Monthly Archives: February 2019

Motivational Interviewing in Higher Education

Motivational interviewing (MI) originated in Norway in the early 1980s by psychotherapists who began to use this principle to treat patients with drinking difficulties.  He suggested one “could use empathetic listening to minimize resistance and increase motivation for change” 1. The methodology was further developed, revised and expanded 2, 3 by William Miller and fellow clinical psychologist Stephen Rollnick to elicit change behavior using intrinsic motivation to overcome resistance and ambivalence.

MI has gained greater popularity with it’s expansion from treatment of addiction by psychologists to healthcare providers working to elicit change health-related behaviors such as smoking cessation, exercise and healthy eating habits.  This is where I first encountered MI.  The outpatient physical therapy clinic where I was working offered a continuing education class for physical and occupational therapists to learn MI principles, conversation and listening (especially listening) skills to elicit change behavior in our patients.  Most of our patients are motivated to perform their home exercise program and implement lifestyle modifications, if necessary, to help in pain management and improving function.  However, as in the classroom, there always seems to be 1 or 2 patients on your schedule where it feels like pulling teeth to get them involved and motivated to participate.

During the 2-day MI course, we practiced reflective and empathetic listening skills and learned how to drive a conversation so the patient is the one doing most of the talking.   I worked to expand these new skills with my patients in the PT clinic.  It was harder than I anticipated to withhold my opinion on how I thought various obstacles could be overcome or ways my patients could make time in their day to do their home exercise program.  However, what emerged was a patient-driven conversation where they devised ways to make behavioral changes and I felt like I was doing less work.  Woah.

I split my time between treating patients as a PT in an outpatient PT clinic and being a PhD student.  For many reasons I love this split in my roles, but one of the best parts is experiencing how what I learn in one environment influences my actions in the other.  In my role as a lab instructor, discussion leader and eventually sole instructor on campus, one of my biggest challenges was knowing how far to go to reach out to the seemingly disengaged or apathetic students.  I felt responsible for their learning, I wanted them to get the most out of the short time we spent together in the classroom and I wanted them to have a positive experience.  At the same time, I recognized that I cannot make a student learn.  It was unclear to me how far I should be reaching, how often should I pull them into the conversation and really, how to manage the less well-engaged students.

I made use of the many wonderful people and resources available to me to better understand how others dealt with similar experiences and feelings.  I also started to think about how I handle the patients in the PT clinic that are there “because my doctor sent me”, at least on the surface don’t seem to want to be there and take few actions to help themselves resolve their pain.   And then the thought, “why not use MI strategies in the classroom”, came to me.  While MI is continually evolving over time with its ongoing expansion into more disciplines, to me, MI is a style of listening (really listening) and questioning to facilitate change behaviors by working with the other person to identify their intrinsic motivation.  And many of the keywords used to describe MI are words that have also been used to describe high-quality pedagogical techniques such as collaboration, empathy, autonomy and promoting self-efficacy.

After a few reflective listening conversations, what followed was not a miracle transformation of student behavior.  However, I gained a much better understanding of the student’s situation from her perspective, with many layers of complexity built in, and was able to give that student what she needed at that moment in time – which did not involve getting an A in that class.  We were now on the same page.  I felt so much better about the situation and I lost the guilt and stress over not being able to improve participation in the seemingly unengaged student in the back of the class.  This student seemed to also feel more comfortable in class and with me.  She did not pass that class, but it was what she needed to do at that time.  She took the class again over the summer, when her personal life allowed her to succeed in the classroom, with a high level of engagement throughout the term.  It was a huge win for both of us – she was eventually successful in the classroom and I felt good about meeting her where she was on that path to success.

I certainly am not the only one who has thought to transfer MI strategies from the healthcare setting to the classroom.  In fact, Harvey Wells and Anna Jones have recently published a couple papers on the theoretical basis4 and practical application5 of using MI in higher education classrooms.  They argue that using MI in higher education classrooms can lead to student-teacher collaboration, facilitate building self-efficacious behaviors in students and establish a student-driven pathway to change4.  After all, isn’t learning a non-linear process of change?  Why not couple that process with a set of useful techniques educators can use to see the change they want to see in students?

To be sure, there are challenges associated with taking a method or style of communication from one discipline and adapting it to another.  Certainly, empathetic and reflective listening practices can easily lead to a greater emotional involvement, yet as Wells & Jones4 have described, “education is not (nor should be) therapy”.  Using MI strategies should not be viewed as a mechanism to “treat” a student, but rather as a tool to foster change within a student and help educators to understand where they need to meet the student, so they can walk along the same path instead of pushing against each other.

While empirical evidence is needed to determine the effectiveness of using MI in higher education, given my own use of and success with MI, I can foresee MI practices becoming more prevalent in higher education as a mechanism to identify student-driven goals with a pathway for educators and students to collaboratively meet those goals.  I encourage you to do a little reading on MI practices.  At a minimum it will make you a better listener.

 

References

1) Rollnick, S. and Allison, J. (2004). Motivational Interviewing. In The Essential Handbook of Treatment and Prevention of Alcohol Problems. (105-116). Chapter 7: West Sussex, England: John Wiley & Sons, Ltd.

2) Miller, W.R. and Rollnick, S. (1991). Motivational interviewing: Preparing people for change. New York, NY: Guilford Press.

3) Miller, W.R. and Rollnick, S. (2013). Motivational Interviewing: Helping people change, 3rd edition. New York, NY: Guilford Press.

4) Wells, H. and Jones, A. (2018). Learning to change: the rationale for the use of motivational interviewing in higher education, Innovations in Education and Teaching International, 55:1, 111-118.

5) Wells, H., Jones, A. and Jones, S.C. (2014). Teaching reluctant students: using the principles and techniques of motivational interviewing to foster better student-teacher interactions, Innovations in Education and Teaching International, 51:2, 175-184.

 

Katie Kolwaski completed her BS and DPT from the University of Wisconsin – Madison.  After practicing as a full-time PT for 4 years, she decided to pursue further education at the University of Oregon.  In 2017, she finished a MS degree in Muscle Physiology and then transitioned into the Neurophysiology lab for her PhD, studying the impact of mental fatigue on neuromuscular function in older adults and the potential role of physical activity in modulating that relationship.  Katie has since moved to the University of Western Ontario in the great white north in order to finish her PhD.  She continues to treat patients as a PT and teach students within the Physio school in London, ON as a TA.
It was Just a Bag of Candy, but Now It’s a Lung – Don’t Be Afraid to Improvise When Teaching Physiology

Many of us have been teaching the same course or the same topic in a team-taught course for many years.  I have been teaching the undergraduate Anatomy and Physiology-II (AP-II) course at a community college for four years.  People often ask, “Doesn’t it get old?  Don’t you get bored, teaching the same topic?”  Without hesitation, I answer, “No.” Why?  First, on-going research continually brings new details and insight to nearly every aspect of cell and integrative physiology.  You’re always learning to keep up with the field and modifying lectures to incorporate new concepts.  Second, you truly want your students to learn and enjoy learning and continually seek out ways to teach more effectively.  You try new approaches to improve student learning.  However, the third reason is truly why teaching physiology will never get old or dull.  No two students and no two classes are alike; individual and collective personalities, career goals, academic backgrounds and preparedness, and learning curves vary from class to class.  About half my students have not taken the general biology or chemistry courses typically required for AP-I or AP-II (these are not required by the college).  The unique combination of characteristics in each group of students means that on any given day I will need to create a new makeshift model or a new analogy for a physiological mechanism or structure-function relationship to help students learn.  Thus, even if all physiological research came to complete fruition, the teaching of physiology would still be challenging, interesting, and entertaining.  Many of my peers share this perspective on teaching physiology.

Irrespective of one’s mastery of integrative physiology, as teachers we must be ready and willing to think creatively on our feet to answer questions or clarify points of confusion.  A common mistake in teaching is to interpret the lack of questions to mean our students have mastered the concept we just explained, such as the oxygen-hemoglobin dissociation curve.  Despite the amazing color-coding of green for pH 7.35, red for pH 7.0 and blue for pH 7.5 and perfectly spaced lines drawn on that PowerPoint slide, your Ms./Mr. Congeniality level of enthusiasm, and sincerest intentions – you lost them at “The relationship of oxygen saturation of hemoglobin to the partial pressure of oxygen is curvilinear.”  You know you lost them.  You can see it in their faces.  The facial expression varies: a forehead so furrowed the left and right eyebrows nearly touch, the cringing-in-pain look, the blank almost flat stare, or my favorite – the bug-eyed look of shock.  Unfortunately, it will not always be obvious.  Thus, it is essential we make an effort to become familiar with the class as a group and as individuals, no matter how large the class.  Being familiar with their baseline demeanor and sense of humor is a good start.  (I have students complete ‘Tell Me About Yourself’ cards on the first day of class; these help me a great deal.)  During lecture, we make continual and deliberate eye contact with the students and read their faces as we lecture and talk to them, rather than at them.  In lab we work with and talk to each group of students and even eavesdrop as a means to assess learning.  Time in class or lab is limited, which tempts us to overlook looks of confusion and move on to the next point.  However, when students do not accurately and confidently understand a fundamental concept, they may have even greater difficulty understanding more integrated and complicated mechanisms.  You must recognize non-verbal, as well as subtle verbal cues that students are not following your logic or explanation.  In that immediate moment you must develop and deliver an alternative explanation.  Improvise.

As per Merriam-Webster, to improvise is to compose, recite, play, or sing extemporaneously; to make, invent, or arrange offhand; to fabricate out of what is conveniently on hand.  What do you have on hand right now to create or develop a new explanation or analogy?  Work with what you have within the confines of the classroom.  These resources can be items within arm’s reach, anything you can see or refer to in the classroom.  You can also use stories or anecdotes from your own life.  Reference a TV commercial, TV show, movie, song, or cartoon character that is familiar to both you and your students.  Food, sports, and monetary issues can be great sources for ideas.  I cook and sew, which gives me additional ideas and skills.  Play to your strengths.  Some people are the MacGyvers of teaching; improvisation seems to be a natural born gift.  However, we all have the basic ability to improvise.  You know your topic; you are the expert in the room.  Tap into your creativity and imagination; let your students see your goofy side.  Also, as you improvise and implement familiar, everyday things to model or explain physiological or structure-function relationships you teach your students to think outside the box.  Students learn by example.  My own undergraduate and graduate professors improvised frequently.  My PhD and post-doc advisors were comparative physiologists – true masters of improvised instrumentation.

Improvise now, and improve later.  Some of my improvised explanations and demonstrations have worked; some have fallen flat.  In some cases I have taken the initial improvised teaching tool and improved the prototype and now regularly use the demonstration to teach that physiological concept.  Here are three examples of improvisational analogies I have used for the anatomy of circular folds in the intestine, the opening and closing of valves in the heart, and the role of alveoli in pulmonary gas exchange.  Disclaimer:  These are not perfect analogies and I welcome comments.

Surface area in the small intestine.  Students understand that the surface area of a large flat lab table is greater than the surface area of a flat sheet of notebook paper.  A sheet of paper can be rolled into a tube, and students understand that the surface area of the ‘lumen’ is equal to the surface area of the paper.  In AP-I, students learned that microvilli increase the surface area of the plasma membrane at the apical pole of an epithelial cell, and many teachers use the ‘shag carpet’ analogy for microvilli.  Similarly, they understood how villi increase surface area of the intestinal lumen.  However, some students did not quite understand or cannot envision the structure of circular folds.  As luck would have it, I was wearing that style of knit shirt with extra-long sleeves that extend just to your fingertips.  I fully extended the sleeve and began to explain. “My sleeve is the small intestine – a tube with a flat-surface lumen (my arm is in the lumen) – no circular folds.  This tube is 28 inches long and about 8 inches around.  As I push up my sleeves as far as I can, and the fabric bunches up.  These messy folds that form are like circular folds.  And, now this 6 inch tube with all these circular folds has the same surface area as the 28-inch plain tube.”  (I sew; I know the length of my own arm and am great at eyeballing measurements.)

Heart valves open and close as dictated by the pressure difference across the valve.  This is integral to ventricular filling, ejection of blood into the lung and aorta, and the effect of afterload.  Heart valves are one-way valves.  A few students heard ‘pressure difference’ and were lost.  Other students had trouble understanding how stroke volume would decrease with an increase in afterload.  What can I use in the room?  There’s a big door to the lab, and it has a window.  It opens in one direction – out, because of the doorframe, hinges and door closure mechanism; it only opens, if you push hard enough.  I ran over to the door.  “The lab door is a heart valve.  It’s the mitral valve, the lab is the atrium, and the hallway is the ventricle.  The door only opens into the hall – the mitral valve only opens into the ventricle.  When it closes, it stops once it sits in the frame.”  I asked a student about my size to go outside the room, and push against the door closed – but let me open it; she could see and hear me through the window.  “As long as I push with greater force than she applies to keep it shut, the door or valve will open.”  The student played along and made it challenging, but let me open the door.  ‘Blood flows from the atrium into the ventricle, as long as the valve is open.  But, as soon as the pressure in the ventricle is greater than the pressure in the atrium the valve closes.”  The student forcefully pushed the door shut.  They got it!  Now, afterload …?  Back to the lab door.  “Now the lab door is the aortic valve, the lab is the left ventricle, and the hall is the aorta.  This valve will open and stay open as long as the pressure in the ventricle is greater than the pressure in the aorta.  The longer the valve is open, the greater the volume of blood ejected from the ventricle.  The volume of blood ejected from the ventricle in one beat is the stroke volume.  The pressure that opposes the opening of the aortic valve is afterload.  What happens with afterload?”  I then asked the tallest, strongest student in class to play the role of Afterload; he too got into the role.  “Afterload has now increased!  The pressure that opposes the opening of the valve has increased.  Will I or won’t I have to push harder to open the door – now that afterload has increased?”  The student is very strong; I can barely push the door open.  “I not only have to push harder, but I can’t keep the door or valve open for very long.  Look.  Even though the ventricle pressure is greater, the valve is open for a shorter period – so less blood is ejected and stroke volume decreases.”

Alveoli increase the surface area for gas exchange.  Students see the lungs as 2 large sacs, and the surface area available for gas exchange between air and blood is simply the inner lining of each sac.  However, each lung is made of millions of tiny air sacs or alveoli into which air flows.  How this anatomical arrangement greatly increases surface area for gas exchange is not intuitively obvious.  The overall size of the lung does not increase, so why would the surface area increase?  As luck would have it, it was Halloween.  I had brought a big bonus bag of individually wrapped bite-size candies to class.  “One lung is like this bag.  If we cut open the bag and measure the sheet of plastic, it would be about 18 inches by 12 inches or 216 square inches.  But if we completely fill it with candy, it might hold at least 150 pieces of candy.”  I quickly unwrapped one piece of candy, held up the wrapper, and estimated a single wrapper was 4 square inches.  “If we fill one bag with 150 pieces of candy, we then have 600 square inches of surface area.  Which would provide greater area for gas exchange: one big lung or millions of alveoli?”  I revised this particular improvised explanation using scissors, a ruler and two 11-oz bags of Hershey’s® kisses.  I carefully opened both bags and transferred kisses from one bag to the other, until it was completely full, i.e., 112 kisses, and taped it shut.  I then fully opened up the other bag; it was 10 inches x 8 inches or 80 square inches.  An individual kiss wrapper is 4 square inches; all 112 individual wrappers are 448 square inches.

My improvised analogies are not perfect, but they have served as great teaching tools.  If you can improve upon these, please do.  Share any suggestions you have and lastly, share your improvised explanations and analogies.  Thanks.

Alice Villalobos received her B.S.in biology from Loyola Marymount University and her PhD in comparative physiology from the University of Arizona-College of Medicine.  She has been in the Department of Biology at Blinn College for 4 years where she teaches Anatomy and Physiology II and Introduction to Human Nutrition.  She guest lectures in undergraduate courses at Texas A&M University on the topics of brain barrier physiology and the toxicity of heavy metals.
Mentoring Mindsets and Student Success

There are numerous studies showing that STEM persistence rates are poor (especially amongst under-represented minority, first-generation, and female students) (1-2). It is also fairly broadly accepted that introductory science and math courses act as a primary barrier to this persistence, with their large class size. There is extensive evidence that first-year seminar courses help improve student outcomes and success, and many of our institutions offer those kinds of opportunities for students (3). Part of the purpose of these courses is to help students develop the skills that they need to succeed in college while also cultivating their sense of community at the university.  In my teaching career, I have primarily been involved in courses taken by first-year college students, including mentoring others while they teach first-year courses (4). To help starting to build that sense of community and express the importance of building those college success skills, I like to tell them about how I ended up standing in front of them as Dr. Trimby.

I wasn’t interested in Biology as a field when I started college. I was going to be an Aerospace Engineer and design spaceships or jets, and I went to a very good school with a very good program for doing exactly this. But, college didn’t get off to the best start for me, I wasn’t motivated and didn’t know how to be a successful college student, so my second year of college found me now at my local community college (Joliet Junior College) taking some gen ed courses and trying to figure out what next. I happened to take a Human Genetics course taught by Dr. Polly Lavery. At the time, I didn’t know anything about Genetics or have a particular interest, I just needed the Natural Science credit. Dr. Lavery’s course was active and engaged, and even though it didn’t have a lab associated with it we transformed some E. coli with a plasmid containing GFP and got to see it glow in the dark (which, when it happened almost 20 years ago was pretty freaking cool!). This was done in conjunction with our discussions of Alba the glow-in-the-dark rabbit (5). The course hooked me! I was going to study gene therapy and cure cancer! After that semester, I transferred to Northern Illinois University and changed my major to Biology.

So, why do I bring this up here? When I have this conversation with my undergraduate students, my goal is to remind them that there will be bumps in the road. When we mentor our students, whether it be advisees or students in our classes, it is important to remind them that failure happens. What matters is what you do when things do go sideways. That is really scary for students. Many of our science majors have been extremely successful in the lead up to college, and may have never really failed or even been challenged. What can we do to help our students with this?

First of all, we can build a framework into our courses that supports and encourages students to still strive to improve even if they don’t do well on the first exam. This can include things like having exam wrappers (6)  and/or reflective writing assignments that can help students assess their learning process and make plans for future assessments. Helping students develop self-regulated learning strategies will have impacts that semester (7) and likely beyond. In order for students to persevere in the face of this adversity (exhibit grit), there has to be some sort of hope for the future – i.e. there needs to be a reasonable chance for a student to still have a positive outcome in the course. (8) This can include having a lower-stakes exam early in the semester to act as a learning opportunity, or a course grading scale that encourages and rewards improvement over the length of the semester.

Secondly, we can help them to build a growth mindset (9), where challenges are looked forward to and not knowing something or not doing well does not chip away at someone’s self-worth. Unfortunately, you cannot just tell someone that they should have a growth mindset, but there are ways of thinking that can be encouraged in students (10).

Something that is closely tied to having a growth mindset is opening yourself up to new experiences and the potential for failure. In other words being vulnerable (11). Many of us (and our students) choose courses and experiences that we know that we can succeed at, and have little chance of failure. This has the side effect of limiting our experiences. Being vulnerable, and opening up to new experiences is something important to remind students of. This leads to the next goal of reminding students that one of the purposes of college is to gain a broad set of experiences and that for many of us, that will ultimately shape what we want to do, so it is okay if the plan changes – but that requires exploration.

As an educator who was primarily trained in discipline-specific content addressing some of these changes to teaching can be daunting. Fortunately there are many resources available out there. Some of them I cited previously, but additional valuable resources that have been helpful to me include the following:

  • Teaching and Learning STEM: A Practical Guide. Felder & Brent Eds.
    • Covers a lot of material, including more information of exam wrappers and other methods for developing metacognitive and self-directed learning skills.
  • Cheating Lessons: Learning from Academic Dishonesty by Lang
    • Covers a lot relating to student motivation and approaches that can encourage students to take a more intrinsically motivated attitude about their learning.
  • Rising to the Challenge: Examining the Effects of a Growth Mindset – STIRS Student Case Study by Meyers (https://www.aacu.org/stirs/casestudies/meyers)
    • A case study on growth mindset that also asks students to analyze data and design experiments, which can allow it to address additional course goals.

 

  1. President’s Council of Advisors on Science and Technology. (2012). Engage to excel: Producing one million additional college graduates with degrees in science, technology, engineering and mathematics. Washington, DC: U.S. Government Office of Science and Technology.
  2. Shaw, E., & Barbuti, S. (2010). Patterns of persistence in intended college major with a focus on STEM majors. NACADA Journal, 30(2), 19–34.
  3. Tobolowsky, B. F., & Associates. (2008). 2006 National survey of first-year seminars: Continuing innovations in the collegiate curriculum (Monograph No. 51). Columbia: National Resource Center for the First-Year Experience and Students in Transition, University of South Carolina.
  4. Wienhold, C. J., & Branchaw, J. (2018). Exploring Biology: A Vision and Change Disciplinary First-Year Seminar Improves Academic Performance in Introductory Biology. CBE—Life Sciences Education, 17(2), ar22.
  5. Philipkoski, P. RIP: Alba, The Glowing Bunny. https://www.wired.com/2002/08/rip-alba-the-glowing-bunny/. Accessed January 23, 2019.
  6. Exam Wrappers. Carnegie Mellon – Eberly Center for Teaching Excellence. https://www.cmu.edu/teaching/designteach/teach/examwrappers/ Accessed January 23, 2019
  7. Sebesta, A. and Speth, E. (2017). How Should I Study for the Exam? Self-Regulated Learning Strategies and Achievement in Introductory Biology. CBE – Life Sciences Education. Vol. 16, No. 2.
  8. Duckworth, A. (2016). Grit: The Power of Passion and Perseverance. Scribner.
  9. Dweck, C. (2014). The Power of Believing that you can Improve. https://www.ted.com/talks/carol_dweck_the_power_of_believing_that_you_can_improve?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare
  10. Briggs, S. (2015). 25 Ways to Develop a Growth Mindset. https://www.opencolleges.edu.au/informed/features/develop-a-growth-mindset/. Accessed January 23, 2019.
  11. Brown, B. (2010). The Power of Vulnerability. https://www.ted.com/talks/brene_brown_on_vulnerability?language=en&utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare
Christopher Trimby is an Assistant Professor of Biology at the University of Delaware in Newark, DE. He received his PhD in Physiology from the University of Kentucky in 2011. During graduate school he helped out with teaching an undergraduate course, and discovered teaching was the career path for him. After graduate school, Chris spent four years teaching a range of Biology courses at New Jersey Institute of Technology (NJIT), after which he moved to University of Wisconsin-Madison and the Wisconsin Institute for Science Education and Community Engagement (WISCIENCE – https://wiscience.wisc.edu/) to direct the Teaching Fellows Program. At University of Delaware, Chris primarily teaches a version of the Introductory Biology sequence that is integrated with General Chemistry and taught in the Interdisciplinary Science Learning Laboratories (ISLL – https://www.isll.udel.edu/). Despite leaving WISCIENCE, Chris continues to work on developing mentorship programs for both undergraduates interested in science and graduate students/post-docs who are interested in science education. Chris enjoys building things in his workshop and hopes to get back into hiking more so he can update his profile pic. .