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.

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