Monthly Archives: April 2015

Talking Physiology: Oral Exams in an Undergraduate Course

discussAt one point, I’m sure many of us experienced (perhaps ‘suffered’ is more the appropriate term here) through an oral examination.  This may have been at the culmination of a graduate degree or perhaps as part of a certification of some kind.  The event likely produced anxiety, stress, and perhaps even sweat.  However, we also probably (1) prepared extensively; (2) identified strengths and weaknesses in our understanding; and (3) most definitely survived.  It is these latter experiences that I aim to achieve by having my undergraduate physiology students complete cumulative oral exams (though the anxiety and stress are fairly unavoidable).

The Course

Primarily, the students enrolled in my Human Physiology course are mid-level exercise science, pre-physical therapy, dietetics, and exercise physiology majors.  At this point, they have completed a general biology and chemistry sequence as well as a semester of Human Anatomy with a cadaver-based laboratory.  I use a variety of instructional methods, trying to incorporate active learning and student-centered techniques in an effort to improve student performance and learning, as has been well-documented in the literature .

The Backstory

In full disclosure, I’m not a veteran instructor, so the backstory is relatively short.  After my first semester of teaching, I was grading cumulative final exams and questioning whether this method of assessment was really indicative of students’ knowledge of physiology, particularly from a conceptual and “big picture” perspective.  With graduate school oral exams in my recent memory and thinking that they were a great way to demonstrate knowledge (or unfortunately, a lack thereof), I asked myself: what if I implemented oral exams at the undergraduate level?

The Exams

If you’re like me, one way to ensure that something gets incorporated into a course is to include it on the syllabus.  It was staring me in the face now: “Cumulative Oral Exam – 1 @ 50 pts”.  So what was this going to look like?  How was I going to administer this for ~60 students and how would I grade them?  That semester, and the two since, the format has been fairly similar:

  • Students sign up for 20 min time slots
  • A list of potential questions is provided to the students well in advance.  They choose one question to respond to and I choose the other.
  • There are about 30 questions that are intentionally broad in nature.  Examples include:
    • What can change membrane potential and why does this happen?
    • How do we regulate blood glucose levels?
    • What determines and regulates mean arterial pressure?
    • Why and how do we breathe?
  • A rubric is used for grading and immediately provided to the students.
  • An excellent (20 pts) response to each of the two questions is defined as: “Student demonstrates extensive knowledge and understanding of topic, ability to think critically and creatively, and answers follow up questions in a thoughtful and complete manner.  No misinformation is provided.”
  • Overall performance is excellent if “Appropriate terminology is used throughout discussion and student is fully engaged and prepared, providing answers without significant struggle.”

Typically, the exams average ~10 min and the rest of the time is spent discussing the student’s performance, areas for improvement, and any questions regarding the material that was covered (or in many cases, the questions they were relieved not to have to answer!).

The Hindsight

While students are anxious (not an uncommon finding in this type of situation), most are grateful for this relatively low-stakes (50 pts out of a 1000 pt course, while the written final is 150 pts) opportunity to be tested on cumulative knowledge.  The broad nature of the questions makes them fairly impossible to simply “look up” so they must try to integrate information presented throughout the course.  I also truly appreciate the opportunity to meet with each student one-on-one, something that would not necessarily happen otherwise.  Some specific tips for anyone who might consider incorporating this form of assessment into your courses:

  1. Technology can be your friend.  Utilizing appointment slots in my University Google Calendar helps with the logistics.
  2. Why?  How?  Asking follow-up questions, for more information, or even interrupting what sounds like a memorized response to a question challenges students and can expose misconceptions that you can then correct.
  3. Provide help when needed. I tell students up front that I will help them if they get stuck.  Asking leading questions keeps the exam flowing and can lower anxieties and prevent embarrassment.
  4. Welcome surprises.  Each semester, my impressions of a student’s interest or abilities in the course have been altered as a result of their oral exam.
  5. Don’t forget to sell it.  Reminding students that preparing for the oral portion will ‘jumpstart’ their preparation for the ‘traditional’ final, can go a long way in helping them deal with what is likely a unique and stressful situation.

The Future

As I learn more about teaching and learning (including through resources like this blog, Advances in Physiology Education, programming at conferences, and my continually expanding network of fellow educators), I continue to reflect on these exams and seek ways to improve them.  Eventually, I’d like to truly measure what impact they may or may not have on student learning and performance.  Would a mid-term oral exam be beneficial? If so, how could the process be streamlined to decrease instructor time-commitment?  Could I observe a conversation between partners and glean similar insights?  I look forward to hearing your feedback and discussing through the comments section!


PECOP Crecelius head







Anne Crecelius is an Assistant Professor in the Department of Health and Sport Science at the University of Dayton.  She teaches Human Physiology and a Capstone Research course.  She returned to her undergraduate alma mater to join the faculty after completing her M.S. and Ph.D. studying Cardiovascular Physiology at Colorado State University.  Her research interest is in the integrative control of muscle blood flow.  She is a member of the American Physiological Society (APS), serving on the Teaching Section Steering Committee and the Communications Committee.


Pedagogical Perspectives: The Flipped Classroom Approach

The Traditional Teaching Method

Think back to any one of your undergraduate classes.  If you were a typical university student in a typical educational environment, you probably remember entering the lecture hall, opening your notebook (or laptop, depending on your age), and copying down everything the instructor said once class commenced.  At the end of the lecture, you packed up your belongings and headed back out of the hall, either to your next class or to study or to meet with friends.  Occasionally you might have raised your hand to ask a question, but chances were that you never spoke a word from start to finish of the class.  Instead, you frantically copied everything that was said for fear of missing a key concept and waited until after class (typically waiting until just before a major test) to review your notes in order to comprehend what the professor was trying to say.

Probably sounds familiar.  This is the traditional didactic pedagogy, or “sage on the stage” approach, that has been adopted by essentially every institution of higher learning currently in existence.  But here’s the question: did you ever take a moment to ask why most undergraduate courses are set up this way?  Did you ever wonder if there was a better approach to higher learning, and if so, why a less effective pedagogy has been the norm?

Personally, I never asked these questions as an undergraduate student.  As a first year undergraduate, I was awestruck by academia and felt small and insignificant.  By senior year, I felt indoctrinated into academia and never thought to question the system I was so immersed in and so passionate about.

New Technologies and a New Approach

It was two recent, seemingly unrelated experiences that led me to reevaluate the didactic method and postulate a theory about the present construct of academia.  The first was exposure to alternative pedagogies through a series of faculty development workshops.  I was already familiar with many of them as a complimentary tool to a predominantly lecture-based system, but had never seriously considered them as alternatives to didactic lectures.  The second experience came as I did research on the subject of the history of anatomical dissection for a seminar I was preparing to give.  Coming across a series of historical sketches of medieval anatomy lessons, I reflected on the position of the instructor, center stage in the lecture theater, and how remarkably similar the scene appeared to my own undergraduate lessons.  All at once a thought occurred to me; could the reason that didactic lectures in academia are the norm simply be because that was the way it had always been done?  The modern university architecture can be traced back to the University of Bologna, founded in 1088, more than 300 years prior to the development of the first printing press in Europe.  In a time predating the ability to mass produce textbooks, it follows that the most efficient means of disseminating knowledge would be for students to transcribe their own personal notes as professors lectured from a master text.  Even with affordable access to textbooks, there has, until recently, be little reason to reevaluate the didactic teaching approach.

But take a look at the technological advances over the past few decades.  Thinking back 20 years to my freshman year in college, Windows 95 had just been released, Netscape Navigator allowed me to surf the net for the first time, and I was introduced to the concept of email.  Not one of my professors was making use of PowerPoint, and it would be another full decade before the terms Wikipedia, Facebook, Twitter, and YouTube would enter the vernacular.  Technology has taken giant leaps forward over this time, but while most of us have happily embraced technology within the classroom, we cling stubbornly to traditional pedagogy.  I believe it is time to reevaluate the methods by which we teach and open our minds to new teaching possibilities that only recently have become practical approaches to higher education in large classroom settings.

The Flipped Classroom

One approach that shows particular promise is that of the flipped classroom.  The concept was first developed by independent groups in the late 1990’s (1-3) and popularized by Salman Khan in the mid 2000’s.  In a traditional classroom setting, students attend lectures conducted by course instructors, then use out of class time to independently review the material and complete activities or homework related to the class content.   In a flipped classroom approach, lecture content is presented prior to class in the form of pre-class readings or pre-recorded podcast videos and the classroom session incorporates group activities related to the subject material viewed prior to class time.  In this new approach, the instructor’s role changes from the “Sage on the Stage” to a “Guide on the Side”, directing students as they complete higher-level learning in-class activities.

The concept of a flipped classroom is novel, but gaining in popularity.  A decade ago, the feasibility of creating a series of video podcasts was daunting for most professors, and the means of distributing this work to an entire class even more so.  Only in the last few years has technology with regard to recording software and internet uploading progressed to the point that delivering lectures outside of the classroom has become a practical approach to teaching.  There are numerous advantages to the flipped classroom.  While the initial production of video podcasts is laborious and time consuming, post-production editing allows the instructor to provide students with a high quality end product free of awkward pauses and errors.  It also allows the student to view the podcast at a convenient time and to control the flow of the lecture.  Playback speed can be slowed for students struggling to keep up with the material or sped up for students knowledgeable in the field or as a review of the material prior to a test or exam.  Rather than timing bathroom breaks around their class schedules, or struggling to maintain focus for the full duration of a 50 minute lecture, students can pause the recording whenever they need to take a break.  Rather than interrupting a live lecture to ask a professor to repeat or elaborate on part of the content, students can rewatch segments of the lecture multiple times and bring questions to class for the active phase of the lesson.  Students also have direct access to classmates and course instructors during the active phase of learning for clarification of difficult concepts, rather than struggling to complete the assignment independently and often incorrectly.

The principle caveat with the flipped classroom approach is with design of the in-class content.  Instructors place a great deal of effort in development of the podcasts, but if sufficient forethought and effort are not put into the in-class phase, the active learning opportunity is squandered, leading students to question the necessity for a flipped classroom design in the first place. Instructors considering the flipped classroom approach should explore a variety of other pedagogies that can be incorporated into the in-class phase of the flipped classroom.  PBL, CBL, and TBL approaches can all be modified to fit into the flipped classroom setting with positive results.

My Flipped Classroom Experience

glasses-272399_1280My first foray into the flipped classroom approach occurred this past fall, in a clinical anatomy course offered to both medical and allied health students in the first semester of their professional studies.  The course has traditionally posed a challenge because of the varied experiences of the incoming students.  The content must cover basic anatomical concepts and move at an appropriate pace for students with little to no anatomical background, but also introduce advanced concepts to challenge and motivate students with an extensive background in anatomy.  Prerecorded video podcasts work well with this diverse group, as each student can move through the content at their own pace.  For the in-class phase, the majority of class was occupied with a clicker based active learning exercise that incorporated both individual and group learning exercises.  Students were presented with a series of multiple choice questions involving clinical scenarios related to the anatomical principles discussed in the video podcasts.  There were 3 separate phases for each question.  In the first phase, students used their clickers to answer the question independently without discussion, applying their knowledge of the relevant anatomy.  Once the polling was closed, students were shown the results of the poll, but not the correct answer.  In the second phase, the question was reposed, with the students discussing the answer options with their surrounding peers.  Although each student still answered independently, they now had the benefit of input from their classmates to reach their decisions.  At the end of the second phase of polling, the updated poll results were shown, followed by the correct answer to the problem.  In the third reflective phase, the rationale for the correct answer was summarized and lingering questions addressed, incorporating student responses wherever possible.  At the satisfactory conclusion of the third phase, another question was presented and the cycle repeated.

As this was the first time experimenting with a flipped classroom approach, I collected a large amount of data on test performance and student perceptions that I am in the process of analyzing.  Of encouragement was the finding that the students generally performed better on tests following a flipped class approach as compared to a traditional didactic setting.  Of particular interest is the type of questions the students improved upon.  Prior to data analysis, I went through tests from both the present year and the previous year, when I taught the class using a didactic approach.  I first flagged all questions appearing on both sets of tests, then classified these questions as basic rote memory, as advanced application, or as not falling definitively into either category.  Test scores on basic rote memory and advanced application questions were compared between the two groups of students.  In both the didactic and flipped classroom sessions, students scored higher in the basic rote memory compared to the advanced application questions.  When comparing between the groups, however, there was little difference in scores on the basic rote memory style questions, but students in the flipped classroom group scored significantly higher on advanced application questions when compared to students in the didactic lecture group.  These results suggest that while students are very good at memorizing details from their textbooks, they struggle with the application of knowledge (in this case, with clinical scenarios), and that the flipped classroom approach that was used helped specifically with this area of comprehension.

Student surveys also provided interesting insights into perceptions of my attempt at a flipped classroom approach.  In response to a survey distributed following completion of the course, 75% of students polled reported preferring the flipped classroom approach compared to traditional didactic lectures, compared to 20% who preferred didactic lectures.  Students also seemed to recognize and agree with the proposed benefits of a flipped classroom approach.  80% of students polled agreed that the flipped classroom approach allowed them to better apply their knowledge of anatomy to clinical situations when compared to a traditional didactic approach.  70% agreed that, at the conclusion of the course, they had a better understanding of anatomical principles because of the flipped classroom approach, compared to less than 10% who disagreed with this statement.  In the comment section of the survey, students appreciated having control over the pace of the lecture.  Students reported pausing the lecture at regular intervals in order to refocus their attention or to use external sources to help clarify confusing concepts, and feeling more engaged than during traditional didactic classroom lectures.  Students also reported that having completed the video podcast in advance made classroom and laboratory sessions more productive, as they had ample time to reflect upon the concepts.

Without question, the single most cited limitation to the flipped classroom approach was the perceived time commitment.  Nearly 90% of students polled agreed that the flipped classroom approach required a greater time commitment compared to didactic lectures, while only 5% of students disagreed with this statement.  This was, in large part, due to the fact that many of the podcasts ran well over an hour.  While generating the podcasts, I was only too aware that I was no longer restricted to the 50 minute time constraints of scheduled class sessions and the need to rush the last few slides to cover the material.  Put simply, I let this new found freedom go to my head, and made the podcasts as long as I deemed necessary to explain the material.  If I could offer one piece of advice to colleagues considering a flipped classroom approach, keep your podcasts short, if you wish to minimize student animosity.  With preplanning and video editing to remove unnecessary pauses, a standard 50 minute lecture can be presented in less than 45 minutes.

Another factor that contributed to the time drain was that most students reported frequently pausing the recording to digest what was being said, which could inflate viewing time by as much as three-fold.  It’s important to note, however, that the reason for this time inflation was that students were taking the time to comprehend the material being presented.  Compare this to a didactic lecture, where students can easily fall behind the pace of the lecture and spend an equivalent amount of time outside of class reviewing their notes to understand the content.  As one student reflected, “Sometimes it seemed more time consuming to have the lectures to watch every evening.  I feel, however, compared to other classes, that I did not need to put in nearly as much additional study time.”

The flipped classroom is one of a number of pedagogies emerging to challenge the practicality of the didactic approach to learning.  With the development of different classroom technologies, instructors should be encouraged to explore a variety of pedagogies and consider their incorporation into the various courses they teach.  The choice of approach depends on the content of the course and the teaching style of the instructor.  Forcing a professor to adopt a pedagogy that they are resistant to is likely to prove disastrous.  But instructors should be encouraged to keep open minds and not be afraid to try new approaches to teaching.  We owe this much to our students, as well as our profession.


  1. Lage, M. Platt, G. and Treglia, M. (2000), Inverting the Classroom: A gateway to Creating an Inclusive Learning Environment. Journal of Economic Education, v31 n1 p30-43.
  2. King, A. (1993), From Sage on the Stage to Guide on the Side. College Teaching, v41 n1 p30-35.
  3. Baker, J.W. (2000), The “Classroom Flip”: Using Web Course Management Tools to Become the Guide by the Side. Selected Papers from the 11th International Conference on College Teaching and Learning, 9-17.

PECOP picture  Inglis

Stuart Inglis is a Professor of Basic Biomedical Sciences with the Sanford School of Medicine at the University of South Dakota, and serves as director of medical anatomy laboratories at the university. He received an undergraduate degree in kinesiology from McMaster University, a MSc in exercise physiology from the University of Western Ontario, and a PhD in Biological Sciences from Ohio University, with a research focus on morphological changes to skeletal muscle tissue in response to different forms of exercise. He is in a teaching faculty position at USD, teaching anatomy and musculoskeletal medicine to medical students, as well as OT, PT, PA, and undergraduate coursework. He is also involved in developing an anatomical museum at USD, advising medical students in research projects on anatomical variants, and with exercise physiology research with the Kinesiology and Sport Sciences program.