September 14th, 2020
Why demonstrating and embracing uncertainty should be a learning objective, especially in uncertain times?

Uncertainty.  We have all heard that word quite frequently lately.  It tends to carry negative connotations and feelings of uneasiness.  It seems the answer to every question these days is, “well, it depends”.  As physiology educators, this is not new to us.  How many times have we answered a student’s broad question with this same phrase?    Regardless of how much active learning is accomplished in the classroom, students at all levels are tasked with preparing for and taking standardized tests.  My children started taking assessments in preschool, multiple choice tests for grading purposes in kindergarten, and state assessment tests in 3rd grade.  Then there will be standardized tests for admissions to college, graduate admissions, and licensing.  It’s no wonder that some students are conditioned to study ‘to the test’ instead of having the goal of truly learning the material, and are hesitant to express when they don’t know something.   I spent the first decade of my career teaching science at the undergraduate level and have spent the last five years teaching in the professional school setting, including medical, dental, and podiatry students.  I have found that these health professions students in particular become especially aware of uncertainty when they start gaining experience with clinical cases and with patients.  I also notice that they are uneasy with uncertainty even from the interactions in the classroom – they are high achieving students and don’t want to be wrong, to be perceived as not knowing an answer or a concept, of maybe feeling like they don’t belong.  In truth, many students have the same questions, and the same feelings, but are hesitant to express them.   It is known that dealing with uncertainty and ambiguity, especially in professions where people are serving patients whose health is at stake, can result in the experience of stress, anxiety, depression, and burnout (1).  Wellness is an important consideration, especially in a climate where things seem to be changing day-to-day and we are provided limited information and answers.  How one deals with uncertainty can lead to life and professional decisions including which career or specialty to pursue.  While this concept is not novel, actually teaching students how to tolerate or even embrace uncertainty is a relatively new concept, one which I think should be made a more purposeful objective in our courses.   What if instead of shying away from admitting we don’t know something, we learn how to accept it, and how to approach the problem to find the most effective answer?  How do we best learn to tolerate uncertainty, and train our students how to cope with and learn from uncertainty?  What are the benefits of embracing uncertainty?   

Bring uncertainty into the classroom Thoughtfully and purposely embedding uncertainty into activities in the classroom does several things.  First, it allows students to learn that not every question has an absolute answer.  Students need help shifting their mindset.  This also encourages students to work with material at higher levels of Bloom’s taxonomy, like evaluation and application.   Additionally, this helps create a culture in the classroom where asking questions and admitting to what we don’t know is a good thing, and brings value to classroom discussions.  This allows students to bring in their own experiences in an attempt to work through a problem and arrive at an answer, enhancing students’ learning.  Students can build their confidence as they find value in embracing the unknown as they learn to navigate the process to find the answers to their questions.   The learning theory constructivism suggests that students build their own learning, that knowledge is built upon knowledge, and that it works best in context (2). This encourages students to bring their own experiences to the learning process, and the result is that each student may bring a different perspective and answer (3).  These principles match well with the intention of teaching how to manage uncertainty.  A goal is for students to be engaged and motivated in an active learning environment, allowing them to share ideas and build their knowledge based on their prior knowledge and experiences.  

Leading to deeper learning To further expand the idea of students building their mental models, activities designed to allow for more open-ended thinking or answers, which build upon each other, can be utilized.  For example, in the cardiovascular physiology component of our medical course, we build on the basic concepts in a series of small group sessions which encourage students to work in their teams to answer questions pertaining to these concepts.  We may start with the principles of hemodynamics but eventually work our way to the integration of cardiac function and vascular function.  These sessions require students to not only recall knowledge, but also apply information in a manner which may lead to uncertainty.  They learn to question the severity of perturbations, the balance of factors which interact, and the cause and effect.  We find students may become frustrated with the “it depends” answer, but they learn how to view the nuance and ask the appropriate questions.  This type of exploration and learning transitions well to more clinical sessions, where students need to know which questions to ask, which tests to order, and which colleagues to consult.    

Demonstrate uncertainty as educators and professionals In addition to our basic science session, I spend a lot of time teaching with clinical colleagues in the pre-clerkship medical classroom.  We have a small cohort of core educators who participate in a special type of small group learning we call Clinical Reasoning Conferences.  The core educators are either basic scientists or clinicians and come from different disciplines, bringing different experiences and expertise to each session. We are always joined by content experts in our sessions with the students as well.  This means that we are likely to be in a session where we are not the content expert, but have immediate access to one. This gives us an opportunity to demonstrate uncertainty in the classroom, to students who feel constant pressure to know everything and to perform at the highest level.  To be honest, it took a while for us to get comfortable with telling the students, “I don’t know”, but that “I don’t know” was, in reality, “I don’t know but let’s get the answer”, which gave us the opportunity to demonstrate how we get the answer.  It could be a reference from the literature, a clinical resource, or a colleague.  Students not only benefit from getting perhaps a more comprehensive answer to their questions, but also knowledge that no one can know everything or even how much is still unknown.  It is imperative in medicine that they learn and practice how to find appropriate information in order to make the most informed decision when it comes to patient care.  These practices have also been shared by other medical educators (1).  Clinical Reasoning Sessions also include students teaching the material to their colleagues, and we make it clear in our expectations that we much rather they describe their process and maybe come up with an incorrect conclusion than have short, although correct, answers which do not demonstrate process and reasoning.  Another goal is to allow the students plenty of chances to practice answering questions of a clinical nature posed by faculty, and allow them to become comfortable asking faculty questions, well before they start their clerkships.    

Manage expectations In my experience, students appreciate the ability to give feedback and share their expectations of their courses and programs.  They also align these with their own expectations of themselves.  Faculty and course directors work to resolve the students’ expectations with their own, and to assist students in forming and revising their expectations of and their role and responsibilities within the course.  Educating during a pandemic has shined a light on and challenged the way we manage these expectations. A word I have heard my colleagues use lately is grace; we should extend grace to our students, to ourselves, and ask for grace from others.  This is another way we can demonstrate how we deal with uncertainty, which can hopefully serve as a soft teaching point for our students.    

Outside of the science classroom Developing skills to help us manage uncertainty extends to outside of our classroom.  We hope that students will take the lessons and continue to use them in other classes, or outside of school altogether.  Medical schools often offer electives, some of which are tied to wellness or extracurricular subjects.  For example, some of our electives include Artful Thinking, in which students hone their skills of observation, application, and context, and Fundamentals of Improv, so that students can work on skills of listening, support, creativity, and quick thinking and response.  Other schools and programs offer similar experiences for students (4,5).  The narrative medicine program emphasizes skills of reflective writing to focus on the human side of medicine, reminding why we’re here in the first place (6).  

Challenging ourselves and encouraging our creativity One of the most important lessons I learned in the transition to remote and hybrid education over the past six months was to face the uncertainty with planning, reflection, and flexibility.  I am the type to have a backup plan to my backup plan, which I realized gave me the flexibility to be more creative in my course design and preparation.  I feel that my courses benefitted from my ability to challenge myself, because of uncertainty, and I intend to continue to reflect and employ what I consider my ‘best practices’ even when we move back into the in-person classroom in the future.   We are exposed to uncertainty every day.  How we choose to frame our mindset, to help our students and ourselves tolerate or even embrace uncertainty can bring benefits both in and outside of the classroom.  

References and further reading Twelve tips for thriving in the face of clinical uncertainty, accessed 8/28/20  https://www.tandfonline.com/doi/pdf/10.1080/0142159X.2019.1579308 What is Constructivism?, accessed 8/28/20 https://www.wgu.edu/blog/what-constructivism2005.html Inviting Uncertainty into the Classroom, accessed 8/28/20 http://www.ascd.org/publications/educational-leadership/oct17/vol75/num02/Inviting-Uncertainty-into-the-Classroom.aspx Teaching Medical Students the Art of Uncertainty, accessed 8/28/20 https://www.cuimc.columbia.edu/news/teaching-medical-students-art-uncertainty The Alda Method, Alda Center for Communicating Science, accessed 9/4/20 https://www.aldacenter.org/alda-method Narrative Medicine Program, Accessed 9/4/20 https://medicine.temple.edu/education/narrative-medicine-program The Diagnosis, Prognosis, and Treatment of Medical Uncertainty https://www.jgme.org/doi/pdf/10.4300/JGME-D-14-00638.1 The Ethics of Ambiguity: Rethinking the Role and Importance of Uncertainty in Medical Education and Practice https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC5497921&blobtype=pdf Helping Students Deal with Uncertainty in the classroom https://www.edutopia.org/blog/dealing-with-uncertainty-classroom-students-ben-johnson Learning: Theory and Research http://gsi.berkeley.edu/media/Learning.pdf          


Rebecca Petre Sullivan, Ph.D.
Associate Professor of Physiology
Lewis Katz School of Medicine at Temple University
Dr. Rebecca Petre Sullivan earned her Ph.D. in Physiology from the Lewis Katz School of Medicine at Temple University and completed a Post-Doctoral Fellowship in the Interdisciplinary Training Program in Muscle Biology at the University of Maryland School of Medicine.  She taught undergraduate biology courses at Ursinus College and Neumann University.  As an Associate Professor of Physiology and a Core Basic Science Educator, she is currently course director in the Pre-Clerkship curriculum at LKSOM and at the Kornberg School of Dentistry; in addition to teaching medical and dental students, she also teaches physiology in Temple’s podiatry school and in the physician assistant program.  She is a member of Temple University’s Provost’s Teaching Academy.  She was the recipient of the Mary DeLeo Prize for Excellence in Basic Science Teaching in 2020 and a Golden Apple Award in 2017 from LKSOM, and the Excellence in Undergraduate Teaching Award from Neumann University in 2012.
August 31st, 2020
“Zoom” into data analysis with JupyterLab
Inimary Toby-Ogundeji, PhD
Assistant Professor
University of Dallas

The use of JupyterLab notebook provides a user-friendly method for learning data analysis.  It is easy to work with and also provides a variety of datasets for direct use and case study data discussions.  One example follow-up task that can be used to extend this data analysis activity is performing logistic regression.  An example approach using Firth’s logistic regression method is provided here (https://bit.ly/31gb7vG).  JupyterLab provides a temporary workspace to accomplish basic tasks in R.  One consideration is that it doesn’t maintain the user’s data and/or work once they close the browser.  Analysis performed in JupyterLab cannot be saved to the virtual platform, however files from the work session can be exported out and saved externally.  For users wanting to have the capabilities of saving work sessions and transferring between JupyterLab sessions in a streamlined manner, they can establish a freely available account.

The activity described in this article highlight a user-friendly method to learn some basic data analysis skills.  It is ideal for students with little to no experience in Biostatistics, Bioinformatics or Data Science.  The article provides an opportunity for students to reflect and practice analysis of data collected from biological experiments within an online learning environment.  The activity is suitable for an instructor led session (using an app with screen sharing capabilities). This article provides basic knowledge about how to use R for simple data analysis using the JupyterLab virtual notebook platform.

The goal of this activity is to familiarize the user with the basic steps for importing a data file, retrieval of file contents and generating a histogram using R within a JupyterLab environment.  The workflow steps to accomplish these tasks are outlined below:

  • Access JupyterLab
  • Access “R”
  • Access datasets
  • Perform summary statistics
  • Data visualization

Workflow Step-by-Step instructions and screenshots from JupyterLab

1. Access JupyterLab
a. Login to JupyterLab here: https://mybinder.org/v2/gh/jupyterlab/jupyterlab-demo/try.jupyter.org?urlpath=lab

Home page of JupyterLab Notebook

2. Access “R”

a) Select the (+) symbol at the top left of the JupyterLab screen;

b) Select R

R Console

3. Access the dataset

a) Select the directory titled: “UPMC_cohort”;

b) Identify the filename “meta.csv”.

c) Type data<-read.csv(“meta.csv”,header=TRUE, stringsAsFactors-FALSE)

d) Click run

e) Type data

f) Click run

Dataset from “meta.csv”

4. Perform summary statistics (on variable Cigarette_Pack_Years)

a) Type str(data)

b) Click run

c) Type data$Cigarette_Pack_Years

d) Click run

e) Type summary (data$Cigarette_Pack_Years)

f) Click run

Datatypes for each variable in dataset
Summary statistics

5. Draw a histogram using the “hist” function

a) Type hist(data$Cigarette_Pack_Years, 100, main=”Use of Cigarette (in years)”, xlab=Cigarette Pack Years”, ylab”Frequency”)

b) Click run

Histogram

References:
JupyterLab- https://jupyterlab.readthedocs.io/en/latest/getting_started/overview.html

R programming- https://www.r-project.org/

Github- https://github.com/initoby/JupyterLab_R_basics/blob/master/PECOP

Dr. Toby holds a PhD in Biomedical Sciences (specialization in Organ Systems Biology) from Ohio State University, College of Medicine. Her postdoctoral training was in Functional Genomics at the FAA-Civil Aerospace Medical Institute in Oklahoma City.  She is currently an Assistant Professor of Biology at University of Dallas.  She teaches several courses including: Human Biology, Bioinformatics and Biostatistics.  She enjoys mentoring undergraduate students and is an active member of The APS. Dr. Toby’s research program at UD is focused on cell signaling consequences that occur at the cellular/molecular interface of lung diseases. She is also leveraging the use of computational methods to assess immune sequencing and other types of high throughput sequencing data as a means to better understand lung diseases.

August 17th, 2020
Evidence-based teaching: when evidence is not enough
Gregory J. Crowther, PhD
Everett Community College

On June 23, Dr. Chaya Gopalan of Southern Illinois University spoke at the APS Institute of Teaching and Learning on the topic of “The Flexibility of Using the Flipped Classroom as a Virtual Classroom During the COVID-19 Pandemic.” The presentation was great — full of empirical data, practical tips, and audience participation.

One of the questions that arose was, assuming that one is flipping a class with video lectures, how long should those video lectures be? I can’t remember what Chaya said about this at the time, but many others used the chat window to weigh in. They mostly argued that shorter is better, with 10-12 minutes being a commonly prescribed upper limit.

The author droning on during a long video lecture.

I had heard this “shorter is better” mantra many times before, and believed that it was well-supported by the literature. Still, I had resisted any impulse to shorten my own videos. I was already generating one video per chapter per course — 50 videos per quarter in all. If I divided each video into four shorter videos, that would be 200 videos per quarter to manage. Couldn’t my students just hit “pause” and take breaks as needed?

Thus, the video-length issue was making me increasingly uncomfortable. I think of myself as an evidence-based teacher, yet I seemed unwilling to go where the evidence was pointing.

Having battled myself to an impasse, I decided to email Chaya. I wrote:

…If you — as an expert flipper who has read the literature and published your own papers on this — were to tell me, “Come on, Greg, the evidence is overwhelming — for the good of your students you just need to make your videos shorter — stop whining and do it!” then I probably would comply. So … what do you think?

Chaya declined to respond with an ultimatum, but she did note that her own videos vary greatly in length — from 8 minutes to an hour! A lot of this variation is topic-specific, she said; some “stories” need to be told as a single chunk, even if it takes longer to do so.

Chaya’s point about chunking the material according to natural breakpoints was exactly what I needed to hear. While the idea of shortening videos because “shorter is better” did not itself inspire me, the idea of finding those breakpoints and reorganizing the material accordingly seemed utterly worthwhile. Maybe this would help my students more easily track their progress within each chapter. And off I went — I was finally ready to shorten my videos!

So, what lessons can be extracted from this bout of navel-gazing?

The thing that jumps out at me is this: my long-held resistance to a fairly mild idea (“make your videos shorter!”) was suddenly overcome not by conclusive new research, but by a subtle shift in perspective. When Chaya made a particular point that happened to resonate with me, I now wanted to make the change that I had been guiltily avoiding for months.

This was — for me, at least — a valuable reminder that, while evidence-based teaching is undoubtedly a good thing, behavior is rarely changed by evidence alone. There’s just no substitute for direct conversations in which open-minded people with shared values can stumble toward a common understanding of something.

It may be slightly heretical for me to say so, but I’ll take a good conversation over a peer-reviewed paper any day.

Greg Crowther teaches human anatomy and physiology at Everett Community College (north of Seattle). He is the co-creator of Test Question Templates, a framework for improving the alignment of biology learning activities and summative assessments.

August 3rd, 2020
Protecting yourself means more than a mask; should classes be moved outside?
Mari K. Hopper, PhD
Associate Dean for Biomedical Science
Sam Houston State University College of Osteopathic Medicine

Disruption sparks creativity and innovation. For example, in hopes of curbing viral spread by moving classroom instruction outdoors, one Texas University recently purchased “circus tents” to use as temporary outdoor classrooms.

Although circus tents may be a creative solution… solving one problem may inadvertently create another. Moving events outdoors may be effective in reducing viral spread, but it also increases the skin’s exposure to harmful ultraviolet (UV) radiation from the sun. The skin, our body’s largest organ by weight, is vulnerable to injury. For the skin to remain effective in its role of protecting us from pollutants, microbes, and excessive fluid loss – we must protect it.

It is well known that UV radiation, including UVA and UVB, has deleterious effects including sunburn, premature wrinkling and age spots, and most importantly an increased risk of developing skin cancer.

Although most of the solar radiation passing through the earth’s atmosphere is UVA, both UVA and UVB cause damage. This damage includes disruption of DNA resulting in the formation of dimers and generation of a DNA repair response. This response may include apoptosis of cells and the release of a number of inflammatory markers such as prostaglandins, histamine, reactive oxygen species, and bradykinin. This classic inflammatory response promotes vasodilation, edema, and the red, hot, and painful condition we refer to as “sun burn.”1,2

Prevention of sunburn is relatively easy and inexpensive. Best practice is to apply broad spectrum sunscreen (blocks both UVA and UVB) 30 minutes before exposure, and reapply every 90 minutes. Most dermatologists recommend using SPF (sun protection factor) of at least 30. Generally speaking, an SPF of 30 will prevent redness for approximately 30 times longer than without the sunscreen. An important point is that the sunscreen must be reapplied to maintain its protection.

There are two basic formulations for sunscreen:  chemical and physical. Chemical formulations are designed to be easier to rub into the skin. Chemical sunscreens act similar to a sponge as they “absorb” UV radiation and initiate a chemical reaction which transforms energy from UV rays into heat. Heat generated is then released from the skin.3  This type of sunscreen product typically contains one or more of the following active ingredient organic compounds: oxybenzone, avobenzone, octisalate, octocrylene, homosalate, and octinoxate. Physical sunscreens work by acting as a shield. This type of sunscreen sits on the surface of the skin and deflects the UV rays. Active ingredients zinc oxide and/or titanium dioxide act in this way.4  It’s interesting to note that some sunscreens include an expiration date – and others do not. It is reassuring that the FDA requires sunscreen to retain their original “strength” for three or more years.

In addition to sunscreen, clothing is effective in blocking UV skin exposure. Darker fabrics with denser weaves are effective, and so too are today’s specially designed fabrics. These special fabrics are tested in the laboratory to determine the ultraviolet protection factor (UPF) which is similar to SPF for sunscreen.  A fabric must carry a UPF rating of at least 30 to qualify for the Skin Cancer Foundation’s Seal of Recommendation. A UPF of 50 allows just 1/50th of the UV rays to penetrate (effectively blocking 98%). Some articles of clothing are produced with a finish that will wash out over time. Other fabrics have inherent properties that block UV rays and remain relatively unchanged due to washing (some loss of protection over time is unavoidable) – be careful to read the clothing label.

Some individuals prefer relying on protective clothing instead of sunscreen due to concerns about vitamin D synthesis. Vitamin D activation in the body includes an important chemical conversion stimulated by UV exposure in the skin – and there is concern that sunscreen interferes with this conversion. However, several studies, including a recent review by Neale, et al., concluded that use of sunscreen in natural conditions is NOT associated with vitamin D deficiency.5,6 The authors did go on to note that at the time of publication, they could not find trials testing the high SPF sunscreens that are widely available today (current products available for purchase include SPFs over 100).

Additional concern about use of sunscreens includes systemic absorption of potentially toxic chemicals found in sunscreen. A recent randomized clinical trial conducted by Matta and colleagues investigated the systemic absorption and pharmacokinetics of six active sunscreen ingredients under single and maximal use conditions. Seven Product formulations included lotion, aerosol spray, non-aerosol spray, and pump spray. Their study found that in response to repeat application over 75% of the body surface area, all 6 of the tested active ingredients were absorbed systemically. In this study, plasma concentrations surpassed the current FDA threshold for potentially waiving some of the additional safety studies for sunscreen. The authors went on to note that the data is difficult to translate to common use and further studies are needed. It is important to note that the authors also conclude that due to associated risk for development of skin cancer, we should continue to use sunscreen.

Yet another concern for using sunscreen is the potential for harmful environmental and human health impact. Sunscreen products that include organic UV filters have been implicated in adverse reactions in coral and fish, allergic reactions, and possible endocrine disruption.8,9 In some areas, specific sunscreen products are now being banned (for example, beginning January of 2021, Hawaii will ban products that include oxybenzone and octinoxate). As there are alternatives to the use of various organic compounds, there is a need to continue to monitor and weigh the benefit verses the potential negative effects.

Although the use of sunscreen is being questioned, there is the potential for a decline in use to be associated with an increase in skin cancer. Skin cancer, although on the decline in recent years, is the most common type of cancer in the U.S. It is estimated that more than 3 million people in the United States are diagnosed with skin cancers each year (cancer.net). Although this is fewer than the current number of Americans diagnosed with COVID-19 (Centers for Disease Control and Prevention, July 20, 2020) – changes in human behavior during the pandemic (spending more time outdoors) may inadvertently result in an increase in the number of skin cancer cases in future years.  

While we responsibly counter the impact of COVID-19 by wearing masks, socially distancing, and congregating outdoors – we must also continue to protect ourselves from damaging effects of the sun. As physiologists, we are called upon to continue to investigate the physiological impacts of various sunscreen delivery modes (lotion, aerosol, non-aerosol spray, and pumps) and SPF formulations. We are also challenged to investigate inadvertent and potentially negative impacts of sunscreen including altered Vitamin D metabolism, systemic absorption of organic chemicals, and potentially adverse environmental and health outcomes.

Again, solving one problem may create another challenge – the work of a physiologist is never done!

Stay safe friends!

Mari

References:

  1. Lopes DM, McMahon SB. Ultraviolet radiation on the skin: a painful experience? CNS neuroscience & therapeutics. 2016;22(2):118-126.
  2. Dawes JM, Calvo M, Perkins JR, et al. CXCL5 mediates UVB irradiation–induced pain. Science translational medicine. 2011;3(90):90ra60-90ra60.
  3. Kimbrough DR. The photochemistry of sunscreens. Journal of chemical education. 1997;74(1):51.
  4. Tsuzuki T, Nearn M, Trotter G. Substantially visibly transparent topical physical sunscreen formulation. In: Google Patents; 2003.
  5. Passeron T, Bouillon R, Callender V, et al. Sunscreen photoprotection and vitamin D status. British Journal of Dermatology. 2019;181(5):916-931.
  6. Neale RE, Khan SR, Lucas RM, Waterhouse M, Whiteman DC, Olsen CM. The effect of sunscreen on vitamin D: a review. British Journal of Dermatology. 2019;181(5):907-915.
  7. Matta MK, Florian J, Zusterzeel R, et al. Effect of sunscreen application on plasma concentration of sunscreen active ingredients: a randomized clinical trial. Jama. 2020;323(3):256-267.
  8. Schneider SL, Lim HW. Review of environmental effects of oxybenzone and other sunscreen active ingredients. Journal of the American Academy of Dermatology. 2019;80(1):266-271.
  9. DiNardo JC, Downs CA. Dermatological and environmental toxicological impact of the sunscreen ingredient oxybenzone/benzophenone‐3. Journal of cosmetic dermatology. 2018;17(1):15-19.

    All images from:
    Royalty Free Stock Pictures – Public Domain Images
    www.dreamstime.com/

Prior to accepting the Dean’s positon at Sam Houston State University, Dr Hopper taught physiology and served as the Director of Student Research and Scholarly Work at Indiana University School of Medicine (IUSM). Dr Hopper earned tenure at IUSM and was twice awarded the Trustees Teaching Award. Based on her experience in developing curriculum, addressing accreditation and teaching and mentoring of medical students, she was selected to help build a new program of Osteopathic Medicine at SHSU. Active in a number of professional organizations, Dr. Hopper is past chair of the Chapter Advisory Council Chair for the American Physiological Society, the HAPS Conference Site Selection Committee, and Past-President of the Indiana Physiological Society.

July 20th, 2020
Physiology Educators Community of Practice (PECOP) Webinar Series

The American Physiological Society (APS) is pleased to announce a new webinar series focused on our educator community. The monthly series includes live webinars focused on education best practices, synchronous and/or asynchronous teaching, establishing inclusive classrooms and publishing. Educator town halls will also be featured as we strive to support and engage the educator community throughout the year.

Starting this month, take advantage of the educator webinar series by visiting the events webpage on the APS website. Register for each webinar, learn about speakers and their talks today!

What to do on the First Day of Class: Insights From Physiology Educators?
July 23, 2020
12 p.m. EDT

Join in the discussion about how to greet students on the first day of class and set the tone for the rest of the course.

Speakers:

  • Barbara E. Goodman, PhD from the Sandford School of Medicine, University of South Dakota (Vermillion)
  • Dee Silverthorn, PhD from the University of Texas at Austin

A successful semester: Applying resilient and inclusive pedagogy to mitigate faculty and student stress
August 20, 2020
2 p.m. EDT

As we head into an uncertain academic year, spend an hour with us to consider strategies which will help you and your students navigate our changing academic, professional, and personal lives. Participants will work through pragmatic and concrete strategies they can transition into their own work to promote student learning and minimize stress.

Speakers:

  • Josef Brandauer, PhD from Gettysburg College (Penn.)
  • Katie Johnson, PhD from Trail Build, LLC (East Troy, Wisc.)

Writing & Reviewing for Advances
September 17, 2020
12 p.m. EDT

This session will be a chance to encourage all who have adapted their teaching during the COVID-19 pandemic to share their work. This topic also ties in to the Teaching Section featured topic for EB 2021.

Speaker:

  • Doug Everett, PhD from National Jewish Health (Denver, Colo.)

A Framework of College Student Buy-in to Evidence-Based Teaching Practices in STEM: The Roles of Trust and Growth Mindset
October 22, 2020
12 p.m. EST

This topic is relevant to building trust, which goes hand-in-hand with inclusion and diversity. Trust is essential for the different modalities of teaching which educators and students will experience in the fall.

 

Educators Town Hall
November 19, 2020
12 p.m. EST

A chance to talk about what happened during the fall semester and also plan for the upcoming year

July 6th, 2020
Balancing Coursework, Student Engagement, and Time
Jennifer Rogers, PhD, ACSM EP-C, EIM-2
Associate Professor of Instruction
Director, Human Physiology Undergraduate Curriculum
Department of Health and Human Physiology
University of Iowa

First, a true story. Years ago, when my son was very little, he and his preschool friends invented a game called “What’s In Nick’s Pocket?” Every day before leaving for school my son would select a small treasure to tuck into his pocket.  The other 3- and 4- year olds at school would crowd around and give excited “oooh’s” and “aaah’s” as he presented his offering, which had been carefully selected to delight and amaze his friends.  And so it is with the PECOP blog forum—as each new post arrives in my inbox I wonder with anticipation what educational gem has been mindfully curated by colleagues to share with the PECOP community.

My contribution? Thoughts on the balance between coursework, student engagement, and time.  Student engagement in this context refers to a wide range of activities that exist outside of the traditional classroom that offer valuable opportunities for career exploration and development of professional skills.  Examples include:

  • Internships: either for course credit or independently to gain experience within a particular setting
  • Study Abroad opportunities
  • Participation in a student organization
  • Peer tutor/mentoring programs
  • Research: either as a course-based opportunity or as a lab assistant in a PI’s lab (paid or unpaid)
  • Job experiences: for example, as a certified nursing assistant, medical transcriptionist, emergency medical technician
  • Volunteer and community outreach experiences
  • Job shadowing/clinical observational hours

These are all increasingly popular co-curricular activities that allow students to apply concepts from physiology coursework to real-world scenarios as an important stepping stone to enhance career readiness and often personal development.  At the same time, however, students seem to more frequently communicate that they experience stress, anxiety, and concerns that they “are not at their best,” in part due to balancing coursework demands against time demands for other aspects of their lives.  If you are interested in learning more about the health behaviors and perceptions of college students, one resource is the American College Health Association-National College Health Assessment II (ACHA-NCHA II) Undergraduate Student Reference Group Data Report Fall 2018 (1).  Relevant to this blog, over half of the undergraduates surveyed (57% of 11,107 participants) reported feeling overwhelmed by all they had to do within the past two weeks.

I recently gave an undergraduate physiology education presentation that included this slide.  It was an initial attempt to reconcile how my course, Human Physiology with Lab, (a “time intensive course” I am told), fits within the context of the undergraduate experience.

I was genuinely surprised by the number of undergraduates in the audience who approached me afterward to essentially say “Thank you for recognizing what it feels like to walk in my shoes, it doesn’t seem like [my professors, my PI, my parents] understand the pressure I feel. “

In response, and prior to the changes in higher education following COVID-19, I began to ponder how to balance the necessary disciplinary learning provided by formal physiology coursework and participation in also-valuable experiential opportunities.  The Spring 2020 transition to virtual learning, and planning for academic delivery for Fall 2020 (and beyond), has increased the urgency to revisit these aspects of undergraduate physiology education.  As PECOP bloggers and others have mentioned, this is a significant opportunity to redefine how and what we teach. 

It has been somewhat challenging to me to consider how to restructure my course, specifically the physiology labs, in the post COVID-19 era when lab activities need to be adaptable to either in-person or virtual completion.  My totally-unscientific process to identify areas for change has been the “3-R’s” test. With regard to physiology lab, there may be many important learning objectives:

  • An ability to apply the scientific method to draw conclusions about physiological function
  • The act of collecting data and best practices associated with collection of high-quality data (identification of control variables, volunteer preparation/preparation of the sample prior to testing, knowledge of how to use equipment)
  • Application of basic statistical analyses or qualitative analysis techniques
  • Critical thought and quantitative reasoning to evaluate data
  • How to work collaboratively with others, that may be transferrable to future occupational settings: patients, clients, colleagues
  • Information literacy and how to read and interpret information coming from multiple resources such as scientific journals, online resources, advertisements, and others, and
  • Science communication/the ability to communicate information about human function, in the form of individual or group presentations, written lab reports, poster presentations, formal papers, infographics, mock patient interactions, etc.

Arguably, these are all important lab objectives.  Really important, in fact.

So, what is the 3 R’s test, and how might it help?  The 3 R’s is simply my way of prioritizing.  In order to triage lab objectives, I ask myself: What is Really Important for students to master throughout the semester versus what is Really, Really Important, or even Really, Really, REALLY Important?  For example, if I can only designate one activity that is Really, Really, REALLY Important, which one would it be?  The answer for my particular course is science communication.  It is obviously a matter of semantics, but I like being able to justify that all course activities are still Really Important, even if it is only my inner dialogue.  Going into the unknowns of the Fall semester, this will help me guide how course activities in physiology lab are transformed. 

Another worthy goal, in light of academic stress and allocation of effort for maximum benefit, is to improve the transparency of expectations for students.  A common question that arose during the spring semester was if students would still learn what they needed to in preparation for future coursework or post-graduation opportunities.  The identification of one or two primary learning outcomes (the Really, Really, REALLY important ones) may attenuate feeling overwhelmed by a long list of lab-related skills to master if there is another abrupt shift to virtual instruction mid-semester; course objectives can still be met even if we discontinue in-person lab sessions. 

To return to the original topic of balancing time demands allocated to formal coursework and valuable experiences, the two broad conclusions I have reached fall under the categories what I can do in my own courses and suggestions for conversations to be had at the program level.

In My Courses: COVID-19 has sped up the time course for revisions I had already been considering implementing in physiology labs.  Aligning course activities with what is Really, Really, REALLY important will help me manage preparation efforts for the coming fall semester (and hopefully keep my stress levels manageable).  Another important goal is to improve the transparency of course goals for students, ideally alleviating at least a portion of their course-induced stress through improved allocation of effort.  Ultimately, I hope the lab redesigns reinforce physiology content knowledge AND provide relevant experiences to promote career readiness.  *It is also necessary to emphasize to students that both will require focused time and effort.

At the Program Level:  Earning a degree in physiology is not based on acquired knowledge and skills in a single course, rather it is an end-product of efforts across a range of courses completed across an academic program.  Here are some ideas for program-wide discussion:

  • Faculty should identify the most important course outcome for their respective courses, and we should all meet to talk about it. Distribute program outcomes throughout the courses across the breadth of the program.  (Yes, this is backward design applied to curriculum mapping.)  From the faculty perspective, perhaps this will reduce feeling the need to teach all aspects of physiology within a particular course and instead keep content to a manageable level.  From the student perspective, clear communication of course objectives, in light of content presented within any particular course, may promote “buy in” of effort.  It may also build an awareness that efforts both inside and outside of the classroom are valuable if the specific body of content knowledge and aptitudes developed across the curriculum, relevant for future occupational goals, is tangibly visible.
  • Review experiential/applied learning opportunities. Are there a sufficient number of opportunities embedded within program coursework?  If not, are there other mechanisms available to students, for example opportunities through a Career Center or other institution-specific entities?  Establishing defined pathways for participation may reduce student stress related to not knowing how to find opportunities.  Another option would be to consider whether or not the program would benefit from a career exploration/professional skills development course.  Alternatively, could modules be developed and incorporated into already existing courses? 
  • Lastly, communicate with students the importance of engaging in co-curricular activities that are meaningful to them; this is more important than the number of activities completed. Time is a fixed quantity and must be balanced between competing demands based on personal priorities. 

As we consider course delivery for Fall 2020, the majority of us are reconsidering how we teach our own courses.  There are also likely ongoing conversations with colleagues about plans to navigate coursework in the upcoming semesters.  If everything is changing anyway, why not take a few minutes to share what is Really, Really, REALLY important in your courses?  The result could be an improved undergraduate experience related to balancing the time and effort allocations required for success in the classroom along with opportunities for participation in meaningful experiences.

Reference:

1. American College Health Association. American College Health Association-National College Health Assessment II: Undergraduate Student Reference Group Data Report Fall 2018. Silver Spring, MD: American College Health Association; 2018.

Jennifer Rogers completed her PhD and post-doctoral training at The University of Iowa (Exercise Science).  She has taught at numerous institutions ranging across the community college, 4-year college, and university- level higher education spectrum.  Jennifer’s courses have ranged from small, medium, and large (300+ students) lecture courses, also online, blended, and one-course-at-a-time course delivery formats.  She routinely incorporates web-based learning activities, lecture recordings, and other in-class interactive activities into class structure.  Jennifer’s primary teaching interests center around student readiness for learning, qualitative and quantitative evaluation of teaching strategies, and assessing student perceptions of the learning process.

June 29th, 2020
Cultivating a growth mindset for the work of diversity and inclusion
Lisa Carney Anderson, PhD
Associate Professor
Department of Integrative Biology and Physiology
University of Minnesota
Minneapolis, MN

I live in Minnesota and work at the University of Minnesota.

I’m sure you have read and heard about the Twin Cities in the news.  George Floyd was murdered by a police officer in Minneapolis. In addition, in the past few years, members of the Minneapolis Police have killed other Black citizens.  Consequently, a large number of people of all ages, colors and creeds poured into the streets to protest police brutality.  I am a White cis woman with privilege. Though I feel confident about my abilities as a physiologist and an educator, I’m not confident about the work of diversity and inclusion. Nonetheless, I am trying to figure out how I can use my privilege to provide a better learning and life experience for my students of color.

In 2018, at the Institute on Teaching and Learning, Katie Johnson of Trail Build, gave a powerful presentation on diversity and inclusion (2).  In her talk, she met us where we all lived.  She started by saying that she was a scientist and teacher.  If it was her job to be objective, what could she possibly do to promote diversity and inclusion?  Then she said something amazing.

We as physiologists ask our students to think in new ways.  We ask them to learn a lot of new terms: homeostasis, contractility, permeability, peristalsis and clearance.  Then we ask them to learn a lot of concepts.  Negative feedback mechanisms can maintain the cellular environment. Increased intracellular calcium increases the strength of a cardiac contraction.  Permeability is related to the number of open ion channels in a membrane. Peristalsis is a wave like contraction that moves contents along the gut lumen. Clearance is defined in terms how much plasma per unit of time is cleaned of a given substance.  Then we ask our student to put the terms and concepts into a framework that explains how the body works.  And we don’t ask students to do this sequentially, we ask them to accomplish this simultaneously.  Holy Smokes. That is hard work.  We ask our students to struggle with physiology.

So here is the amazing part.  If we ask our students to think in new ways to learn physiology, then we, as faculty, should be willing to think in new ways to address racism and equity in science and education. 

Dr. Johnson also gave us insight into the student experience.  For example, cold calling students is not a fair classroom practice.  I’ve learned that this is where small group discussion or Think-Pair-Share exercises (3) can be very helpful. If students have a chance to try out their ideas on a peer, then they may gain confidence to share an idea with the whole class. 

For example, I’ve also learned to be intentional when I set up student groups.  Here in very White Minnesota, I might have a few students of color.  I look at my class list and I look at the students’ pictures and try to make sure there are at least two students of color in a group even if that means some groups are all White. My process for assigning groups is far from perfect because, I may not recognize that a student identifies as non-white.  I don’t assume to know the comfort level of my students but my sense is that this practice addresses at least some of the stress of being the only person of color in a small group.  I have a colleague that calls imperfect classroom interventions like this, “filling in the gaps when a systemic solution is not available to address stereotype threats.”

So, what is a stereotype threat?

Before Mr. Floyd was murdered, I read the book, Whistling Vivaldi: how stereotypes affect us and what we can do, by Claude M. Steele (4).  From his work I have learned universities are power structures that can be very intimidating for students.  Through rigorous experimentation, Dr. Steele demonstrated how stereotype threat, or the stress of feeling marginalized interferes with a student’s performance. The burden of constantly feeling like you don’t belong is exhausting.  As I read this book, I thought back on my own experience as an undergraduate, first-generation, female. I was the only female in physics lab.  I felt like no one wanted to be my lab partner and no one wanted me there.  The lab teacher made jokes at my expense. I got Cs in physics.  Was it because I’m bad at physics?  Was it because I felt marginalized?  Is this how my students of color feel?

First of all, I’ve learned from Dr. Steele in Whistling Vivaldi and Dr. Johnson from Trail Build that there are things I can do to help my students with stereotype threats.  I can help them practice affirmation.  I’ll share with you how I do this in my Clinical Physiology Class.  This is a two-course series in which students from nursing anesthesia, biomedical engineering, physiology, kinesiology and other biological sciences come together to learn about pathophysiology and clinical physiology.  I assign the students to interdisciplinary groups such that representatives from all majors are distributed as evenly as possible throughout the groups.  I try to balance genders and make sure that no student of color is alone in a group of White students.  Then I encourage them in their discussions to think about the assets they bring to the conversation: leadership, math ability, problem solving, biochemistry knowledge, clinical experience, research experience, practicality, being a peacemaker and so on.  Because, as the American humorist, Will Rogers, is reported to have said, “We are all ignorant, only on different subjects.” I try to get them to see that they have knowledge their peers don’t have and that is why it is important for them to be present.

Second, I try to help my students have an incremental mindset rather than a fixed mindset.  This comes from the work of Carol Dweck (1) also described in Whistling Vivaldi. An incremental mindset is one in which a student might think “today, not possible but tomorrow, POSSIBLE.”  I tell my students that physiology is a way of thinking and you have to practice it.  No one is born knowing physiology and just because physiology is hard does not mean it is the wrong field for them. I want my students to realize I have had failures but they don’t define me. For example, I tell my students about the first time I took biochemistry when I was a senior in college.  I got a D and not because I didn’t work hard. I spent many lonely hours going over my notes but when it came time for the test, and I just couldn’t remember a single glucose molecule.  Then in graduate school, I took biochemistry again.  I got some large pieces of butcher paper.  I drew molecules and pathways and enzymes.  I drew them over and over from memory.  While I rode the bus, I reflected on how the pathways were related.  For fun I would predict what would happen if a particular enzyme did not work.  I used retrieval, mental models and reflection (though at the time I did not realize that’s what they were called).  I learned a lot of biochemistry, I earned a lot of confidence, and I got a good grade.  Now people call me Dr. Anderson.  Not because I’m a genius but because I know it is possible to grow into goals and aspirations.

Leading a classroom with an incremental mindset (also called a growth) mindset, in my opinion, is a powerful way for me to promote equity in my educational mission.  If I am honest with them about the struggles I’ve had, they might be willing to come into office hours and get some help. If students know that I went from a D to an A, they might think that they can do it too. Instead of seeing a poor grade on a test as the limit of their knowledge, they might see it as room to grow and work they need to do.  If they stay in the class, they can realize that improvement; if they drop the class, they are behind in completing their program and behind financially. If I can keep a student of color from dropping the class and help them with study skills, then that is one small step for equity.

Finally, as we make our way towards the fall, it is important to acknowledge that some of our students, especially our students of color and our Black students may have experienced trauma in their lifetimes.  They are traumatized by the isolating effects of the pandemic. They are traumatized by seeing repeated airings of the murder of George Floyd in Minneapolis and Rayshard Brooks in Atlanta. They are traumatized due to societal inequities that value their lives and bodies and education less than others. We must acknowledge their experience.

Two weeks ago, one of my medical physiology students invited me to a rally at the St. Paul State Capitol as part of “White Coats for Black Lives.”  At first, I didn’t want to go. I was scared of getting exposed to the Covid-19 virus.  But nonetheless I found myself typing in an email, “How can I participate?” My student invited me so I had to be part of the solution. So, I put on my black mask and my white coat and I headed to the State Capital.  I spoke to my students, and they offered me a sign. “SILENCE IS COMPLICITY.”  I found my spot on the lawn and I held up my sign. The lawn was full of health care providers and educators from all over the Twin Cities.   I listened to an inspiring student-led protest in favor of providing health care access for all, increasing the diversity of student and faculty bodies and ending race-based medicine.  I was deeply moved by the experience and I was glad I came.  Our students of color and their allies are demanding more of us as faculty, departments and institutions.

I’m getting comfortable with being uncomfortable. I’m ready to listen because I am not an expert in anti-racism and I’m ready to work even though I might make some mistakes along the way.  I’m hoping to cultivate a growth mindset around issues of racism and spending my time listening to experts, reading on my own and learning. We ask this of our students every day and we as faculty can do no less.

References:

  1. Claro S, Paunesku D, Dweck CS. Growth mindset tempers the effects of poverty on academic achievement. Proc Natl Acad Sci U S A. 2016;113(31):8664-8668.
  2. Johnson, K.M.SInclusive Practices for Diverse Student Populations. Plenary. APS Institute on Teaching and Learning, Madison, WI, June 18-22, 2018.
  3. Lyman, F. “The responsive classroom discussion.” In Anderson, A. S. (Ed.), Mainstreaming Digest. College Park, MD: University of Maryland College of Education, 1981.
  4. Steele, C.S. Whistling Vivaldi: how stereotypes affect us and what we can do, W.W Norton & Company: New York, 2010.

Lisa Carney Anderson is an Associate Professor and Director of Education in the Department of Integrative Biology and Physiology at the University of Minnesota. She completed her doctoral training in muscle physiology at the University of Minnesota. She directs the first-year medical physiology course. She also teaches nurse anesthesia students, dental students and undergraduates. She is the 2012 recipient of the Didactic Instructor of the Year Award from the American Association of Nurse Anesthesia.  She co-authored a physiology workbook called Cells to Systems: Critical thinking exercises in Physiology, Kendall Hunt Press. Dr. Anderson’s teaching interests include encouraging active learning through retrieval and assessment of student reflection.  She has joined the APS Teaching Section Steering Committee as Secretary.

June 22nd, 2020
Keeping the Connection Alive During Remote Instruction
Candace Receno, PhD
Assistant Professor, Exercise Science & Athletic Training
Ithaca College

As a first year Assistant Professor, making the shift to remote learning during COVID-19 was certainly a gamechanger. As many previous blog posts have highlighted, the way we needed to look at instruction changed and forced both students and faculty to rapidly adapt. There were so many things that needed to be considered when making the transition. How flexible can our students be, now that some have become primary caretakers or have fallen ill or need to seek employment? How do instructors tackle making significant changes to their course, now that they are also dealing with similar issues? How do both groups create and participate in a high-quality course experience with fewer resources and a very short amount of time to adjust? Many of the insightful blogs posted have really highlighted how to keep these considerations in mind in order to create online courses that still meet course objectives and foster a high-quality learning experience. I have learned so much through reading these posts, in addition to numerous resources provided to our community. Through integration of these resources into my own courses, I found myself also trying to think of ways that I could keep the courses inherently “me”. Engaging and connecting with students on a personal level has always been something that I found helpful to my own teaching, but becomes hard when the mode of communication has shifted. This can also be difficult when some classes must be delivered asynchronously, in an effort to accommodate the changing lifestyles of our students. Perhaps just as important to a high-quality learning experience as shifting our instruction methods, is finding new ways to create the human connection that is much easier developed with on-campus learning. Here, I highlight some of the methods I found to be successful in making sure that I was able to keep my students engaged in the course while miles apart. While these may sound like really simple ideas, I’ll admit that I didn’t realize how important they were to the student experience until I had reflective conversations with many students after the Spring semester. With times of uncertainty still ahead, I plan to continue using these methods in the future.

1. Staying online after the class has ended.

This is probably the simplest of the suggestions to integrate, but really seemed to make a difference in getting the students more comfortable opening up over the computer screen. For my synchronous courses, I always ended class time by reminding the students I would stay in the virtual classroom to answer any questions or just to chat. I found that once students realized I would be sticking around for a few minutes regardless of if anyone else stayed, they were more willing to hang around and ask questions they might not have felt comfortable asking in front of other students or e-mailing me about. This also gave me another opportunity to reflect on how I was constructing my online course materials. Hearing what points students needed extra clarification on forced me to consider how topics that were ordinarily well understood in the physical classroom needed to be shifted with remote instruction.

2. Integrating video/audio into online discussion boards.

I needed to teach asynchronously for a particular course where students had concerns about internet availability and meeting other personal obligations, which came with completely different issues from my synchronous course. Posting notes in addition to pre-recorded lectures allowed me to successfully get course material across, but it was still missing the personal component that is fostered via in class discussion. The use of discussion boards where both the students and I posed questions to one another helped with that. Importantly, I asked students to record their questions/answers for the discussion board via video or audio whenever possible. Students continually reported that it was nice to actually hear and see one another even though live sessions were not possible. Moreover, they described how it was nice to laugh and share with one another, as responses did not have to be rehearsed and could closely mimic what might have happened in the physical classroom. 

3. Holding several office hours, varying in day and time.

Disclaimer: This may be harder to implement for some individuals because with COVID-19 comes a host of additional responsibilities and stresses that need to be attended to. But, if possible even for one day, I highly recommend it. The traditional times for which we hold office hours may not be feasible when we take into account the added responsibilities of needing to stay at home. So, why not hold office hours at different times that lend themselves to our new schedules? I found that holding office hours much later than I normally would resulted in many more students coming to them. Moreover, similar to my first suggestion, I made sure that students knew I’d be in the meeting room for my virtual hours regardless of if students signed up or not. Previously, I had always had an “open door policy” where students knew they could stop by my office without prior notice as long as my door was physically open. The new virtual office hours I held helped to mimic that. By having drastically different hours on different days, I tried to make sure that students could stop in whenever suited them. An important memory that stuck with me about this particular method was an instance when I was available at 7 pm on a Tuesday night. I had a student who showed up just wanting to talk, and stated, “I figured I wasn’t bothering you since you were on here anyway.”  Prior to COVID-19, she often stopped in to talk about how things were going. Through our virtual conversation, I learned that this student wasn’t seeking any help related to the class, but just wanted to talk because it helped things feel “normal” again. Even if you can’t hold a large variety of office hours, I truly think that doing something that helps mimic the ways you previously interacted with your students is so helpful during this time.

4. Holding “unofficial” hours.

This was a tip that I originally learned from a colleague, and adapted to fit my own subject matter. This colleague would host “unofficial”  hours, where she would sporadically e-mail students to let them know she would be in an online meeting room partaking in some fun activity. For example, on a random weeknight, she e-mailed students and said they could join in on her quest to make enchiladas. Several students took her up on that offer, and she used it as a time for the class to come together without any defined learning expectations. This gave her students the opportunity to connect as they would have previously, in a class that was now asynchronous during remote learning. She began to take sessions one step further, and would ask her students to describe ingredients in her cooking sessions in the context of her speech language pathology lectures. In an effort to take her advice and put my own spin on it, I began asking students to join me when I would participate in online workouts. It became a great way to have students connect with their classmates using an activity that we all had some interest in. With students in my pathophysiology course, I’d sneak in questions about how students felt after participating in a particular exercise and how this might impact the clinical populations they work with, giving me a way to reiterate what they had learned in a real-world context. 

In my experience, a large part in keeping students engaged was understanding that the human component to a course has the potential to impact student learning irrespective of how well we can pivot our course formats to meet remote instruction needs. No matter how it’s done, showing the students that you are still on the other side of that WiFi signal is an important consideration for all of us. I hope that my experience helps to identify other ways you might do this, and I’d appreciate you sharing your own ways to cultivate the student-instructor relationships via online methods.

Candace Receno is an assistant professor in the Exercise Science & Athletic Training department at Ithaca College in Ithaca, NY. She earned her PhD in Science Education from Syracuse University and served as a Post-Doctoral Fellow in the Biological Sciences department at Le Moyne College for two years. Candace just completed her first year as an Assistant Professor at Ithaca College, where her undergraduate and graduate courses include Advanced Exercise Physiology, Cardiopulmonary Assessment for Exercise, Pathophysiology, and Foundations of Human Performance and Wellness. She also hopes to continue engaging undergraduates in research related to exercise performance in special populations.

June 2nd, 2020
Teaching an Integrated Human Anatomy and Physiology Course: Additional Lessons Learned and Online Course Adjustments
Jennifer Ann Stokes, PhD
Assistant Professor of Kinesiology
Southwestern University

In my previous blog post, I outlined the lessons learned in my first run teaching a year-long integrated upper-division human anatomy and physiology course. It has been about a year and a half since the original post and after having taught the course for a second time I will review and add to my list of initial lessons learned. Additionally, this spring semester brought new challenges with a very swift move to online coursework due to COVID-19, so I will also comment on the resulting course alterations. As a reminder, this course sequence (A&P I and II) is an upper-division junior and senior level course at my college and class sizes are very small (20-24 students) allowing for maximum time for interaction, questions, and instructor guidance both in lecture and lab.

First, I will review the previous lessons learned and add additional commentary based on what I learned in my second year. If you haven’t yet, I would check out the previous blog for the initial notes.

1) Use an integrative textbook.

My textbook of choice is still Physiology: An Integrated Approach by Dee U. Silverthorn. For anatomy, I continued to supplement the anatomy information, such as the specifics of the skeletal system and joints, muscles, histology, etc., through the use of models and other reference material in hands-on lab activities. One addition made in the second year was the use of AD Instrument’s Lt online learning platform.  I discuss the addition of Lt in more detail later in this post, but I think it is important to note here too since the Lt lessons directly complemented the textbook material and helped bridge the gap between lecture and lab for the students.

2) Start building and assessing students’ A&P knowledge from the ground up, and build incrementally.

Laying the foundation for the core concepts is critical to the student’s understanding, application, and mastery of the complex integrative content that this course builds. I took this foundation building more seriously the second time around and, in the end, I did not have to spend more time on the basic content but instead I provided more formative assessment opportunities. This helped the students who did not have as strong a background or understanding of the basic material to recognize that they needed additional assistance. In addition to the weekly homework assignments which were graded for completion only, I added weekly low-stake quizzes using our learning management system (LMS). At first I thought the students would dislike the extra work, but an end-of-the-year survey indicated that they appreciated the extra practice and that the quizzes helped them feel better prepared for the exams.

3) Create a detailed course outline, and then be prepared to change it.

This lesson holds true for just about any course, but I found it especially true for an integrated A&P course – even when teaching it a second time. And it is even more important when you have to switch to online delivery. In the second year, I learned to appreciate that no two cohorts of students are the same and what took the previous cohort a day to master took the next cohort up to two days in some cases. Having the “flex days” at the end of each section was crucial for concept review and content integration. These are days where no new content is introduced, but instead we review and practice together.

4) Constantly remind your students of the new course format.

I cannot emphasize this enough: students will want to revert back to what they are comfortable with and what has worked for them in the past. I constantly remind students that their “cram and forget” method will not serve them well in this course and provide them with ample opportunity to practice this both on the formative and summative assessments. In the second year I continued the individual meetings with each student after their first exam to discuss study strategies and new ways to approach this material, but I also implemented additional check-ins throughout the year particularly with those students who were struggling. I continued to remind the students that the course content not only builds throughout the entire semester but also the entire year! I hammered this point home a bit more with the addition of “retention” quizzes which were delivered unannounced throughout the year and tested major core concepts and application.

5) Solicit student feedback.

Students can be brutally honest, so use that to your advantage. A lot of the new things I added in my second year teaching this course came from the first year-student feedback. I send out my own surveys with specific questions throughout the year which the students fill out anonymously. I find that students are happy to help, especially when they can see a course alteration mid-semester which was based on their feedback.

6) Be prepared to spend a lot of time with students outside of the classroom.

Still very true, but that’s probably my favorite part of this job. Even when we switched to online course delivery the virtual office hours were busy and students took advantage of the extra review and time to ask questions. 

In this second section, I will add additional lessons learned in my second year of teaching this course and comment on the changes made when the course moved online mid-way through the second semester.  

7) Over-communication.

One of the things I am known for with my students is consistent and clear communication, probably to the point of over-communication. I also emphasize that communication is a two-way street, so just as I am constantly communicating information to them, I expect them to do the same to me, including any accommodations, sports travel, or general course questions. I model this behavior with regular use of our LMS announcement page and I use the start of each class to review important deadlines and open the floor for questions. The move to online instruction only made this over-communication even more important. Early on in the transition period I checked in often to let them know the new plan and opened discussion pages to allow them to ask questions and express any concerns. I checked in multiple times a day using the LMS announcement page, posted a “live” course schedule and tables of new homework and quiz due dates all in one central location, and I added silly memes to the discussion boards to up engagement. I also added resource pages on the basics of Zoom and how to be an online student since this was very new territory for them (and me). Looking back this was a lot of information that was constructed and disseminated very quickly, but an end-of-the-year survey indicated they appreciated the information and that it told them that I was prepared and willing to help them during the transition.

8) More assessments. More practice. More activity.

In my second year, I assigned more practice problems from the textbook to help the students prepare for the exams and held problem sessions outside of class for review. This additional time and practice was well received even when it was a greater time commitment for the students. With the move to online instruction I was thankful that I had already established a fairly homework-heavy course as these assignments became even more important. The assigned “lecture” time was switched to virtual problem solving sessions and the course moved even more toward a flipped-classroom model. Since the switch to online occurred after I had already built a pretty solid reputation with this class (about a semester and a half) they were used to reading and problem solving before class, even if that class was now online. All homework and quizzes moved online which allowed for quicker feedback to the students on their progress and, thus, more time for questions before the exams. The switch to fully online homework and quizzes I plan to keep even when the course moves back to in-person as the quick feedback for the students and less time spent hand-grading by me is worth the extra time it takes to set-up the online modules.

9) Utilization of LMS Discussion Forums.

Honestly, the use of the LMS discussion forums did not start until the course moved online, but their quick success made me question why I had not taken advantage of this tool earlier. When the course moved online I added discussion pages with titles such as “What is going on?!? General course questions.” and “What I am most nervous about with the course moving online is…” The goal was to provide an outlet for students to ask questions and share their concerns. I always started the discussion myself, giving them a sort of “jumping off” point and an example. These discussion pages were utilized by almost all members of the course and were rated very highly in the end. Students could comment any time of day enhancing the accessibility of the discussion. I will modify these to be used in my courses moving forward for both in-person and online courses.

10) Online presence for both lecture and lab.

I actually increased my A&P online presence prior to the mandatory switch to online coursework with the implementation of AD Instruments Lt learning platform in the fall semester. My students received free access to both the anatomy and physiology modules thanks to an award from the American Physiological Society. The Teaching Career Enhancement Award supported a year-long study assessing the use of the ADInstruments Lt learning platform and its interactive and immersive lessons aimed at enhancing knowledge, retention, and practical application of the integrative course content. The Lt platform was fully customized to the course material and was used both in the lecture classroom and in the lab. In the lab, students were able to interact with a data acquisition system that is more “game-like” and familiar, while still collecting high-level human physiology data. Lt also allowed for the creation of new lessons that engaged students with the use of embedded questions in multiple formats, including drag-and-drop labeling, drawing, short answers, and completion of tables. These lessons were used in many ways: for pre-lab preparation, in-lab and post-lab assessment, and for active learning activities in the classroom. Lessons were completed individually or in small groups, and questions were set up with hints, immediate feedback, multiple tries, and/or automatic grading.

These modules were also incorporated in the active-learning lecture component of the course, providing additional exposure and practice with the content. The Lt lessons directly complemented the textbook material and helped bridge the gap between lecture and lab for the students. When the course moved fully online I was incredibly thankful that Lt was already in use in my course and that the students were already comfortable and familiar with the platform. I used Lt exclusively for the online labs and supplemental lecture content for the remainder of the spring semester. Just as before, the lessons and modules were customized by me to fit my course learning objectives and prepare the students for their new online assessments. Students could complete the online coursework at their leisure and stop by the virtual office hours for help or post questions on the discussion boards for feedback. Student feedback indicated that the addition of Lt to this course enhanced accessibility of the course content, provided extra practice and exposure to the material, and overall was rated highly by the students.  

And just as I did before, now I turn the conversation over to the MANY seasoned educators who read this blog. What did you learn in your quick move to online coursework? Did you implement any new pedagogical tools which you will continue to use even with in-person instruction? Please share!

Jennifer Ann Stokes is a soon-to-be Assistant Professor of Kinesiology at Southwestern University in Georgetown, TX, after spending the last three years at Centenary College of Louisiana. Jennifer received her PhD in Biomedical Sciences from the University of California, San Diego (UCSD) and following a Postdoctoral Fellowship in respiratory physiology at UCSD, Jennifer spent a year at Beloit College (Beloit, WI) as a Visiting Assistant Professor of Biology to expand her teaching background and pursue a teaching career at a primarily undergraduate institution. Jennifer’s courses include Human Anatomy and Physiology (using an integrative approach), Nutritional Physiology, Exercise Physiology, Medical Terminology, and Psychopharmacology. Jennifer is also actively engaged with undergraduates in basic science research (www.stokeslab.com) and in her free time enjoys cycling, hiking, and yoga.

May 11th, 2020
Shifting course expectations as well as the mode of delivery during the spring 2020 COVID-19 pandemic
Kristen L.W. Walton, PhD
Biology Department
Missouri Western State University

COVID-19 (Coronavirus Disease 2019) is caused by infection with SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2).  Current evidence suggests that this zoonotic coronavirus originated in China in late 20191, and it subsequently spread rapidly across the globe, causing significant morbidity and mortality.  To help contain the spread of this virus, many countries have implemented policies and orders aimed at reducing contact between people.  The terms “social distancing” and “flatten the curve” have been rapidly imbued in our culture. Indeed, a Google Trends search shows a significant surge in searches for “social distancing” between the week of March 1-7, 2020 and the week of March 29-April 4, 20202.  In the United States, to help mitigate the rapid spread of SARS-CoV-2, a few colleges and universities began to announce in early March that they would be suspending face-to-face classes and shifting to all-online instruction, and soon most postgraduate institutions in the USA followed suit, including my institution.

In early March, as the situation became recognized as increasingly urgent by the higher education institutions in our region, the administration at my institution, Missouri Western State University (MWSU), made a decision to extend spring break by one week, through March 22.  Then, in the middle of that second week of spring break, the university administration announced that MWSU would cancel all face-to-face classes for the rest of the semester, and students would have several options regarding their grades for the spring 2020 semester3.  Higher education institutions across the USA have grappled with how to handle grades in this unprecedented time.  Students who did not sign up for online classes are finishing their face-to-face courses, in many if not most cases, as hastily-constructed online versions.  Many institutions have chosen to make all classes pass/fail, others have opted to keep letter grades as the only option, and still others, including MWSU, have given students flexible options to choose a pass/fail option or a letter grade.  The MWSU administration also gave faculty flexibility in determining whether to create a “culminating experience” for students who elected to complete their courses. This could mean anything from reducing the amount of content and/or assessments, changing the format of assessments (for example, a final paper in lieu of a final exam), or essentially continuing as originally planned but with online course delivery and assessments.  This flexibility for faculty was intended to recognize that some types of classes are more amenable than others to a shift to online delivery.  Students whose midterm grade was a C or higher could elect to choose the “credit” (pass) grade option for the course if they chose not to complete the culminating experience; students who chose to complete the culminating experience earned a letter grade based on their course grade at the end of the semester.  To increase flexibility for students, this option was available to students up until the last day of classes, April 24.  The deadline for a withdrawal from the class was also extended to April 24.

For me, as a biology faculty member, the flexibility allowed by our administration in how to structure the last five weeks of my classes led to a lot of thought about my courses and how to best achieve the course objectives for each of them.  I spent many hours considering this, discussing options with my colleagues in a socially distant manner, through emails and our first Zoom department meeting, a somewhat difficult transition for our close-knit group of faculty used to frequent in-person conversations.  I also spent time reading a flurry of articles and blog posts about the importance of being understanding of the major disruption to our students’ lives and college experience4; the importance of recognizing the difficulty in creating a high-quality online course experience with a few days’ notice5; and, not to be overlooked, the importance of tending to one’s own needs, both professional and personal, in this high-stress time.  

Depending on one’s personal situation, a faculty member could also be dealing with changes in family schedules and responsibilities due to children who were suddenly not attending school or day care.  Illness could strike any of us or our friends and family members, certainly adding to the stress and anxiety experiences.  Partners could be furloughed as businesses shuttered their doors due to the pandemic.  While some academics touted their ability to be highly productive during the quarantine and even cited the invention of calculus by Sir Isaac Newton during the black plague as inspiration, others pointed out that quarantine is not universally a time when one can focus solely on work and scientific discovery.  This is true for me, on a personal level.  I have two elementary school-aged children whose school closed a week after my university suspended face-to-face classes.  I have had sole responsibility for child care and helping them with their school work at home, while also moving my classes online and maintaining other work responsibilities.  Many of the students in my classes are non-traditional and have similar child care and “home school” responsibilities.  Others have financial stress due to job layoffs, or, conversely, increased work stress and time demands for those working in the health care field.  Another concern is that many of our students have poor access to broadband internet and technology to access class materials online.  Several of my students emailed me during the transition stating that they were using only a smartphone to access course materials and had no access to a laptop or desktop computer, printer, or other technology, and no high-speed internet.

Consideration of my students’ access to technology, stress, and other burdens, as well as the other factors described above led me to make different choices for each of my three classes this spring.  For my honors colloquium, titled, ironically enough, Plagues That Changed the World, my co-instructor and I decided not to try to coordinate the student-led presentations that were scheduled for the last 6 weeks of the semester and instead only required a final paper.  Seven of 13 undergraduates in this course chose the credit grade based on their midterm grade, and did not complete this rather minimal culminating experience. For my upper-division biology majors course, Molecular Basis of Disease, which is a capstone-type elective course that is not a prerequisite for any other classes, I chose to culminate the lab portion by keeping a scheduled lab quiz, but not attempt to recreate the planned five-week group research project.  For the lecture portion of that class, students who elected to complete the culminating experience wrote a literature review article as originally planned and were given one online exam instead of two in-class exams.  Even with this reduced workload, 6 of the 15 undergraduates enrolled in the course chose to take a credit grade and did not complete the course.  My third course this spring, Pathophysiology, is primarily populated by pre-nursing majors and population health majors, with a few pre-health-professions biology majors.  It would not have been appropriate to drop content or assessments of content knowledge from this course, because the overwhelming majority of students in the course needed to learn that content for success in later coursework.  As it happens, I have taught this lecture-only course in an online format in the summer for several years, so transitioning it to an online delivery mode was relatively easy, with a few exceptions: increased modes of accessing the material, and exams.  I have structured the all-online previous version of that class to be asynchronous, based on knowledge of my student population, many of whom work full time while also taking classes.  I felt that was still the best choice in these uncertain times.  However, in addition to posting video lectures, I downloaded the audio-only podcasts and posted them separately for students who did not have regular high-speed internet access or were working solely from a smartphone with a small screen.  I also made additional course notes available.  

As for the exams, I have always required proctored exams in the online version of this course, and structured them similarly to the written exams taken by students in the traditional, face-to-face version of the course.  Proctored online exams would not have been feasible in the COVID-19-induced chaos that ensued in late March and early April, as some of my students were moving home many states away, finding themselves under self-quarantine, caring for family members, etc., and I myself had schedule considerations to juggle with children and their school work and Zoom meetings which competed for our limited bandwidth home internet.  I tried to strike a balance between several considerations:  best practices for online unproctored exams, such as making them open-book and not easily Google-able; the format and level of rigor students were used to from the first two written, face-to-face exams; and being mindful of unequal access to technology among my students.  In this class, 81 of 86 undergraduates completed the culminating experience, a high proportion driven largely by the requirement of their specific majors for a letter grade in this required course.

As I write this, I still have several papers to grade and final course grades to enter.  I can say with certainty, however, that the choices for assessments and content coverage that I made for my Pathophysiology course did not appear to substantially disadvantage the majority of students, and the course grade distribution will be noticeably higher than usual, aside from the small number of students who did not complete the course.  Several of my colleagues have observed similar increases in their course grades this semester.  In that course, I erred on the side of leniency with the exams, but since I could not in good conscience drop content from that course – pre-nursing students still need to have learned about diseases of the digestive tract, even if COVID-19 interrupted their semester! – I am comfortable that they will at least have a reasonable degree of preparation for their subsequent courses.  For my other two courses, grades will not be higher and in some cases students submitted work that was of lower quality than I expected from their work earlier in the semester.  I strongly suspect that many students who chose to complete those courses did not have the focus or the ability to do so as well as they would have in the face-to-face courses.  I do not have survey data to help clarify what the students were thinking, but I suspect the students who needed the letter grade for subsequent coursework approached this altered, online part of the semester differently from those who were only taking an elective where a credit grade would suffice or a GPA issue was not anticipated.  Informal feedback from all three of my classes included several students commenting about how they did not sign up for online classes because they prefer traditional-format classes, comments about family issues (helping children with school work, moving back home because of job loss, stressful quarantine situations), and comments about missing deadlines because of work or other outside responsibilities.

Although I still need to submit my final course grades for the spring 2020 semester, the summer session is already looming.  My institution chose a few weeks ago to offer only 100% online summer classes, so my usual summer online Pathophysiology class will need to have exam structure revamped away from the written, proctored format that I have previously used.  In addition, many institutions including my own are having discussions about the fall semester.  At this time, we just don’t know what the COVID-19 situation will be in late August.  We have been told to prepare for something unusual, whether it will be a fully online semester, a restructured semester with two or three shorter block sessions, or some other plan.  In preparing for that, I will be considering these questions for each of my classes:

1. How can the course learning objectives best be accomplished in an altered course format?

2. What are the best ways to transition a heavily hands-on lab course to an online or shortened course format?

3. What are the needs of the student population in this course?

4. What is the appropriate balance between flexibility versus maintaining appropriate expectations in the course?

Considering the course goals and learning objectives is a critical component of any course design or transition to a different format, and the course may need to change if the different format is not amenable to the original goals and learning objectives.  In this time of forced transitions to altered course structures and the impacts of COVID-19 mitigation strategies on us and our students, choices might be different from the choices we would otherwise make. It’s also important for faculty, administrators, and students to recognize that different types of courses may be more or less easy to convert to an all-online format.  And while online instruction can be excellent and perhaps this experience will encourage broader use of certain online course components in future face-to-face classes for many faculty, it is not the “college experience” that many students expect and there is speculation among higher education administrators that enrollments will be down this fall, adding to the financial distress that many universities and colleges are already experiencing. Although I have read some opinion pieces that higher education should use this spring as a springboard to shift to more online courses permanently, I would argue that it’s also important to recognize that a large proportion of our students and faculty, myself included, strongly prefer those face-to-face classes and hope to return to them as soon as we can.  I am certain that as a global community of physiology educators we will continue to interact and support each other as we navigate all of the upcoming transitions.

References:

Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5:536–44.

Google Trends, search term “social distancing”. URL  https://trends.google.com/trends/explore?geo=US&q=social%20distancing  , accessed April 30, 2020.

Missouri Western State University COVID-19 information. URL https://www.missouriwestern.edu/covid-19/keep-learning/ , accessed April 30, 2020.

Barrett-Fox, Rebecca. “Please do a bad job of putting your classes online” URL https://anygoodthing.com/2020/03/12/please-do-a-bad-job-of-putting-your-courses-online/ , accessed April 30, 2020. 

Darby, F.  5 Low-tech, time-saving ways to teach online during COVID-19.  The Chronicle of Higher Education  URL  https://www.chronicle.com/article/5-Low-Tech-Time-Saving-Ways/248519  accessed April 30, 2020.

Kristen Walton is a Professor in the Biology Department at Missouri Western State University.  She earned her PhD in Physiology from the University of North Carolina-Chapel Hill in 2001 and was a SPIRE (Seeding Postdoctoral Innovators in Research and Education) Postdoctoral Fellow at UNC-Chapel Hill from 2001-2006.   In 2006, she began her current position at Missouri Western State University, a primarily undergraduate institution.  She has taught a variety of undergraduate courses including animal physiology, pathophysiology, immunology, molecular basis of disease, introductory cell biology, public health microbiology, and human anatomy & physiology.  Her research interests are in intestinal inflammation and inflammatory bowel disease, and in discipline-based education research.