Physiology and STEM educators at colleges and universities around the world have deployed creative and innovative strategies to preserve class and laboratory instruction during a pandemic.

My residential, liberal arts, undergraduate institution implemented a hybrid learning format, as did many others.  The hybrid format was adopted by the institution because room capacities were reduced to accommodate physical distancing and because we expected that COVID quarantines and isolations would force faculty and students to attend remotely.  Classrooms were outfitted with cameras and microphones in the HyFlex model to facilitate remote participation.  All classes and laboratories were forced to move online during certain blocks as a response to regional COVID rates and some students participated remotely for the entire year—including those who participated from their international homes.

More drastically, we converted our “normal” semester schedule (students complete four courses across a semester) into a block schedule.  Under the block schedule, students enrolled in one course at a time, intensively, for just under four weeks per course.  Courses met for three hours per day, four days per week.  Students completed a forced-choice mini-exam at the end of each unit and larger exams with forced-choice and short answer questions at the middle and end of the course (Table 1).  Laboratories were scheduled as additional meeting times.  Instructors and departments were granted a great deal of flexibility in laboratory scheduling so there were many permutations to lab schedules within a block—sometimes a student attended laboratory for three-hour sessions twice per week, other times a student attended for 1.5 hours four times per week.

In this post, I’ll address the changes that we made to our Human Anatomy and Physiology I and II (Biology 325 and Biology 326) sequence.  I’ll also reflect on the successes and challenges of the revisions and what we have retained in our return to in-person, normal semester scheduling.

Although we no longer utilize the block schedule at my institution, these reflections may be useful to instructors who are considering intensive summer courses and to instructors who would like to facilitate active and remote learning for other reasons.  It is important to note that the difficulties I address below are more likely to affect underserved, underprepared, or otherwise disadvantaged students and faculty, so particular attention to equity is important in considering how to deliver remote and/or intensive learning experiences.

Class (“lecture”) revisions

We adopted a flipped approach to the classroom portion of the course.  We chose this approach primarily in recognition that three-hour time blocks could only be successful with substantial interaction.  The flipped approach also helped us to navigate the hybrid format given that we anticipated technical concerns and/or limited attention spans would negatively impact the quality of meetings for remote students (three hours is an exceptionally long time to attend a Zoom class!).  Four instructors taught the courses each semester.  We divided each semester’s material into four units and each instructor created pre-class lecture videos of the relevant material for their assigned unit (Table 1).  Pre-class lecture videos totaled approximately one hour to 1.5 hours per class meeting.  The instructor also developed in-class materials for their assigned unit—typically case studies and/or worksheets.  Class began with instructors answering questions about pre-class video content and daily class objectives in response to student small group discussions.

Importantly, the block schedule reduced net class meeting hours and required us to prune as much content as possible.  We also integrated units that were previously separate.  For example, rather than address cellular physiology and skeletal physiology in separate units, cellular physiology was delivered using the calcium homeostasis and skeletal physiology for application (Table 1).

Lessons learned:

As noted above, instructors divided video and class material preparation by unit.  This required a high level of trust between instructors, and a willingness to try new ideas and pedagogies.  It worked well because our instructional team is cohesive and, although our pedagogical approaches vary, we value each other’s approaches.  Students benefitted from the lecture styles of four different instructors.

The flipped approach was helpful for practice and application of material.  The block schedule affords little time between class meetings given that classes meet for three hours per day on consecutive days.  Case studies and worksheets that applied lecture content helped students to identify points of confusion and build understanding. Further, students loved the ability to return to pre-lecture videos and rewatch points of confusion.  We now have a wealth of videos and in-class activities in our toolbox.  We continue to use many of the videos and assignments and recommend this approach to others– you might try flipping portions of class meetings as a starting point.

The intensive nature of the block schedule was advantageous in that students focused on one course at a time (so only needed to catch up in one course if COVID forced them to miss class).  A single course was their primary school-related responsibility during a block because they had no other courses and sports were largely on hold.  On the other hand, the intensive schedule left little time to develop content retention and build conceptual mastery.  There was little to no opportunity for spaced repetition.  We are currently seeing under-retention of content from last year in this year’s students.  If others attempt intensive schedule courses, it is important to recognize that content retention may be curtailed but conceptual development could be preserved with sufficient practice and application.

More generally, we are finding that students forgot how to time-manage and study in the block schedule.  They did not need to balance multiple classes or, for the most part, sports and social engagements.  The intensive nature of the block meeting schedule meant that much of their out-of-class time was spent preparing for the next day’s class rather than reviewing and studying material.  Some students (particularly those who are already disadvantaged) balanced this experience with intensified caregiving demands amid COVID restrictions.  Overall, student study habits declined—they are now struggling to optimize location, motivation, strategies, and pacing for self-regulated learning.

Students often operated in semi-isolation last year—often interacting with black boxes on a screen instead of classmates—and struggled to stay engaged via Zoom, even in breakout rooms.  This is a particular struggle for small, residential, liberal arts institutions where learning is typically done in small communities supported by close relationships.  Faculty found it difficult to build relationships with students during a four-week class with 50% remote participation each day and a requirement for meetings via Zoom (office visits were prohibited).  Students were less able to build a sense of STEM identity and belonging given the weaker relationships and reduced laboratory engagement (see below).  Sense of belonging and identity was likely especially challenging for individuals from minoritized groups with already lower STEM identity and belonging.

Lab revisions

All physiology experiments were removed from the laboratory sequence for the 2020/2021 academic year in response to the block schedule and to requirements for physical distancing and reduction of respiratory droplets.  The laboratory sequence consisted entirely of human anatomy.  We immediately recognized that learning a semester’s worth of human anatomy in four weeks—on top of class material—would be near impossible.  Therefore, we proposed a self-paced online anatomy lab experience that students could complete outside of their other coursework across the entire semester.  We utilized the Complete Anatomy platform (Elsevier; https://3d4medical.com/) and required students to submit a schedule for studying and completing practicals based on their own course schedule and other obligations each block.  Instructors held weekly instructional sessions via Zoom and met with students for tutoring as needed.  Instructional sessions were recorded and provided to students.

Lessons learned:

Any online, self-paced instructional platform will be subject to technical difficulties including spotty or slow home internet access and limited computing resources.  In addition, the Complete Anatomy platform posed surprising technical difficulties with gradebook access, content generation, and personal computer compatibility.  There were also notable technical glitches when delivering assessment via the Complete Anatomy platform.  We were able to either troubleshoot or work around each of the difficulties (for example, uploading Complete Anatomy images into our LMS for assessment), but it was labor-intensive and stressful.  Content generation was time-intensive and required a team of undergraduate teaching assistants during each semester and the prior summer.  We were lucky to have an outstanding team of teaching assistants who were so capable that they were awarded as institutional Student Employee Team of the Year (https://www.csbsju.edu/news/student-employee-awards-2021).

We were hopeful that the 3D visualization aspect of the platform (https://cdn.3d4medical.com/media/complete-anatomy-3/2019/screens.mp4) would help students improve mental 3D visualization abilities given that this has been a struggle for past students.  This did not seem to occur, although it is difficult to be sure given that most student work was completed away from instructors.  This year we paired Complete Anatomy software with physical models for in-person lab instruction and the combination works well.  We value Complete Anatomy as a study tool but some technical difficulties have continued, making it less suitable for assessment.  Online anatomy assessment was, of course, also limited because we had no way of enforcing a closed-book requirement.

Instructors observed that students did not retain as much content compared to previous years.  This is likely a result of multiple factors, including procrastination and approaches to learning.  Regardless of the original schedule developed by each student, many procrastinated and completed a flurry of practicals near the end of the semester.  Clearly those students were not practicing the spaced repetition that is important for learning.  Additionally, students often approached practicals as an item to be checked off a to-do list rather than a learning task.  When we hold laboratory sessions in-person, we can motivate and encourage students toward deep-, rather than surface-, learning in a way that we were unable to do remotely.  If we were to repeat the self-paced structure, we would enforce the students’ planned schedules more strictly.

Summary

We are happy to be back to a normal schedule with in-person instruction—made possible (thus far) by an institutional vaccination requirement for students and faculty and by masking requirements.  We have retained tools and strategies from last year, including flipped instructional materials and Complete Anatomy as a study tool.  We have moved away from other tools and strategies.  However, we (and others) may continue to offer intensive online summer options in which many of these approaches may be retained.

Table 1:  Class schedule

		Pre-class video topics	In-class activities
Unit 1	Day 1	·       Course introduction ·       Homeostasis ·       Endocrine system	·       Osteoporosis case part 1 ·       Study plan
	Day 2	·       Cellular signaling ·       Microscopic structure of bone ·       Bone remodeling mechanisms ·       Bone remodeling regulation	·       Osteoporosis case study part 2
	Mini-exam 1
	Day 3	·       Cellular junctions ·       Passive membrane transport ·       Active membrane transport ·       Ca++ transport (osteoclast and intestinal epithelial cell)	·       osteoporosis case study part 3
	Day 4	·       Bone growth and fracture repair	·       Osteoporosis case study part 4 ·       Bone growth disorders activity
	Mini-exam 2
Unit 2	Day 5	·       Resting membrane potentials	·       Resting membrane potential worksheet and practice questions
	Day 6	·       Neuron functional anatomy ·       Graded potentials	·       Neuron functional anatomy worksheet ·       Graded potentials worksheet
	Mini-exam 3
	Day 7	·       Action potentials ·       Action potential propagation	·       Action potential worksheet and practice questions
	Day 8	·       Synapses and synaptic transmission ·       Synapses and synaptic integration	·       Synapses and synaptic integration worksheet and practice questions
Exam 1
Unit 3	Day 9	·       Nervous system introduction ·       CNS protection	·       Brain trauma case study
	Day 10	·       Functional brain anatomy	·       Brain regions functional scenarios activity
	Mini-exam 4
	Day 11	·       Receptor physiology (somatosensation) ·       Pain	·       Neanderthal pain discussion (Zeberg et al., 2020)
	Day 12	·       Vision ·       Autonomic nervous system	·       Autonomic nervous system case studies
	Mini-exam 5
Unit 4	Day 13	·       Control of movement ·       Functional skeletal muscle anatomy	·       Brain machine interface worksheet (Flesher et al., 2016; Moritz et al. 2008; O’Doherty et al., 2011; Sasada et al., 2014) ·       Muscle functional anatomy worksheet
	Day 14	·       Sliding filament theory ·       Neuromuscular junction ·       Excitation contraction coupling	·       Neuromuscular junction worksheet ·       Malignant hyperthermia case study
	Mini-exam 6
	Day 15	·       Graded contractions ·       Muscle metabolism and fiber types	·       Motor recruitment worksheet ·       Muscle training worksheet
Exam 2

 

Jennifer Schaefer is an Associate Professor of Biology, the Biology Department Chair, and the Neuroscience Minor Director at the College of St. Benedict/St. John’s University.  She earned her B.A. in Biology from St. Olaf College in 2002 and her Ph.D. in Physiological Sciences from the University of Arizona in 2010. Jennifer’s teaching expertise is in anatomy & physiology and neurobiology.  Her research in the science of teaching and learning investigates the interaction between metacognition and self-efficacy for student academic performance.  Jennifer collaborates on an ongoing national collaboration to develop a consensus set of core concepts for undergraduate neuroscience education and her research in neurobiology investigates motor control circuits in Drosophila. Jennifer is a member of the American Physiological Society, Society for Neuroscience, Faculty for Undergraduate Neuroscience, and Phi Beta Kappa Jennifer E. Schaefer Associate Professor of Biology College of Saint Benedict and Saint John’s University