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.

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