|The pandemic has been a time of introspection for some. The lack of places to go, people to see, and things to do has been coupled with a forced reevaluation of how we go about almost every aspect of our lives. There is also a measure of concern about what the world will look like once we exit this pandemic. Many of us who are in regular staff and faculty positions are fortunate enough to be safe and secure in our own little bubbles, and thinking about emerging from that brings with it some anxiety.
In talking through ideas for this post, my wife suggested A Christmas Carol and the idea of taking stock of my career and feelings about teaching. Where am I? Where do I want to be? Questions that we all struggle with, and questions that may have been brought to the forefront during the pandemic. Please forgive me publicly doing a little self career counseling, as well as a little license with the A Christmas Carol concept…
The Ghost of Teaching Past (Pre-pandemic):
The Ghost of Teaching Past takes the form of my 4-year Review Committee, which just submitted my letter a couple of days ago. Preparing my materials for my 4-year review, I had to sit down and reflect on both my recent work and on my long-term accomplishments since coming to University of Delaware. Before the pandemic, if I had been asked to briefly describe my teaching I’d have said it was a “work in progress”.
I was fortunate the Department of Physiology at University of Kentucky valued teaching, and that I had the mentorship of Dr. Dexter Speck (among others) to get me started on the right track as an educator. Actually getting started as a full-time college instructor in 2011 made me realize that although I was aware of what I should be doing, that didn’t really mean I knew how to actually put in practice while actually doing that job. I was thrown in the deep end, and had to do a lot of on the job learning (sorry NJIT students!). As time progressed, I figured out that I preferred to have students focus on really learning a few fundamental concepts, as opposed to conducting a whirlwind tour through everything. I began using more case studies and data in my courses, but grand plans for massive course overhauls were subsumed by the day-to-day. I still lectured a bit too much, and although I talked a lot about testing higher order concepts in my classes, we probably ended up in the border country between lower and higher more often than not. I was neither universally loved by my students nor universally despised. Somewhere in the middle of things, I suppose. But always at least vaguely improving as I learned and became more experienced.
Starting off, there was nothing in my career but the teaching. I wasn’t as involved in APS as I am currently. I had no scholarship or research of any sort. No expectations of university or professional service. Plenty of time to focus on my teaching and on my students. But then that changed. I began to get “career aspirations”. I started pursuing opportunities to be more involved in things I was interested in, beyond just the teaching, and forgot how to say no when asked to be involved in things I was maybe a little less interested in.
Maybe a bit like Scrooge, I wandered away a bit from my initial focus, in pursuit of that career. But, that is what you are supposed to do right? Get involved. Publish. Get promoted. Become well known in your field. Move into administration someday.
The Ghost of Teaching Present (Pandemic):
The Ghost of my Teaching Present takes the form of our newest puppy, Ladybird, who arrived in the opening days of quarantine. Early after we got her, she would sit on the desk and fall asleep while I taught, providing the perfect commentary on my work. Later, she would come bouncing downstairs to check-in on what was happening when she remembered that there were other people in the house, and pee on the rug at my feet if I didn’t get up and take her outside.
All summer my institution debated their fall plans, alternating between the optimism of a fully in-person semester, various versions of hybrid curricula, and being fully online. We ultimately settled on almost exclusively online, with only a handful of small and specialized courses meeting in person. The constantly changing plan made it difficult to actually move forward with preparing, both because you didn’t actually know what you were preparing for and also because just the idea of preparing for all of the potential possibilities was mentally exhausting. This led into a very difficult and dispiriting semester. I was burnt out.
Spring then proceeded in largely the same fashion, just (thankfully) without the same back and forth on in-person vs. remote course delivery plans. If this was the montage segment of the movie, you’d see the fast-forwarding of the days going by, with me sitting in slightly different places around the house, wearing slightly different college hoodies, dogs coming and going from wherever I was to see what I was doing and bark at me for not taking them for walks, and any of those days could really be any other.
This is a common story though. For many educators around the country, and around the world, it has not been a matter of IF someone will experience burn out during the last 12+ months, but WHEN. And, of course, a large portion of our ranks were already teetering on the brink of burn-out before the pandemic ever began (1,2). There are many reasons for faculty burn-out in 2020, and that has been written about extensively (3,4) – for example, did you know there is a burn-out scale? (5). For me, it was the constant time in front of the computer and the blurring of the line between work and personal time even further than it was before the pandemic. Back when things were “normal” I had a fairly long commute, but that allowed me to mentally and emotionally shift from work mode to home mode and vice versa. During the pandemic my commute has been about 15ft. We also can’t forget the overriding stress that was 2020 regardless of what you do for a living and where in the world that you are.
It was also that teaching just didn’t feel as fulfilling. I actually hated teaching towards the end of the fall 2020 semester. I didn’t look forward to classes. There was a feeling of isolation. Teaching to a computer screen full of black boxes with names, but mostly no faces. No feedback. Conversations via the chat box. Turning down letter of recommendation requests because even though I know the name, I can’t attach a face to that name, or a single interaction that I had with them. We’d gotten away from what made me like teaching in the first place.
As we catch back up, it is the middle of the spring 2021 semester. I have actually come to realize that I was starting to make better connections with students than I typically would have most semesters. Yes, I wasn’t chatting with the handful of people who sat in the front row every day anymore, but I was learning more about more of the students than I had before. And, they were learning more about me. Having the glimpse into my life through the lens of my webcam, seeing my pets and kids, all of my stuff and my wife’s stuff on the bookshelves and walls. This leads to conversations that might not have happened otherwise. For example, during an office hours appointment, one of my dogs came downstairs to bark at me, and this made the student’s dog start barking, and that led to a 20min conversation about dog adoption and training. Surprisingly, no one has said a word about the life-size Slimer from Ghostbusters that sits over my shoulder…
In class, though much of what I hear from my students is via the chat box and direct messages, I am hearing from what feels like a wider cross-section of the class. Even when teaching online there are the students who always volunteer to answer questions, but now for some questions I’ll get numerous responses all at once. I think this also helps me avoid some of my implicit biases, because I am not calling on people, but fielding what comes in. Despite being terrified to look at my course evaluations from spring and fall as part of my review process, I actually found them to be much more positive and supportive than I could have possibly imagined.
The pandemic forced me to reorganize all of my course materials so that students could largely navigate through them on their own. Since it was miserable to talk at a computer screen, I finally ditched all my lecturing and made over class time to be solely focused on working on and talking through problems, and then just-in-time teaching built off of group quizzes and surveys asking students what they needed more time/explanation. I try to be more intentional with my communication to the class, but I am still working on the whole “sending a weekly email announcement” to my classes routine.
Do I enjoy teaching again? No, not yet. But, it is better. My courses are better organized though, and I think I have gotten back on track with fully flipping my courses and being more student centered. As difficult as it was, 2020 did positively impact my teaching for the long-run. I encourage everyone to look for those positives amidst all of the negative feelings, and think about how they can carry forward to the future.
The Ghost of Teaching Yet to Come:
The Ghost of my Teaching Yet to Come doesn’t seem to have arrived yet. I don’t think it will come in quite as bleak a form as the one seen by Scrooge in A Christmas Carol though, and that in and of itself is a progress from a few months ago.
At the moment, it looks like in the upcoming fall semester we will still be online for the large class that I teach and others of that size, but moving back to in person for most (if not all) smaller classes. This means sort of a transition semester back to “normal” – but how does that transition work, and do I even want to make it?
Do I want to go back to campus? Honestly, I am not sure. But, I am definitely not as excited about it as many of my colleagues and my students. I don’t miss my office on campus, I prefer my home office. I definitely don’t miss the lecture halls that I am stuck teaching in. Of course, the feeling of a campus full of students will probably help me warm to the idea once we get back to “normal”. In the short term, I do know that I am not looking forward to teaching in person in the fall. Many of you have conquered this already, but I am not looking forward to trying to teach through a mask, or figure out how to run my new human physiology lab course with the students socially distancing.
For my big physiology course, I actually feel like I might be a better teacher online, at least when compared to being forced to teach in old, out-of-date, stadium seating lecture halls. It is easier to field responses from all of my students via chat in zoom. It is easier (at least it seems so) to have students work in small groups than it is in that cramped lecture hall, with no space for laptops, or the ability to actually turn and face each other. And, I feel less pressure to lecture since I am not spending class standing behind a lectern in an auditorium.
The pandemic has initiated a change in approach for educators – a widespread, forced adoption of technology and new teaching practices (6,7). How will the increased comfort with technology, on the part of the both teachers and students change education going forward? Now that more teachers and students have had experience with online education, will preferences shift? (8) As a parent and teacher, I’ve joked with others that there will be no more snow days because we have set up these systems to allow remote learning.
Will students want and expect more of an on demand, 24-7 approach to their courses? Will students (and parents) feel that the “college experience” is worth the extra costs associated with coming to campus, or will they flock to institutions where they can learn online wherever/whenever they want?
Or, will the future look like what I think my fall semester will look like? Big “lecture” courses online; small classes and labs in person. Many of us already taught a combination of in person and online courses before the pandemic, but will that become the norm? How much will we as educators even have a say in it?
Those are the details, but what about the big picture? As for what directions my career takes, I have even less answers. Despite the nice, neat boxes quantifying our time devoted to particular tasks on a distribution of effort report, I don’t think any of us have really figured out the proper balance between our teaching, our scholarship, our service and the rest of our lives.
May we all gain the insight of the next steps to take and emerge from this pandemic sure of our directions!
One amazing aspect of physiology is the coordinated, almost choreographed function of millions of moving parts. The body has mastered multitasking, maintaining hundreds of parameters within narrow and optimal ranges at the same time. This very aspect of physiology fuels our passion and enthusiasm for teaching physiology and piques the interests of students. The networks of numerous overt and subtle interdependent mechanisms and signaling pathways between multiple organs and tissues that regulate plasma calcium or energy intake, for example, also represent major challenges to understanding and learning physiology for students. We ask our students to combine the wisdom of two old sayings: “You can’t see the forest for the trees’, and “The devil is in the details.” They need to understand both the bigger picture of the whole animal and the nuanced interlinking of mechanisms, and even molecules, that seamlessly and dynamically maintain different parameters within narrow ranges. It can be frustrating and discouraging for students. Furthermore, passing with high marks in systems physiology or anatomy-physiology II is a criterion for eligibility to apply to various health profession programs. As educators we must acknowledge the complexity of physiology and find ways to help our students literally see and master smaller sections of the larger regulatory network so they can recreate and master the larger network.
For even the best prepared student, as well as the student who cannot take all recommended prerequisite courses for A&P-II or basic physiology, the collection of numerous parts, mechanisms, equations and connections, principles, and laws can represent an obstacle to learning. Student comments such as, “There is so much to know.”, “It’s so complicated.”, and “Physiology is hard.” are accurate and fair, but also warrant validation. A little bit of validation and communicating the challenges we encountered as students goes a long way in helping our students’ willingness to endure and continue to strive. Physiology courses are not impossible, but they are difficult and might well be the most difficult courses a student takes. I will not pretend or lie to my students. If I were to dismiss physiology as a whole or a given concept as easy and simple, I risk my student thinking they should be learning principles effortlessly or instinctively and begin to doubt themselves and give up. It helps to confess apprehensions you yourself felt when first learning various physiological concepts or phenomena. As a novice physiology student, I had many moments at which I wanted to tap out. ne major example was my introduction to the beautiful, albeit daunting display of all the electrical and mechanical events that occur in only the heart during a single cardiac cycle in just 0.8 seconds, i.e., the Wiggers diagram. Every time I project this diagram on the screen, I give students a moment to take it in and listen for the gasps or moans. I admit to my students that upon seeing that diagram for the first time I looked for the nearest exit and thought to myself, ‘Are you kiddin’ me?” Students laugh nervously. They sigh in relief when I tell them that my professor broke down the diagram one panel at a time before putting all together; his approached worked, and that is what I will do for them. Dr. Carl Wiggers was committed to teaching physiology and developed the diagram over 100 years ago as a teaching tool for medical students (1). The diagram is instrumental in teaching normal cardiac physiology, as well as pathophysiology of congenital valve abnormalities and septal defects. Nevertheless, students still need help to understand the diagram. Again, here an example of the function of just one organ, the heart, being a central element to a larger network that regulates a major parameter – blood pressure. Learning regulation of blood pressure can be an uphill battle for many students.
Cardiovascular physiology is typically a single unit in an undergraduate physiology course, and it is often the most challenging and difficult exam of the semester. Several years ago, when preparing to teach this section in an AP-II course I felt compelled to find ways to help students break-down and reconstruct pieces of complex regulation of blood pressure. I considered the many high-tech digital learning resources and online videos available to our students but wondered whether those resources help or hinder students. I was also looking for tools that would facilitate multisensory learning, which is shown to yield better memory and recall (2). Despite all these high-tech resources, I noticed students were still avid users of notecards and were convinced they held the secret to success in AP-I and thus, must also be the key to success in AP-II or systems physiology. I found this quite amusing, because we used notecards back when I was in college in the 80s – when there were no digital learning platforms and highlighters only came in yellow. Students tote around stacks of hand-written, color coded notecards that grow taller as the semester progresses, but often their comprehension and ability to connect one concept or mechanism to the next does not increase with the height of the stack. Students often memorize terms on note cards but cannot readily connect the mechanism listed on one card to that on the next card or explain the consequence of that mechanism failing. Around this time a non-science colleague was talking to me about her successful use of concept maps with her students. To me, concept maps look a lot like biochemical pathways or physiological network diagrams. It dawned on me. I did not need to reinvent the wheel or make a newer better teaching tool. I simply needed to help my students connect The Notecards and practice arranging them to better pattern regulatory networks. Students were already writing a term on one side of the card and a definition and other notes on the back. Why not build on that activity and more deliberately guide students to use cards to build a concept map of the network for regulation of blood pressure which is central to cardiovascular physiology?
Blood pressure is a physiological endpoint regulated by a nexus of autoregulatory, neural and hormonal mechanisms and multiple organs and tissues. Blood pressure is directly dependent on cardiac output, vascular peripheral resistance, and blood volume, but can be altered by a tiered network of numerous neural, hormonal and cellular mechanisms that directly or indirectly modulate any one of the three primary determinants. The expansive network, e.g., numerous organs and tissues, and multiple and intersecting effects of different mechanisms within the network, e.g., the renin-angiotensin-aldosterone system modulates both vascular resistance and blood volume) make it difficult to see the network in its entirety. Nevertheless, students must understand and master the entire network, the individual mechanisms, and the nuances. Thus, in preparing for the cardiovascular section and planning how to implement the concept map, I made a list of all components that comprised the regulatory network for blood pressure with the first terms being blood pressure, cardiac output, vascular peripheral resistance, and blood volume. At this point in the semester, the students had learned the basics of cellular respiration and metabolism. I began the very first cardiovascular lecture with an illustration of the human circulatory system projected on the screen as I worked at the white board. In the center of the board, I drew a cell with a single mitochondrion and three simple arrows to indicate the use of glucose and oxygen to convert ADP to ATP. Guided through a series of questions and answers, students collectively explained that the heart must pump blood through arteries and veins to deliver oxygen and glucose and fat needed to generate ATP, as well as to remove carbon dioxide and other wastes. Using the illustration of the human circulatory system, I then carefully explained the human circulatory system is a closed system comprised of the blood (the medium carrying oxygen, nutrients, CO2 and other wastes), the heart (the pump), and the arterial and venous vessels (the conduits in which blood flows from the heart to the tissues where oxygen and nutrients are delivered and CO2 and other wastes are removed). If adequate pressure is sustained, blood continues to flow through veins back through the heart and to the lungs to unload CO2 and reoxygenate blood and then back to the heart to make another round. I further explained blood pressure must be regulated to ensure blood flow to tissues optimally matches both metabolic need for oxygen and nutrients and production of CO2. On the board, I then wrote “Blood Pressure (BP)” and stated that because this is a closed circulatory system, blood pressure changes in direct response and proportion to cardiac output or volume of blood pumped out of heart into systemic vessels in one minute, the total volume of blood in the system, and the vascular resistance that opposes flow and will be predominantly dependent vasoconstriction and vasodilation. I wrote the terms “Cardiac Output (CO), Blood Volume (BV), and Vascular or Total Peripheral Resistance (VPR) one at a time underneath BP, each with an arrow pointing directly to BP. I stated that any factor that changes cardiac output, blood volume, or vascular resistance can indirectly alter blood pressure. For example, a change in heart rate can change cardiac output and thus, alter blood pressure. I then distributed the series of hand drawn diagrams shown below. As I pass out the sheets and display on slides, I tell them they will be learning about all these various factors and mechanisms and will be able to recreate the network and use it as a study aid.
To get students started, I handed out the list of cardiovascular terms, hormones, equations, etc. and several small pieces of paper, e.g., 2”x2” plain paper squares, to each student. [I found free clean scratch paper in various colors in the computer lab and copy room recycling bins.] Students can also take their trusty 3”x5” cards and cut each in half or even quarters or use standard-size Post-It® notes. I explained that as I introduce a term or mechanism they will write the term or conventional abbreviation on one side of the paper and the definition and pertinent information on the other in pencil for easier editing. [I emphasized the importance of using conventional abbreviations.] For example, Blood Pressure would be written on one side of the paper and ‘pressure exerted against vessel wall’ on other, along with ‘mm Hg’, and later the equation for mean arterial pressure (MAP) can be added. I had my own set of terms written on Post-It® notes and arranged BP, CO, BV, VPR and other terms on a white board so they could see the mapping of functional relationships take shape. As new concepts were taught and learned, e.g., CO = Stroke Volume (SV) x Heart Rate (HR), the respective terms were added to the concept map to reflect the physiological relationships between and among the new mechanism to the existing mechanisms or phenomena already in the concept map. In that case, on the back of the CO paper or card one might write “volume of blood ejected from ventricle in one minute into aorta”, “CO = HR x SV“, “If HR is too fast, CO will decrease!”, “Right CO must equal Left CO!” I explained students can lay out their terms on a table, floor, their bed, etc. I reminded students how important it was to say the terms out loud as they wrote the terms in their best penmanship. This helps students slow down and deliberately think about what they are writing and refer to their lecture notes or textbook (be it an actual book or e-book). I had given students copies of the complete concept map of all terms but did not dictate exactly what they should write on the back of the cards. The small size of the paper or card, almost forces students to annotate explanations; this helped them better encapsulate their ideas. I was open to checking their annotation and reflecting back to students the apparent meaning of their word choice. While studying alone or with study partners, students were encouraged to audibly define terms and relationships among mechanisms as they arranged their maps in the correct configuration. They were encouraged to ‘shuffle the deck’ and recreate subsections of the network to understand mechanistic connections at different points in the network. Because I had given them the diagrams or concept maps for cardiac output, blood volume, and vascular resistance, students were able to check their work and conduct formative assessments alone or in groups in an accurate and supportive manner.
Students expressed that manually arranging components allowed them to literally see functional and consequential relationships among different mechanisms. The activity complemented and re-enforced quizzes and formative assessments already in use. It’s not a perfect tool and certainly has room for improvement. There are quite a few pieces of paper, but students found ways to keep the pieces together, e.g., binder clips, Zip-lock bags, rubber bands. Nonetheless, it is simple, portable, and expandable concept map students can use to learn cardiovascular physiology and represents a tool that can be applied to teach and learn other regulatory networks, such as those of the digestion-reabsorption-secretion in the GI tract and calcium homeostasis.
- Wiggers C. Circulation in Health and Disease. Philadelphia, PA: Lea & Febiger, 1915.
Many of us are continuously trying to be as inclusive in our teaching as possible. One early concept I learned in this effort was to use person-first language, where one “puts the person before the disability, and describes what a person has, not who a person is”. This small change can lead to a more comfortable and inclusive classroom and also model behavior that future health professionals (the majority of my students) will need to employ in their careers.
Yet, there’s another ‘person first’ approach that I take in my classes and interactions with students that I think also builds inclusivity and perhaps more importantly, trust and understanding between my students and me. I try to be a person first, and a professor second. I try to see my students as people first, and students second. In the past year, during the unprecedented COVID-19 pandemic, this has been especially important as we all attempt to deal with additional life stresses, course modalities, and uncertainties.
As a person, the past year has not only been marked by the pandemic, but rather a significant medical challenge. In March 2020, amidst emergency planning to send students home permanently for the semester and move to remote teaching, I was diagnosed with Stage IV metastatic breast cancer. In 2014, in my second year as a faculty member, I had gone through chemo, surgery, radiation, and continued therapy for what was at that time stage III breast cancer. Remission lasted nearly five years. Since the original diagnosis, while I never felt like cancer defined me, it became an essential part of me, as a person, and as a professor.
The hormonal treatment regimen I followed from 2015-2019 provided a real-life example of many of the principles of the endocrine system that I taught my mid-level Human Physiology students. Along with an example of my grandmother stubbornly tapering off high-dose IV steroids after a kidney infection, I began to teach “my story” as our application of the endocrine system chapter in my flipped-classroom course.
I present a case study on “Patient X”, only revealing that I am in fact patient X after the relevant physiology is covered. As I explain to students, it’s not just an example to allow them to apply what they are learning to a clinical situation. Rather, it’s my attempt to demonstrate that the knowledge they are (hopefully) gaining, the vocabulary and critical thinking skills are not meant to just serve their future professional goals, but their personal life as well. They may be the one in the future helping a loved one navigate a challenging health situation. I’ve been forever grateful for my own physiological knowledge helping me to deal with my diagnosis, treatment, and prognosis.
This year, with the progression of my disease, the lesson takes a slightly different tone (although better this semester since my current infusion treatment has led to some regression of lung metastases). I also take the time to have a “soapbox moment” (and yes, I call it that…) to also inform students about metastatic breast cancer in general, some statistics, and the importance of early detection. I remind the students about the importance of drug discovery and clinical trials in changing people’s lives, mine included.
This year, in anticipation of writing this post, as part of the pre- and post- reflection students complete about “why is important to understand hormones?” I asked them for feedback on my person-first approach of sharing my own story. In addition to many students reflecting that they did in fact “see the bigger picture” of why we learn basic physiology, many provided comments that support my approach. A selection of some of their responses:
“I really liked that you incorporated your own personal story into class because it made me feel like I genuinely knew you better as a person rather than just my professor – students really don’t get to see their teacher’s lives outside of class, but I think it’s really special when they do and when they are vulnerable with us and can share things like you did. It also gave us some insight as to why you do the things you do and why you are interested in what you teach. Thank you for sharing!”
“You sharing your story today and being vulnerable with us gave real-life application to what we are learning. We are able to now better understand that learning this information is not just about memorizing facts to get a good grade. Rather, it shows us the importance of what we are studying and how we can use it to help others throughout our lifetime. So, thank you very much for sharing and inspiring other teachers to share as well.”
“I am really happy that you shared your personal story. I think case studies are a great way to learn in general, but actually knowing the person in the case makes is so much more powerful. I will never forget today’s class and I genuinely have a much better understanding and appreciation for the material that we covered.”
Obviously, not everyone has their own story to tell, but my guess is that we all have ways that we can be vulnerable and connect the material to our own lives, encouraging our students to do the same. Storytelling and narrative medicine have received recent attention as ways to promote empathy and build trust. Why not then share our own stories? Why not put the person first in our teaching?
Anne Crecelius (@DaytonDrC) is an Associate Professor in the Department of Health and Sport Science at the University of Dayton.. She teaches Human Physiology, Introduction to Health Professions, and Research in Sport and Health Science. 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) and on the leadership team for the Physiology Majors Interest Group (P-MIG).