Spring 2020 is often denoted with an asterisk. The asterisk means different things to different people. For many people it means, “Things will never be the same.” COVID-19 has changed the venues from which we teach, but not our commitment to continually improve our teaching. We have adapted our lectures, labs, and office hours to online platforms to keep students and ourselves safe. I am no seer, but once classes moved online in mid-March I knew this would be a long haul from which I must learn and never forget. After submitting final grades, I asked myself, “What have you learned? Which practices will you continue to implement to create a better learning environment for students irrespective of world health status or platform?” My asterisk on Spring 2020 is community.
For Spring 2020 I was assigned three sections of an upper level exercise nutrition course and one section of basic exercise physiology. Each was a critical course. Kinesiology majors must pass exercise physiology before any other upper level kinesiology course; this was a new course for me. The exercise nutrition course, which I taught the prior semester, includes an in-class presentation with a hefty point value; it also is the departmental assessment tool for communication skills. Over the last several years the level of stress and anxiety among undergraduate students in my physiology courses has been progressively increasing, nearly choking their joy of learning. Colleagues in other fields observe similar trends. The majority of students taking physiology courses seek careers in health professions. Given the competitive nature of the respective training programs, students are driven to earn that A. Add to that the worry of paying for tuition, rent, food, books, computers, and transportation and complicated academic and social transitions from high school to college. Their family expectations loom over them. Some students are full-time students, but also full-time parents. For first-generation college students these circumstances may bear even greater weight. Thus, while preparing for Spring 2020 I decided to approach that semester with greater compassion for students. This led to my forming a community of learners in each class a priority. Ultimately, this helped me better meet the needs of my students during that first phase of the pandemic.
Webster defines compassion as “sympathetic consciousness of others’ distress together with a desire to alleviate it.” In preparing for Spring 2020, I identified aspects of each course that presented major challenges for students and represented sources of stress, anxiety, frustration, and discouragement. I hoped to address those challenges and thereby, alleviate a source of stress. Most exercise physiology students had not taken biology or basic physiology; thus, I had to teach them basic cell biology and basic physiology so they could better understand the significance of acute responses to exercise. Based on my past experience teaching the exercise nutrition course, students needed more confidence speaking in public. Furthermore, any given student might have known just two or three other students by name and were hesitant to speak in general. I had to help them feel more at ease so they could talk and think out loud among their peer group. We each want to belong to a community. We value our individuality, but we are social beings. Students must feel accepted and comfortable in class, so they can ask and answer questions within a small group or entire class. A critical component of learning is not answering a question, but verbally defending that answer and exchanging ideas with others. Many are afraid to answer incorrectly in front of others. The classroom must be a safe place. As the teacher, I am responsible for creating a sense of community. While I did a great job getting to know my students’ names, faces and fun facts, I wasn’t helping students know each other. For both courses I decided to include more activities that required students to talk directly to each other and become accustomed to speaking out loud. With 20-25 students per class, it was feasible. I would sacrifice class time and not be able to cover as much material. So be it. Students would master the fundamentals, learn to apply the knowledge, and have a shot at enjoying learning and becoming life-long learners. Coming to class and learning might even become a reprieve from other stressors.
How could I create community among unacquainted 20+ students? Provide opportunity to interact as a class or in pairs or groups as often as possible. I had to be persistent, kind, and patient. The first day of classes I explained my intention was that students become familiar with each other, so that they were comfortable asking and answering questions and contributing to discussions. This would facilitate learning and help me better gauge their understanding. This also might help them find a study partner or even make a new friend. I told them I made it a point to learn everyone’s name as soon as possible and would call on each student numerous times. I made it clear that I know when people are shy; I promised to be kind and not call on them until they were ready. Each day I arrived as early as possible and cheerfully greeted each student by their preferred name and asked open ended questions, e.g., ‘How are your other classes going?” At least once a week, students worked in pairs to complete worksheets or quizzes; we would reconvene as a class and I would call on different pairs to answer. I called on different pairs each time, so every group had chance to speak. I encouraged them to work with different classmates for different in-class activities. Initially, there was resistance, but I consistently commended them for their efforts. Gradually, more students would proactively raise their hands to be called on, and it could get pretty loud.
On the first day of the nutrition classes I also announced the presentation assignment and that we’d get started on it the 1st week of classes by forming pairs and by becoming accustomed to talking in front of the class. To let them know that dread of public speaking is shared by all, I confessed to feeling nervous before every lecture; however, I love teaching and channel that nervous energy to keep the lectures upbeat. I explained they might never get over the nervousness of public speaking, but they can learn nothing is wrong, being nervous is expected; it will become easier. The trick is to start small. So, at the start of every class period, one or two students would be asked to stand up, introduce themselves, and tell the class what they found most interesting from the last lecture. The other students would give the presenter their undivided attention. For shy students, I spoke directly but quietly to them before class and suggested that they could focus on me while they spoke. After each introduction I cheerfully thanked students as positive re-enforcement. These introductions also served to highlight what was covered in the last class. Because each nutrition course class met 3 times a week for 50-minute sessions, students interacted frequently. For the exercise physiology course, students worked in pairs to complete a ‘1-2-3 plus 1’ worksheet with questions on three key concepts from the previous lecture and one question on new material in the upcoming lecture. They worked on questions for 5 minutes, and then I would call on different pairs to answer questions and explain sticking points for about 10 minutes. It also was the transition into that day’s new material. This class met twice per week for 80 minutes each session; thus, plenty of time remained even after the 15-minute Q&A. They were grasping the integration of cellular mechanisms at the cellular and systems levels. The time and effort to plan and execute these activities was well worth it. Students were learning and enjoying class, as well as getting to know each other. By late February communities had formed. Each class had a friendly and inclusive feeling, and attendance was nearly perfect. Even shy students began echoing my greetings or waving and smiling at classmates arriving to class. Individual classes had their own running jokes.
The week before Spring Break universities were discussing whether or not students would return to campuses after the break. COVID-19 was here. The Thursday and Friday before Spring Break were the last days I met with students in person. I confirmed the rumors. Students would not return to campus after the break, and all courses would be entirely online. I clarified that I would present lectures ‘live’ at the regularly scheduled class times. I opened the floor to discussion. If I knew their concerns, I’d have a better chance at maintaining the sense of community. Students were completely honest. Seniors were sad, because graduation would be cancelled. Students were hoping they could keep their jobs here in town to pay rent. Athletes on scholarships worried that if the season were canceled they’d lose funding. Others would be learning from their parents’ homes, which had no Internet access. The most common concern was whether they would be as successful learning online. They were worried about the lack of accountability. One student feared he’d stop attending lectures and miss assignments; one reason he came to class was that I called him by name and talked to him every day. Another student doubted I’d have any personality when giving online lectures; I took this as a challenge. Students in the nutrition classes were worried about presentations, which were taking shape and now had to be presented somehow. They were scared. Now, I was scared for them – but had the wherewithal to not say that out loud. One student outright asked, ‘Is this even gonna’ work?!” I admitted it would be a challenge, in part because I had never taught an online class, and this was my first pandemic! They laughed nervously. What a relief to hear them laugh! Then, I remembered my goal to practice compassion and let that guide me. I calmly stated the following, “This is not an ideal situation, but we will make it work, and I mean WE. I will do my best to not make this situation any more difficult than it has to be. I will communicate with you regularly, so read my emails. If you have any problems or questions you must let me know immediately, so to give me a better chance to help you. It will be ok.” That this was the last time I would see my students in person. It was a sad day.
I took my students’ concerns into account and still made my priority community. If I could maintain that sense of community, they would be more likely to login to lecture and learn. I kept it as simple, direct, and familiar as possible. I already had been posting all lecture notes and materials on the university’s learning management system (LMS) and using the drop box for homework submissions. Thus, I opted to use the real-time video conferencing tool in the LMS to deliver, record and save lectures and hold office hours. An ounce of prevention is worth a pound of cure. I established the practice of sending each individual class a weekly email on Sunday afternoon that listed the week’s lecture topics, specific links to each lecture and office hours, due dates for quizzes, upcoming exams, announcements, and miscellaneous reminders. The very first email included step by step instruction for logging into the LMS video conferencing tool (which had been proofread and tested by a colleague), and I attached the revised syllabus. I kept these emails as upbeat as possible. On the class website, I also posted important announcements, along with links to the live and recorded lectures. I kept the class website uncluttered and organized to make it easy for students to find what they needed. In the middle of a pandemic, it was absolutely essential to keep my promise to my students and myself and not to make learning or teaching online any more difficult than necessary.
I continued teaching the fundamentals and worked to maintain that sense of community. I opened and logged into the virtual lecture room 10-15 minutes before lecture started and would allow students to do the same. I would still greet them as they entered, asked them to turn on the video at least once, so I could see their faces and make sure they were doing ok. They would also greet each other. I encouraged them to ask questions or comment directly using their mics or in the chat message feature. As I lectured, I kept track of questions and answers to my questions; I would address students by name just as I had in person. They learned quickly that they could use the chat feature to communicate with each other, sometimes not about physiology or nutrition. I didn’t mind. I also knew they missed being on campus and seeing classmates and friends, and they were isolated. For the exercise physiology course, we continued the practice of starting each lecture period with the 1-2-3 plus 1 worksheet and still spend about 15 minutes on that activity; the students really valued this activity. Because the practice proved to facilitate learning, I posted these questions on the class website, but also emailed the class a copy the day before to be sure they had a copy – a 5-minute task to keep them engaged and coming to class. For the nutrition class, I offered an extra credit assignment, ‘Who is this?’ For one class, I had a list of 10 walk-up songs from different students; students had to name the artist and tell me the full name of the student who claimed that as their ‘walk-up’ song. Another class had to name the student learning online the farthest distance from campus and name the student whose birthplace was farthest from campus; they also had to list the exact city, state or country and distance in miles. The third class had to list the first and last names of all graduating seniors in the class and their career goals. For extra points, they all participated. It was meant to encourage them to stay connected and think about something else.
We had a share of glitches and mishaps, but my students stepped up to the plate. The lack of equal access to the Internet could not be more painfully obvious. One exercise physiology student informed me that his only access to the Internet was his cell phone. He took the initiative to asked whether I would accept images of hand-written 1-2-3 worksheets sent to me by email. He never missed an assignment and made arrangements to borrow a friend’s laptop for exams. A nutrition student, I will call Brett was learning from home in a small town about 2 hours from the nearest ‘real’ town; his family home had no Internet and a poor mobile phone signal. He emailed to explain that once his dad got paid he would buy the equipment and he would be online soon. He was concerned about missed quizzes and the respective points and missed lectures. What do you say to that? When you know you have all the power, you must use that power to do good and not make anyone’s life harder than it has to be. I re-opened quizzes and sent him links to the recorded lectures; he wasted no time catching up. Then there was the matter of the nutrition presentations. Another lifeline. Students continued to work together, sending presentation files to each other and to me. Students taught themselves to use Zoom, Google Slides, and the LMS video conference feature. No one complained. Multiple pairs wanted to present during the same session, so they could be an audience, lend moral support, and ask questions. The presentations were impressive. Students were so enthusiastic. However, my favorite presentation was by Brett and ‘Josh’; they presented via the LMS conference feature. Brett’s Internet cut out completely on second slide; he tried to reconnect to no avail. I remained calm; they remained calm. They decided Brett would call Josh; Josh would hold his cell phone to the mic on his computer so I could hear Brett narrate his part of the talk. Teamwork! Let your students inspire you.
I left time at the end of each lecture to offer encouraging words and reminders to stay safe and take care of themselves. I also would state that I looked forward our next meeting. As the semester was winding down end-of-lecture discussions and questions become more serious. Across all classes the basic questions were similar. “Will I graduate on time? How will this impact my career plans? Do you think this will be over by the Fall? Do you think they’ll have a cure soon?” There was no sugar coating this. I would validate their concerns and offer my honest opinion in a kind-hearted manner. My last virtual lecture was on a Friday in May. I decided to name each graduating senior, so the class could congratulate and applaud for them. A student asked me to give a commencement speech. She was serious. I remembered what my gut told me back in mid-March, and so I began. “I cannot tell you how proud of how hard each of you has worked and how well you worked together. Life is hard. It’s ok to be scared. You have risen to the occasion. Keep rising. Learn all you can from this situation. You are meant to do great things, however subtle or grand. You will fall and make mistakes. You will need help along the way and must help others on their journey. It has been a privilege to work with you. I will think of you often and wish you well.” Spring 2020* *Helping my students form a community, an inclusive safe place to learn, think out loud, be wrong, correct mistakes, and help each other. That is the practice I will continue to implement to create a better learning environment for students irrespective of world health status or platform.
Advances in Physiology Education is one of the family of journals published by the American Physiological Society (https://journals.physiology.org/journal/advances). Submissions of manuscripts to Advances cost nothing and accepted papers are available with free access from their initial posting online. Annually a printed copy of the journal with all 4 issues is available to those who request it. Publications in Advances are contributed from the global community of physiology educators and carefully peer-reviewed by expert colleagues. Of all the APS family of journals, 7 out of the 10 most accessed articles (full-text accesses) during 2019 were published in Advances. The top three accessed Advances articles are briefly described below.
Number 1 Most Accessed 2019:
“Applying learning theories and instructional design models for effective instruction” by Mohammed K. Khalil and Ihsan A. Elkhider from the University of South Carolina School of Medicine in Greenville, South Carolina, USA published on April 11, 2016 (Adv Physiol Educ 40:147-156, 2016). In this article from the Best Practices series, the major learning theories are discussed and selected examples of instructional design models are explained. The objective of the article is to present the science of learning and instruction as the theoretical evidence for the design and delivery of instructional materials in the classroom and laboratory. As of June 2020, this article has been downloaded 81,467 times!
Number 2 Most Accessed 2019:
“Measuring osmosis and hemolysis of red blood cells” by Lauren K. Goodhead and Frances M. MacMillan from the School of Physiology, Pharmacology, and Neuroscience of the University of Bristol, Bristol, UK published on May 19, 2017 (Adv Physiol Educ 41: 298-305, 2017). This article from the Sourcebook of Laboratory Activities in Physiology series, describes classroom laboratory experiments to help students visualize and appreciate osmosis (the movement of water and small molecules across selectively permeable membranes of mammalian cells). Animal blood is bathed in solutions with differing osmolarities and tonicities to explore the concept of water movement by osmosis and the resultant hemolysis. As of June 2020, this article has been downloaded 71,180 times.
Number 4 Most Accessed 2019:
“Attention span during lectures: 8 seconds, 10 minutes, or more?” by Neil A. Bradbury of the Department of Physiology and Biophysics of Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA published on November 8, 2016 (Adv Physiol Educ 40:509-513, 2016). This article presents a Personal View by reviewing the literature on the “common knowledge” and “consensus” that there is a decline in students’ attention 10-15 min into lectures. The author believes that the most consistent finding from his literature review is that the greatest variability in student attention arises from differences between teachers and not from the teaching format itself. Thus, it is the job of the instructor to enhance their teaching skills to provide not only rich content but also a satisfying lecture experience for the students. As of June 2020, this article has been downloaded 39,910 times.
The other four Advances articles in the top 10 most accessed in 2019 included an APS Refresher Course Report on “Smooth muscle contraction and relaxation” by R. Clinton Webb, a Best Practices series article on “Learning theories 101: application to everyday teaching and scholarship” by Denise Kay and Jonathan Kibble, an editorial on “The ‘African gene’ theory: it is time to stop teaching and promoting slavery hypertension hypothesis” by Heidi L. Lujan and Stephen E. DiCarlo, and a Staying Current review on “Recent advances in thermoregulation” by Etain A. Tansey and Christopher D. Johnson. These articles ranged from >20,000 to almost 30,000 downloads.
This short article shows the variety of offerings in Advances in Physiology Education and documents the global demand for these contributions to the literature.
|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.|
Inimary Toby-Ogundeji, PhD
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
2. Access “R”
a) Select the (+) symbol at the top left of the JupyterLab screen;
b) Select R
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
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
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
R programming- https://www.r-project.org/
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.
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.
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.
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!
- Lopes DM, McMahon SB. Ultraviolet radiation on the skin: a painful experience? CNS neuroscience & therapeutics. 2016;22(2):118-126.
- Dawes JM, Calvo M, Perkins JR, et al. CXCL5 mediates UVB irradiation–induced pain. Science translational medicine. 2011;3(90):90ra60-90ra60.
- Kimbrough DR. The photochemistry of sunscreens. Journal of chemical education. 1997;74(1):51.
- Tsuzuki T, Nearn M, Trotter G. Substantially visibly transparent topical physical sunscreen formulation. In: Google Patents; 2003.
- Passeron T, Bouillon R, Callender V, et al. Sunscreen photoprotection and vitamin D status. British Journal of Dermatology. 2019;181(5):916-931.
- 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.
- 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.
- 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.
- 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
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.
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.
- 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
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.
- 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.
- 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
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.
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.
Lisa Carney Anderson, PhD
Department of Integrative Biology and Physiology
University of Minnesota
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.
- 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.
- Johnson, K.M.S. Inclusive Practices for Diverse Student Populations. Plenary. APS Institute on Teaching and Learning, Madison, WI, June 18-22, 2018.
- Lyman, F. “The responsive classroom discussion.” In Anderson, A. S. (Ed.), Mainstreaming Digest. College Park, MD: University of Maryland College of Education, 1981.
- 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.