March 18th, 2020
Involving students in the teaching experience
Karen L. Sweazea, PhD, FAHA
Arizona State University

As faculty, we often find ourselves juggling multiple responsibilities at once. Although many of us are interested in adding hands-on or other activities to our classes, it can be difficult to find the time to develop them. This is where more advanced students who have already taken the class or graduate students can help.

A couple of summers ago I requested the help of an extra teaching assistant in my Animal Physiology course. The role of the position I was requesting was unique as I was not seeking a student to help with grading or proctoring exams. Rather, the role of this student was to help develop in-class activities that would enhance the learning experience of students taking the course.

For each lesson, the special graduate student TA was tasked with finding an existing (ex: https://www.lifescitrc.org/) or creating a new activity that could be implemented in the classroom during the last 10-20 minutes of each session, depending on the complexity of the activity. This enabled me to begin converting the course into a flipped classroom model as students enrolled in the course were responsible for reading the material ahead of time, completing a content comprehension quiz, and coming to class prepared to discuss the content and participate in an activity and/or case study. Special TAs can also assist with developing activities for online courses.

While the benefits of having such a TA for the faculty are clear, this type of experience is also beneficial to both the TA as well as the students enrolled in the course. For the TA, this experience provides an opportunity to develop their own teaching skills through learning to develop short lesson plans and activities as well as receiving feedback from the faculty and students. For the students, this is a great way to build cultural competence into the course as TAs are often closer in age to the students and may better reflect the demographics of the classroom. Cultural competence is defined by the National Education Association as “the ability to successfully teach students who come from a culture of cultures other than our own.” Increasing our cultural competency, therefore, is critical to student success and is something that we can learn to address. Having special TAs is just one way we can build this important skill.

Karen Sweazea is an Associate Professor in the College of Heath Solutions at Arizona State University. Her research specializes in diabetes and cardiovascular disease. She received her PhD in Physiological Sciences from the University of Arizona in 2005 where her research focused on understanding glucose homeostasis and natural insulin resistance in birds. Her postdoctoral research was designed to explore how poor dietary habits promote the development of cardiovascular diseases. 

Dr. Sweazea has over 40 publication and has chaired sessions and spoken on topics related to mentoring at a variety of national and local meetings. She has additionally given over 10 guest lectures and has developed 4 graduate courses on topics related to mentoring and professional development. She has mentored or served on the committees for undergraduate, master’s, and doctoral students and earned an Outstanding Faculty Mentor Award from the Faculty Women’s Association at Arizona State University for her dedication towards mentoring.   

March 2nd, 2020
Strategies and Tips for Inclusive Advising
Katie Johnson, PhD
Programmatic Improvement Consultant
Trail Build, LLC

Educators often find themselves in the role of advisor, either formally or incidentally. If you teach or lead a research group, it is likely students or trainees arrive at your office door with a plethora of questions or issues, seeking your input. Yet, very few academics have formal training in how to advise students.

How do you become a productive advisor who supports the success of your students? For the purpose of our discussion, I am defining advisor as any person who provides guidance, information, or advice to a student or trainee, the advisee. Many productive and inclusive advising strategies align with effective teaching practices.

Inclusive advising strategies interrupt assumptions an advisor may have about the needs, issues, or questions facing an advisee. It also acknowledges and embraces the relationship between the academic, professional, and personal trajectories of each advisee. One approach to inclusive advising is to use a question-focused advising strategy. Rather than advisors serving only as a conduit for information, advisors should ask advisees thoughtful and strategic questions, within the context of a collegial and respectful conversation. When an advisor carefully and attentively listens to the responses provided by the advisee, the advisor gains important information about how to support and assist the advisee.

There are many points to consider when advising, but here are a few suggestions for advisors, followed by examples of questions advisors can ask advisees. These questions are not to be used in sequential order, but rather as needed.

1. Listen carefully. This strategy is a lot harder than it sounds. It is easy to provide information, but is the information the right information? When careful and engaged listening directs advising, advisors are much more likely to provide the information and support needed by the advisee.

Questions to ask advisees: How can I help you? What brings you to my office today? What are your goals for this project/assignment/course? Did we address the issue that brought you in today? Do you think the solutions we talked about today are attainable? Do you have any other questions for me?

2. Believe advisees when they say they are struggling. Again, much harder than it sounds. Help advisees think through productive steps forward, rather than sending them off to figure things out on their own. Check-in with them later to help address lingering questions.

Questions to ask advisees: Can you remember a time when things were going well? What worked for you at that point? What strategies are you using to navigate these issues? If those strategies are not working, can we brainstorm other strategies? Can we work together to find resources to support your success? Do you have local friends you can turn to when you are having difficulties?

3. Guide advisees to identify what they need to achieve their academic, professional, and personal goals. After careful listening, assign advisees homework. Assignments could include visiting a resource on campus or doing directed online research to find the information they need to design a plan to accomplish their goals. Schedule future appointments for the advisee to report back what they found.

Questions to ask advisees: What information do you need to achieve your goals? What information do you have? What resources do you need to find? Is there anyone you know who would be a good resource?

4. Recognize the power dynamic between advisors and advisees. Even the most friendly and welcoming advisors can be intimidating to advisees. It takes courage to talk to an advisor. Given the power dynamic, advisees may be too intimidated to speak-up when they do not understand their advisor’s suggestions or advice.

Questions to ask advisees: Can you explain to me what your next steps should be to address this issue? Is there anything I said that I need to explain in a different way for you to be better prepared to address this issue?

5. Advisors are at a different point in their career than their advisees. It is likely the life priorities of any given advisee and advisor are different. Ask advisees about their priorities, listen carefully, and believe what they say.

Questions to ask advisees: Where do you see yourself in ten years? What is your ideal lifestyle? What is essential to this lifestyle for you to feel successful? How do you like to spend your time?

While these concepts may take time to incorporate into your advising, here are a few quick tips:

1. Really good advising takes time. Make sure to reserve enough time and energy to have productive advising meetings.

2. Successful advising is a continuous process. Expect numerous interactions in the classrooms, hallways, over e-mail, and during private meetings. This multiple check-in approach allows for investigation and reflection.

3. Articulate the expectations and responsibilities of advisees and advisors. It is possible you are your advisee’s first advisor. Advisees may not know the reason or meaning for an advisor or appropriate boundaries. As an advisor, determine your expectations and communicate these expectations to your advisees.

4. Offer options to schedule meetings. While walk-in office hours have some benefits, a dedicated time and space allows both advisee and advisor to focus on the task at hand. Offer designated advising timeslots for advisees. Signing-up for timeslots could occur either on a sheet of paper or using a free online tool that automatically syncs to online calendars.

5. If you expect advisees to meet at your office, make sure you tell your advisees where your office is located. Advisees should also know how to contact you if they must change or miss a meeting.

6. Schedule group advising to work with advisees who have similar academic or professional (NOT personal) issues. This will save the advisor time, and the advisees benefit from conversations with students or trainees asking similar questions.

7. Recruit a more advanced student or trainee to meet with advisees about standard advising issues, such as program requirements or course registration. It is effective if this meeting occurs prior to the advisor-advisee meeting, so unanswered questions and clarifications can be provided by the advisor.

8. You do not need to know the answer to everything. Know your limits and your resources. Institutions often have services and professionals trained in handling various student situations. Have their phone numbers or emails readily available so you can connect advisees directly to the assistance they need. Know your responsibilities around state and federally mandated reporting.

Productive and inclusive advising is an opportunity to help and to support students and trainees as they develop their own paths to success. What an amazing perk of being an educator! Happy Advising!

REFERENCES:

Chambliss DF. How College Works. Harvard University Press, 2014.

Cooper KM, Gin LE, Akeeh B, Clark CE, Hunter JS, Roderick TB, Elliott DB, Gutierrez LA, Mello RM, Pfeiffer LD, Scott RA, Arellano D, Ramirez D, Valdez EM, Vargas C, Velarde K, Zheng Y, Brownell SE. Factors that predict life sciences student persistence in undergraduate research experiences. PLOS ONE 14: e0220186, 2019.

Johnson KMS, Briggs A, Hawn C, Mantina N, Woods BC. Inclusive practices for diverse student populations: Experimental Biology 2017. Adv Physiol Educ 43: 365–372, 2019.

Katie Johnson, Ph.D., is an experienced practitioner and evaluator of inclusive teaching and mentoring practices. Dr. Johnson advises and serves on national STEM education initiatives and committees, working with a diverse network of collaborators. As a Programmatic Improvement Consultant, Dr. Johnson assists institutions and organizations to develop innovative solutions to curricular and assessment challenges. Prior to becoming an independent consultant for Trail Build, LLC, Dr. Johnson was Chair and Associate Professor of Biology at Beloit College. She earned her Ph.D. in the Department of Molecular Physiology and Biophysics at Vanderbilt University and her B.S. from Beloit College. Disclosure: Dr. Johnson serves as an external consultant for the American Physiological Society.

February 17th, 2020
Building a Conceptual Framework to Promote Future Understanding
Diane H. Munzenmaier, PhD
Program Director
Milwaukee School of Engineering

For most of my career, I taught physiology and genetics to medical students and graduate students.  My experiences with many students who had difficulty succeeding in these courses led me to the realization that the way high school and college students learn the biological sciences does not translate to effective physiology learning and understanding at the graduate level.

Medical students, by virtue of their admission to medical school, have, by definition, been successful academically prior to matriculation and have scored well on standardized exams.  They are among the best and brightest that our education system has to offer.  Yet, I have always been amazed at how many medical students truly struggle with physiology.  It is considered by many students to be the most difficult discipline of the basic medical sciences.  Most students come into medical school as expert memorizers but few have the capacity or motivation to learn a discipline that requires integration, pattern recognition, and understanding of complex mechanisms.  My overall conclusion is that high school and college level biological science education does not prepare students to succeed in learning physiology at the graduate level.  Furthermore, I believe if students were prepared to better appreciate and excel in basic physiology at earlier grade levels, the pipeline for graduate education in the physiological sciences would be significantly increased.

Over the past 5 years, it has become a passion of mine to promote a new way of teaching biology and physiology: one that helps students make connections and that lays a conceptual framework that can be enhanced and enriched throughout their educational careers, rather than one that promotes memorization of random facts that are never connected nor retained.  I recently joined the Center for Biomolecular Modeling at the Milwaukee School of Engineering (MSOE CBM) in order to focus on developing materials and activities to promote that type of learning and to provide professional development for K-16 teachers to help them incorporate this type of learning into their classrooms.

One of my first projects was to develop resources to allow students to study the structure-function relationships of a specific protein important in physiology and use that understanding to relate it to relevant physiology/pathophysiology concepts.  The program is called “Modeling A Protein Story” (MAPS) and, so far, I have developed resources for 3 different project themes: aquaporins, globins, and insulin.

The overall concept is for the students to build their understanding slowly and incrementally over time, usually as part of an extracurricular club.  They start by understanding water and its unique properties.  Then they learn about proteins and how they are synthesized and fold into specific 3D conformations in an aqueous environment based largely on their constituent amino acids and how they interact with water.  Eventually they progress to learning about the unique structure of their protein of interest and how it is related to its function.  Once they have developed a solid understanding of that protein, they work in teams to choose a specific protein story that they will develop and model.  This includes finding a structure in the Protein Data Bank, reading the associated research paper to determine what was learned from the structure, designing a model of the structure in Jmol, an online 3D visualization software, and 3D printing a physical model of the protein that helps them tell their story.  Stories can be anything related to the theme that the students find in their research and consider interesting.  For example, student-developed aquaporin stories have ranged from AQP2 in the kidney to AQP4 in the brain to the use of AQP proteins to develop biomimetic membranes for water purification in developing countries.  By choosing projects that students are interested in, they more readily accept the challenge of reading primary research literature and trying to piece together a confusing puzzle into an understandable “story”. 

In the past year, I have used the insulin theme resources and piloted an active learning project-based curriculum at the undergraduate, high school, and middle school levels on insulin structure-function, glucose homeostasis, and diabetes mellitus.  The type of learning environment in which this curriculum was introduced has varied.  Middle school level children participated in the active learning environment as part of a 2-week summer camp.  High school students from an innovative charter school in downtown Milwaukee were introduced to the project-based curriculum as a 9-week seminar course, and the activity was taught to freshman biomolecular engineering students at the Milwaukee School of Engineering as a team project in their first quarter introductory course.

Some of the activities utilized materials that we have developed at the MSOE CBM and were subsequently produced for distribution by our sister company, 3D Molecular Designs.  Others utilize resources that are readily available online such as those available at the Protein Data Bank at their educational site, PDB-101.  Finally, still other resources have been developed by us specifically for this curriculum in order to help the students move between foundational concepts in an attempt to help them make important connections and to assist them in developing their conceptual framework. 

One of the activities that helps them try to make sense of the connection between glucose and insulin is this “cellular landscape” painting by Dr. David Goodsell at Scripps Research Institute and available at PDB-101.

They learn the basic concept that when blood glucose increases after a meal, insulin is released from the pancreas and allows glucose to be taken up and stored by the cells.  But how?  When they are given this landscape and minimal instructions, they must look closely, connect it to what they already know and try to make sense of it.  They work together in a small group and are encouraged to ask questions.  Is this a cell?  If so, where is the plasma membrane and the extracellular/intracellular spaces?  What types of shapes do they see in those spaces?  What is in the membrane?  What are those white dots?  Why is one dot in one of the shapes in the membrane?  Why are there yellow blobs on the outside of the cell but not on the inside?  Eventually they piece together the puzzle of insulin binding to its receptor, leading to trafficking of vesicles contain glucose transporter proteins to the plasma membrane, thereby allowing the influx of glucose into the cell.  By struggling to make detailed observations and connections, a story has been constructed by the students as a logical mechanism they can visualize which is retained much more effectively than if it had been merely memorized.

In other activities they learn how insulin in synthesized, processed, folded, stored, and released by the pancreatic beta cells in response to elevated blood glucose.  They use a kit developed by MSOE CBM that helps them model the process using plastic “toobers” to develop an understanding of how insulin structure is related to its function in regards to the shape and flexibility required for receptor binding but also related to its compact storage in the pancreas as hexamers and the importance of disulfide bonds in stabilizing monomers during secretion and circulation in the blood.  

As the students build their understanding and progress to developing their own “story”, the depth of that story depends on grade level and the amount of time devoted to the project.  Undergraduate students and high school students who have weeks and months to research and develop their story tend to gravitate to current research into protein engineering of insulin analogs that are either rapid-acting or slow-release, developed as type 1 and type 2 diabetes medications, respectively.  The basic concepts behind most of these analogs are based on the structure-function relationships of hexamer formation.  Rapid-acting medications usually include amino acid modifications that disrupt dimer and hexamer formation.  Slow-release medications tend to promote hexamer stability.  Middle school students or high school students with limited time to spend on the project may only focus on the basic properties of insulin itself.  The curriculum is driven by the students, so it is extremely flexible based on their capabilities, time, and motivation.  Students ultimately use their understanding of insulin structure-function to design and 3D-print a physical model that they highlight to show relevant amino acid modifications and other details that will help them to present the story they have developed based on their learning progression and research. 

In conclusion, we have found that this type of open-ended project-based active learning increases learning, retention, and motivation at every educational level  with which we have worked.  Students are initially frustrated in the process because they are not given “the answer” but they eventually learn to be more present, make observations, ask questions, and make connections.  Our hope is that introduction of this type of inquiry-based instruction in K-16 biological sciences education will eventually make the transition to graduate level physiology learning more successful.

Diane Munzenmaier received her PhD in Physiology studying the role of the renin-angiotensin system on skeletal muscle angiogenesis. This was followed by postdoctoral study of the role of astrocytes in stroke-induced cerebral angiogenesis. She joined the faculty of the Department of Physiology at the Medical College of Wisconsin in 1999 and the Human and Molecular Genetics Center in 2008. As Director of Education in the HMGC, Dr. Munzenmaier lectured and developed curriculum for medical and graduate school physiology and genetics courses. She developed an ACGME-accredited medical residency curriculum and Continuing Medical Education (CME) courses for physician education. She also enjoyed performing educational outreach to K-12 classrooms and the lay public. She is passionate about education and career mentoring for students of all levels. Her specific interests in biomedical science education are finding engaging ways to help clarify the link between structure and (dys)function in health and disease.

February 3rd, 2020
Lighting the Spark: Engaging Medical Students in Renal Physiology
Jessica Dominguez Rieg, PhD
Department of Molecular Pharmacology and Physiology
University of South Florida Morsani College of Medicine

Recently, I spent some time reflecting on the way we teach physiology at my institution. One thing that kept coming to my mind- why does renal physiology get such a bad reputation? We often hear medical students commenting that renal physiology was the hardest topic of the first year, that there’s too much math involved, and concepts like acid-base and electrolyte disorders are too difficult to grasp. Does a negative attitude about renal physiology really matter in the long run? If the students can successfully pass USMLE Step 1, can I rest easy knowing they are competent in understanding how the kidneys function? Or can I, a basic science faculty, make a bigger impact on how these students view the renal system?

Chronic kidney disease is a growing public health concern in the United States, affecting roughly 40 million adults. Given the increasing burden of disease, an aging population, and modern medicine that is keeping patients with end-stage kidney disease alive longer, we need a robust workforce in nephrology. However, the field of nephrology is in the middle of a major crisis, and there is significant concern that there will not be an adequate workforce to meet the healthcare needs of patients afflicted with kidney disease. Only 62% of available nephrology fellowship positions were filled in the 2019 National Resident Matching Program match and less than 45% of positions were filled by U.S. MD graduates, making nephrology one of the least competitive subspecialties1. When does the waning interest in nephrology begin? Many think it starts early in a medical student’s academic journey.

I recently surveyed our medical students at the University of South Florida Morsani College of Medicine (250 respondents) and found that 60% of students agreed or strongly agreed that the topic of nephrology is interesting and yet close to one-third of them agreed or strongly agreed that renal pathophysiology is too complex and challenging for them. When asked what makes the biggest impact on their future career choice, 60% indicated that having role models and mentors in the specialty field was high impact; however, less than half of the students felt they had been exposed to encouraging role models or mentors in nephrology. Students ranked rotations during clerkships as having the highest impact in career choice; and yet our students are first exposed to nephrology during their Internal Medicine clerkship in their 3rd year, which only last 8 weeks. Not surprisingly, students ranked didactics in the preclinical years as having the lowest impact on career choice. What if we can change that? Perhaps there is too little done too late- and we just can’t get enough momentum going to gain a critical mass of students interested in nephrology. Is there anything that we, as medical physiology educators, can do to help? We can light the spark!

1. Make it matter. The complexity of renal physiology must be taught with meaningful clinical context. Students need to understand the clinical importance of what they are learning or there is a high chance they will get turned off from the very beginning. One of the best ways I have found to make it matter, is to work closely with my clinical colleagues. Not only can they provide (and co-teach) examples of how to

2. Make it digestible. Students often get overwhelmed by the level of detail that is expected in the renal block. We must ensure we are giving them the important content in bite-sized pieces so they have time to think about it, apply it, and understand it. I give our students a blank nephron map2 at the beginning of the renal block and ask that they work together to fill it out. On the last day of the renal block, we go through the maps together as a summary of renal function. Students like having all the transporters, hormones and key characteristics about each region of the nephron in one place. It helps them organize their knowledge and also gives them something to refer to in Year 2 and beyond.

3. Make it relatable. At our institution, students get renal physiology at the end of Year 1, so they’ve had all other organ systems besides reproductive physiology. I use many analogies throughout the renal system and always to try to highlight the similarities with the intestinal tract, which they are more familiar with at that point in time. After all, the nephron is like a “mini-intestine”, with similar histological features and transporter profiles. By relating the new renal content to something they’ve seen before, it can help make it a little easier to understand (and allows them to make systemic connections).

4. Make it stick. Students struggle with grasping acid-base disturbances. Consistent repetition and practice problems is key! Many times, students learn multiple ways to approach interpreting acid-base disturbances (different formulas, different values for expected compensatory responses, etc.) depending on who is teaching. This can be frustrating and confusing for students. We have found that having all faculty that teach some aspect of acid-base balance use a single resource, a step-by-step guide to interpreting acid-base disturbances3, has been very helpful in ensuring consistency in what we teach. Students also work through many practice problems in interpretation of arterial blood gases, starting in Year 1, again in Year 2, and again during the clerkships. The result is that students have gone from scoring less than 50% on NBME acid-base questions, to close to 90%- it’s sticking!

5. Make it fun! One of the notoriously challenging lectures in our preclinical years is integration of acid-base, volume, and electrolyte disorders. Traditionally, it was a lecture given by a nephrologist and was very technical and clinically oriented. However, students were lost and overwhelmed. So, I partnered with an internal medicine physician and we revamped the session into a fun, interactive series of cases where we co-facilitated discussion. Students were introduced to the 14th book of Lemony Snicket’s A Series of Unfortunate Events: The Hazardous Hospital, where they were asked to investigate the mysterious health issues of Sir Cornelius. The cases we presented were challenging and framed with very relevant basic science concepts, and students loved it! Not only did they have fun while learning, but they really appreciated having a basic scientist and clinician teaching together.

In conclusion, renal physiology is challenging and may be contributing to a lack of interest in a career in nephrology. As medical physiology educators, we have the ability to work with our clinical colleagues and revamp how we teach the renal system. We can get students engaged and excited about renal physiology by making the content clinically relevant, digestible, relatable and fun. After all, there needs to be a spark to light the fire!

References:

  1. National Resident Matching Program, Results and Data: Specialties Matching Service 2019 Appointment Year. National Resident Matching Program, Washington, DC. 2019
  2. Robinson PG, Newman D, Reitz CL, Vaynberg LZ, Bahga DK, Levitt MH. A large drawing of a nephron for teaching medical students renal physiology, histology, and pharmacology. Advances in Physiology Education. 42:2, 192-199, 2018.
  3. DeWaay D, Gordon J. The ABC’s of ABGs: teaching arterial blood gases to adult learners. MedEdPORTAL. 2011;7:9038.

Dr. Dominguez Rieg is a faculty member in the Department of Molecular Pharmacology & Physiology at the University of South Florida Morsani College of Medicine. She is the Course Director for the Gastrointestinal, Endocrine, Renal and Reproductive Systems block and the Physiology Integration Director that is responsible for mapping physiology content objectives across the entire curriculum. She teaches endocrine, renal and reproductive physiology and renal pathophysiology in multiple courses in the pre-clerkship years. She received her PhD in Physiological Sciences from the University of Arizona. Her research interests are kidney-intestine crosstalk and intestinal function in the context of systemic diseases such as obesity and diabetes. When she’s not at work, she is enjoying time with her young daughter and four German Shepherds.

January 27th, 2020
Can the Flipped Classroom Method of Teaching Influence Students’ Self-Efficacy?
Chaya Gopalan, PhD, FAPS
Associate Professor
Departments of Applied Health, Primary Care & Health Systems
Southern Illinois University Edwardsville

Self-efficacy is the belief in one’s ability to succeed in a specific situation or accomplish a specific task (Bandura, 1977). Students with high self-efficacy have higher motivation to learn and, therefore, are able to reach higher academic goals (Honicke & Broadbent, 2016). Gender, age, and the field of study are some factors that are known to affect self-efficacy (Huang, 2013). Genetics plays a significant role (Waaktaar & Torgersen, 2013). Certain physiological factors such as perceptions of pain, fatigue, and fear may have a marked, deleterious effect on self-efficacy (Vieira, Salvetti, Damiani, & Pimenta, 2014). In fact, research has shown that self-efficacy can be strengthened by positive experiences, such as mastering a skill, observing others performing a specific task, or by constant encouragement (Vishnumolakala, Southam, Treagust, Mocerino, & Qureshi, 2017). Enhancement of self-efficacy may be achieved by the teachers who serve as role models as well as by the use of supportive teaching methods (Miller, Ramirez, & Murdock, 2017). Such boost in self-efficacy helps students achieve higher academic results.

The flipped classroom method of teaching shifts lectures out of class. These lectures are made available for students to access anytime and from anywhere. Students are given the autonomy to preview the content prior to class where they can spend as much time as it takes to learn the concepts. This approach helps students overcome cognitive overload by a lecture-heavy classroom.  It also enables them to take good notes by accessing lecture content as many times as necessary. Since the lecture is moved out of class, the class time becomes available for deep collaborative activities with support from the teacher as well as through interaction with their peers. Additionally, the flipped teaching method allows exposure to content multiple times such as in the form of lecture videos, practice questions, formative assessments, in-class review, and application of pre-class content. The flipped classroom therefore provides a supportive atmosphere for student learning such as repeated exposure to lecture content, total autonomy to use the constantly available lecture content, peer influence, and support from the decentered teacher. These listed benefits of flipped teaching are projected to strengthen self-efficacy which, in turn, is expected to increase students’ academic performance. However, a systematic approach measuring the effectiveness of flipped teaching on self-efficacy is lacking at present.

References:

Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological review84(2), 191.

de Moraes Vieira, É. B., de Góes Salvetti, M., Damiani, L. P., & de Mattos Pimenta, C. A. (2014). Self-efficacy and fear avoidance beliefs in chronic low back pain patients: coexistence and associated factors. Pain Management Nursing15(3), 593-602.

Honicke, T., & Broadbent, J. (2016). The influence of academic self-efficacy on academic performance: A systematic review. Educational Research Review17, 63-84.

Huang, C. (2013). Gender differences in academic self-efficacy: A meta-analysis. European journal of psychology of education28(1), 1-35.

Miller, A. D., Ramirez, E. M., & Murdock, T. B. (2017). The influence of teachers’ self-efficacy on perceptions: Perceived teacher competence and respect and student effort and achievement. Teaching and Teacher Education64, 260-269.

Vishnumolakala, V. R., Southam, D. C., Treagust, D. F., Mocerino, M., & Qureshi, S. (2017). Students’ attitudes, self-efficacy and experiences in a modified process-oriented guided inquiry learning undergraduate chemistry classroom. Chemistry Education Research and Practice18(2), 340-352.

Waaktaar, T., & Torgersen, S. (2013). Self-efficacy is mainly genetic, not learned: a multiple-rater twin study on the causal structure of general self-efficacy in young people. Twin Research and Human Genetics16(3), 651-660.

Dr. Chaya Gopalan received her PhD in Physiology from the University of Glasgow, Scotland. Upon completing two years of postdoctoral training at Michigan State University, she started her teaching career at St. Louis Community College. She is currently teaching at Southern Illinois University Edwardsville. Her teaching is in the areas of anatomy, physiology, and pathophysiology at both undergraduate and graduate levels for health science career programs. Dr. Gopalan has been practicing evidence-based teaching where she has tested team-based learning and case-based learning methodologies and most recently, the flipped classroom. She has received several grants to support her research interest.

January 20th, 2020
Best Practices for Success in Teaching Physiology, Part III – Seeing Results
Thomas M. Nosek, Ph.D.
Professor Emeritus, Department of Physiology and Biophysics
Case Western Reserve University

In this final article of the series, the discussion comes to a completion with the remaining aspects that show the results of the tools that were presented in part I and the implementation techniques in pat II.

17. Administer weekly quizzes.
We administer a 10 multiple choice question, computer-based quiz to both resident and Internet students (using the testing function in the CMS) every Monday before class that covers the material from the previous week’s lectures. Grades on these quizzes constitute 15% of the final grade in the course. The intent of the quizzes and their 15% contribution to the final course grade is to encourage students to keep up with the course material.

Advantages
: The courses move along very quickly and if a student gets behind studying the material, they are at a severe disadvantage – there typically is not enough time for the students to catch up. Once a student’s answers are submitted, their grade is immediately reported so the students have immediate feedback on their performance.
Disadvantages: Faculty must write these quiz questions and time must be taken to administer the quizzes. Staff must be available to help students who have problems with the software on the day of the quiz. It is inevitable that a few students will have problems with their computers. Thus, the department has purchased 10 computers dedicated for use by students having difficulty during the quiz/exam administration. A room or group of rooms with Internet service and power sources for computer chargers must be available for the administration of quizzes and exams.


18. Provide weekly Study (Homework) Questions.
At the beginning of each week, we provide approximately 10 multiple choice study questions for each chapter in the assigned textbook that is covered that week. Students are encouraged to work together on these questions; they are free to use the textbook, class notes, and any other learning resource. However, the students are on their honor to enter their own answers to the question in the testing function of the CMS by noon each Saturday. Immediately after the due date for the questions, the answers with detailed explanations are provided to the students. Grades on these Study Questions constitute 15% of the final grade in the course.

Advantages: We have found that students who read the textbook do better than students who do not. These study questions encourage students to read the textbook. They key the students in on the most important points in each chapter helping them prepare for quizzes and exams. This learning resource has been rated very highly by the students.
Disadvantages: These study questions are created each year by the TA’s. Unfortunately, the TA’s are not always experienced in writing questions and many questions must be corrected after they are posted. It is best if these questions are written by faculty or at least reviewed by them before the questions are released to the students.

 

19. Administer computer-based Block examinations.
The textbook we use is organized by organ systems. The course is divided into Blocks by these organ systems. A faculty member is assigned to coordinate each Block. This faculty member is responsible for soliciting quiz and Block exam questions from each of the faculty members lecturing during the Block. At the end of each Block, a computer-based multiple-choice examination is administered through “Exemplify/ExamSoft” which we purchase for each of the students. The Block exam average constitutes 70% of the final course grade. These exams are secure so that they can be used from year to year with only slight modifications to better word questions that are found to be confusing and to modify them to accommodate for different faculty teaching the material.

Advantages: Blocks are typically 4 weeks long and there are 4 Blocks/semester. This breaks up the semester into 4 parts and gives the students 4 opportunities/semester to demonstrate their knowledge of the material. The computer-based exam system gives them immediate feedback on their performance.
Disadvantages: As noted above for quizzes, staff must be available to help students who have problems with the exam software on the day of the exam. As noted above, it is inevitable that a few students will have problems with their computers. Thus, the department has purchased 10 computers dedicated for use by students having difficulty during the exam administration. A room or group of rooms with Internet service and power sources for computer chargers must be available for the administration of Block exams. For the Internet students who cannot come to Cleveland to take the Block exams, we administer the exams through ProctorU, a service paid for by the department. This service uses the CMS to administer the exam through their proprietary software where a proctor observes the students through their computer camera and reports any inappropriate activity.


20. Use a “Difficulty Factor” (DF) to adjust quiz and Block exam grades for difficulty.
It is very difficult to predict how well students will perform on multiple choice quizzes and Block exams. Our expectation is that the median score on each Block exam will be 85% with 100% – 85% = A, 84% – 70% = B, and anything less than 70=C (with a C considered a failing performance in graduate school). Until a track record can be established for an exam, performance on each exam will be used to calculate the DF = the difference between the median on an exam and 85%. For example, if the median on an exam is 80%, 5% points are added to each student’s grade to bring the class median to 85%. If the median on an exam is greater than 85%, the DF = 0. After 3 years of administering a secure exam, the DF is calculated from the average of the DF’s for the previous 3 years.

Advantages: This system of adjusting the Block exam grades has been effective in making the final class average in the course close to 85% and a distribution of grades approximately 50% A’s and 50% B’s with only a few C’s. The students see the grading system as non-competitive; i.e., they do not see themselves as being in competition with other students for a limited number of A’s. Although it has never happened, it is possible for all students to earn an A in the course.
Disadvantages: None


21. As soon as possible after quizzes and Block exams are completed, hold a review session to discuss the correct questions.
Review sessions are conducted by the TA’s immediately after the class that follows the administration of the Monday quizzes and immediately after the Block exams. In these review sessions, the right answers to each question are provided. Students are allowed to contest the answer to a question. All contested questions of substance are taken to the faculty member responsible for the quiz or Block exam for evaluation and possibly changing the right answer or accepting multiple right answers. When this happens, the question is immediately corrected for use on the next year’s quiz/exam.

Advantages: It is very useful for students to have immediate (or near immediate) feedback on their performance on quizzes and Block exams. In this way they can identify concepts that they have not mastered and correct their thinking before moving on to the next topic.
Disadvantages: Steps must be taken to keep quiz and Block exam questions secure during these review sessions.

 

22. Provide faculty advisors to the MSMP students.
Each of the MSMP students is assigned a faculty advisor from the primary and secondary departmental faculty. We limit the number of students assigned to each faculty member to no more than 10/year. The advisors are responsible for writing letters of recommendation for their advisees. Students are encouraged to meet personally with their advisor at the beginning of the program and then at least after each Block exam in the first year core courses. During the second year, they meet with their advisors as needed. Internet students are encouraged to contact their advisor via phone or Skype on the same schedule.

Advantages: Students have access to a faculty member who can advise them on how to best navigate the courses and the MSMP program. Based on the student’s unique situation, they can also advise them on which electives will be most helpful to them when they apply to a medical professional program. Personal meetings are important so that the advisor can write a personalized letter of recommendation.
Disadvantages: Advisors are not equally knowledgeable about the intricacies of getting into professional medical programs and don’t provide the same quality of advice. Students tend to seek advice from the faculty members who have the reputation of being the best advisors, even when they are not assigned to that advisor. It is difficult to recruit enough faculty to be advisors to keep the student/advisor ratio at 10/incoming class.


23. Provide peer advisors.
At the beginning of the academic year, each matriculating MSMP student is assigned a peer advisor from the second year MSMP students. They are encouraged to meet and have social activities together. Each peer advisor is given $10/advisee to defray the cost of a social activity; ex. pizza party, bowling party, etc.

Advantages: Students appreciate meeting second year MSMP students who have successfully completed the first year core courses. Especially at the beginning of the program, this contact helps the incoming students become acclimatized to CWRU, the MSMP program, and Cleveland.
Disadvantages: It is not always easy to recruit enough 2nd year MSMP students to keep the student/advisor ratio at approximately 5.

 

24. Provide Teaching Assistants who have already had the core courses.
At the end of the academic year, we interview students who have successfully completed their first year in the program and who want to be Teaching Assistants (TA’s). Typically, these students have a perfect 4.0 GPA and have had some TA experience during their undergraduate experiences. The TA’s conduct weekly review sessions for the core courses, hold office hours for personalized Question and Answer sessions, administer the quizzes and Block exams, and post the materials provided by faculty in the CMS. Three of the nine TA’s have been assigned to work exclusively with the Internet students, being sure to contact them at least once/week.

Advantages: The TA’s provide an invaluable service to the MSMP program, relieving the AA and faculty from having to deal with many routine administrative duties. This experience is very valuable to the TA’s, greatly enhancing their resumes. This position pays $15/hour for up to 20 hours/week of work thus giving the second year students some income. These TA positions have become very prestigious, especially when considering that every TA has gained admittance to the medical professional program of their choice after graduating with the MSMP degree.
Disadvantages: We hire 9 TA’s/year and this comes with a price tag that must be met by the income generated by the program.


25. Require students to complete a faculty/course/program evaluation at the end of each Block of the course.
At the end of each Block exam in the core courses and at the end of each elective, each student is required to complete a Block/faculty/program evaluation administered through SurveyMonkey. Student grades are not released until they complete all surveys. The Director of the MSMP program creates the template for this survey and the TA’s appropriately modify it and post it online for each Block of the courses.

Advantages: This feedback is provided to the Block coordinators, the MSMP Administration Committee members, the faculty teaching in the Block, and the TA’s. This feedback is coordinated by the AA. The Block coordinator and the members of the MSMP Administration Committee see the full evaluations. The faculty and TA’s only see their own evaluations. This information is very important for faculty and TA’s to know how their interactions are valued by the students and by the Block coordinators and MSMP Administration Committee members to evaluate the courses and program and take steps to continuously improve it.
Disadvantages: The AA must take time to keep track of students who have completed the evaluations and explain to those students who have not completed them why their course grade has not been posted.

Dr. Nosek earned his B.S. in Physics from the University of Notre Dame in 1969 and his Ph.D. in Biophysics from The Ohio State University in 1973.  After post-doctoral research in the Cardiovascular Physiology Training Program in the Department of Physiology and Pharmacology at the Bowman Gray School of Medicine of Wake Forest University, he went to the Department of Physiology at the Medical College of Georgia (1976-1997) where he was the Coordinator of the Muscle Cell Biology Research Group (conducting research on the cellular basis of muscle fatigue) and the Coordinator of the Computer Aided Instruction Research Group (editing and being a section author of “Essentials of Human Physiology:  A Multimedia Resource” published by the DxR Group).  He served as Director of the medical physiology course taught to first year medical students and was the Director of the Departments Ph.D. program.  In 1997, he moved to Case Western Reserve University School of Medicine where he was Associate Dean of Biomedical Information Technologies (creating the Computer-Based Integrated Curriculum through 2006) and Professor of Physiology and Biophysics until he retired in 2014 becoming Professor Emeritus.  He served as the department’s Director of Medical Education.  He was founding Director of the MS in Medical Physiology Program at CWRU from 2010 – 2019 when he became Director Emeritus.

January 13th, 2020
Best Practices for Success in Teaching Physiology, Part II – Using the Tools
Thomas M. Nosek, Ph.D.
Professor Emeritus, Department of Physiology and Biophysics
Case Western Reserve University

In last week’s article, 9 aspects were discussed on what to bring to a classroom for the methods of effective teaching of physiology.

10. Encourage all faculty to use PowerPoint presentations during class
These files are made available to the class in the CMS at least a day before each lecture. Sometimes faculty modify these files right before the lecture is given. Therefore, we provide both a pre- and post-lecture PowerPoint presentation in the CMS.

Advantages: Students report that they like PowerPoint presentations. Many will review this file before lecture and take notes on their computers in the pre-lecture PowerPoint during lecture. Faculty have become very creative using the advanced features of PowerPoint, linking to video files, sound files, animations, etc.
Disadvantages: Faculty must create the PowerPoint file for uploading into the CMS at least a few days before the scheduled class. Some students report that they find the presentation of one PowerPoint after another to be monotonous.


11. Encourage all faculty to use computer/Internet-based simulations, sound files, videos, and animations during class.
There are extensive physiological simulations/animations/sound files/videos available on the Internet. We encourage faculty to use these whenever they think they enhance the learning experience. For example, when teaching the nerve action potential, we use a Hodgkin and Huxley nerve simulation computer program. We give students in small groups a series of questions to answer using the simulation. Another example is during the muscle physiology lectures; an animation of action potential conduction along the muscle fiber and into the t-tubules upon activation of the neuromuscular junction is presented and discussed in class along with an animation of the cross-bridge cycle.

Advantages: Active learning is always better for retention than passive learning. When students use computer simulations to answer a set of questions they engage the material to a greater extent and have a deeper understanding of the physiological principles. Viewing animations also helps students to understand difficult concepts. Students rate the use of these learning resources very favorably.
Disadvantages: Students are all required to own a personal notebook computer. They will often have problems installing computer simulations and animations on their personal computers. Thus, a staff member must be available to assist them so that they have access to these learning resources.


12. Provide Learning Objectives for each lecture in the CMS.
A Learning Objective (LO) is a statement of what a student is expected to be able to DO after they have heard a lecture. It is not a statement of what the lecturer presented. For example, “Know the cross-bridge cycle” is not a valid LO. “Be able to draw from memory the 6 stages of the cross-bridge cycle for a typical skeletal muscle” is a valid LO.

Advantages: The students will know exactly what they are supposed to be able to DO after they hear a lecture. We have a policy that no quiz or Block exam question can be asked unless it links to one of the provided LO’s.
Disadvantages: The faculty giving the lecture must create these LO’s for their lectures and make them available to the students far enough ahead of the lecture to be useful. It is not always easy for faculty to write specific LO’s, LO’s that are not too general and therefore useless.

13. Live stream each lecture and record it for posting in the CMS
We are provided a staff member from the university’s Teaching & Learning Support division to be present at all lectures and review sessions to live stream and record each lecture using Echo 360. The recording is posted in the CMS as soon after the lecture as possible. Because the videos must be processed to some extent before they can be posted, this cannot be immediate. Two hours after the lecture is a reasonable time to have these posted online.

Advantages: This year, 26% of the class is taking the MSMP program over the Internet. Only a small percentage of these students are able to view the lectures live and they rely on the recordings to access the material. It is interesting to note that attendance at the live lectures falls off the further into the two semesters of core courses one gets. At times, as much as 50% of the resident students opt to skip class and view the lectures online. Feedback from the students indicates that they do this for many different reasons. Foul winter weather in Cleveland is often cited. However, many students indicate they find it to be a great advantage to be able to speed up the lecture (up to 2x normal speed is available) when a faculty member is lecturing slowly over something they find easy to understand. On the other hand, if they don’t understand something that the professor says in class, they have the option of stopping the video and replaying it and even looking the material up in the textbook so that they will understand what has been presented before they move on with the next aspect of the lecture. Also, students with learning disabilities requiring accommodations report that they are often unable to focus their attention for a 2-hour lecture. Being able to stop the lecture to take a break before refocusing on the material prevents them from wasting time in a lecture setting where they report being totally overwhelmed and lost.
Disadvantages: This resource encourages students to skip the live lectures. Faculty often complain about low student attendance at their presentations. However, there is no evidence that student performance is compromised when they view videos of a lecture rather than physically attending it. Because of the dependence of students on this resource, we have trained all of the Teaching Assistants to back up the staff member charged with making the recordings.


14. Use an audience response system (ARS) during lecture.
We use TurningPoint as our ARS. It seamlessly integrates with PowerPoint. Each student is given a “clicker” at the beginning of the year after making a deposit in the amount of the cost of the clicker. This deposit is refunded when the clicker is returned at the end of the academic year. Faculty are encouraged to stop the lecture approximately every 15 minutes (approximately the length of time a student can effectively concentrate on lecture material) and present a question to the class in PowerPoint. Students are given a few minutes to reflect on the question before they are asked to register their answer to the question via their clicker. The number of students responding is observed on the PowerPoint slide. When a plateau is reached in the number of students responding, the faculty advances the slide to show the right answer to the question. If the class overwhelmingly answers the question correctly, no further discussion is necessary although the faculty member may want to go through each answer and explain why it is right or wrong. However, if less than 50% of the class answers the question correctly, the ARS will have helped the faculty identify a concept that has not been well understood by a majority of the students. This is an opportunity for the faculty not to progress to the answer slide but to further discuss the material. The system allows for revisiting a question, having the students to answer the question a second time after further discussion of the topic. If the students’ answers are split evenly among a number of choices, faculty are encouraged to use the “Peer Instruction” technique discussed below.

Advantages: Many years ago, we tested the effectiveness of an ARS on medical students at CWRU and found that student performance on a standard exam was enhanced by as much as 10% with the use of an ARS. Student feedback from MSMP students indicate that they very much appreciate the use of the ARS. Online students who watch the lectures live are encouraged to register their answers to ARS questions in the streaming software. A TA is always available during class to answer questions from the Internet students or to ask the lecturer questions on behalf of an Internet student. Online students who are watching the lectures asynchronously are encouraged to write down their answers on a piece of paper while they are watching the lecture.
Disadvantages: Students do not always remember to bring their clickers to class. The number of students responding to ARS questions is never equal to the total number of students in attendance. Faculty must create the ARS questions and incorporate them into their lectures. Some faculty do not feel comfortable doing this or just refuse to cooperate even with strong coaxing. TA’s have offered to help faculty create these questions with limited success.

 

15. Utilize “Peer Instruction”
“Peer Instruction” has been popularized by Eric Mazur at Harvard University (Miller et al., 2015 – https://journals.aps.org/prper/abstract/10.1103/PhysRevSTPER.11.010104). When an instructor identifies a topic that the students do not clearly understand (often prompted by the use of an ARS question that generates an ambiguous set of answers), the professor directs the students to gather in small groups of 3-4 where they are sitting in a large or small class setting and discuss among themselves the question. We have used this technique effectively in a large classroom setting with up to 150 students.

Advantages: The hypothesis is that one of the students in the small group will know the answer to the question and will be able to teach their peers the concept even more effectively than the professor. Mazur has reported positive results in students’ comprehension using this technique. Using this technique has the advantage of breaking up the flow of the class and invigorating the students as it actively engages them in the learning process. Our students have rated the use of this technique very favorably.
Disadvantages: Using this technique does take up class time and can disrupt the flow of the lecture. Not all students are willing to actively engage in this process and would prefer a passive learning experience.

 

16. Use the “Flipped Classroom” technique.
By a “Flipped Classroom” I mean providing students with pre-recorded lectures or other learning resources in the CMS that they are required to view/use before class. Class time is reserved for using the ARS to ask students questions over important aspects of the physiology presented in the pre-recorded lecture or in the other supplied learning resource – no lecture is given.

Advantages: The majority of students indicate that they enjoy the “Flipped Classroom” and that the use of ARS questions during the class time helps them to learn the material.
Disadvantages: Faculty must take the time to record this specialized lecture, often without an audience. Only approximately 70% of the students attending a “Flipped” class will have reviewed the assigned material before class. Because there is no lecture, they are not prepared to actively learn from the ARS questions. Some students complain that the required viewing of material before class is an added study time burden from which they do not see a clear benefit.

In the final week of the series, aspects that have been shown to provide a return of investment in the classroom will be discussed.  

Dr. Nosek earned his B.S. in Physics from the University of Notre Dame in 1969 and his Ph.D. in Biophysics from The Ohio State University in 1973.  After post-doctoral research in the Cardiovascular Physiology Training Program in the Department of Physiology and Pharmacology at the Bowman Gray School of Medicine of Wake Forest University, he went to the Department of Physiology at the Medical College of Georgia (1976-1997) where he was the Coordinator of the Muscle Cell Biology Research Group (conducting research on the cellular basis of muscle fatigue) and the Coordinator of the Computer Aided Instruction Research Group (editing and being a section author of “Essentials of Human Physiology:  A Multimedia Resource” published by the DxR Group).  He served as Director of the medical physiology course taught to first year medical students and was the Director of the Departments Ph.D. program.  In 1997, he moved to Case Western Reserve University School of Medicine where he was Associate Dean of Biomedical Information Technologies (creating the Computer-Based Integrated Curriculum through 2006) and Professor of Physiology and Biophysics until he retired in 2014 becoming Professor Emeritus.  He served as the department’s Director of Medical Education.  He was founding Director of the MS in Medical Physiology Program at CWRU from 2010 – 2019 when he became Director Emeritus.

January 7th, 2020
Best Practices for Success in Teaching Physiology, Part I – The Toolbox
Thomas M. Nosek, Ph.D.
Professor Emeritus, Department of Physiology and Biophysics
Case Western Reserve University

I have been actively involved in graduate and medical student education since 1972 – 47 years.  From my first time before the students, I have been searching for the optimal way to engage the students during class time, to provide alternatives to standard lectures, and to encourage active learning – all with the desire to help them understand physiological principles.

Over the years, I have had experience directing the Medical Physiology course team-taught to first year medical students and directing departmental MS and PhD programs.  Since 2011, I have served as the Program Director of a 32-credit hour MS in Medical Physiology program at Case Western Reserve University – a program designed to aid students gain admittance to professional medical programs; MD, DO, POD, DDS, PA, and PhD. It is classified as a Special Post-Baccalaureate program.  The program consists of 20 credit hours of lecture-based core Physiology courses (Medical Physiology I and II, Translational Physiology I and II, and Physiology Seminar I and II) which are designed to be taken in the first year of study to establish a strong understanding of physiological principles.  Twelve credit hours of graduate level electives, preferably taken in the second year of the program in any department at the university, round out the 32 credit hour degree requirement.  The program has grown from 43 students in the first class to 175 this past year, 45 of whom are taking the program over the Internet.  My responsibilities as director of this program and serving as the course director for the core courses have allowed me to test many of my ideas to optimize student learning of physiology, gaining feedback from the students along the way via surveys.

In this series of articles, I will introduce and discuss each of the aspects of the courses/program that I hope my colleagues will find useful as they consider how they may construct or modify the physiology courses/program for which they are responsible.  I will also present the advantages and disadvantages of each of these features.  I prefer to create hyperlinked text so that you can access detailed information only when you want it.  In lieu of that here, I suggest you read the bolded headers below and only read the detailed text that follows if this topic is of interest to you.

1. Have an Administration Committee to help administer the courses/program.
We have a 7 faculty member Administration Committee constituted from our primary and secondary faculty which I chair that established the program and now administers it, conducting constant quality assessments. Members of the committee help to recruit faculty from across the university to present lectures and continue to fill vacancies when they arise.

Advantages: The faculty have a wealth of experience and wisdom that cannot be matched by one person alone trying to administer a course or program. The committee reviews the student evaluations and recommends changes to improve the quality of the course/program.
Disadvantages: Faculty are not always available to meet on a monthly basis to keep a close eye on the courses and the program.


2. Have an Administration Assistant.
An administrative assistant (AA) is essential to process class registrations/program applications, to answer basic student questions about the details of the courses/program – referring detailed or difficult questions to faculty when appropriate, and taking care of administration of the courses. The AA also serves as a liaison with the Graduate School.

Advantages: Many tasks associated with administering a course/program are routine and do not need faculty involvement. An AA can save faculty a great deal of time.
Disadvantages: Of course hiring an AA costs money that hopefully can be recouped from the tuition generated by the course/program. Finding an AA with the right personality who can be understanding but yet firm with the students is challenging.


3. Organize the course around a textbook.
We chose to use Boron and Boulpaep’s “Medical Physiology” as the textbook for the core Medical Physiology courses. We start the courses with Chapter 1 and end it two semesters later with Chapter 62.

Advantages: Faculty are instructed as a minimum to present the material covered in the chapter associated with their assigned lecture. However, they have the academic freedom to teach the material in the order and in the style that they find most effective and consistent with their own personality/teaching style. Unless a professor states otherwise, the textbook becomes the authority in any disputes over quiz, homework, or Block exam questions.
Disadvantages: There are many physiology textbooks to choose from, with none being equally strong on all topics. In a medical physiology course I directed at the Medical College of Georgia many years ago, we tried using monographs for each section of the course, choosing what we thought was the best learning resource for that block of material. This was more expensive than recommending a single textbook and was not viewed favorably by the students.

4. Arrange the course/program so that it can be given over the Internet
For a wide variety of reasons, not all students are able to come to your campus to take courses or to enroll in your program. We recommend that all students come to campus to become immersed in the rich learning environment only physical presence on campus can provide. However, making your course/program available over the Internet gives access and opportunity to many more students. Some students do our entire program over the Internet. The degree requirements and standards of performance are exactly the same for resident and Internet students. A few take the first year of the program over the Internet and then come to Cleveland for the second year so that they can engage in clinical experiences at one of our affiliated hospitals (The Cleveland Clinic, University Hospitals, MetroHealth Medical Center, The Cleveland VA). A few students are resident students for the first year and then move back home to take the elective courses over the Internet. A very few resident students take elective courses as Internet classes even when they are in Cleveland because of scheduling conflicts often caused by recruiting visits to medical school and other health professions programs.

Advantages: This option provides flexibility and availability of the courses/program to students who just are unable to move to Cleveland. This has a positive impact on enrollment. In the 2019 matriculating class, 45 students are taking the MSMP program over the Internet.
Disadvantages: Internet programs must be approved at the level of the university’s academic governing body. Internet courses must also be specifically approved. Extra effort must be expended to make the Internet courses/program as engaging as possible with standards that are equal for resident and Internet students. Students who take the program over the Internet often do so because they are working and cannot afford to leave their jobs. If they agree to decelerate the program (taking no more than 6 credit hours of courses/semester), their performance is essentially equal to resident students. Internet students cannot take advantage of the rich learning community that we have created for the MSMP students nor can they develop the personal friendships that naturally occur among students mutually engaged in a very demanding academic experience.


5. Allow students to begin the program or take the courses any semester.
The preferred starting semester for our program is fall semester. The core courses are available only fall and spring semester and must be taken in sequence. However, we have made the electives offered by the Physiology Department available all semesters. One semester/year, lectures in the electives are given live, are video recorded, and available to both resident and Internet students. The recorded lectures are used in the other two semesters to make the course available only over the Internet.

Advantages: This gives the students the flexibility of beginning the program at any time of the year. Since providing this option, we have increased our enrollment with ~10-15 students starting spring semester and another ~10 starting summer semester.
Disadvantages: When we originally established the program, we designed it to have the students take the core courses before they took the electives. Students starting spring and summer semesters can only take electives these semesters because the core physiology courses must be taken in sequence and are only offered once/year. Although we think that it is somewhat of a disadvantage for students to take electives before they have had the core physiology courses (they have not mastered core physiological principles before taking specialized courses), for some students it is actually an advantage because we can steer them to take elective courses which will better prepare them for the rigorous core physiology courses.

6. Discourage students from working during the course/program.
Our data shows a negative correlation between the number of hours a student works/week and their performance in the core physiology courses. During the second year in the program when students are taking electives, we actually do encourage students to work part time in a medically related position. This often takes the form of involvement in a clinical trial which is a very beneficial experience for our students. Student success in getting into a professional program is contingent upon a very good performance in our program. We consider a good performance being a final GPA of 3.5 and above. Students should be warned that working too many hours can jeopardize their chances of getting into a medical professional program.

Advantages: The MSMP program is essentially the last opportunity students have to enhance their credentials for admittance to a professional medical program. If they do not perform well in the program, they will have to move on to another career. Therefore, we must do everything to optimize their chances of success. Almost all students with a final GPA of 3.6 or above have been successful getting into a medical professional program. As their GPA tends more toward 3.0, their probability of success decreases.
Disadvantages: The students must incur additional debt in order to not work while they are enrolled in our program. If a student absolutely must work, we recommend that they decelerate the program, taking no more than 6 credit hours/semester. This often increases the time it takes the students to complete the program.


7. Choose an Internet-based Course Management System (CMS)All information about the course and learning resources for each lecture are posted at the beginning of the semester in the CMS. We have used both Blackboard and Canvas as CMSs with equal success.

Advantages: There is one easily accessible location where students can find all information about the course. Students expect all their learning resources to be in a CMS – this has become a requirement for all our courses.
Disadvantages: None


8. Provide a course syllabus
The course syllabus details which chapter in the assigned textbook will be covered during each class and lists any supplemental learning resources that will be useful to the students in the calendar of the CMS.

Advantages: Students know well ahead of time which lectures covering which textbook chapters will be given on any particular day.
Disadvantages: The details of the course must be established at the very beginning of a semester for posting in the CMS.


9. Only have experts teach their area of expertise
It is our preference to have an expert/active researcher in an area teach that area in the core courses. The electives are typically taught by faculty in their area of expertise.

Advantages: Because they are experts in the areas they teach, lecturers are best able to organize the material, create the learning resources associated with the lecture, write quiz and test questions, and answer student questions.
Disadvantages: This goal is not always achievable because there is not always a faculty member with a particular area of expertise. Therefore, faculty are sometimes asked to lecture outside their area of expertise. Experts in a particular area are not necessarily the best lecturers. Although they know the material, they may not present it in an optimal, engaging way.

Next week, the series will continue with the aspects that are important for implementation of teaching in physiology classrooms!

Dr. Nosek earned his B.S. in Physics from the University of Notre Dame in 1969 and his Ph.D. in Biophysics from The Ohio State University in 1973.  After post-doctoral research in the Cardiovascular Physiology Training Program in the Department of Physiology and Pharmacology at the Bowman Gray School of Medicine of Wake Forest University, he went to the Department of Physiology at the Medical College of Georgia (1976-1997) where he was the Coordinator of the Muscle Cell Biology Research Group (conducting research on the cellular basis of muscle fatigue) and the Coordinator of the Computer Aided Instruction Research Group (editing and being a section author of “Essentials of Human Physiology:  A Multimedia Resource” published by the DxR Group).  He served as Director of the medical physiology course taught to first year medical students and was the Director of the Departments Ph.D. program.  In 1997, he moved to Case Western Reserve University School of Medicine where he was Associate Dean of Biomedical Information Technologies (creating the Computer-Based Integrated Curriculum through 2006) and Professor of Physiology and Biophysics until he retired in 2014 becoming Professor Emeritus.  He served as the department’s Director of Medical Education.  He was founding Director of the MS in Medical Physiology Program at CWRU from 2010 – 2019 when he became Director Emeritus.

December 23rd, 2019
Backward planning of lab course to enhance students’ critical thinking
Zhiyong Cheng, PhD
Food Science and Human Nutrition Department
The University of Florida

Development of critical thinking and problem-solving skills hallmarks effective teaching and learning [1-2]. Physiology serves as a fundamental subject for students in various majors, particularly for bioscience and pre-professional students [1-8]. Whether they plan on careers in science or healthcare, critical thinking and problem-solving skills will be keys to their success [1-8].

Backwards course design is increasingly employed in higher education. To effectively accomplish specific learning goals, instructions are to begin course development with setting learning objectives, then backwardly create assessment methods, and lastly design and deliver teaching and learning activities pertaining to the learning objectives and assessment methods. In terms of development of critical thinking and problem-solving skills, a lab course constitutes an excellent option to provide opportunities for instructors and students to explore innovative paths to their desired destinations, i.e., to accomplish specific learning goals.

In a traditional “cookbook” lab setting, detailed procedures are provided for the students to follow like cooking with a recipe. Students are usually told what to do step-by-step and what to expect at the end of the experiment. As such, finishing a procedure might become the expected goal of a lab course to the students who passively followed the “cookbook”, and the opportunity for developing critical thinking skills is limited. In a backwards design of a lab course; however, the instructor may engage the students in a series of active learning/critical thinking activities, including literature research, hypothesis formulation, study design, experimental planning, hands-on skill training, and project execution. Practically, the instructor may provide a well-defined context and questions to address. Students are asked to delve into the literature, map existing connections and identify missing links for their project to bridge. With the instructor’s guidance, students work together in groups on hypothesis development and study design. In this scenario, students’ focus is no longer on finishing a procedure but on a whole picture with intensive synthesis of information and critical thinking (i.e., projecting from generic context to literature search and evaluation, development of hypothesis and research strategy, and testing the hypothesis by doing experiments).

An example is this lab on the physiology of fasting-feeding transitions. The transition from fasting to feeding state is associated with increased blood glucose concentration. Students are informed of the potential contributors to elevated blood glucose, i.e., dietary carbohydrates, glycogen breakdown (glycogenolysis), and de novo glucose production (gluconeogenesis) in the liver. Based on the context information, students are asked to formulate a hypothesis on whether and how hepatic gluconeogenesis contributes to postprandial blood glucose levels. The hypothesis must be supported by evidence-based rationales and will be tested by experiments proposed by students with the instructor’s guidance. Development of the hypothesis and rationales as well as study design requires students to do intensive information extraction and processing, thereby building critical thinking and problem-solving skills. Students also need to make sound judgments and right decisions for their research plans to be feasible. For instance, most students tend to propose to employ the hyper-insulinemic-euglycemic clamp because the literature ranks it as a “gold standard” method to directly measure hepatic gluconeogenesis. However, the equipment is expensive and not readily accessible, and students have to find alternative approaches to address these questions. With the instructor’s guidance, students adjust their approaches and adopt more accessible techniques like qPCR (quantitative polymerase chain reaction) and Western blotting to analyze key gluconeogenic regulators or enzymes. Engaging students in the evaluation of research methods and selection helps them navigate the problem-solving procedure, increasing their motivation (or eagerness) and dedication to learning new techniques and testing their hypotheses. Whether their hypotheses are validated or disproved by the results they acquire in the end, they become skillful in thinking critically and problem solving in addition to hands-on experience in qPCR and Western blotting.

Evidently, students can benefit from backwards planning in different ways because it engages them in problem-based, inquiry-based, and collaborative learning — all targeted to build student problem solving skills [1-8]. For a typical lab course with pre-lab lectures; however, there is only 3-6 hours to plan activities. As such, time and resources could be the top challenges to implement backwards planning in a lab course. To address this, the following strategies will be of great value: (i) implementing a flipped classroom model to promote students’ pre- and after-class learning activities, (ii) delivering lectures in the lab setting (other than in a traditional classroom), where, with all the lab resources accessible, the instructor and students have more flexibility to plan activities, and (iii) offering “boot camp” sessions in the summer, when students have less pressure from other classes and more time to concentrate on the lab training of critical thinking and problem solving skills. However, I believe that this is a worthwhile investment for training and developing next-generation professionals and leaders.

References and further reading

[1] Abraham RR, Upadhya S, Torke S, Ramnarayan K. Clinically oriented physiology teaching: strategy for developing critical-thinking skills in undergraduate medical students. Adv Physiol Educ. 2004 Dec;28(1-4):102-4.

[2] Brahler CJ, Quitadamo IJ, Johnson EC. Student critical thinking is enhanced by developing exercise prescriptions using online learning modules. Adv Physiol Educ. 2002 Dec;26(1-4):210-21.

[3] McNeal AP, Mierson S. Teaching critical thinking skills in physiology. Am J Physiol. 1999 Dec;277(6 Pt 2):S268-9.

[4] Hayes MM, Chatterjee S, Schwartzstein RM. Critical Thinking in Critical Care: Five Strategies to Improve Teaching and Learning in the Intensive Care Unit. Ann Am Thorac Soc. 2017 Apr;14(4):569-575.

[5] Nguyen K, Ben Khallouq B, Schuster A, Beevers C, Dil N, Kay D, Kibble JD, Harris DM. Developing a tool for observing group critical thinking skills in first-year medical students: a pilot study using physiology-based, high-fidelity patient simulations. Adv Physiol Educ. 2017 Dec 1;41(4):604-611.

[6] Bruce RM. The control of ventilation during exercise: a lesson in critical thinking. Adv Physiol Educ. 2017 Dec 1;41(4):539-547.

[7] Greenwald RR, Quitadamo IJ. A Mind of Their Own: Using Inquiry-based Teaching to Build Critical Thinking Skills and Intellectual Engagement in an Undergraduate Neuroanatomy Course. J Undergrad Neurosci Educ. 2014 Mar 15;12(2):A100-6.

[8] Peters MW, Smith MF, Smith GW. Use of critical interactive thinking exercises in teaching reproductive physiology to undergraduate students. J Anim Sci. 2002 Mar;80(3):862-5.

Dr. Cheng received his PhD in Analytical Biochemistry from Peking University, after which he conducted postdoctoral research at the University of Michigan (Ann Arbor) and Harvard Medical School. Dr. Cheng is now an Assistant Professor of Nutritional Science at the University of Florida. He has taught several undergraduate- and graduate-level courses (lectures and lab) in human nutrition and metabolism (including metabolic physiology). As the principal investigator in a research lab studying metabolic diseases (obesity and type 2 diabetes), Dr. Cheng has been actively developing and implementing new pedagogical approaches to build students’ critical thinking and problem-solving skills.

December 9th, 2019
Building bridges: Medical physiology teaching in China
Ryan Downey, Ph.D.
Assistant Professor
Co-Director, Graduate Physiology Program
Team Leader, Special Master’s Program in Physiology


Department Pharmacology and Physiology
Georgetown University Medical Center
Washington, D.C.

The Chinese Society of Pathophysiology hosted the 2019 Human Functional Experiment Teaching Seminar and the Second Human Physiology Experimental Teaching Training Course 25-27 October. Across two and a half days, educators from across China met at Jinzhou Medical University in the province of Liaoning to discuss and workshop the latest ideas in active learning and interactive teaching techniques. In many ways, especially in terms of the esteem in which this meeting is held by its attendees, this meeting was not dissimilar from the APS Institute on Teaching and Learning, which will hold its next biennial meeting this coming June in Minneapolis. For the 2019 meeting, the organizers decided to invite an international speaker, which is how I found myself on a plane headed to China. As part of my visit, not only did I get to attend the workshop hosted at Jinzhou Medical University, but also I was hosted by several of the meeting organizers at their home institutions to see their facilities. In this writeup, I will reflect on some of the observations that I made during the many different conversations that I had with the educators participating in the meeting.

The most common question that I got from my hosts was, “What kinds of technology do you use in your classrooms and labs and how do you use them?” What surprised me the most about this question wasn’t the actual question itself, but the perception that many of the educators at the meeting held that they were lagging behind in the implementation of using technologies as   teaching and learning tools. The large majority of teaching spaces that I visited were equipped with much the same technology as any classroom or lecture hall that I would find in an American university: computers, projectors, large-screen LCD displays, and power at every seat to accommodate student personal electronic devices. While there was the occasional technological oddity, such as a computer here or there that was still running Windows XP, the technology available to these educators was very much on par with the technology I would expect at any modern university, which is why I was surprised that the educators had the perception that they were behind in implementing different technologies. In my conversations with them, I discussed the use of audience response systems like iClicker and PollEverywhere as well as interactive elements like gamification through websites such as Kahoot!, but my emphasis in these conversations was exactly the same as I have with educators at home: we need to make sure that there is a sound pedagogical basis for any engagement we use with our students and that the technology doesn’t matter. I can use 3×5 colored  index cards to create an audience response system that functions as well as (or sometimes even better!) than clickers because no one has any problems with the WiFi while using a 3×5 card. The technology facilitates our instruction and should never drive it for the sake of itself.

A common thread of many discussions was the use of internet technologies in teaching. While there is much to be said about the limitations of the ‘Great Firewall’ of China and the amount of government regulation that occurs over their communications, it’s important to note how little these limitations affect the day-to-day activities of the majority of citizens. There are Chinese versions of almost every single internet convenience that we would take for granted that function at least as well as our American versions. Their social media system has grown to the point that many international users are engaging on their platforms. There are food delivery apps and the local taxi services have all signed on to a common routing system (at least in Beijing) that functions in a similar way to Uber or Lyft. In a side-by-side comparison between my phone and one of the other meeting participants, there is near feature parity on every aspect. From an educational standpoint, however, there are some notable differences. The lack of access to Wikipedia is a notable gap in a common open resource that many of us take for granted and there is not yet a Chinese equivalent that rivals the scope or depth that Wikipedia currently offers. Another key area in which internet access is limited is their access to scholarly journals. This lack of accessibility is two-fold, both in the access to journals because of restrictions on internet use as well as the common problem that we are already familiar with of journal articles being locked behind paywalls. The increasing move of journals to open access will remove some of these barriers to scholarly publications, but there are still many limits on the number and types of journal articles that educators and learners are allowed through Chinese internet systems.

The most common request that I received while attending the educators meeting was, “Tell me about the laboratories you use to teach physiology to your medical students.” I think this is the largest difference in teaching philosophy that I observed while in China. The teaching of physiology is heavily based on the use of animal models, where students are still conducting nerve conduction experiments with frogs, autonomic reflex modules with rabbits, and pharmacological studies in rats. These are all classic experiments that many of us would recognize, but that we rarely use anymore. One key area of the workshops were modules designed to replace some of these classic animal experiments with non-invasive human-based modules, such as measuring nerve conduction velocities using EMG. My response that the majority of our physiology teaching is now done through lecture only was met with a certain degree of skepticism from many of them because the use of labs is so prevalent throughout the entire country. Indeed, the dedication of resources such as integrated animal surgical stations runs well into the hundreds of thousands of dollars per laboratory room set up, and to facilitate the entirety of students each year, there are multiple labs set up at each university. As the use of non-invasive human experiments expands, an equal amount of space and resources are being given to setting up new learning spaces with data acquisition systems and computers for this new task. In this area, I think that we have much to gain from our Chinese counterparts as many of the hardest concepts in physiology are more easily elucidated by giving students the space to self-discover in the lab while making physiological measurements to fully master ideas like ECG waves and action potential conduction.

Upon returning home, I have been asked by nearly everyone about my travel experiences, so I think it may be worth a brief mention here as well. I cannot overstate the importance of having a good VPN service setup on all of your electronic devices before traveling. Using a VPN, I had near-normal use of the internet, including Google and social media. My largest problem was actually trying to access local Chinese websites when my internet address looked like I was outside of the country. I have had good experience with NordVPN, but there are several other very good options for VPN service. Carrying toilet paper is a must. There are lots of public restrooms available everywhere in the city, but toilet paper is either not provided or available only using either social media check-ins or mobile payments. For drinking water, I traveled with both a Lifestraw bottle and a Grayl bottle. This gave me options for using local water sources and not having to rely on bottled water. The Lifestraw is far easier to use, but the Grayl bottle has a broader spectrum of things that are filtered out of the water, including viruses and heavy metals, which may be important depending on how far off the tourist track you get while traveling. My final tip is to download the language library for a translator app on your mobile device for offline use so that you can communicate with others on the streets. When interacting with vendors and others not fluent in English, it was common to use an app like Google Translate to type on my device, show them the translated results, and they would do the same in reverse from their mobile device.

One of the themes across the meeting was building bridges — bridges between educators, bridges between universities, bridges across the nation and internationally. I’m glad to have had the opportunity to participate in their meeting and contribute to their conversation on building interactive engagement and human-focused concepts into the teaching of physiology. Overall, the time that I spent talking to other educators was useful and fantastic. Everyone I met and interacted with is enthusiastic and excited about continuing to improve their teaching of physiology. I left the meeting with the same renewed energy that I often feel after returning from our ITL, ready to reinvest in my own teaching here at home.

Ryan Downey is an Assistant Professor in the Department of Pharmacology & Physiology at Georgetown University. As part of those duties, he is the Co-Director for the Master of Science in Physiology and a Team Leader for the Special Master’s Program in Physiology. He teaches cardiovascular and neuroscience in the graduate physiology courses. He received his Ph.D. in Integrative Biology from UT Southwestern Medical Center. His research interests are in the sympathetic control of cardiovascular function during exercise and in improving science pedagogy. When he’s not working, he is a certified scuba instructor and participates in triathlons