One of the primary factors that attracted me to my current position, a tenure-track Assistant Professor of Biology at a small teaching-intensive liberal arts college, was the fact that my new department gave me the freedom to update and, in the end, completely overhaul the existing Anatomy and Physiology (A&P) curriculum. This position allowed great academic freedom, especially to a new professor, and department support for trying new teaching strategies and activities was, and still is, very high. So as a new entrant into the field of physiology education, and as someone who is interested in pedagogical research, this opportunity and level of freedom excited me.

My predecessor, while a fantastic educator, had built the year-long A&P sequence in the traditional form of one to two weeks on a specific topic (e.g. histology, the skeletal system, or the respiratory system) and an exam every so often that combined the previously covered topics. Both the topics covered and the exams could very much stand on their own, and were more like separate units. This course design was exactly the way I took the A&P course, longer ago than I care to admit, although at a different institution. In fact, most of my college courses were taught this way. And while that may be appropriate for some fields, the more I was reading and learning about teaching A&P the more I was starting to convince myself that I wanted teach A&P in an integrated fashion as soon as I got the chance.

So here I was, the bright-eyed and bushy-tailed newly minted Assistant Professor of Biology, with the academic freedom to teach A&P in the best way that I saw fit. One important thing to note: this course sequence (A&P I and II) is an upper-division junior and senior level course at my college, and class sizes are very small (20-24 students) allowing for maximum time for interaction, questions, and instructor guidance both in lecture and lab. (That latter point is key, but we’ll talk more about that in a minute.)

I entered the 2017-2018 academic year with a brand-new, shiny, exciting, and most importantly, integrated A&P course plan and a lot of enthusiasm. Along the way I took meticulous notes on what worked, what didn’t work, and the areas that needed improvement. Now in the 2018-2019 academic year I’m teaching this integrated course sequence for the second time, all while taking those same meticulous notes and comparing student feedback. Below I’ve compiled what I deem (so far) to be some of the most important lessons that I learned along the way:

 1) Use an integrative textbook.

This I was fortunate to do from the start. While this is an A&P course (not just P), I decided to use Physiology: An Integrated Approach by Dee U. Silverthorn as my primary text. Not only is the book already designed to be used in an integrative fashion, but there is ample introductory material which can be used to remind students of previous course material that they need to know (see lesson #2 below) and there are entire chapters dedicated to the integration of multiple systems (e.g. exercise). The assessment questions in the text are also well organized and progressive in nature and can be assigned as homework for practice or pre-reading assignments. Anatomy information, such as the specifics of the skeletal system and joints, muscles, histology, etc., was supplemented through the use of models and other reference material in hands-on lab activities.

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

There are two important parts to this lesson: A) previous course knowledge that is applicable to this upper-division A&P course, and B) the new A&P material itself.

In my initial run of the course I made the mistake of starting out at a bit too advanced of a content level. I assumed more knowledge was retained from previous courses by the students than actually was. I learned very quickly that I needed to take a step back, but not too far. Instead of re-teaching introductory chemistry, biology, and physics, I took the opportunity to remind them of the relevant key principles (e.g. law of mass action) and then pointed them to pages in the text or provide additional material where they could review.

I applied this same philosophy as we progressed through new material. Lower-order Bloom’s principles should be assessed and mastered first, before progressing to the higher-order skills for each new section. In my second iteration of the course I implemented low-stakes (completion-based grade) homework assignments to be completed before the class or lab period, which were aimed to get a head-start on the lower-order skills. Then in class we reviewed these questions within the lecture or lab and added on with more advanced questions and/or activities. This format of pre-class homework was very well received by the students, and even though it is more work for them, they said that it encouraged them to keep up with the reading and stay-on track in the class. As the class progressed, I added in more advanced homework problems that integrated material from previous chapters. Obviously, if you are going to teach in an integrated fashion then you will need to assess the students in the same way, but a slow-build up to that level and ample low-stakes practice is key.

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

This lesson holds true for just about any course, but I found it especially true for an integrated A&P course. As an instructor, not only did I need to be well versed in A&P, but I also needed to see the big picture and connect concepts and ideas both during the initial course construction and as the course progressed. I went into the course with an idea of what I wanted (and needed) to cover and during the course students helped guide what topics they struggled with and/or what they wanted to learn more about. So while still sticking to covering the basics of a course, I was still able to dive a bit deeper into other topics (such as exercise) per student interest. This also helped boost motivation for student learning when they feel they have some agency in the material.

Another aspect of the lesson is the addition of what I call “flex days”. Students will find this style of teaching and learning challenging and some will need more time and practice with the material. I found it very helpful to add in a “flex day” within each unit where no new material was covered, but instead time was dedicated to answering questions and additional practice with the concepts. If a full class day can’t be dedicated, even 30 minutes can be put to great use and the students really appreciate the extra time and practice.

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

Students will want to revert back to what they are comfortable with and what has worked for them in the past. They will forget that information needs to be retained and applied later in the course. I found that I needed to constantly remind students that their “cram and forget” method will not serve them well in this course. But, simply telling them is not enough, so I allowed for practice problems both in and outside of class that revisited “older” material and prepared them for the unit exams with integrative questions which combined information from different chapters. I even listed the textbook chapters at the end of the question so that they would know where to find the material if needed.

Along with this, I found that tying material back to central themes in physiology (e.g. structure-function, homeostasis, etc.) also helped the students connect material. I am fortunate that the entry level biology courses at this college teach using the Vision and Change terminology, so the basic themes are not new to them, making integration at least on that level a bit more approachable.

5) Solicit student feedback.

Students love to be heard and they love to know that their input matters. And in the design of a new course I want to know what is working and what is not. I may think something is working, but the students may think otherwise. Blank notecards are my best friend in this instance. I simply have a stack at the side of the room and students can or cannot fill them out and drop them in a box. I often ask a specific question and solicit their input after an activity or particularly challenging topic. Of course, the second part of this step is actually reading and taking their input seriously. I’ve often made some last minute changes or revisited some material based on anonymous student feedback, which also ties back to lesson #3.

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

Some students are great about speaking up in class and asking questions. Other students are more comfortable asking questions outside of class time. And of course, I found that students of both flavors will think that they know a particular concept, and then find out, usually on an exam, that they do not (but that is probably not unique to an integrative course). So, after the first exam I reached out to every student inviting them to meet with me one-on-one. In these meetings we went through not only the details of the exam, but study skills. Every student needed to be reminded and encouraged to study a little bit every day or at least every other day to maximize retention and success. This also helped create an open-door policy with students who needed and wanted more assistance, increasing their comfort level with coming to office hours and asking for help.

As you may have inferred, teaching this type of course takes a lot of time. I’ll be honest and say that I wasn’t necessarily mentally or physically prepared for the amount of time it took to design and run this course, especially in my first year of teaching, but I made it work and I learned a lot. During this process I often discussed course ideas with department colleagues and A&P instructors at other universities. I perused valuable online resources (such as LifeSciTRC.org and the PECOP Blog) for inspiration and guidance. I also found that I spent a lot of time reflecting on just about every lecture, activity, and lab to ensure that the content connections were accurate, applicable, and obtainable by the students. And while I know that the course still has a ways to go, I am confident in the solid foundation I have laid for a real integrative A&P course. And, just as I am doing now with its second iteration, each run will be modified and improved as needed to maximize student learning and success, and that is what makes me even more excited!

Now I turn the conversation over to the MANY seasoned educators that read this blog. Do you have experience designing and teaching an integrated A&P course? What advice do you have for those, like me, that are just starting this journey? Please share!

Jennifer Ann Stokes is an Assistant Professor of Biology at Centenary College in Shreveport, LA. She received her PhD in Biomedical Sciences from the University of California, San Diego (UCSD). Following a Postdoctoral Fellowship in respiratory physiology at UCSD, Jennifer spent a year at Beloit College (Beloit, WI) as a Visiting Assistant Professor of Biology to expand her teaching background and pursue a teaching career at a primarily undergraduate university. Now at Centenary College, Jennifer teaches Human Anatomy and Physiology I and II (using an integrative approach), Nutritional Physiology, Medical Terminology, and Psychopharmacology. Jennifer is also actively engaged with undergraduates in basic science research (www.stokeslab.com) and in her free time enjoys cycling, hiking, and yoga.