that 1 hour of intense, clinically oriented, and high yield threshold concept learning is much more beneficial and time efficient than 4 hours of didactic lecture. And faculty discovered it was fun!

Another aspect under appreciated by faculty of your time is that students enjoy being able to learn in their own environment as opposed to in the classroom.  In your day coffee shops were filled with students studying away, but technology has allowed for large communities of learners to “get together” from their own homes.  Time spent traveling from various hospital sites during the clerkships was saved by developing online communities for learning and using technology to facilitate discussion.  Students felt more at ease critiquing another’s differential with this new design and appreciated the time saved from travel.

As I said my friend, medical education has been transformed in exciting and very positive ways!  Successful faculty have worked with the students to enhance the learning experience as opposed to trying to teach the way we were taught!  Faculty focused more on the learning process as opposed to trying to relay knowledge to the students.  It was discovered that technology could not substitute for poor teaching. Faculty learned to develop activities to get students out of their comfort zones so that true learning could occur.  And lastly, faculty realized that their roles were not eliminated. Rather the role of faculty had to change from the expert sage on the stage to the facilitator of student learning!

Well, I can’t wait to see what the next ten years will bring!  You will be happy to know that your two daughters have grown up to be beautiful, caring people!

 

See you in 10 years and Fly Eagles Fly!!

Dave Harris of 2028

 

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I realize that this letter may be viewed as provocative, crazy, and aspiring!  However, I hope that the conversations in medical education can begin to REALLY improve patient safety and outcomes in the future.  What changes do you think will occur in medical education in the next 10 years?

 

David M. Harris, PhD, is currently an Associate Professor of Physiology at the University of Central Florida College of Medicine in Orlando, Florida.  He received his PhD from Temple University School of Medicine, completed his post-doctoral research at Thomas Jefferson University, and was offered his first faculty position at Drexel University College of Medicine. He moved away from Philly to Orlando in 2011.  He has written several educational research manuscripts, mostly about the use of high fidelity mannequin simulators in medical physiology and currently serves as an Associate Editor for Advances in Physiology Education.  He is also on the Aquifer Sciences (formerly MedU Science) leadership team developing a curriculum that provides tools or how to integrate basic science knowledge with clinical decision making  to prevent harm.

Reference:  Le TT, Prober CG. A Proposal for a Shared Medical School Curricular Ecosystem. Acad Med, March 6, 2018

April 9th, 2018
Surviving Hurricane Maria: A professor’s story (Part 2)

Previously in our story…Hurricane Maria had just ravaged the island nation of Dominica

Flag of Saint Kitts and Nevis

While I waited, my school did what many said could not be done. Our staff and administration arranged for us to be able to complete the fall semester, on the only-lightly damaged island of St. Christopher (usually called St. Kitts), which had been grazed by both Irma and Maria.  They arranged for a large passenger ship which normally ferried cars and people from Italy to Spain and back to sail over to the Caribbean and be modified into a floating campus for our thousand-plus student body for the rest of the year.  They arranged for temporary accommodations for faculty and staff on St. Kitts, where our other sister school, Ross University School of Veterinary Medicine (10), is located.  They revised the schedule to have us resume our semester in October and finish in early January.  And then they set these plans in motion.

In mid-October, I finally got the notice I’d been waiting for, my reporting day to arrive on St. Kitts for my temporary assignment there.  I’d lived on St. Kitts before while working at one of my former schools, so I knew that it wasn’t the same as Dominica.  It was wealthier, far wealthier, with so many cruise ships coming to call during high season that we were almost an afterthought to them.  It had the movie theater and the golf courses and the high-end hotels, and the island infrastructure to handle the mass of tourists who came and went by the planeload and shipload every day.  But on the same token, in Dominica we were a part of the community, we were welcomed by the people, and we were careful to try to be good neighbors.  In St. Kitts, we were mostly treated like tourists, who were perhaps staying a little longer than usual, and on a ship that wasn’t going to sail away with us.  Most of the Kittitians were still the very friendly people you can find everywhere in the Caribbean, of course, but it wasn’t Dominica and I knew it before I arrived.  We faculty were to arrive a few days before the students to get situated and find places to live on the island while the student accommodations/our campus continued its journey across the Atlantic to our new home away from home.

Belle Mont Farm Eco-Resort

When I got to St. Kitts, it was…a pleasant surprise.  It wasn’t half as hard to get through customs as I had feared, and the Marriott is a nice hotel.  We stayed there a day or two before the students started to arrive.  To make room for the students, most of the faculty were moved to an eco-resort on the far side of St. Kitts for about a week, which opened in its off-season just for us.  While I appreciated their going above and beyond on our behalf, I only stayed one night before moving into an apartment in town. I just wanted to unpack my suitcases, settle in somewhere, and get back into a routine.

Because I left the eco-resort so early, I was available to help the students come in on their arrival day.  And come in they did, one charter flight at a time to the airport, and one to three buses (they call them cruisers) at a time to the Marriott.  Tired, bleary-eyed, some clearly still suffering the effects of six or more days on Dominica under indescribable conditions ending in evacuation and weeks of uncertainty, the students came.  You couldn’t help but feel for the ordeal they had survived… or admiration for their grit to return anyway, when a small group of others had taken a leave of absence.  On that day and night when the students came in charter flight after charter flight, wave after wave, a dozen volunteers and I helped each group one by one.  We were the friendly faces from home greeting them after their long ordeal.  We smiled and shook their hands and took their bags inside, helped them through check-in, provided them some simple meals, and tried to make each returning student feel special.  It started for me in the afternoon, and then into the evening, and then into the night, with each group of students arriving more and more exhausted.  By 1 a.m. I was feeling pretty exhausted too, but we kept going until the very last group made it in somewhere close to 2 a.m.

I am told that still more planeloads of students flew in the next morning, but I slept in.  That afternoon, students were being transported from the hotel to the port, where our ship had come in.  The lines were long and the sun was hot and the students just wanted to get inside and get to their new berths.  Many of the faculty who were staying at the eco-resort had come into town that morning to help students move in during the morning/afternoon shift.  I showed up for the afternoon/evening shift.  As we had done the previous day, we volunteers did our very best to keep everyone comfortable at the port, as students went through the tedious process of being identified, cleared to come onto the ship, given berth assignments, and other things past my station at the port.  I made a point to smile and joke and most students appreciated it.  By mid-evening the last students had made it past my sorting station at the dock entrance and headed into the ship, so I stumbled home for another exhausted sleep.

There was a lot more involved in starting work at the temporary campus than just showing up, but I and the other faculty made do.  The ship had just one large cafeteria so we sometimes had to wait in meal lines during its designated breakfast-lunch-dinner times.  Many of the prior amenities on the ship (e.g., a movie theater and a pool deck) had been converted into classroom and study areas before we boarded, and other spaces were modified for student use later.  This included the conversion of an entire deck of the ship which is usually a car garage into an air-conditioned suite of temporary study spaces, clinical exam rooms, and simulation labs. Since the ship spent most days at sea, it was rather crowded at first.  We faculty didn’t have offices per se but like the students we each found our place to be during the day.  My place was at the back of the third semester classroom, in a corner with AC, electric hookups, and a view of the harbor.  I usually teach in second semester as do most physiologists, so I absorbed a lot of clinical applications even as I worked on lectures and active learning sessions, module directing, pre-mini-workshop design, and all the other routines of a typical teaching-oriented school.  And in so doing I, like so many other faculty who don’t get to know a lot of students normally, did connect with many of them.  When we had to get up at 3:30 a.m. to catch the 4:15 a.m. bus to get us to the boat before it sailed at 5:00 a.m. to make room for a set of larger cruise ships throughout the day, we shared in the students’ experience of having to make sure they too were up at the same time, early enough to download their most important materials of the day before we sailed, just in case the harbormaster put us far out at sea.  When the days came that other ships left late and we didn’t dock until 7:30 at night, the students shared that with us too.

Photo: St. Kitts in the morning light, mid-November 2017. Photo credit: Bruce Wright

Along the way, we made time for some activities.  Twice I went scuba diving with fellow members of our RUSM (Med School) Scuba Club (11); others went diving even more regularly.  People organized groups for exercise on the outside deck every morning and night.  There were religious services, club meetings, and other miscellaneous activities on the boat.  Off the boat there was at least one school-planned movie outing, an island tour, and a few students even made it to a “beach bash” hosted by the RUSVM (Vet School) Scuba Club.  More informally, the port facilities were nice as one would expect at a regular Caribbean cruise ship stop, with everything that entails. It became a shared experience of life in close quarters, dedicated to a common purpose and with a common spirit that we would make it through, together and with no drop in our commitment to teaching and learning despite it all.

Would I have traded it for a nice quiet semester in Dominica with no Hurricane Maria in the first place?  Well, sure!  But you have to deal with what life gives you and we made the best of it.  And the quality of the teaching did not go down.  We might have been in close quarters but we delivered virtually the same curriculum in the fall as we had in the previous spring and summer.

By mid-November, air service to Dominica was spotty but running, so I booked a trip there for a few days including Thanksgiving Day.  We’d just found out that we were going to be in Knoxville, Tennessee for the January semester but no one knew much more than that.  While some people started actively looking for places to live, I planned my return to Dominica and hoped the school would handle the Knoxville move for me and many others (it did).  I booked a room at the only hotel open in Portsmouth, Dominica, just in case my cottage was uninhabitable, and then I hoped for the best.

Photo: Sunset in Dominica, late November 2017. Photo credit: Bruce Wright

When I flew in, it was afternoon and, well, the island I loved looked different.  This was now two months after Hurricane Maria did its damage and still the island was brown, not green.  The volcanic ridges were sharp and distinct, and the remains of trees were all over them, standing tall and naked.  But if I looked closely, I could see that at the tops of the trees, leaves had started growing again.  Not enough to cover the scars on the land, not yet, but enough for some hope.  I had the taxi driver take me to my cottage before going to the hotel, and amazingly almost everything had survived.  The food and other perishables were gone with a few other items (e.g., my Swiss army knife), but overall I had a lot of things to ship home.  When someone had built the place he or she had cemented the window frames into the concrete wall for extra strength, which isn’t standard practice anywhere but it worked there.  Whoever it was had also put odd-looking vents under the roof which somehow prevented the roofs from flying.  As a result, though my furniture was flooded at floor level, almost everything else was salvageable.  It was a miracle compared to the sheer devastation we’d driven through from the airport to town.  That night I saw my first sunset on Dominica in many months, and it was beautiful.

Photo: Looking north from Portsmouth, Dominica, Thanksgiving Day 2017. Photo credit: Bruce Wright

I spent the next two days getting almost everything from my cottage packed up and sent to the local shipping agent for transport back to the USA.  Since my office had survived intact (another unexpected blessing) I took a couple of textbooks and other important items from there. But I didn’t take everything. I left most things in my office against the day I would return.  I also took a few photographs. I chose to avoid taking pictures of the damaged areas. Instead I shot photos of things I’d never seen before, like the caved-in side of a cliff face on the mountain north of town that to me looked just like a monkey’s hand.  Along the way I saw the determination of the people to recover even as they all hoped we would be back in May, and I hoped the same thing.  But it was not to be.  As I flew out with my bicycle sold, my cottage empty, and my most essential items from home and office in two suitcases, I was pretty sure that Dominica wouldn’t be ready for us by then.  There were still too many without power, too many living under tarps and in barely-repaired dwellings, too many roofs still off and the insurance companies being slow to pay claims.

The semester ended relatively uneventfully.  The students adjusted to where they were going to be in the spring, and so did I.  Knoxville, Tennessee is a nice southern city with both friendly people and all the movie theaters one could ever want. I even went once!  Most of our students are here with us, though some are still in St. Kitts with some of our faculty.  We’ve learned we’re to be here through the September 2018 semester so we have some sense of permanence.  Though I would love to return to Dominica as soon as possible, having a safe, happy Dominica with functional buildings, power, water, cell service, and the other non-movie theater basics restored is really important too, so I can’t complain.  Here I am, a professor at a medical school in the United States, just like I wanted to be so many years ago.  And whether here or Dominica or anywhere else my fate takes me, I’ll get by.

As I told one of my advisees who was having a bad day last December, in the end a school isn’t buildings at all.  A medical school is its people, medical faculty training students through increasingly difficult tasks until at the end the students have risen up to a higher level, doctors ready to begin their postgraduate medical education journey.  The medical arenas and the classrooms and the simulation labs and the journal collections and the fraternity/sorority homes and even the occasional Italian ship sailing thousands of miles to become a “floating campus” are all just the scaffolding around what is really important.  That one student, his or her classmates, his or her basic science and clinical faculty, and everyone else from the Dean to I.T. to the people washing dishes in the back of the cafeteria who make sure everything else runs…these people are the real school.  They make it possible for that one student to excel.

And that’s something that no hurricane– however powerful– can stop.  Ask LSU if it stopped for either Camille or Katrina.  Ask Hofstra if it stopped for Sandy, Baylor if it stopped for either Rita or Harvey, or Nova Southeastern if it stopped for either Andrew or Irma.  Like those other disasters, Hurricane Maria is part of history now. And just like those other schools went on after their respective storms, we’ll keep going too, training the next generation of physicians, semester after semester.  As we do, I’ll be right there doing my part for my students, my school, and the greater medical education community.  Because in the end, that’s not only what I was trained to do, it’s still my passion today.

Bruce E. Wright graduated with a PhD in Physiology from LSU Health Sciences Center in 1993.  He had postdoctoral fellowships/research faculty positions at the University of Florida and East Carolina University.  He served several years as faculty at a liberal arts college in Georgia.  He worked at three Caribbean medical schools from 2005-2008 before joining the faculty at Ross University School of Medicine in 2008.  He worked for two years at a US-based osteopathic medical school in 2013 and 2014 before returning to Ross University in late 2014.  Dr. Wright is currently Treasurer/Award & Event Coordinator for the American Physiological Society’s Teaching Section.  He has served as a reviewer for Advances in Physiology Education.  He is National Faculty for the National Board of Osteopathic Medical Educators (NBOME), for whom he has written and reviewed items for different exams.  He regularly attends Experimental Biology and was an attendee and presenter for the first Institute for Teaching and Learning meeting in Bar Harbor, Maine in 2014.  He is currently interested in educational research involving teaching methodologies.

Photograph: The author with three RUSM students (from left to right, Armin Hojjat, Harenda Ipalawatte, Bruce Wright, and Eddy Mora) just after a double-tank scuba dive, off St. Kitts, November 2017. Used with permission by Harenda Ipalawatte.

References/links/other:

  1. http://www.dominica.gov.dm/about-dominica/country-profile
  2. https://medical.rossu.edu/about.html
  3. http://www.dominica.gov.dm/tropical-storm-erika
  4. https://weather.com/storms/hurricane/news/tropical-storm-harvey-forecast-texas-louisiana-arkansas
  5. https://weather.com/storms/hurricane/news/hurricane-tropical-storm-irma-recap-2017
  6. https://en.wikipedia.org/wiki/Hurricane_Maria
  7. https://www.youtube.com/watch?v=l-5fHwER-Zc
  8. https://www.caricom.org/media-center/communications/press-releases/dominica-prime-minister-roosevelt-skerrit-addresses-the-un-general-assembly
  9. https://www.wunderground.com/cat6/category-5-hurricane-maria-hits-dominica
  10. https://veterinary.rossu.edu/about.html
April 2nd, 2018
Surviving Hurricane Maria: A professor’s story (Part 1)

It’s funny, as I begin to write this blog, that I realize that it’s nearly 25 years now since I received my Ph.D. in Physiology in New Orleans.  Back then, I was sure that my career track would lead me to becoming a full professor at a medical school in the United States one day, though I didn’t know exactly how I would get there.  Not being a world traveler, I certainly never expected to spend a day in the Caribbean, but life is funny sometimes.

Like so many other graduates of my day, the “optimal” career track didn’t pan out for me.  My postdoctoral experience didn’t involve receiving any federal grants, so instead of moving straight into medical school, I became involved in undergraduate education. Several years later while advising students, I learned about Caribbean medical schools. When I studied them in more depth, I discovered one program in particular in which I could teach college seniors advanced A&P part-time while I took medical school courses part-time too.  I took a leap of faith and applied for it. Shortly after they accepted me, I took my first flight over the turquoise-blue of the Caribbean Sea.

 

That was the day my life changed

There was and is something different about the Caribbean, its varied islands and its colorful people, so friendly in some places and so unfriendly in others, but always full of life and adorned in bright colors.  Along the way I picked up medical-level Gross Anatomy and with that extra qualification, moved into full-time faculty positions at a couple of small medical schools in the British and Dutch Caribbean.  On those tiny islands I relearned my discipline as a generalist as few others of my generation have done.  There I was THE physiologist with no backup and neither a travel allowance for attending conferences or taking trips home to see my family, nor support for any research.  Instead I had to not only teach the entire medical physiology course by myself three times per year, I also had to assist the anatomy faculty in cadaver dissection twice per week and occasionally teach in an undergraduate course.  My typical medical school course load was 14-16 hours per week of just contact time in lecture and lab, not counting writing exams every three weeks and having many, many meetings with students.  It was hard but it changed me, and made me a better teacher. With this Caribbean-acquired training as a medical physiology generalist, in 2008 I moved up to a first-tier Caribbean medical school in the Commonwealth of Dominica (not the Dominican Republic!), initially to teach digestive physiology.

 

Flag of the Commonwealth of Dominica

Dominica will always have a special place in my heart.  It is a small volcanic island in the British Caribbean that is shaped like a chrysalis (1).  At its widest it’s only about 18 miles and at its longest 29 miles, but it is almost a mile high. It has no five star resorts, no golf courses, and no movie theaters.  It’s hard to get to by air, and even cruise ships mostly go past it in favor of better-developed ports on the islands north and south of it. When I first arrived the entire population on-island was only about 73,000, mostly hugging the west (Caribbean) coast. But for several years I lived in a house on a hillside 500 feet above the Caribbean Sea watching the sun set over the ocean every night from my front porch. On Saturday I would sometimes go down to the village of Mero below me where there would be a half mile of pure gray sand beach and only a dozen people on it.  On Sunday, I might go down again to where five hundred locals had come to party on the beach, or I might have just sat on my porch and listened to the music from far below, as the stars came out and the Southern Cross hung in the April sky. One time, and only one time, I climbed the 4800 foot mountain in the center of the island where there is no trail up to the cloud-cloaked peak.  One time, I swam, dove, and rappelled down a river through a canyon greener than the Emerald City.  And along the way, I taught at a very special school, with smart, tough, high quality faculty and students alike, Ross University School of Medicine (2).

 

Photo: Dominica from my cottage porch, April 2017. Photo credit: Bruce Wright

Through most of my years there, Dominica was spared the worst that Mother Nature could bring to bear.  We liked to say that it was in the perfect place in the Lesser Antilles, too far north for the big Cape Verde hurricanes that would not be turned north as they tracked west through the Central Atlantic to hit, and too far south for those Atlantic storms that did get pulled north as they approached the islands.  Sometimes a tropical storm would come and dump a lot of rain but that just turned the tap water brown or white for a day, no big deal.  The island stayed its radiant green from the tropical rain forests, only browning out for 1-2 months per year in the dry season from January to April.

 

 

In 2015, Tropical Storm Erika formed almost on top of us, and hit the island with the worst rainfall it had experienced in decades.  Dozens of people died and whole towns were cut off for months.  We thought we’d been hit by the Big One, as the estimated damage from Erika’s island-wide flash flooding was about 500 million dollars, or well over half of Dominica’s gross domestic product (3). For two years the island slowly recovered, rebuilding its water treatment facilities, repairing washed-out bridges, and helping rebuild flooded coastal communities.

By August 2017, Dominica was almost completely back.  We too were back.  Our school had had its own water supply even before Erika hit, and the electricity never went out in Portsmouth afterwards. Like the rest of Dominica, my school did lose cell phone service and internet for several days after that storm, which was a serious concern.  Once we were reconnected with the world, we moved to make sure our school would never be caught like that again.  My school installed its own satellite, set up evacuation plans, and built a new student center rated to withstand a Category 5 hurricane. Along the way it continued to matriculate three sets of students per year, semester in and semester out.  Collectively, we thought we’d survived the worst and recovered very well.

No one expected the hurricane onslaught of 2017.  Three major hurricanes, three major disasters, with consequences felt in several parts of the United States, were always theoretically possible but most people didn’t expect more than one to pan out. In the middle of August, I was on vacation at my wife’s home in Georgia as eventual Major Hurricane Harvey formed in the Atlantic and passed south of Dominica as a tropical storm.  Most storms that go that way fizzle out in the eastern Caribbean, but Harvey survived and went on to ravage Houston and the surrounding region of the northwestern Gulf of Mexico like few hurricanes ever had (4). The United States’ people and its government mobilized to help Texas and Louisiana, as it so often does after a major disaster.  I breathed a sigh of relief that Dominica was spared again even as I too donated to help the Gulf coast.

I returned to work before the beginning of the September semester.  Irma was still far out to sea in the Central Atlantic, but it looked like it was going to be trouble almost as soon as it cleared Africa.  I told many first semester students days before Hurricane Irma reached the Lesser Antilles that they should invest in a full set of hurricane supplies as if it would be the worst storm they would ever experience in their lives. Then, when it didn’t hit, they could eat the food, drink the bottled water, and cook with the extra propane all semester long.  Some took this advice to heart and others didn’t.  As Hurricane Irma came closer and closer, it kept heading straight for Dominica, defying days of forecasts that it would turn northwest, and strengthening all the way to one of the strongest Category Five storms of all time.  Only at the last minute seemingly did it turn at last.

Irma was a terrible storm, even by historical standards (5).  It destroyed St. Maarten and several other islands but all we got from it was severe rain and tropical-storm force winds, with only minor damage to our fragile infrastructure.  We grieved for our comrades including our sister school American University of the Caribbean north of us, and then watched as this storm’s heaviest rain bands hit the Miami area, causing even more flooding damage only weeks after Houston’s deluge.  As our University headquarters were there, this had some effect on our operations, but again from Dominica we breathed a sigh of relief.  We had been spared the worst again.

Chugging along some distance behind Irma, another tropical wave came off of the African coast, looking suspicious right from the start.  Maria, as it was to eventually be named, was absolutely the worst case scenario for the island of Dominica and for our basic science campus there (6).  It wasn’t supposed to be a major hurricane when it hit.  The forecasts all said if it hit at all, it was likely to be a strong tropical storm, maybe a Category One.  Nevertheless, in preparing for a business trip to Chicago for the second week of September, I had a group meeting with my mentees a week early, because sometimes even a simple rainstorm over Puerto Rico could delay my return by a day, and I was to return on Monday, September 18th.  I took my work computer with me on the trip on a hunch I might need it before I got back to Dominica.  I had no idea how right I was.

As I worked at my business meeting, I kept following the progress of Maria, joking that it might just prevent me from returning on Monday, but hoping that it would turn like so many storms before it.  This was not to be. By late Saturday even though it was only tropical storm strength, it was apparent that on Sunday the regional airlines were going to evacuate their small aircraft to havens like Aruba and Curacao to the south and Central America to the west.  Since there weren’t going to be any flights, my travel agent arranged for me to go back to my family in Georgia on that Monday to wait out the storm.  We expected I probably wouldn’t get back to Dominica until air service was restored to Puerto Rico, probably four to six days after I’d originally been scheduled to return to Dominica.

September 18th, 2017… Imagine being inside a tornado.

Imagine looking up to see your roof flying away and then the wind and rain coming in on top of your inadequate shelter as you brace your feet against the closet door, hoping it will hold.  Imagine hanging on for hours and hours of storm, enduring howling winds and painful rain and your stuff blowing away around you, hoping you wouldn’t die. If you have trouble imagining it, so do I, because I wasn’t there.  My colleagues who were there said that I was the luckiest person at the school, to be thousands of miles away that fateful day. From my computer screen at home that night I watched the storm give Dominica a direct hit with 160 mile per hour sustained winds, and turning only as the eye was literally over the island such that the entire west coast of the island was struck by the eyewall of Category Five Hurricane Maria.  As I flew home over the United States that day, eighty to ninety percent of the buildings in the country were about to be damaged or destroyed, the hospital, power generators and water reservoirs damaged or destroyed, and the roads and bridges so shakily repaired after Erika destroyed again (6).  The morning after the storm, people went out and saw that not one tree had escaped unscathed on the entire island, and in many places the trees had lost their bark or been snapped in two (7).  Virtually every telephone pole was either in need of repair or down entirely. The airport was knocked out again from both rain and the river beside it washing through the terminal and over the runway. Unlike with Erika, the seaport and its dock and warehouse capacity on the west coast was heavily damaged as well.  And of course, dozens of people were dead and dozens more are still missing to this day. The island was brought to its knees.

A few days after the storm, the prime minister declared in a speech to the United Nations General Assembly that “Eden is broken” (8).

Photo: GOES-16 visible image of Maria just before sunset, at 5:17 pm EDT Monday, September 18, 2017. Image credit: NOAA/RAMMB. (9)

At our campus, that brand new hurricane-proof building delivered.  All of our people were safe, though many of our older buildings were heavily damaged.  The French islands north and south of us weren’t so badly damaged and they were able to get helicopters up to survey the scene of total devastation that Dominica had become.  Our campus became a site for them and other rescuers to base, as it was more functional than any other location on the north side of the island.  With help from many others including the U.S. military, over a thousand students, faculty, staff, and family members were evacuated off the island through seas crowded with entire forests of dead trees and other debris.  Our CEO was there to greet many Ross refugees in Miami as they returned to the US to an uncertain future.  And as before, I watched it all from a distance, not personally devastated as they were but a refugee just the same.  I found out from a colleague who had been my neighbor that my concrete cottage had held up better than most. Like three of the other cottages in the complex it still had both a roof and windows following the storm, but no one could say if anything inside had survived the flooding, or whether the post-storm looters who sadly went through many other places had broken in after they were evacuated.  As soon as I could, I checked in with my school to let them know where I was and that I was safe. I was told to sit tight and wait for instructions, just like everybody else.  So that’s what I did, for several weeks.

Stay tuned for next week’s exciting conclusion…

 

Bruce E. Wright graduated with a PhD in Physiology from LSU Health Sciences Center in 1993.  He had postdoctoral fellowships/research faculty positions at the University of Florida and East Carolina University.  He served several years as faculty at a liberal arts college in Georgia.  He worked at three Caribbean medical schools from 2005-2008 before joining the faculty at Ross University School of Medicine in 2008.  He worked for two years at a US-based osteopathic medical school in 2013 and 2014 before returning to Ross University in late 2014.  Dr. Wright is currently Treasurer/Award & Event Coordinator for the American Physiological Society’s Teaching Section.  He has served as a reviewer for Advances in Physiology Education.  He is National Faculty for the National Board of Osteopathic Medical Educators (NBOME), for whom he has written and reviewed items for different exams.  He regularly attends Experimental Biology and was an attendee and presenter for the first Institute for Teaching and Learning meeting in Bar Harbor, Maine in 2014.  He is currently interested in educational research involving teaching methodologies.

References/links/other:

        1. http://www.dominica.gov.dm/about-dominica/country-profile
        2. https://medical.rossu.edu/about.html
        3. http://www.dominica.gov.dm/tropical-storm-erika
        4. https://weather.com/storms/hurricane/news/tropical-storm-harvey-forecast-texas-louisiana-arkansas
        5. https://weather.com/storms/hurricane/news/hurricane-tropical-storm-irma-recap-2017
        6. https://en.wikipedia.org/wiki/Hurricane_Maria
        7. https://www.youtube.com/watch?v=l-5fHwER-Zc
        8. https://www.caricom.org/media-center/communications/press-releases/dominica-prime-minister-roosevelt-skerrit-addresses-the-un-general-assembly
        9. https://www.wunderground.com/cat6/category-5-hurricane-maria-hits-dominica
        10. https://veterinary.rossu.edu/about.html 
March 19th, 2018
Writing—Work in Progress

As a scientist and educator over the years, I have had the good fortune and pleasure to write and edit many manuscripts and documents, especially in collaborations with mentors, colleagues, and students. As most of us in the business know, writing doesn’t always come easy. It is often very challenging to convey information, thoughts, and ideas in a coherent and straightforward manner, and leave little room for misinterpretation, confusion, and ambiguity. In addition, it can be hard to convey excitement in writing. Writing is an art and deserves time and effort to create a masterpiece. Realistically though, time is rarely on our side for routinely creating works of art. However, we should still try!

 

Writing for me is work in progress, but very enjoyable. I know that I can always improve. Consequently, I seek better and more creative ways to express myself. I certainly wasn’t always enthusiastic about writing. Graduate students and postdoctoral fellows please take note! As a graduate student writing my early manuscripts, I would often string a few sentences together that seemed reasonable and whisper to myself, “This is close and good enough.” It rarely was. My doctoral mentor, Dr. Walter F. Boron (presently at Case Western Reserve University) almost always caught those good enough sentences when we sat together meticulously reviewing every sentence when editing a manuscript. This experience was humbling, yet highly educational, and certainly one of the high points of my graduate school years. I have continued this tradition in my own lab— enduring the occasional sighs of annoyance from my students.

 

The extra effort in writing can be a wonderful and rewarding experience. Many helpful resources are available. Don’t be afraid to pull out that composition/grammar book when needed. I am particularly fond of The Random House Handbook (1), which remains dust-free on my office bookshelf. Also, make use of that Thesaurus tab in Microsoft® Word! Finally, learn from the creativity of others in their writing prose, sentence structure, and expression usage.

I leave you with a list of some of my favorite writing points and guides from over the years.

I acquired most of these from my former advisor, Dr. Boron; I owe him a great deal of gratitude. I also used Ref. 1 to supplement my understanding. Write on and become my fellow artists!

1. Tell a story with the goal of exciting your readers (yes, even with a scientific manuscript).

2. Assemble outlines.

3. Write rather than stare at a blank screen/page for too long. You can always edit a mess later.

4. Edit exhaustively, but spaced out over time.

5. Get input from others.

6. Scrutinize every sentence.

7. Ask the following for every sentence:

“Does it say what I want it to say?”

“How can I make it clearer and/or shorter?”

8. Write active sentences. For example, “Compound X caused effect Y” is better than, “The effect Y was caused by compound X.”

Writing active sentences also holds when citing the work of others. For example, “Smith et al. showed that…” is stronger than, “It has been shown that… (Smith et al.).”

9. Use parallel construction in multi-part sentences. For example, “Compound X caused an increase in Y, and Compound A caused a decrease in B.”

Use parallel construction for multiple sentences that are clearly linked. For example, if you are making three points and you start the first sentence with, “First,…,” then you should have a “Second,…” and a “Third,…”

10. Give the direction of an effect whenever possible. Using the example above, “Compound X caused an increase in Y” is better than, “Compound X had an effect on Y.” Sentences should be as informative as possible.

11. Use present tense when discussing a universal truth.

12. Be consistent in using declarative or non-declarative statements in main headings, in-line headings, figure legends, etc. throughout a body of work.

13. Be careful assigning an action to an inanimate object such as an experimental result. For example, “Experiment X showed Y.” Did the experiment really perform an action?

14. Use caution when starting a sentence with This or These. The reference needs to be clear.

15. Use then in if/then statements. Many writers leave out the then. For example, “If you add media A, then the cells will die” flows better than, “If you add media A the cells will die.” If you use if in an if/then sentence, then hunt for the expected then.

16. Use more gerunds, which are refreshingly active. For example, “Applying X increased Y” is more appealing than, “Application of X increased Y.”

17. Experiment with less frequently used forms of punctuation, e.g., the semicolon and em dash. It’s fun!

18. Don’t confuse that and which clauses. That is used in a restrictive clause to understand sentence meaning. Which is used in a nonrestrictive clause to present additional information; which follows a comma.

19. Use because instead of since in many cases. Since refers to time.

20. Minimize split infinitives. Some will argue with me on this one. For example, “to argue incessantly” is better than, “to incessantly argue.” It is sometimes difficult to avoid splitting up to-base verb pairs because they then sound clumsy. Some will reason that a split is acceptable in those cases. My Father’s response: “No. Rewrite the sentence.”

21. Be careful with generic terms such as numerous, many, variety of, etc. Ask yourself, “Is the term accurate? How many exactly?” Consider giving an appropriate example to the reader.

22. Use respectively sparingly. For example, “The results from experiments A, B, and C were 5.6, 8.9, and 4.3, respectively” is hard to follow and tedious. A good general rule: Avoid sentences that require the reader to match up terms in different parts of the sentence.

23. Remember the neither…nor combination.

24. Know the difference between i.e. and e.g.

25. Consider abandoning the old-fashioned, two-space rule between sentences that was popular with typewriter use. We’re in the age of computers with line justification.

Mark O. Bevensee, PhD is an Associate Professor in the Department of Cell, Developmental & Integrative Biology at the University of Alabama at Birmingham. His laboratory focuses on studying the cellular and molecular physiology of acid-base transporters involved in regulating intracellular pH in health and disease. Dr. Bevensee also teaches— primarily cell and renal physiology to graduate and professional students. He has served as the Director of the Renal Module for medical students since 2006, and currently serves as the Co-Director & Interim Director of the Master of Science in Biomedical and Health Sciences post-baccalaureate program. He is a member of many education committees, including the Medical Education Committee of the University of Alabama School of Medicine. He serves on the editorial board of Advances in Physiology Education (American Physiological Society, APS) and Medical Science Educator (International Association of Medical Science Educators, IAMSE), as well as the Membership committee of IAMSE. He has been a member of the APS for over 20 years, and is the newly elected Awards Councilor of the Cell and Molecular Physiology Section (CaMPS) Steering Committee of the APS.

Reference:

1. Crews, F. C. (1992). The Random House Handbook, 6th Ed. McGraw-Hill, Inc., New York.