Monthly Archives: June 2021

Pandemic, Physiology, Physical Therapy, Psychology, Purpose, Professor Fink, Practical Exams, and Proficiency!

Pandemic

To say that the COVID-19 pandemic has affected education would be an understatement.  Physical distancing measures that were introduced across the world to reduce community spread of SARS-CoV-2 (the COVID-19 pathogen), necessitated a cessation or reduction of in-person instruction, and the introduction of what has come to be known as “emergency remote education”(1, 2).  Emergency remote education or teaching (ERE or ERT) is different from remote or online education in that, it is not planned and optional, but rather, a response to an educational emergency (3).

Physiology for Physical Therapy Students

Against the backdrop of the COVID-19 pandemic, as I was trying to keep my primary research program on regenerative and rehabilitative muscle biology moving forward (4), engaging with the scientific community on repurposing FDA-approved drugs for COVID-19 (5, 6), and working on the Biomaterials, Pharmacology, and Muscle Biology courses that I teach each year; I was requested to take on a new responsibility.  The new responsibility was to serve as the course master and sole instructor for a 3-credit, 15-week course on Physiology and Pathophysiology for Professional Year One (PY1) Doctor of Physical Therapy (DPT) students.  I had foreseen taking on this responsibility a couple of years down the road, but COVID-19 contingencies required that I start teaching the course in January 2021.  I had always believed that within the Physical Therapy curriculum, Anatomy, Physiology and Neuroscience, were courses that could only be taught by people who were specialists – i.e. you had to be born for it and should have received a level of training needed to become a master of Shaolin Kung Fu (7).  With less than a year to prepare for my Physiology and Pathophysiology course, and with the acknowledgment that I was not trained in the martial art of Physiology instruction, I looked for inspiration.  The Peter Parker Principle from Spider-Man came to mind – “With great power comes great responsibility” (8).  Unfortunately, I realized that there was no corollary that said “With great responsibility comes great power”.  Self-doubt, anxious thoughts, and frank fear of failure abounded.

Psychology and Purpose

Call it coincidence, grace, or anything in between; at the time when I started preparing to teach Physiology and Pathophysiology, I had been working with a psychological counselor who was helping me process my grief following my father’s passing a couple of months before COVID-19 was declared a pandemic.  In addition to processing my grief, through counseling, I had also started learning more about myself and how to process anxious thoughts, such as the fear of failing in my new superhero role of teaching Physiology and Pathophysiology to Physical Therapy students.  Learning how to effectively use my “wise mind” (an optimal intersection of the “emotional mind” and “reasonable mind”), writing out the possible “worst outcomes” and “likely outcomes”, practicing “self-compassion”, increasing distress tolerance, working on emotional regulation, and most importantly embracing “radical acceptance” of the things I cannot change, helped me work through the anxiety induced by my new teaching responsibility.  This does not mean that my anxiety vanished, it just means that I was more aware of it, acknowledged it, and worked my way through it to get to what I was supposed to do.  I also learned through counseling that purpose drives motivation.  I realized that my anxiety over teaching Physiology was related to the value I placed on the teaching and learning of Physiology in Physical Therapy and other health professions.  Being a Physical Therapist and Physiologist who is committed to promoting movement-centered healthcare, I found motivation in the prospect of training Physical Therapists to serve as health educators with the ultimate goal of improving human movement.  Therefore, the idea of developing a course that would give my students a solid foundation in the Physiology and Pathophysiology of Human Movement began to excite me more than intimidate me.  The aspects of my personality that inspired me to publish a paper on the possible pathophysiological mechanisms underlying COVID-19 complications (5), stirred in me the passion to train the next generation of Physical Therapists, who through their sound knowledge of Physiology would likely go on to transform healthcare and promote healthier societies through movement (9).

The point about purpose being a positive driver of motivation, mentioned above, has been known to educational psychologists for a while.  When students see that the purpose of learning something is bigger than themselves, they are more motivated to learn (10).  So, rather than setting up my course as a generic medical physiology course, I decided to set it up as a Physiology and Pathophysiology of Human Movement course that is customized for human movement experts in training – i.e. Student Physical Therapists.  I set my course up in four modules – Moving the Body (focused on muscle and nerve), Moving Materials Around the Body (focused on the cardiovascular and pulmonary systems), Fueling Movement (focused on cellular respiration and the ATP story), and Decoding the Genetics of Human Movement (focused on how genetic information is transcribed and translated into proteins that make movement possible).

Professor Fink

For those of you who have not heard of Professor Steven Fink, you should look him up (11).  A Ph.D.-trained Physiologist and former member of the American Physiological Society (APS), Professor Fink has posted over 200 original educational videos on YouTube, covering Anatomy, Physiology, Pharmacology, and other subjects.  I had found his YouTube videos several years ago, while looking for good resources for my Pharmacology course, and never stopped watching them ever since then.  I would watch his videos while exercising, and listen to them during my commute (and sometimes even during my ablutions!).  There were two topics in Physiology that scared me the most – cellular respiration and genetics.  I had learned these topics just well enough to get me through high school, four years of Physical Therapy School, one year of Post-Professional Physical Therapy training, six years of Ph.D. training in a Physiology laboratory, six years as a Postdoctoral Fellow (also in a Physiology laboratory), and several years as an Assistant Professor in Physical Therapy.  However, despite the “few years” I had spent in academia and my 10+ years being a member of the APS, I never felt that I had gained mastery over the basic physiology of cellular respiration and genetics.  So, when I started preparing to teach Physiology, I decided to up my number of views on Professor Fink’s videos on cellular respiration and genetics.  Furthermore, I reached out to Professor Fink and asked him if he would serve as a teaching mentor for my new course and he very kindly agreed.  I am fortunate to be a teacher-scholar in a department and university, which places a high priority on teaching, and supports training in pedagogy and the scholarship of teaching and learning through consultation with experts within and outside the university.  As part of our mentoring relationship, Professor Fink gave feedback on my syllabus, course content, testing materials and pedagogical strategies.  He also introduced me to “Principles of Anatomy and Physiology, 16th Edition, by Gerard J. Tortora, Bryan H. Derrickson, which proved to be a useful resource (ISBN: 978-1-119-66268-6).  Through all these interactions, Professor Fink demonstrated that a person can be a “celebrity professor” and still be a kind and gentle human being.  Having him as my teaching mentor played a significant role in building my confidence as a physiology teacher.  Research shows that academic mentoring is related to favorable outcomes in various domains, which include behavior, attitudes, health, interpersonal relations, motivation, and career (12).

Practical Exams

As the COVID-19 pandemic rolled on through the Winter, Spring/Summer, and Fall semesters of 2020, it became certain that I would have to teach my Physiology and Pathophysiology course in a virtual environment come January 2021.  I had to figure out a way to make sure that the learning objectives of my course would be met despite the challenges posed by teaching and testing in a virtual environment.  Therefore, I came up with the idea of virtual practical exams for each of the four modules in my course.  These practical exams would be set up as a mock discussion between a Physical Therapist and a referring health professional regarding a patient who had been referred for Physical Therapy.  Students would take the exam individually.  On entering the virtual exam room, the student would introduce themselves as a Student Physical Therapist and then request me (the referring healthcare professional) to provide relevant details regarding the patient, in order to customize assessment, goal setting and treatment for the patient.  With the patient’s condition as the backdrop, I would ask the student questions from the course content that was relevant to the patient’s condition.  A clear and precise rubric for the exam would be provided to the students in keeping with the principles of transparency in learning and teaching (13).

Proficiency

As we went through the course, the virtual practical exams proved to be an opportunity to provide individualized attention and both summative and formative feedback to students (14).  As a teacher, it was rewarding to see my Physical Therapy students talk about cellular respiration and gene expression with more confidence and clarity than I could do during my prior 12+ years as a Ph.D.-trained Physiologist.  It was clear to me that my students had found a sense of purpose in the course content that was bigger than themselves – they believed that what they were learning would translate to better care for their patients and would ultimately help create healthier societies through movement.

In the qualitative feedback received through a formal student evaluation of teaching (SET) survey, one student wrote “Absolutely exceptional professor.  Please continue to do what you are doing for future cohorts.  You must keep the verbal practical examinations for this class.  Testing one’s ability to verbally explain how the body functions and how it is dysfunctional is the perfect way to assess if true learning has occurred.”  Sharing similar sentiments, another student wrote “I really enjoyed the format of this class. The virtual exams in this class forced us to really understand the content in a way that we can talk about it, rather than learning to answer a MC question. I hope future students are able to learn as much as I did from this class.”

Closing Remarks

When I meet students for the first time during a course, I tell them that even though I am their teacher, I am first a student.  I let them know that in order to teach, I first need to learn the content well myself.  Pandemic pedagogy in the time of COVID-19-related emergency remote education has reinforced my belief that, the best way to learn something is to teach it.  Thanks to my Physiology and Pathophysiology of Human Movement course, I learned more about myself, about teaching and learning, and of course about cellular respiration and genetics.  Do I now consider myself a master of Physiology instruction?  No!  Am I a more confident physiology teacher?  Yes!  Has writing this article made me reflect more on what worked well and what needs to be fine-tuned for the next iteration of my Physiology and Pathophysiology course?  Yes!

REFERENCES:

  1. Williamson B, Eynon R, Potter J. Pandemic politics, pedagogies and practices: digital technologies and distance education during the coronavirus emergency. Learning, Media and Technology. 2020;45(2):107-14.
  2. Bozkurt A, Jung I, Xiao J, Vladimirschi V, Schuwer R, Egorov G, et al. A global outlook to the interruption of education due to COVID-19 pandemic: Navigating in a time of uncertainty and crisis. Asian Journal of Distance Education. 2020;15(1):1-126.
  3. Hodges C, Moore S, Lockee B, Trust T, Bond A. The difference between emergency remote teaching and online learning. Educause review. 2020;27:1-12.
  4. Begam M, Roche R, Hass JJ, Basel CA, Blackmer JM, Konja JT, et al. The effects of concentric and eccentric training in murine models of dysferlin-associated muscular dystrophy. Muscle Nerve. 2020.
  5. Roche JA, Roche R. A hypothesized role for dysregulated bradykinin signaling in COVID-19 respiratory complications. FASEB J. 2020;34(6):7265-9.
  6. Joseph R, Renuka R. AN OPEN LETTER TO THE SCIENTIFIC COMMUNITY ON THE POSSIBLE ROLE OF DYSREGULATED BRADYKININ SIGNALING IN COVID-19 RESPIRATORY COMPLICATIONS2020.
  7. Wikipedia contributors. Shaolin Kung Fu – Wikipedia, The Free Encyclopedia 2021 [Available from: https://en.wikipedia.org/w/index.php?title=Shaolin_Kung_Fu&oldid=1026594946.
  8. Wikipedia contributors. With great power comes great responsibility – Wikipedia, The Free Encyclopedia 2021 [Available from: https://en.wikipedia.org/w/index.php?title=With_great_power_comes_great_responsibility&oldid=1028753868.
  9. American Physical Therapy Association (APTA). Transforming Society – American Physical Therapy Association [Available from: https://www.apta.org/transforming-society.
  10. Yeager DS, Henderson MD, Paunesku D, Walton GM, D’Mello S, Spitzer BJ, et al. Boring but important: a self-transcendent purpose for learning fosters academic self-regulation. Journal of personality and social psychology. 2014;107(4):559.
  11. Fink S. ProfessorFink.com [Available from: https://professorfink.com/.
  12. Eby LT, Allen TD, Evans SC, Ng T, Dubois D. Does Mentoring Matter? A Multidisciplinary Meta-Analysis Comparing Mentored and Non-Mentored Individuals. J Vocat Behav. 2008;72(2):254-67.
  13. Winkelmes M. Transparency in Learning and Teaching: Faculty and students benefit directly from a shared focus on learning and teaching processes. NEA Higher Education Advocate. 2013;30(1):6-9.
  14. Alt D. Teachers’ practices in science learning environments and their use of formative and summative assessment tasks. Learning Environments Research. 2018;21(3):387-406.
Joseph A. Roche, BPT, PhD.  Associate Professor.  Physical Therapy Program.  Eugene Applebaum College of Pharmacy and Health Sciences.  

I am an Associate Professor in the Physical Therapy Program at Wayne State University, located in the heart of “Motor City”, Detroit, Michigan.  My research program is focused on developing regenerative and rehabilitative interventions for muscle loss arising from neuromuscular diseases, trauma and aging.  I have a clinical background in Physical Therapy and have received intensive doctoral and postdoctoral research training in muscle physiology/biology.

https://www.researchgate.net/profile/Joseph-Roche-2

https://scholar.google.com/citations?user=-RCFS6oAAAAJ&hl=en
Things about self-care during the pandemic that you already know but should hear again anyway.

As the pandemic begins to show signs of weakening its grasp on the world, the stress and pressures of the past 15 months continue to wear on educators everywhere. This blog covers some aspects of self-care that may provide helpful reminders to us all for managing the ongoing situation, and a call for us to be honest with ourselves about how we’re doing, to give permission to ourselves to ask for support, and when we need it, to ensure that we get the help that we need.

I don’t actually know how long it feels like it has been since I first learned we went virtual last March. It simultaneously feels like it’s been forever and just a few weeks. I do know that by the time I got to 18 December, the last day of the fall semester, I had nothing left in reserve. I woke up on Saturday morning and I have no idea how long I sat there on the edge of the bed staring at the wall before I realized it. The fatigue and the burnout had been mounting for months and I knew that my self-care had been slipping. It took about 2 weeks of intense rest and recovery before I was able to resume any sort of work and I still find myself fatiguing mentally more quickly than ever before.

I’d outlined this article talking about self-care months ago, and in the spirit of this article, will admit that it was originally due on 18 September. Between asking how I was qualified to talk about this topic as I felt that I was barely holding things together myself, and challenge that there was always one more thing on my to-do list that needed doing, that date came and went on the calendar. So here we are, at the end of another semester, but the topic is as relevant as ever. I’ll focus on 3 key areas here, and share what I can about my successes and challenges in meeting my own self-care needs.

Meet your basic needs

As physiologists, we KNOW that bodies need rest, exercise, and sustenance. But how often do we make sure that we’re getting everything that we need?

The initial work-from-home situation meant that one of my first realizations of the new pandemic reality was that I needed to make myself go outside the house or else I would spend days in a row trudging between the bed, the refrigerator, and my at-home work area. I have added a daily, recurring to-do item on my task manager, “Get outside and move!” Most days this works. I have better success if I do it early in the day, as sometimes I find that I don’t have the energy or motivation after a long day on Zoom. Looking ahead to the fall and returning to campus, my challenge will be to preserve this time for walking, running, and other outdoor activities when my daily commute resumes.

The American College of Sports Medicine (ACSM) recommends that we get at least 30 minutes of moderate intensity exercise 5 times per week, or vigorous activity for at least 20 minutes 3 times per week. Everyone should also engage in muscle-strengthening activities at least 2 times per week.1 That looks like different things to each of us, but the trick is to find something that you enjoy doing. Or at least, that you don’t hate doing.

The average adult needs between 7 and 9 hours of sleep per night. This amount slowly decreases as we age. This hasn’t ever been an area that I’ve struggled with. I actively use the sleep management features on my phone, with wind-down times, do not disturb hours, and reduced brightness and color hue settings. During the pandemic, however, sleep has been an important marker of my stress and fatigue. As the fall semester progressed, I found my nightly sleep creeping up, at one point getting 10-11 hours of sleep per night and still feeling tired. Make sure to get an appropriate amount of sleep to meet your rest needs, and use any changes in your sleep pattern to help identify changes in your stress and overall mental health.

And finally, I know that I am preaching to the choir telling you that a well-balanced diet is key to both maintaining energy levels throughout the day, supporting your immune system, and keeping up with other aspects of your general health. On this note, I would also bring up that occasionally indulging in a favorite meal or treat can often be mentally restorative, but that moderation is key here. I’m now on my second 50-lb bag of flour of the pandemic and while most of my baking has been breads, pastas, and other staple foods, the occasional cake or batch of cookies can be very powerful in keeping me feeling like my normal self.

Tracking priorities

Someone once explained priority management to me as juggling. Some of the balls in your hands are made of glass, some of them are made of plastic. A few of those balls may be the size of softballs or even a bowling ball, most of them are going to be smaller and more manageable. The trick is to know which of your priorities are the glass balls, the ones that have to be managed and kept up in the air until they are completed. The plastic balls can occasionally be set down, or when things get away from us, sometimes even dropped. I felt bad every time I looked at my task manager and postponed working on this piece for the PECOP blog, but I also knew that it wasn’t one of the balls that were mission-critical for me to keep in the air, so it got set down or shuffled around.

To keep track of which of my to-do items are made of glass and which are plastic, I set them to different priorities in my task manager. There are lots of to-do list and task manager apps. My personal favorite is Todoist, but there are some other fantastic ones out there, including Habitica, Things 3, and others. Find one that works for your organizational style and keeps you motivated to get things done. I’ll admit that I was hesitant to move away from using stickie notes for my to-do lists, but I find that I’m far more organized now then I was with my old system, and it allows me to stay on top of my responsibilities much more accurately. Even if I do postpone some of those tasks a few (or more) times when I know that they have flexibility to them.

Take a break

I think this one is the hardest, especially during the pandemic. Work-from-home has made it easier than ever to get a few more things done since we didn’t have to commute to the office anymore. Add in the pressure of social media posts telling us how others have had time to learn new musical instruments, pick up hobbies, and engage in elaborate projects, it’s easy to feel like we are underachieving in our own personal lives. For me personally, I’ve spent more time in office hours with students and the email flow has at least doubled compared to pre-pandemic levels when the semester is in session. That feeling of always having something to do and never being done makes it hard for me to disengage at the end of the day. Not only does this lead to prolonging our working hours, but it may have negative health consequences. A new report from the World Health Organization gives new evidence that work weeks longer than 55 hours may lead to increased risk of ischemic heart attacks, strokes, and other adverse events.2

I’ve talked about using a task manager with my list of things I need to be working on; I use that tool in concert with my calendar app to tell me where I need to be and when I need to be there. As much as possible, I will only add things to one or the other, but not both. The two exceptions that I make to this is scheduling my exercise on busy days when I’m likely to put it off or get side tracked into other tasks and blocking out periods of time where my explicit task is to walk away from work and relax for a little bit. Another useful tool is using the in-office hour settings on my calendar app and do-not-disturb features on my mobile devices to help enforce no-work hours when I am done for the day.

The difficult thing about our current situation is that I don’t think I’ve said anything that we don’t already know, that we haven’t been told numerous times by others, and that we probably often repeat to our colleagues when we provide words of comradery and support to one another. As educators, we often find ourselves in the role of care givers, so it’s far easier for us to tell others to take care of their basic needs, manage our priorities, and take breaks then it is for us to follow our own advice. On that note, the one thing that I will add to this article is this:

It’s okay to not be okay. The stress and pressure are real and we are each dealing with the current situation in ways that may or may not be keeping us together. Just because someone has their stuff together on the outside doesn’t show us what they need on the inside. I love that we’re asking each other how we’re doing more often, but I fear that we’re giving the easy answers and not taking full advantage of our wonderful community for the support that it can provide. Give yourself permission to take those breaks, to leave those emails unanswered for an extra day, and to make sure that you’re getting the self-care that you need. And for those times when everything is too much? Reach out and utilize your support networks and health care options to make sure that you are getting what you need. Finally, as a community of educators, we see you, we feel you, and together, we’ll get through this together.

1 ACSM. Physical Activity Guidelines. https://www.acsm.org/read-research/trending-topics-resource-pages/physical-activity-guidelines. Last accessed 15 May 2021.

2 Pega F, et al. (2021). Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environmental International. In press, corrected proof. https://doi.org/10.1016/j.envint.2021.106595

Ryan Downey is an Assistant Professor in the Department of Pharmacology & Physiology at Georgetown University. As part of those duties, he is the Co-Director for the Master of Science in Physiology and a Team Leader for the Special Master’s Program in Physiology. He received his Ph.D. in Integrative Biology from UT Southwestern Medical Center. His research interests are in improving science pedagogy and in the sympathetic control of cardiovascular function during exercise. When he’s not working, he spends time as a certified scuba instructor, baking bread, and playing board games.

Ryan Downey, Ph.D., M.A.
Assistant Professor
Co-Director, Graduate Physiology Program
Team Leader, Special Master’s Program in Physiology

Department Pharmacology and Physiology
Georgetown University Medical Center
Washington, D.C.