November 17th, 2022
Supporting Student Development of Competencies for Health Professions

Like many undergraduate physiology instructors, most of the students I teach are targeting health professional graduate programs after they graduate.  These future physicians, physician assistants, physical therapists, and occupational therapists are interested in the content of my physiology course, as it is often a prerequisite for their applications.  However, in addition to the content of my course, I seek to develop and observe several core competencies that extend beyond subject matter knowledge.  Various health professional organizations have identified a range of competencies they seek in applicants, and most centralized application services ask recommenders to address students’ level of attainment of these competencies.

 

One resource that I have found valuable is the Anatomy of an Applicant guide from the Association of American Medical Colleges which includes the 15 Core Competencies for Entering Medical Students.  These competencies are endorsed by the AAMC Group on Student Affairs (GSA) Committee on Admissions (COA) and help communicate the standards expected of all applicants accepted into medical school.

The competencies are organized into three categories:

Preprofessional Competencies: service orientation, social skills, cultural competence, teamwork, oral communication, ethical responsibility to self and others, reliability and dependability, resilience and adaptability, and capacity for improvement.

Thinking and Reasoning Competencies: critical thinking, quantitative reasoning, scientific inquiry, and written communication.

Science Competencies: living systems and human behavior.

While a physiology course can obviously address science and thinking and reasoning competencies, there are also other opportunities to develop preprofessional competencies in class.  By designing in-class activities in groups, I am able to observe students’ teamwork and oral communication skills.  Oral exams, a technique I employ in my classes also allows me to observe oral communication skills.  Cultural competency can be developed through emphasizing an inclusive classroom and incorporating diverse perspectives into the content included.

Not all of my students are targeting medical school, but there are similar competencies identified in other professions including physician assistant, physical therapy, and across multiple health professions.  In fact, these overlapping competencies can be used as ways to connect students that are pursuing different career paths and highlight the similarities across professions.

One of the challenges of non-science competencies is how to evaluate a students’ achievement.  We are all familiar with standardized exams that can assess the level of science knowledge, or thinking and reasoning capabilities.  Less well-known and discussed are the emerging ways in which other competencies are assessed.  Several programs now require applicants to take the CASPer exam, an open-response situational judgement test.  According to CASPer, the exam assesses: collaboration, communication, empathy, equity, ethics, motivation, problem solving, professionalism, resilience, and self-awareness.  Research has shown predictive validity of CASPer scores and national licensure outcomes which likely supports the increased use of this noncognitive assessment in the application process.  In addition to standardized exams that can be used in application processes, it may be of interest to physiology educators to be aware of assessment tools for specific competencies such as cultural competence and resilience.

Whether one is formally assessing the desired competencies or informally observing them in the classroom and/or laboratory, it is clear that there will continue to be an increased interest in students’ capabilities beyond simply their scientific knowledge.  As educators, it is important to try to support student development in these areas in our classrooms and design activities with this goal in mind.

 

Anne R Crecelius, Associate Professor, University of Dayton

She teaches Human Physiology and a Capstone Research course. She returned to her undergraduate alma mater to join the faculty after completing her M.S. and Ph.D. studying Cardiovascular Physiology at Colorado State University. Her research interest in in the integrative control of blood flow. She is a member of the American Physiological Society (APS) and an inaugural member of the advisory board of the newly established Center for Physiology Education.

November 3rd, 2022
Letter to my trainee-self: translating my research from the bench to…classroom?

I love to read quotes by Greek philosophers. They were wise individuals and did not have access to immediate “knowledge” as we do today thanks to available technologies. After all, the internet would not be created for thousands of years later. What this did afford them the opportunity to do is to engage in what we call critical thinking. It is all they did! Today, their quotes help to keep me grounded; my favorites are the quotes attributed to Aristotle. Aristotle was a scientist, a biologist, an intellectual, and a philosopher, just like us! Yes, it is hard to consider ourselves “philosophers.” However, we are — and among those of us with a Philosophy Doctorate (Ph.D.) represent  2% of the population in the United States (less than 1% worldwide) (OECD, 2021). Earning our doctoral degrees required years, sweat and tears working through graduate training. Most of us have spent countless hours conducting research, analyzing, and interpreting data; our contributions to the field of study are meaningful and novel.

We know a lot of things, so any recent graduate should be ready to land their dream job and hit the ground running, right? Unfortunately, for most trainees this is not the case. The bottom line is that our training did not prepare us for the job, at least not fully prepare for it. In most of the classical doctoral programs in the U.S. you will be trained to be a great research scientist. Chances are you will be teaching, managing lab personnel, and juggling with grant budgets, without any training in pedagogy, human resources, or accounting, respectively. So, how are we supposed to be successful? I wish somebody had told me these things when I was a trainee! I can’t change the past, and I have learned a lot since I was a trainee, so here I am listing some of my learned lessons, using Aristotle’s words of wisdom. This could have helped my younger self, and I am writing this with the hope that my experience helps other young scientists beginning their careers in academia.

The more you know, the less you know

Aristotle was right about this one! The more immersed in your research you are, the more you realize you are missing information. That is, the beauty of research, it never ends, we never know all the answers or mechanisms. No matter what research you are conducting, you are the absolute expert on your study. It is very specific to that one population, system, enzyme, or molecule. Chances are that your first job involves teaching, in some cases a lot of teaching, and it can be intimidating.

Unfortunately, like most of faculty in biomedical sciences, my doctoral studies in physiology didn’t include pedagogy or evidence-based practices in teaching. Yet, most of us are expected to teach high quality courses with large enrollment and be proficient at it. I knew I had a lot to learn, and I wanted to create my identity as an instructor, but I didn’t know how. I had this feeling that I knew a lot of “stuff” about my research and how it could be translated into clinical practice, but not much about teaching physiology!

I dedicated, and I still dedicate long hours and effort to become the best professor I could be, in the classroom, in the lab and in the community. Thankfully, there are resources for you to implement the best evidence-based practices in your classroom:

1-           Join the Teaching section of your professional association. In my case, The American Physiological Society Teaching Section has been my main source of information and training in teaching physiology. “The American Physiological Society Teaching Section promotes excellence in physiology education through educational research and scholarship in physiology.” Most people join other sections because it closely aligns with their research interests. However, you can make the teaching section your secondary or tertiary section and be able to access all of the benefits in training, workshops, mentoring, and generous awards for trainees, early and mid-career, and senior professionals!

2-           Consider attending conferences dedicated to teaching. In my case, attending the APS Institute on Teaching and Learning allowed me to become a better classroom instructor, which changed the trajectory of my career, as I was exposed for the first time to the possibility of conducting research in teaching physiology. Not only did I learn a lot, but also I was able to learn how to incorporate research in teaching into my workplan, increasing productivity and career satisfaction.

3-           Join the newly created Center for Physiology Education. The center was developed with input from more than 500 educators in the field, and it is structured around five interconnected themes: evidence-based teaching practices, inclusive teaching, teaching, and learning integrative physiology, physiology education research and curriculum development.  Together, these components provide a comprehensive approach to advancing physiology education and learning.

4-           Attend as many workshops on teaching as you can! At the University of Louisville, we are fortunate to have UofL Delphi Center for Teaching and Learning, many institutions have similar centers or support for teaching faculty, find yours and attend every workshop possible!

5-           Participate in professional development opportunities for mentoring, depending at what point of your career you are, you can participate as either as a mentee or a mentor, you will be gaining invaluable experience that can be easily transferred to your students in class or research students and trainees in your lab. In my case, I learned a lot about teaching and my mentoring style as a mentor of the Teaching Experiences for Bioscience Educators Fellows and Mentors.

“Those who know, do. Those who understand, teach.”

This is another quote attributed to Aristotle that relates to my teaching philosophy. You can “do” by giving a lecture, or you can teach using critical thinking. In order to teach you have to fully understand the concept, of course! But also, you have to understand the environment, your classroom, department, college and university cultures. To teach, you need to know your students. Not at a personal level necessarily, but understanding the idiosyncrasy of your class is going to be the key for success. Expectations for a class with non-traditional students will be very different than with traditional 18-year-old first year students. You always must know your audience, and how to engage diverse students. You will also learn about your students and community if you are out and engaged. Be out in the community, help or organize science fairs or outreach programs to local schools. Be engaged in your community, this will make you a better teacher too!

To facilitate critical thinking, use data or applied problems. For instance, consider using real life cases to teach mechanisms! After teaching thousands of students, I realized that learning happens by doing, by experimenting, by solving problems. When I teach physiology, I want my students to remember the previously learned system, and the interrelationships among systems. There is nothing better than the work of more seasoned colleagues! The national center for case study teaching in science, now part of the national science teaching association provides thousands of case studies and assignments with the keys and rubrics, that have been previously peer-reviewed with a high level of scrutiny.

Even if teaching is not the core of your identity as a scientist, chances are that at some point you will be teaching trainees, the community, or potential investors, you need to learn how to engage students. Mentoring workshops are very helpful to find your mentoring styles and how to manage your research team. I am going to end this blog with one of my favorite quotes “Excellence is never an accident. It is always the result of high intention, sincere effort, and intelligent execution; it represents the wise choice of many alternatives – choice, not chance, determines your destiny.”

1-           OECD. (2021). Educational attainment of 25-64 year-olds (2020).

Dr. Terson de Paleville teaches Advanced Exercise Physiology, Neuromuscular Exercise Physiology, and Human Physiology courses. Her research interests include motor control and exercise-induced neuroplasticity. In particular, Dr. Terson de Paleville has investigated the effects of activity-based therapy on respiratory muscles, trunk motor control and autonomic function in people with chronic spinal cord injury. Additionally, Dr. Terson de Paleville investigate the effectiveness of team-based active learning in physiology courses.

Daniela Terson de Paleville, PhD

Associate Professor

University of Louisville

October 25th, 2022
Incorporating Conference-Based Assignments into Coursework

Attending professional conferences is an excellent opportunity for students to network, learn, and gain a greater understanding of how science works. Undergraduate students often attend conferences because they are presenting their work; however, attendance at professional conferences even if not presenting can open a variety of opportunities for students (Gopalan et al., 2018). Potential benefits of participation include content knowledge or application gains, exposure to different ideas, better understanding of how different areas of a field integrate, networking building, career exploration, and practice with professional interactions.

 

Prior to attending the conference, instructors should consider preparing students for attendance. Instructors should explain the purpose of professional conferences, highlighting the importance of the exchange of ideas and building professional networks. First time undergraduate attendees, especially, may be unsure of what to expect and how to interact with others professionally. Just as faculty mentors would practice with student presenters, practicing with and mentoring non-presenting student attendees can optimize the student conference experience. Holding a pre-conference information session with students will help them be prepared and make the most of their experience. Informational session topics can include: how to ask questions, talking to poster presenters, what to expect from grad school admissions tables, how to earn continuing education credits, developing or revising a resume to have on hand, identifying presenters in attendance to connect with, and creating a conference schedule. Additionally, instructors can help students create and practice an “elevator pitch” to describe their work and professional goals (Das & Spring, 2022). Das and Spring (2022) recommend students set goals for the conference in advance so their time at the meeting is intentional. In addition to pre-conference instruction and conference-based assignments, a general follow up with students after the conference can provide insight into what students learned, what challenges they encountered, and what they found interesting. Student insight can be helpful in planning for future meetings.

 

Incorporating conference attendance into a course can significantly add to the student course experience. Using conferences to augment a course is a great opportunity to help students integrate course content with development of professional and communication skills. What follows is a list of potential assignments instructors might consider to encourage student participation in conferences. Many of the suggestions below would work well for in person or virtual conferences. The assignments can be implemented for any type of conference; however, encouraging students to attend smaller, regional conferences first is an excellent way to prepare them for larger, national and international conferences. Conference- based assignments could be evaluated for credit, extra credit, or as an additional demonstration of engagement or understanding.

 

 

  1. Make a spotlight box, similar to one you would find in your textbook, about one of the conference presentations. Include background context, important points from the speaker’s talk, and practical applications. Add relevant figures or graphs from other research papers or the speaker’s presentation to frame the spotlight and make it visually appealing to the reader. Be sure to cite your sources.
  2. Make a short YouTube video that summarizes the general topic presented by one speaker. After summarizing the broader content area, highlight information from the speaker’s presentation. Feel free to be creative- present it as a news story or host a debate with fellow classmates! (Heffernan, 2020)
  3. Design a proposal for a talk for next year’s meeting. Choose an area of exercise science you are interested in learning more about. Describe 3-5 learning objectives of the presentation and identify 3 experts in the field who would serve as your speakers. (Heffernan, 2020)
  4. Tell a young child about what you learned at the conference. Choose one of the keynote speakers’ presentations and make a short children’s story about the topic. Make the content fun and easy to understand. Include illustrations which help kids visualize the ideas you present.
  5. Watch/read 3 poster presentations. For each one, summarize the presentation. What are the strengths and limitations of each study? What would you do differently if you were the researcher? Why? What would your next study be and why? (Heffernan, 2020)
  6. Take visual notes on one of the presentations you watch. Your goal is to make your notes about the content visually appealing and make connections between ideas. Because you are connecting ideas, the notes do not need to be in top to bottom order, but organized according to themes. Include questions asked by the audience members and the speaker responses in your notes. (Google “visual note taking” for some cool ideas and pictures).
  7. Write a 2 page scientific summary of a presentation, locate 2-3 peer reviewed resources (preferably by the speaker) related to the talk and infuse them into the summary. (Heffernan, 2020)
  8. Make an infographic (Try programs like Canva, for example) about one of the presentations- include the main points, supporting evidence, conclusions, and practical applications. Be sure the infographic includes figures, is easy to read, and is visually appealing.
  9. Write a poem or song about one of the presentations. For example, write a series of haiku or use a rhyming scheme in a poem. Put your own song lyrics about the talk or content area to the music of another song or use refrains/verses to your own lyrics. For example: “you’re a vein” to “You’re so vain”.
  10. Create a movie trailer (iMovie works great and has pre-made templates) about one of the talks. Use open access videos and pictures from the internet in the movie or make your own with 2-3 classmates (groups of 4 or less). Include info about the presentation as if you were publicizing the talk. Be sure to include the main ideas or conclusions and relevant contextual information.
  11. Ask one or more of the speakers about their career path(s). Write up a 1-page summary of their responses to the following questions. How did they get to where they are? Did their path change and how? Did their interests change as they moved through their careers and if so, why? Was it different or the same as what they expected at your stage in your career? Why is it important to recognize our paths might take different directions than expected?
  12. Create a “BINGO” style card or scavenger hunt to encourage students to communicate with people or investigate different aspects of the conference. (Gopalan et al., 2018)
  13. Use twitter to react to the presentation. Tweet key points from the talk. Tag the speaker or use the conference hashtags in your tweet. (Heffernan, 2020)
  14. Write a short reflection, 1-2 pages, on what you learned about HOW science works. You may want to think about the following: What is the purpose of a conference like the one you attended? How do different presentation types advance research in the field or clinical practice? Why is dissemination of research important?
  15. After learning about different areas of research, what might you be interested in researching? What new ideas were sparked for you from the presentations you attended?

Professional conference attendance is an important opportunity for presenting and non-presenting students. Conference attendance can easily be integrated into various courses from introductory level courses which may encourage students to develop research later in their college careers to upper-level students who may be interested in building professional networks for graduate or professional school. Conference-based assignments are useful ways for instructors to integrate course content, professional development, and conference attendance into their courses.

References

Das, B., & Spring, K. (2022, September 22). 11 Tips for Instructors Bringing Students to ACSM Regional Chapter Meetings. ACSM_CMS. https://www.acsm.org/home/featured-blogs—homepage

Gopalan, C., Halpin, P. A., & Johnson, K. M. S. (2018). Benefits and logistics of nonpresenting undergraduate students attending a professional scientific meeting. Advances in Physiology Education, 42(1), 68–74. https://doi.org/10.1152/advan.00091.2017

Heffernan, K. (2020). MARC in the Classroom. https://www.acsm.org/docs/default-source/regional-chapter-individual-folders/mid-atlantic/marc-acsm_integrating-into-classroom.pdf?sfvrsn=503ff16e_0

Dr. Mary Stenson earned her B.S. in Biology from Niagara University and her M.S. and Ph.D. in Exercise Physiology from Springfield College. She is an Associate Professor of Exercise and Rehabilitation Science at the University of Minnesota Duluth. Dr. Stenson teaches exercise physiology, metabolism, and nutrition. Her research focuses on recovery from exercise and improving the health of college students. Dr. Stenson mentors undergraduate research students each year and considers teaching and mentoring the most important and fulfilling parts of her work.
October 4th, 2022
Dramatization: The Marriage of Theater and the Teaching of Physiology

This blog tells a little bit of my personal history as an educator: from a typical boring lecturer to an extroverted educator who has tons of fun playing drama in the classroom with students.

But first let me wonder: wouldn’t it be great if we teach, and our students learned well and far beyond the exams?

What to do when students’ attendance is not required, like most medical schools, and regardless of the time we spend preparing the session only a few students attend it. Or when attendance is required, like in many undergraduate courses, students struggle and only learn enough to pass the exam. Many of us experience frustration.

It is not fun when we invest so much time in preparing to teach, but the students are overwhelmed with too much content, become so consumed with the exams, and end up relying on memorization that many times only works until the exams.

This was especially true in my early experience with teaching. I was a very traditional lecturer with a clear teacher-centered mind. One year I had to substitute for a colleague and taught the pre-requisite course (cell biology) to my class (physiology). I enjoyed teaching them and the students did well with 100% approval.

When I met the same class in the subsequent semester, I started by telling them that the physiology course would be much easier since I knew that they were taught (by me!) all they needed to know in the pre-requisite course. My naïve belief was that because they were taught, the students would have learned and would not have forgotten. I was confident they were all ready to dig deep into physiology. To my dismay and complete frustration, I realized the students did not remember what I taught them when I had them in my class just a few months before. I started doubting my abilities as a teacher and blamed myself for passing those students. I oscillated between feeling depressed and ashamed.

Who in heaven let me teach them!!!

I guess due to my scientific training, I looked for help in the literature and discovered the journal Advances in Physiology Education. Reading papers about research in education, I realized that something was wrong with the method of teaching most of us use. Lecturing and pushing a massive amount of information at the students makes it difficult for them to learn and remember. I wasn’t the only professor whose students didn’t remember what was taught. Richardson (1) showed that naïve students without prior physiology instruction scored the same as students who had learned physiology before.

All students benefit from some fun in their classroom. When we smile, nerves send signals to the brain, releasing neurotransmitters such as dopamine, endorphins, and serotonin into the bloodstream. Dopamine is the main neurotransmitter in the regulation of motivational processes. It drives us to achieve goals.

Thanks to Advances, the readings opened my mind to explore all forms of learning and teaching – visual, audiovisual, reading, and kinesthetic. Back in 2002, at Unigranrio Medical School in Brazil, the students would come to me struggling to understand action potential and cardiac cycle. The next thing I saw was, that I get them to lift their arms to demonstrate depolarization and step forward to contract the cardiac muscle cell. All of this would happen spontaneously in the corridors and university halls with me telling them to imagine “the depolarization goes from cell to cell, and the electrical signal precedes the mechanical event”. Then with the help of very dear students, DRAMATIZATION was born as a method of teaching that is fun for the students (and teachers) and allows students to better learn new and complicated concepts.

Learning must be fun (2), and we teachers should love teaching. To enjoy teaching we need to create an exciting and relaxed environment for our students. Dramatization is the perfect way to teach while having fun in the classroom. Each participant acts as a cell/structure, and the entire group mimics the organ/system. In this very interactive and engaging activity, every mistake is a learning opportunity (3).

I have been having an extremely positive experience with Dramatization while doing it for two decades. From my first student in 2002, who contacted me years later, to tell me he became a cardiologist due to having fun with cardiac cycle dramatization, from physiology educators who attended my workshop (4) in 2017 at IUPS in Buzios (Brazil), to ITL this year in Madison, WI just to cite a few. Every time I teach other faculty how to do Dramatization, it is a rewarding experience that fills me with the hope that I am contributing as an educator to a better physiology education for a broad learner community.

Art in general is part of our lives, and theater can and should be used for the training of future health professionals. When we think about theater and science education, an aspect that must be considered is the importance of interpersonal relationships between teachers and students. A good interpersonal relationship can contribute as another motivating factor for the fixation on knowledge. A relaxed atmosphere in which humor is present brings the parties involved in the learning process closer together, thus creating an even more favorable space for the process of acquiring knowledge at the same time as creating a moment of relaxation from the usual state of tension experienced by our students. The students might forget what you said, but they will remember what they did.

When students experience this innovative learning modality, it not only promotes retention of information, but it also stimulates a highly engaged class participation. Such an environment favors bonds among classmates and reinforces interrelational intelligence, an invaluable skill for the work of health professionals.

When I first published dramatization, I not even use this name (5).  Then I presented it for medical students at VTCSOM, and one of my students got inspired and developed his own dramatization of the Starling forces (6). Also, very rewarding is to see faculty who attended my workshop, get to develop, and publish their own original dramatizations (7).

I hope you are inspired to try something new in your classroom. If you need data to be convinced how well Dramatization works, the graphs below show the scores of a class of VTCSOM 1st year medical students before doing it (pre-test); for the students who watched it but elected not to actively participate in it (post don’t act); and the students who acted in it (post drama). In summary, simply watching peers doing dramatization already helps to learn, but when the student actively participate in it, they learned even more.

 

 

Next blog I will tell you all about an exciting new project: DramaZoom (8, 9). The lockdown during COVID stimulated us to develop dramatization via Zoom. In collaboration with two physiologists who participated in my workshops before, Patricia Halpin and Elke
Scholz-Morris, we created videos that use dramatization to teach online. Also, Daniel Contaifer Jr designed the background, and Rosa de Carvalho taught us how to do the mimics and facial expressions in DramaZoom.

So, if you want more information on how to bring drama to the classroom, please contact us and let us know how it goes. Finally, if you publish it please cite us, and let’s spread the fun!

Happy teaching

helena@vt.edu

References:

  1. Richardson DR. Comparison of naive and experienced students of elementary physiology on performance in an advanced course. Adv Physiol Educ. 2000 Jun;23(1):91-5. doi: 10.1152/advances.2000.23.1.S91. PMID: 10902532.
  2. DiCarlo SE. Too much content, not enough thinking, and too little fun! Adv Physiol Educ. 2009 Dec;33(4):257-64. doi: 10.1152/advan.00075.2009. PMID: 19948670.
  3. Carvalho, H., McCandless, M. J., 23rd Annual IAMSE meeting, “Dramatization Promotes Learning and Engages Students,” IAMSE, Roanoke (June 11, 2019).
  4. Carvalho, H., IUPS & ADInstruments Teaching Workshop, “The Use of Dramatization to Teach Physiology,” IUPS, Armação de Buzios – Rio de Janeiro, Brazil (August 7, 2017). Additional Information: Start Date: August 2017.
  5. Carvalho H. A group dynamic activity for learning the cardiac cycle and action potential. Adv Physiol Educ. 2011 Sep;35(3):312-3. doi: 10.1152/advan.00128.2010. PMID: 21908842.
  6. Connor, B., Carvalho, H. (2019, August). Using dramatization to teach Starling Forces in the microcirculation for first year medical students. 2019;15:10842.https://doi.org/10.15766/mep_2374-8265.10842.
  7. Halpin PA, Gopalan C. Using dramatizations to teach cell signaling enhances learning and improves students’ confidence in the concept. Adv Physiol Educ. 2021 Mar 1;45(1):89-94. doi: 10.1152/advan.00177.2020. PMID: 33529141.
  8. Carvalho H, Halpin PA, Scholz-Morris E (2022). Dramatization via Zoom to Teach Complex Concepts in Physiology FASEBJ 36:S1. https://doi.org/10.1096/fasebj.2022.36.S1.R2956
  9. Carvalho H, Halpin P, Scholtz-Morris E and de Carvalho R (October 28, 2021). Can We Teach Using Dramatization via Zoom? Teach Excellence Academy for Collaborative Healthcare, Teach Education Day Poster Presentations via zoom. Virginia Tech Carillion School of Medicine.
Helena Carvalho is an educator with more than 20 years of experience. She is an associate professor at Virginia Tech Carilion School of Medicine, Block Director for basic sciences, a PBL facilitator, and teaches several areas in human physiology for medical and Ph.D. students. The main focus of her educational research is to develop innovative teaching methodologies such as Dramatization, DramaZoom, and Manipulatives. She also enjoys outreach and has been sharing excitement about physiology with all levels of education including middle and high school.

 

Rosa de Carvalho is a theater/drama director, actress and teaches mimicking and acting to children and adults for 25 years.  She has specialization in psych pedagogy and has used her talents to empower low-income communities in Rio de Janeiro (Brazil). Her has an incredibly creative mind and uses theater to improve all levels of education and human relationship. Her contribution to education span from elementary school to college level.

September 21st, 2022
Still looking for an ethical way to assess “lifelong learning”

Medical school accreditation process requires that institutions document that medical students develop the skills for “lifelong learning”.  As other standards of the section require that you answer precisely the question that is asked, I found this topic particularly challenging.  “Lifelong” requires that the assessment occurs at the end of life.   Otherwise, you may have been a learner for three-quarters of your life, and this is not lifelong.  One option would be to assess learning capability and then immediately “dispatch” the individual, providing a data point that indeed reflects lifelong learning.  Even as my caffeine titers swing wildly from under- to over-caffeinated, this approach seems unlikely to pass the Institutional Review Board.  In fact, submission of the application may result in my developing a close relationship with individuals with behavioral clinical expertise.

When reaching an impasse, return to the original question. Revisiting the Liaison Committee on Medical Education (LCME) element # 6.3, the title is actually “Self-Directed and Lifelong Learning”.  So, there may be an opening – focus instead on Self-Directed Learning.  The accreditation documents helpfully provide an expanded description

“The faculty of a medical school ensure that the medical curriculum includes self-directed learning experiences that allow medical students to develop the skills of lifelong learning. Self-directed learning involves medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; appraisal of the credibility of information sources; and feedback on these skills from faculty and/or staff.”

Part of the quandary is rooted in the shift of professional education from information acquisition to the development of competencies.  Competencies are much better aligned with professional behaviors, and include aspects of knowledge, skills, and attitudes.  Among the competency domain buckets, self-directed learning is more appropriately identified as a skill and an attitude.

Conversation with a friend (pre-pandemic) indicated that a transposition of the phrase would be useful, and that “directed self-learning” is a more appropriate goal for professional school.  Each institution has a desired set of learning outcomes – the curriculum for the faculty must guide the students so that the skill of independent learning focuses on the knowledge content that must be learned.

The first component in the LCME expanded definition of the element is “…self-assessment of learning needs.”  Assessing this is a challenge – if a learner does identify a gap, you as the facilitator can check off that box.  More challenging is a situation when you recognize a learning need and the learner does not.  To get to check off that box, you have to use open-ended questions to probe the learner’s current state of awareness and lead them on a voyage of self-discovery.  It is indeed a challenge, but the ability to self-identify gaps is an essential characteristic of a professional.  While the journey is a challenge, the creation of the list of learning objectives as an outcome is nice, tangible, and easy to assess.

The second component is more straight-forward “…independent identification, analysis, and synthesis of relevant information.”  Finally, I get to return to my comfort zone – information.   Acquiring information as proof that you know how to acquire information is one logical outcome that is easy to assess.  Assessment of the ability to synthesize that information with other relevant information gets more obscure, and ultimately requires a value judgment.  Overall, still doable.

The third component is “appraisal of the credibility of information sources”.   After establishing a few boundaries (such as “Cite Wikipedia and I will hold you up for public shaming”), learners progressively master when to use texts, professional society position papers, clinical research studies and meta-analyses to obtain the appropriate type and depth of information.  That box is checked.

The concluding component “feedback on these skills”, returns the focus to assessment.   To document this, you have to do an assessment on assessment, or a meta-assessment.  And as evidence both that knowledge alone is not enough and that the ability to appraise the credibility of sources is needed, a Bing search produced over 1 billion web hits for the term “meta-assessment”.  Google Scholar was a little more selective returning only 1,290 results.  None of which I intend to read.

We now live in a world where knowledge gaps are no longer perceived as a problem.  For example, what if I wanted to go to Vermillion South Dakota and did not know how to get there?  The knowledge gap is unimportant as long as I know a successful strategy to remedy that gap.  Apple maps now becomes my new best friend.  Even in 2022, knowledge does still matter.  A keyboarding or spelling error can send (and has sent) travelers in interesting directions.  An individual needs to realize when they are headed in the wrong direction.

So, the “lifelong” adjective remains a non-starter in terms of assessment.  Directed self-learning, however, is a needed goal as we prepare professionals for the challenges that await them.

 

Robert G. Carroll earned his Ph.D. in 1981 from the Graduate School of Biomedical Sciences of the University of Medicine and Dentistry of New Jersey-Newark. Following a 3 year post-doc at University of Mississippi Medical Center in Jackson, he moved to East Carolina University in 1984 as an Assistant Professor of Physiology. He is currently Professor of Physiology at the Brody School of Medicine at East Carolina University and the Associate Dean for Medical Education.

Rob is the past chair the Education Committee for the American Physiological Society, and currently chairs the Education Committee of the International Union of Physiological Sciences. He was editor of the journal “Advances in Physiology Education” from 2008-2013.

Robert G. Carroll, PhD.

Professor of Physiology

Associate Dean for Medical Student Education

Brody School of Medicine at East Carolina University

Greenville NC USA

September 6th, 2022
Navigating Through Imposter Syndrome: A Glimpse of the Reality of Black Mothers in Graduate School

Throughout my entire educational journey, it has always been my nature to consistently work hard.  Coming into a PhD program immediately after my undergraduate studies, I thought I had everything figured out, ranging from potential lab mentors for rotations to specific study strategies for first year curriculum classes. However, no amount of preliminary preparation could have braced me for the mental and emotional challenges that are associated with obtaining a PhD, specifically Imposter Syndrome while being an underrepresented individual in the field. Going through the process of finding a dissertation mentor and adjusting to a new academic setting contributed to the several factors that triggered a deep sense of loneliness and confusion on whether I belong in research. The most difficult aspect of this transition was learning what to look for in a mentor and what type of support would I need to finish the program successfully.  After going through three rotations, I found myself still without a mentor and a lab environment that I felt that I could thrive in. The overwhelming feelings of defeat and rejection clouded my mind, and I was not quite sure where I went wrong.  I asked myself constantly, “Did I not make more conscious decisions on mentors based off their personalities?  Was I not available enough to juggle classes, lab, and being a mom? All these factors were important in my mind but none of these things seemed to put me in the right direction.

 

From that point forward, I decided to take a leap of faith and acknowledge why I wanted to become a scientist in the first place. I came into this field to change the world through scientific discovery, break racial and socioeconomic barriers, and educate minority communities on disease prevention. Looking at the big picture of how my goals are set to impact humanity is what allowed me to change my mindset. As soon as I realigned my values, everything came to me at once. With positivity, patience, and persistence, I was blessed to acquire a mentor who gives me the opportunity to truly express myself without questioning my intellectual ability. This lab is a place where I can be seen for who I am and not what I look like. No matter what I say I am heard, acknowledged, and appreciated for who I am as I am and not what I am expected to be or what I have to offer. I am appreciative of the knowledge, wisdom, and affirmations that are spoken into every experiment I conduct. Learning is an adventure that is worth taking. There will never be a day I regret the lab I chose. Picking your lab is about finding the mentor who is edifying to your soul. When you find your lab, you will know it, and the feeling is indescribable. Working with a team of cutting-edge researchers never gets old.  As a scientist and a black mother in STEM we must never forget to nurture ourselves while also liberating the world through one discovery at a time.

 

Mia Edgerton-Fulton is a highly motivated and aspiring PhD trained neuropathologist, who is passionate about investigating potential therapies in dementia-related diseases. She is currently completing her PhD in Neuroscience at the Medical University of South Carolina where she actively engages in research related to post-stroke cognitive impairment (PSCI) and vascular dementia. Mia’s previous undergraduate experience as a historically black college/university student at Savannah State University has inspired her to advocate for improved health in minority communities by incorporating her scientific knowledge on the impact of stroke and its comorbidities on overall brain health. Mia also expanded her knowledge in dementia research as a neuroscience undergraduate research fellow at the Mayo Clinic. For the future, she plans to pursue a career in the biotechnology industry as an independent scientist with her own startup company.

Mia Edgerton-Fulton

Neuroscience PhD Candidate

Medical University of South Carolina

August 22nd, 2022
Do Animals & Aliens belong in a Human Physiology course?

As a human physiology instructor, one of the most frequent comments I get from students is about how hard the course is. In fact, I have started to bring this up right at the beginning of the semester and offer my students many ways to overcome the challenges, including keeping up with the reading and the homework, coming to office hours with questions, forming study groups, etc… There are several reasons why the students struggle with the physiology course. Physiology can be hard for students due to the amount of material and the nature of the subject which requires integrating knowledge from other fields such as anatomy, biochemistry, cell biology, physics, and chemistry. There is also a lot of heterogeneity among the students learning human physiology. They may be biology majors taking physiology as an elective, or those who are preparing for a career in a health profession, and they may be coming from different backgrounds with varying levels of preparation. Some students may start the course with basic biology knowledge and some pre-conceived notions that may even hinder their ability to learn the intricacies of human physiology.

There is a belief among many physiology students that since there is a lot of factual detail then memorization is the way to go. This inevitably leads to memorization fatigue, and confusion when seemingly contradictory material is encountered. Instead of focusing on the overwhelming number of details, a better strategy would be to focus on common themes or core concepts that once learned will allow the formation of a strong foundation. When the students learn core concepts, they do not need to learn all the details of all the systems, just the common themes and this reduces the cognitive load. By having to remember fewer items, the students can work on learning as opposed to memorizing. Focusing on core concepts allows the students to transfer their learning from one body system to another with an understanding of the basics. Core concepts provide a way to raise the level of knowledge of the students, so that long after they have completed the course, they can continue to learn physiology even if they do not remember all the details.

Michael & McFarland (2011) have compiled a list of 15 physiology core concepts based on physiology faculty surveys that describe the most important parts of teaching physiology. It is clear from Michael et al. (2017) that these core concepts are ‘general models’ as they are widely applicable in most areas of physiology. Some of these core concepts include homeostasis, cell membrane, cell-cell communication, flow-down gradients, and interdependence and provide an excellent framework for the teaching of physiology.

The wide applicability of core concepts allows the instructor to generate models involving animals as well as hypothetical aliens. It may be reasonable to assume that learning core concepts will then enable the students to answer questions and solve problems involving animals and aliens. There are some really good reasons for the use of animal and alien models for teaching core concepts as well as for assessment. The use of animals & aliens in teaching and assessment removes any preconceived notions about how the human body works and can hone in on the most important facets of the concepts that we want the students to learn. Animal & alien models in assessment can be an excellent way to test for comprehension of concepts and the ability to transfer the learning from the known system to a novel scenario.

Problem sets with animals & aliens can be used in teaching as well as assessment. Courses on animal physiology or comparative physiology can shine a spotlight on the common themes between animals and humans. Animal models are routinely used in research to study human diseases as well as to test interventions. Teaching modules that incorporate animal physiology like the one from HHMI Biointeractive on dinosaurs’ ability to maintain their body temperature can engage the students to apply principles of physiology to understanding how dinosaurs were able to regulate their body temperature. Tools like the Fictional Animal project (Batch et al. 2017) help students in their systems thinking to identify the most important physiological models to integrate the various body systems and in addition to understanding the interactions between an animal and its environment.

With the increased interest in space exploration and human travel to moon and Mars, physiology questions on aliens can help us learn more about human physiology and how we might adapt to space. Research on extraordinary life forms at the bottom of the oceans and hydrothermal vents that provide us with more ways to imagine life in space while emphasizing similarities with human physiology. Most importantly, bringing animals, fictional or real, and aliens into the classroom can increase student engagement and impact learning and transfer of knowledge.

One way to use non-human examples is by using the framework of Test Question Templates (TQTs; Crowther et al. 2020), in which clearly articulated Learning Objectives (LO) are used to generate questions. Every TQTs based on an LO can be used to create multiple questions, thus reducing the possibility of memorizing answers. The use of TQTs can result in questions that assess student understanding and application of core concepts, expecting students to use higher levels of Bloom’s taxonomy. (Casagrand & Semsar, 2017). The consistent use of TQTs can build an appreciation of physiology concepts leading to better preparation for patient care and real-life medical scenarios.

The appeal of TQTs for students, in addition to learning concepts as opposed to facts, is also that they can envision what questions can be asked based on an LO. TQTs can be used in class as models for generating questions in which the students can also participate. As instructors, we like it when our students answer questions, but it is even better when they ask the questions. So, does it matter to a pre-health student whether a dinosaur was endothermic or ectothermic? And the answer to that is if it helps the student understand how temperature regulation works, it certainly does.

References:

Batch, S.A., et al. 2017 Adv Physiol Educ. 41:2 https://doi.org/10.1152/advan.00159.2016

Casagrand, K. and Semsar, J. (2017). Adv in Physiol Educ. 41: 170-177. 10.1152/advan.00102.2016

Crowther, G. J. et al. (2020). HAPS Educator 24(1):74-81. https://doi.org/10.21692/haps.2020.006

Michael, J. and J. McFarland (2020). Advances in Physiology Education 44: 752-762. https://doi.org/10.1152/advan.00114.2020.

Michael, J. & McFarland, J. (2011) https://doi.org/10.1152/advan.00004.2011

Usha Sankar Ph.D. is a Sr. Lecturer at Fordham University, Bronx, NY and has been teaching human physiology for over 10 years. Usha is very interested in bridging the gap between teaching and learning and is looking to improve her own physiology teaching as she believes learning about the inner workings of the human body is the most fun thing anyone can do. Usha is also involved in conducting air quality research and collaborating with young scholars from middle and high schools about air quality, health impacts, and climate change research. This research combines all her interests including human health, education, and climate change.

Usha Sankar Ph.D.

Senior Lecturer

Dept. of Biological Sciences

Fordham University

441 E Fordham Rd

Bronx, NY 10458

August 15th, 2022
Impactful activities to create a framework to support team-based activities

While the recent pandemic has forced a number of rapid reforms in learning and teaching, the need to rethink how we learn and teach at the tertiary level began well before that. This has been exemplified by increasing interest in topics such as flipped classrooms, authentic assessments, and students as co-contributors. Although one might argue that the idea of flipped classroom is not new, there has been a growing push to create authentic learning experiences and authentic assessments to better prepare our graduates for the next stage of their careers – be it further professional education or employment. To work towards this goal our department recently restructured our final-year physiology courses to create an environment that empowers students to be agents of their own learning. We believe that over their lifetimes of their degrees, the students should transition from learning through knowledge transfer to self-guided agents in their own learning to promote lifelong learning. To achieve this aim, our assessments were restructured to shift the focus and emphasis from tests and exams, to more authentic assessment tasks. Here we will share an example of one such assessment and the guides we provide to help the students succeed.

In one subject Physiology: Adapting to Challenges, the students are required to work in a team on a project to be presented in a mini-student conference at the end of the semester, to mimic a scientific conference. While a team presentation might not be a truly novel idea, a few factors that we have included in the project design make it distinctive from other similar assessments.

In the early years we were concerned that students would shy away from the team project aspect of the subject. We, like many of our colleagues, thought that the students would detest the prospect of group work and thus be put off by a group project as was observed in a study at another Australian University (White et al. 2007). However, when we surveyed our second- and third-year Physiology students, it was interesting to find that approximately 75% of respondents in both second- and third-year preferred working in groups rather than individually, and the majority of the students understand the importance of acquiring teamwork skills. Many raised concerns about working in a group from prior negative experiences, similar to concerns raised in a previous blog post here. This led us to come up with ways to support the students’ success in this team project. Here we will share some of the lessons we have learned along the way.

1) Broad topics with multiple possible directions

The students were presented with a number of broad research topics or questions of physiology, examples of topics include “Tips and tricks to aging well.” Or “Stress: is it always bad?”. While at first these topics might seem like ‘bad’ topics as they do not appear to provide any research direction, this apparent flaw is also the beauty of this design, as the ‘vagueness’ of the topic gives the student groups flexibility and scope to develop and identify their own common interests within the broad field of physiology and is one of the unique aspects of this assessment. As the starting point covers a broad range of potential directions, the team must arrive at a consensus on the ultimate and final direction of the project. This freedom was an intentional design to give students agency and choice in their project. While some teams do find this lack of direction challenging, the majority of the feedback from the students was positive, with 85% of the respondents in an end of semester survey enjoying the flexibility this provides. In fact, some students stated that they have never experienced this type of freedom in taking their learning into their own hands in their university degree and felt empowered by this option. The feedback from academics who help review these presentations was overwhelmingly positive and we have been consistently impressed by the quality and depth of work produced by our undergraduate students.

2) Create groups based on common interest

The groups were created based on the student nominated projects and not randomly assigned. The students are asked to nominate and rank their top three picks of the projects, together with a short description of their reason for picking that project. The student groups are created from their nominations and the rationale for their interest in the project. This creates groups with a common goal and facilitates the group formation process. While diversity in groups is a well-recognized factor in strong groups, it is also important that groups have common goals. A fine balance must be struck between diverse groups and the common goal. Student feedback on this aspect of the assessment was positive as it gave them a choice on what to research on a topic of their choice. Something that they don’t often get a chance to do in other subjects.

3) Nominate a team mate – if you want

Our previous experience in group formation has shown us that being introduced to a group of unfamiliar people can be a stressful experience for some students, especially with the added stress of an associated assessment. We found that many students appreciated the option and opportunity to nominate a team mate. This reduced their social anxiety in the formation phase of the team. While some students did try to ‘cheat’ the system by either nominating multiple people, or in some cases nominating people in a chain, it is up to the academic to decide whether to allow or disallow these cases. It is important to keep in mind a number of other factors such as making sure that no single student in any group is the solo person without a nominated ‘buddy’ to minimize social exclusion, and still maintaining diversity in the group. The observation from the tutors and teaching staff was that this nominated ‘buddy’ system reduced the social anxiety in early group formation and allowed the groups to move forward to the next stage to discuss their direction sooner.

4) Effective ice breaker activities

Most of us would have experienced ice-breaker activities in a workshop or other types of settings and may have cringed at the idea of these activities. However, finding effective ice breaker activities can help overcome the initial social anxiety and allow the students to get to know each other. The key to effective ice breakers is to choose ones that require and assist their communication, whether it is discussing an idea that is not associated with the assessment (e.g. team name) to reduce the stress, or activities where the team members get to learn something about each other, or work towards a common goal that is not assessment associated. The ultimate aim is to get them to start conversing and help ease the more in depth and intense discussions that will follow. Indeed, in a survey of our students following the ice-breaker activity, the students noted that the ice-breaker activities were cliche but did benefit by increasing comfort with team members by the end of the activity and thus could see the benefit of the activity.

5) Team contract

Following the ice breaker activity, the student teams are asked to discuss and sign a team contract. The team contract provides a framework for the students to discuss and outline their expectations within the team. It includes basic information such as contact information. There are also general procedural discussions such as location for sharing documents, the best means of communication within the team, the preferred method for everyone. The students are advised to set up a team chat that everyone can access. This was an extra layer of challenge in the online learning space as some messaging tools may not be available in some geographical locations.

As the team progresses through the contract, the discussion topics get progressively deeper. The team is asked to discuss their goals and expectations of the project and of each other. They are encouraged to discuss the frequency and duration of meetings outside of scheduled class times; to include discussion of people work responsibilities so they can be considerate of others in setting alternative meeting times; preparation for meetings; note taking in meetings. Finally, the team is asked to discuss how they will deal with conflicts in their group, including topics such as assigning specific tasks, or unmet expectations. The students are provided with scenarios on potential conflicts that they might face and given the time to work through the scenarios as a team. Thus, the team contract guides the teams in a structured and scaffolded discussion about some of the challenging situations they may face.

For the majority of students, this is the first time they have encountered this type of document and it was a daunting task to begin with. However, many students also found the structure of the document with the guided discussion points helpful in navigating some of the more tricky questions.

6) Peer-review and feedback

The student teams undergo two rounds of peer review over the course of 8 weeks. The first peer-review is a required (hurdle) task but is not included in the assessment. This peer review takes place 3 weeks after the groups are formed. The first peer-review is entirely a formative feedback for each member so they have the opportunity for self-reflection and to receive anonymous feedback from their team. This feedback provides the students with an opportunity to adjust any problem behaviors before the final peer review at the end of the project. It also provides the academics with an opportunity to identify any group dynamic issues before it gets too late!

The second peer-review occurs after the final presentation and is counted towards the student grade. The average of the grade they receive from their team mates is used for the grade. In each peer review, the students are asked to assess their team members in a number of criteria:

  • Initiative / self – motivation / motivates others
  • Communication
  • Accountability & sense of responsibility
  • Timeliness and preparation
  • Contribution to the team work & Commitment to the team success
  • Respect & Adaptability

Another key factor is that the peer-review score may be used to adjust the team presentation grade if the student receives a low grade from their team. This increases the student accountability to their team. This also provides the team members a means to hold their team mates to account and minimizes the impact of ‘freeloading’ in the team project. Student feedback on this aspect confirms that peer review is a good way to encourage individual accountability and contribution to the team project with 83% of the respondents in our end of semester survey agreeing to that statement.

We used the tool Feedback Fruit for the peer-review process and it has been a smooth process as this is integrated into our learning management system (Canvas) and the groups synch and import automatically. This reduces the workload tremendously! Before Feedback Fruit become available we tried the same process with Qualtrics. However, this required much more background work to set up the groups for the peer-review process.

We have now run this assessment or similar variations of it, for 5 years, over this time we have made a number of tweaks and adjustments to improve the student learning experiences. Here we have shared some of the lessons we have learned along our journey that we hope readers will find useful. We believe that with some careful sign posts and guard rails we have created a positive and enjoyable learning experience for the students. Not only has this made for an enjoyable learning experience and environment for the students, the workshops have become a highlight of our weeks as we watch the student projects develop and grow. This is reflected in the overall feedback from students, tutors, and assessing academics. Most pleasing is perhaps the student feedback that many found this to be an enjoyable and highly memorable experience and was a highlight of their university journey and they may have learned some interesting facts about physiology that they will take with them as they continue their life journeys.

Angelina is a senior lecturer and the Physiology discipline coordinator in the Department of Anatomy and Physiology in the Faculty of Medicine, Dentistry and Health Sciences, at the University of Melbourne. Her current learning and teaching focus is on practical-based in practical classes, using technology to engage learners in large cohorts in Physiology, and in integrating employability skills within the science and biomedicine curriculum.

Dr Angelina Y Fong PhD GCUT | Senior Lecturer

Physiology Discipline Coordinator

Department of Anatomy and Physiology

School of Biomedical Sciences

Faculty of Medicine, Dentistry and Health Sciences
The University of Melbourne, Victoria, Australia

White, F., Lloyd, H., & Goldfried, G. (2007). Evaluating student perceptions of group work and group assessment. Sydney University Press

 

July 13th, 2022
Designing asynchronous learning material: the Pomodoro way

This post shares my reflection on making asynchronous learning materials during COVID19. I taught physiology to years 1 and 2 medical students at Newcastle University Medicine Malaysia. My usual approach in the classroom is: passive – active – passive i.e. I would first clarify the concepts in which students listen passively, ask questions to push students to think actively, back to passive again, and so forth.

 

When the pandemic hit Malaysia and the country went into complete lockdown, teachers were asked to decide if they wanted to make their teaching session synchronous or asynchronous. It was a stressful time as it was just my third year of teaching, and I still had a lot to learn about teaching. Fortunately, this happened during the semester break, and I had time to ponder these potential issues. Synchronous online sessions happen in real time, just like an in-person teaching session but online. Asynchronous sessions, on the other hand, allow students to go through the learning materials at their convenience.

 

I chose to make all my teaching sessions asynchronous after reflecting on several issues which the students and I might encounter if they were synchronous sessions. The student demography in the university consists of both local (Malaysian) and international students (ranging from Australia, to South Asia, and all the way to Canada). Considering where the students were from, the first problem with conducting synchronous sessions would be the time difference. After making adjustments, we had only a couple of hours a day where the schedule was appropriate for everyone.

 

Using Zoom for teaching was my first time, I needed to take into consideration student engagement, internet connectivity (both students’ and mine), glitches etc. Taken together, I realized that there were more things that were not within my control for a synchronous session, so asynchronous session was the better choice: the students could just go through the materials at their convenience. They could learn at their own pace without the need to stress themselves (and myself) about internet connectivity during a synchronous session or waking up at 5 in the morning; And I could avoid real-time technical issues in the middle of a teaching session. What’s left is student engagement. How do I engage students during asynchronous teaching? What can I do to motivate the students to complete the seemingly ‘boring’ hour-long lectures when they were on their own? Once I decided to make asynchronous materials, I actually felt relief in a way as I just needed to focus on making the materials rather than worried about other issues.

 

When I started working from home during the semester break, I had productivity anxiety which I had not experienced before. I began watching videos and reading articles which people shared on how to be more productive. This was when I discovered the Pomodoro technique. In general, this time management technique improves productivity by breaking down the work day into 25-minute blocks (also called Pomodoro’s) with 5-minute breaks in between the blocks. This actually gave me the idea on how I could help the students to go through the asynchronous learning materials with ‘less suffering’, as well as to achieve more when they were on their own.

 

I divided an hour-long lecture into three parts: Part 1, Part 2 and Summary which mimicked the block mentioned above. Parts 1 and 2 were recorded lectures that were 20-25 minutes long, and the Summary was a short, 5-minute roundup of what had been mentioned. Within the recorded lectures, I also prepared activities for students to assess their own understanding (active learning). For instance, after describing the structure of the skeletal muscle, I inserted another diagram of muscle fibers and asked students to pause the video to try and label the diagram. After explaining the two-neuron model, receptors and the neurotransmitters in the autonomic nervous system lecture, I prepared another diagram and students were asked to pause the video to fill in the blanks. When students resumed the video, I explained the answers. The videos were uploaded into Microsoft Stream and the links to the videos were shared on the university learning management system. I could easily track the number of views of the videos.

 

In between the two parts, there was a 5-minute-long interlude that mimicked the break in Pomodoro technique. A variety of activities was used in the interlude, including a short reading or fun fact related to the previous part. For instance, a question that required students to apply what they learned from the previous part; or games such as crossword puzzles, drag-and-drop for students to match the meanings with the terminology; or in the muscle physiology lecture, a short reading on rigor mortis were given in the interlude. Students could skip this if they wanted to but I encouraged them to follow the activities in the interlude to take a break from the passive listening, and do something active.

 

Other small things I did with this ‘Pomodoro arrangement’ of the learning materials included a clear instruction and the estimated time required to complete it. These are common if one is familiar with taking online courses. Clear instructions and estimated time of completion helped setting goals and expectations for the students the moment they opened the asynchronous learning materials. This might seem trivial, but it’s one of the keys of getting things done.

 

I included captions to all my videos to improve accessibility. Particularly for the new students, they might need time to get used to my accent and certain terminology. On top of that, captions could also be useful to English speakers to improve comprehension (1). PLYmedia found that videos with captions are more engaging and the viewers tend to watch until the end (1). These are something that I wanted for my videos as well. In fact, the sound quality, the accent of the teachers, the internet connection, and whether English is the student’s first language, could all affect the quality of synchronous teaching without proper captions. I would acknowledge that adding captions could be troublesome. When I first tried to edit the caption generated automatically by Microsoft Stream, I was amused by how bizarre it was, full of errors. However, I was actually glad as it reminded me to put efforts into my speaking and pronunciation (especially if you do not have a good microphone). One thing that I learned was that YouTube actually has a better AI system in terms of generating captions, the accuracy rate was high. After getting used to recording videos and adjusting how I speak, I didn’t have to do much editing in my subsequent videos. I also took caption-editing as an additional step to assess the contents of my videos.

 

The completion rate of the videos was 100% based on the number of views recorded in Microsoft Stream and students showed great appreciation about the captions in their feedback. When I asked them privately how they felt about the ‘Pomodoro arrangement’, some students said that they felt accomplished whenever they finished the 20-plus-minutes long videos and were motivated to continue. I believe this is the effect of the original Pomodoro method. Although COVID19 is pretty much ‘over’ in most countries and in-person teaching has resumed, I think this ‘Pomodoro arrangement’ could still be beneficial in blended learning. One might argue that there is no need to deliberately include the ‘breaks’ for the students since the students can just pause an hour-long video on their own. But I see no reason why we can’t actively make this happen by breaking up the lectures into smaller chunks and inserting fun active learning in between.

References:

[1] Albright, Dann. “7 Reasons Your Videos Need Subtitles [Infographic].” Uscreen, 18 Nov. 2020, www.uscreen.tv/blog/7-reasons-videos-need-subtitles-infographic/.

Dr. Tan received his BSc and MMedSc from the University of Malaya, Malaysia, and his Ph.D. from the National University of Singapore. He then worked at Newcastle University Medicine Malaysia (2018-2021) as lecturer, teaching physiology to years 1 and 2 medical students. Currently, he is a lecturer at the Chinese University of Hong Kong (Shenzhen), teaching physiology and histology to years 1 & 2 medical students.
June 17th, 2022
The Great Student Disengagement

With excitement and anticipation for a “return to normal,” faculty, staff and administrators were especially excited to launch Spring semester 2022.  People were vaccinated, students would be attending class with their peers on campus, and extracurricular activities would return to campus. However, it was soon discovered that a return to campus would not mean a return to “normal.”

In addition to the period of “great resignation” and “great retirement,” we soon discovered that a return to campus could be described as the “great student disengagement.”  Faculty observed concerning student behaviors that impacted academic success. Students on our campus have been vocal about their desire to remain at home and on MS TEAMS/ZOOM©. Classroom sessions were required to shift and were often a mixed modality (high flex) as students and faculty underwent COVID protocols that required remote attendance. In a curriculum in which all sessions are mandatory (approximately 20 hours each week in a flipped environment), students requested far more absences in the spring semester than ever before. Even when students were physically present in class, blatant disengagement was observed by faculty.  Attempts to appeal to students’ sense of responsibility and professionalism had little impact in changing behavior.

In attending the Chairs of Physiology meeting at Experimental Biology (EB), student disengagement was an impactful topic of discussion. Somewhat surprisingly, it quickly became apparent that the environment on our campus was somewhat ubiquitous across all institutions of higher education represented in the room that day. Although we shared similar observations, few potential solutions were offered.

Serendipitously, on the final day of EB meetings, the Chronicle of Higher Education published an article by Beth McMurtrie titled “A Stunning Level of Student Disconnection.”  The article shared insight gained from faculty interviews representing a wide range of institutions:  community colleges, large public universities, small private colleges, and some highly selective institutions. Ms. McMurtrie shared stories of faculty who described how students’ brains are “shutting off” and limiting their ability to recall information. The article reports that far fewer students show up to class, those who do attend often avoid speaking, and many students openly admit that they do not prepare for class or complete assignments. Faculty commonly described students as defeated, exhausted, and overwhelmed.

Although specific causes of the “great student disengagement” have not been substantiated, many believe it is the after-math of the pandemic. It seems plausible that the learning environment became more individualized and flexible with fluid deadlines and greater accommodations during the pandemic. Thus, a return to normal expectations has been difficult.

It also seems reasonable that amid the more pressing issues of life (deaths within families, financial struggles, spread of disease), students are reporting high levels of stress, anxiety and general decline in mental health. Perhaps being absent or disengaging while in class (being on cell phones/computers, frequently leaving the room) are simply avoidance mechanisms that allow the student to cope.

Although post pandemic conditions have brought student disengagement to our awareness, some faculty have seen this coming for years.  In a 2020 Perspectives on Medical Education article by Sara Lamb et al. titled “Learning from failure: how eliminating required attendance sparked the beginning of a medical school transformation,” the authors reported low attendance rates, at times as low as 10%, which they attempted to fix with a mandatory attendance policy.  However, over the next six years, student dissatisfaction rose due to the inflexible and seemingly patronizing perception of the policy. This led students to strategize ways to subvert the policies while administration spent significant time attempting to enforce them.  To address the situation, the school transitioned away from required to “encouraged” and “expected” for learning activities.  This yielded both positive and negative results, including but not limited to: increased attendance to non-recorded activities which students deemed beneficial to their learning; reduced attendance to activities that were routinely recorded and posted leading to increased faculty discouragement; reduced administrative burden and tension; and increased student failure rate and feelings of isolation and loneliness.  The authors go on to describe efforts to mitigate the negative outcomes including empowering faculty with student engagement data, and training in active learning pedagogies to enhance student engagement.

As the definitions and root causes of student disengagement pre-date COVID and are somewhat ambiguous, finding effective solutions will be difficult. Perhaps the rapid evolution of teaching and learning brought about by COVID now dictates an evolution of the academic experience and the rise of scholarly projects to address both causes and solutions.

Suggestions on solving the disengagement crisis were published by Tobias Wilson-Bates and a host of contributing authors in the Chronicle of Higher Education dated May 11, 2022. Although we will leave it up to the reader to learn more by directly accessing the article, a list of topics is helpful to recognize the variety of approaches:

  1. Make Authentic Human Connections
  2. Respect Priorities
  3. Provide Hope
  4. Require Student Engagement
  5. Acknowledge that Students are Struggling
  6. Fight Against Burnout

Although we rely on faculty to address student disengagement, it is also useful to consider the stressful environment of faculty. In addition to experiencing the same COVID conditions that students experience, faculty are being asked to continue to provide up-to-date content, utilize engaging teaching modalities, become skillful small group facilitators, as well as advise, coach and provide career counseling.  It is perhaps not surprising that faculty may also feel stressed, isolated, and burned out, surmising that nothing they do makes much difference – opting instead to remain hopeful that students will bounce back.

Regardless of the learning environment on your campus, it is safe to say that now is the time to come together as faculty, students and administrators to discuss the best path forward. Collectively we can work together to set solutions into motion and gather evidence for our effectiveness. It is time to leverage our shared experiences and lessons learned over the past several years of transitioning away from and back into face-to-face classroom instruction. Such reflection and study will support teaching and learning as we all seek to find a “new normal” that meets the needs of students, faculty, and administration alike.

Lamb, Sara & Chow, Candace & Lindsley, Janet & Stevenson, Adam & Roussel, Danielle & Shaffer, Kerri & Samuelson, Wayne. (2020). Learning from failure: how eliminating required attendance sparked the beginning of a medical school transformation. Perspectives on Medical Education. 9. 10.1007/s40037-020-00615-y.

A Stunning Level of Student Disconnection  https://www.chronicle.com/article/a-stunning-level-of-student-disconnection

How to Solve the Student Disengagement Crisis https://www.chronicle.com/article/how-to-solve-the-student-disengagement-crisis

 

Mari Hopper, PhD, is an Associate Dean for Pre-Clinical Education at Ohio University Heritage College of Osteopathic Medicine where she facilitates the collaboration of faculty curricular leadership and their engagement with staff in curricular operations.  Dr Hopper’s areas of professional interest include curricular development, delivery and management; continuous quality improvement including process efficiency and the development of positive learning environments and work culture; and mentorship of trainees in medical education.
Leah Sheridan, PhD, is a Professor of Physiology Instruction at Ohio University Heritage College of Osteopathic Medicine where she serves in curriculum innovation, development and leadership. Dr. Sheridan’s areas of professional interest include the scholarship of teaching and learning, physiology education, and curriculum development.