Dramatization: The Marriage of Theater and the Teaching of Physiology

This blog tells a little bit of my personal history as an educator: from a typical boring lecturer to an extroverted educator who has tons of fun playing drama in the classroom with students.

But first let me wonder: wouldn’t it be great if we teach, and our students learned well and far beyond the exams?

What to do when students’ attendance is not required, like most medical schools, and regardless of the time we spend preparing the session only a few students attend it. Or when attendance is required, like in many undergraduate courses, students struggle and only learn enough to pass the exam. Many of us experience frustration.

It is not fun when we invest so much time in preparing to teach, but the students are overwhelmed with too much content, become so consumed with the exams, and end up relying on memorization that many times only works until the exams.

This was especially true in my early experience with teaching. I was a very traditional lecturer with a clear teacher-centered mind. One year I had to substitute for a colleague and taught the pre-requisite course (cell biology) to my class (physiology). I enjoyed teaching them and the students did well with 100% approval.

When I met the same class in the subsequent semester, I started by telling them that the physiology course would be much easier since I knew that they were taught (by me!) all they needed to know in the pre-requisite course. My naïve belief was that because they were taught, the students would have learned and would not have forgotten. I was confident they were all ready to dig deep into physiology. To my dismay and complete frustration, I realized the students did not remember what I taught them when I had them in my class just a few months before. I started doubting my abilities as a teacher and blamed myself for passing those students. I oscillated between feeling depressed and ashamed.

Who in heaven let me teach them!!!

I guess due to my scientific training, I looked for help in the literature and discovered the journal Advances in Physiology Education. Reading papers about research in education, I realized that something was wrong with the method of teaching most of us use. Lecturing and pushing a massive amount of information at the students makes it difficult for them to learn and remember. I wasn’t the only professor whose students didn’t remember what was taught. Richardson (1) showed that naïve students without prior physiology instruction scored the same as students who had learned physiology before.

All students benefit from some fun in their classroom. When we smile, nerves send signals to the brain, releasing neurotransmitters such as dopamine, endorphins, and serotonin into the bloodstream. Dopamine is the main neurotransmitter in the regulation of motivational processes. It drives us to achieve goals.

Thanks to Advances, the readings opened my mind to explore all forms of learning and teaching – visual, audiovisual, reading, and kinesthetic. Back in 2002, at Unigranrio Medical School in Brazil, the students would come to me struggling to understand action potential and cardiac cycle. The next thing I saw was, that I get them to lift their arms to demonstrate depolarization and step forward to contract the cardiac muscle cell. All of this would happen spontaneously in the corridors and university halls with me telling them to imagine “the depolarization goes from cell to cell, and the electrical signal precedes the mechanical event”. Then with the help of very dear students, DRAMATIZATION was born as a method of teaching that is fun for the students (and teachers) and allows students to better learn new and complicated concepts.

Learning must be fun (2), and we teachers should love teaching. To enjoy teaching we need to create an exciting and relaxed environment for our students. Dramatization is the perfect way to teach while having fun in the classroom. Each participant acts as a cell/structure, and the entire group mimics the organ/system. In this very interactive and engaging activity, every mistake is a learning opportunity (3).

I have been having an extremely positive experience with Dramatization while doing it for two decades. From my first student in 2002, who contacted me years later, to tell me he became a cardiologist due to having fun with cardiac cycle dramatization, from physiology educators who attended my workshop (4) in 2017 at IUPS in Buzios (Brazil), to ITL this year in Madison, WI just to cite a few. Every time I teach other faculty how to do Dramatization, it is a rewarding experience that fills me with the hope that I am contributing as an educator to a better physiology education for a broad learner community.

Art in general is part of our lives, and theater can and should be used for the training of future health professionals. When we think about theater and science education, an aspect that must be considered is the importance of interpersonal relationships between teachers and students. A good interpersonal relationship can contribute as another motivating factor for the fixation on knowledge. A relaxed atmosphere in which humor is present brings the parties involved in the learning process closer together, thus creating an even more favorable space for the process of acquiring knowledge at the same time as creating a moment of relaxation from the usual state of tension experienced by our students. The students might forget what you said, but they will remember what they did.

When students experience this innovative learning modality, it not only promotes retention of information, but it also stimulates a highly engaged class participation. Such an environment favors bonds among classmates and reinforces interrelational intelligence, an invaluable skill for the work of health professionals.

When I first published dramatization, I not even use this name (5).  Then I presented it for medical students at VTCSOM, and one of my students got inspired and developed his own dramatization of the Starling forces (6). Also, very rewarding is to see faculty who attended my workshop, get to develop, and publish their own original dramatizations (7).

I hope you are inspired to try something new in your classroom. If you need data to be convinced how well Dramatization works, the graphs below show the scores of a class of VTCSOM 1st year medical students before doing it (pre-test); for the students who watched it but elected not to actively participate in it (post don’t act); and the students who acted in it (post drama). In summary, simply watching peers doing dramatization already helps to learn, but when the student actively participate in it, they learned even more.

 

 

Next blog I will tell you all about an exciting new project: DramaZoom (8, 9). The lockdown during COVID stimulated us to develop dramatization via Zoom. In collaboration with two physiologists who participated in my workshops before, Patricia Halpin and Elke
Scholz-Morris, we created videos that use dramatization to teach online. Also, Daniel Contaifer Jr designed the background, and Rosa de Carvalho taught us how to do the mimics and facial expressions in DramaZoom.

So, if you want more information on how to bring drama to the classroom, please contact us and let us know how it goes. Finally, if you publish it please cite us, and let’s spread the fun!

Happy teaching

helena@vt.edu

References:

  1. Richardson DR. Comparison of naive and experienced students of elementary physiology on performance in an advanced course. Adv Physiol Educ. 2000 Jun;23(1):91-5. doi: 10.1152/advances.2000.23.1.S91. PMID: 10902532.
  2. DiCarlo SE. Too much content, not enough thinking, and too little fun! Adv Physiol Educ. 2009 Dec;33(4):257-64. doi: 10.1152/advan.00075.2009. PMID: 19948670.
  3. Carvalho, H., McCandless, M. J., 23rd Annual IAMSE meeting, “Dramatization Promotes Learning and Engages Students,” IAMSE, Roanoke (June 11, 2019).
  4. Carvalho, H., IUPS & ADInstruments Teaching Workshop, “The Use of Dramatization to Teach Physiology,” IUPS, Armação de Buzios – Rio de Janeiro, Brazil (August 7, 2017). Additional Information: Start Date: August 2017.
  5. Carvalho H. A group dynamic activity for learning the cardiac cycle and action potential. Adv Physiol Educ. 2011 Sep;35(3):312-3. doi: 10.1152/advan.00128.2010. PMID: 21908842.
  6. Connor, B., Carvalho, H. (2019, August). Using dramatization to teach Starling Forces in the microcirculation for first year medical students. 2019;15:10842.https://doi.org/10.15766/mep_2374-8265.10842.
  7. Halpin PA, Gopalan C. Using dramatizations to teach cell signaling enhances learning and improves students’ confidence in the concept. Adv Physiol Educ. 2021 Mar 1;45(1):89-94. doi: 10.1152/advan.00177.2020. PMID: 33529141.
  8. Carvalho H, Halpin PA, Scholz-Morris E (2022). Dramatization via Zoom to Teach Complex Concepts in Physiology FASEBJ 36:S1. https://doi.org/10.1096/fasebj.2022.36.S1.R2956
  9. Carvalho H, Halpin P, Scholtz-Morris E and de Carvalho R (October 28, 2021). Can We Teach Using Dramatization via Zoom? Teach Excellence Academy for Collaborative Healthcare, Teach Education Day Poster Presentations via zoom. Virginia Tech Carillion School of Medicine.
Helena Carvalho is an educator with more than 20 years of experience. She is an associate professor at Virginia Tech Carilion School of Medicine, Block Director for basic sciences, a PBL facilitator, and teaches several areas in human physiology for medical and Ph.D. students. The main focus of her educational research is to develop innovative teaching methodologies such as Dramatization, DramaZoom, and Manipulatives. She also enjoys outreach and has been sharing excitement about physiology with all levels of education including middle and high school.

 

Rosa de Carvalho is a theater/drama director, actress and teaches mimicking and acting to children and adults for 25 years.  She has specialization in psych pedagogy and has used her talents to empower low-income communities in Rio de Janeiro (Brazil). Her has an incredibly creative mind and uses theater to improve all levels of education and human relationship. Her contribution to education span from elementary school to college level.

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