Each spring semester my colleague and I teach an undergraduate course in animal physiology that emphasizes primary literature and incorporates multiple evidence-based teaching strategies. Using an integrative and comparative approach, students investigate strategies that vertebrate animals use to meet their energy needs, take up and transport oxygen, and maintain hydration and salt balance, with a special emphasis on how animals have adapted to extreme environments. Our course incorporates a flipped teaching (FT) format (2, 4), where students are assigned readings from the textbook and articles from the primary literature outside of class and class time is spent discussing the material and applying that information to explore physiological mechanisms. Instead of lecturing, class time is focused on interactive learning through group work – teamwork is emphasized throughout the course, with students working in groups both inside and outside of class. Our course learning goals are:
1. Acquire a fundamental knowledge of “how animals work”
2. Recognize how prior and new knowledge relate to current/future work
3. Appreciate the importance of animal physiology
4. Understand how to collect, integrate, and communicate information
5. Exercise responsibility and teamwork.
When Rice University moved all classes online due to the COVID pandemic in spring 2020, we were at mid-semester. So like most other educators around the United States, we moved our class to Zoom. The transition from face-to-face to online instruction went fairly smoothly. Although we had only two weeks to make this shift, we did not have to frantically record lectures since our class meetings were discussion based. Additionally, students had been working in teams since the beginning of the semester so we had an established community in our classroom. Students still attended class online and were engaged for the most part. That being said, we observed that students did not turn on their cameras unless we asked them to and definitely seemed more hesitant to answer and ask questions in Zoom. Student engagement and participation increased dramatically when we put students in small groups in breakout rooms; here they interacted as a team, just like they did at round tables in the classroom pre-COVID. Student feedback at the end of the semester revealed that most of them felt like class didn’t change that much after moving online – however, they did miss the in-person interactions with us and their classmates, and some activities did not translate well to an online format; they truly appreciated our efforts to adapt our teaching and made some great suggestions for how we could improve the course in the future for online and/or face-to-face teaching.
After the semester ended, I finally had some time to reflect upon my teaching pre-COVID and during the pandemic. Over the summer, I spent many hours thinking about the course structure and what we would revise for our next offering of the course. As the COVID pandemic continued to rage throughout the fall semester, my colleague and I decided that we would teach our animal physiology course fully online for the spring 2021 semester. And we just learned that due to a spike in COVID cases after Christmas in the Houston area, classes at Rice will be fully remote at least until mid-February. During the pandemic last spring, throughout the summer and fall, and now with classes starting in just two weeks, one key question has guided me as I work on this course: “What do I really want my students to learn about animal physiology?”
How were we assessing student learning?
During the spring 2020 semester, student learning was assessed in multiple ways including individual exams, group exams, a semester long team project, homework, reading quizzes, reflections, etc. Although these mostly formative assessments and the team project require a great deal of effort and time from the students, exams contributed to 70% of the total grade for the course; the team project accounted for 20% of the grade, and all other assignments (e.g., homework, quizzes, reflections) were worth just 10% of the grade. Although there were short “mini exams” every other week, some students still became stressed and anxious when taking the exams, even though they demonstrated an understanding of course material in class discussions and on homework assignments. Once the pandemic forced us to remote instruction, we did modify the exam format to give them more time to take the exam online than they would have had in the classroom; they had a flexible window so they could choose what time/day to take the exam; and the final exam was “open resources.” And we dropped a third exam based on a research article since we lost about two weeks of instruction. We were not overly concerned about cheating since all of our exam questions are short answer format and typically require application and/or synthesis of foundational knowledge to answer the questions (i.e., you can’t just Google the answer).
Overall, student performance on the exams did not change much from pre-COVID to during the pandemic. Still, this weighting of assignments seemed imbalanced to me, with too much emphasis on student performance on exams. I started thinking about how I could shift the weighting of assignments to better reflect student achievement of learning goals. For example, the semester long team project, where students create a fictional animal (1) and showcase their animal during the last week of classes, requires students to understand integration of body systems as well as explain how the systems work together (or don’t) and recognize tradeoffs and physiological constraints. Shouldn’t this creative outlet that requires the highest level of Bloom’s taxonomy count as much towards their course grade as exams? What about all of the other work they do inside and outside of class?
How did I intentionally redesign my course with strategies to promote student success?
Never having taught a course online before the spring 2020 semester and not being sure how to help students cope with additional stresses caused by the pandemic, I attended or participated in numerous webinars, such as the National Institute on Scientific Teaching SI Happy Hours (https://www.nisthub.org), the APS Institute on Teaching and Learning Virtual Week (https://www.physiology.org/detail/event/2020/06/22/default-calendar/institute-on-teaching-and-learning?SSO=Y), and the APS Webinar Series – Physiology Educators Community of Practice (https://www.physiology.org/detail/event/2020/07/23/default-calendar/physiology-educators-community-of-practice-webinar-series?SSO=Y). Support and resources from the Rice Center for Teaching Excellence (https://cte.rice.edu/preparing-for-spring-2021#resources) have been invaluable as I redesign my course.
In an article submitted to Inside Higher Ed about helping students in times of trauma (3), Mays Imad said,
“As teachers, we don’t simply impart information. We need to cultivate spaces where students are empowered co-create meaning, purpose and knowledge — what I have termed a “learning sanctuary.” In such a sanctuary, the path to learning is cloaked with radical hospitality and paved with hope and moral imagination. And it is our connections, the community of the classroom and our sense of purpose that will illuminate that path.”
How can I create a “learning sanctuary” in my classroom environment? What approaches can I take to minimize stress and maximize engagement for students? Here are some strategies I’ve adopted for this upcoming semester to promote student success as we teach our animal physiology course fully online:
How will I know if my students learned animal physiology?
Our overall course goal is “We aim to have you learn mechanisms by which animals solve day to day problems of staying alive; learn skills, strategies, and ways of thinking that are particularly relevant to the study of physiology; and perhaps most important of all, enjoy learning the marvelous phenomena of the animal world.” Throughout the course we strive to help our students learn, not just memorize a bunch of facts that they will forget as soon as they take an exam. In their final reflection about the course, we ask these questions:
1. What impact has something you learned had on your own perceptions?
2. What long-term implications did a specific discovery/piece of information have on you/on society?”
3. What is one or more specific thing that you learned about animals this semester that you will never forget?
I love reading their reflections where they share what they learned in our course. Here are a few of my favorites from the spring 2020 semester:
Even in the midst of a pandemic, I feel confident that my students not only learned physiology but also gained an appreciation for the importance of studying animal physiology. After taking this course, most if not all of them would agree with me that “Animals are Amazing!” And that is what I really want my students to learn about animal physiology.
NOTE: All protocols were approved by the Institutional Review Board of Rice University (Protocol FY2017-294).
1. Blatch S, Cliff W, Beason-Abmayr B, Halpin P. The Fictional Animal Project: A Tool for Helping Students Integrate Body Systems. Adv Physiol Educ 41: 239-243m 2017; doi: 10.1152/advan.00159.2016.
2. Gopalan C. Effect of flipped teaching on student performance and perceptions in an Introductory Physiology course. Adv Physiol Educ 43: 28–33, 2019; doi:10.1152/advan.00051.2018.
3. Imad M. Seven recommendations for helping students thrive in times of trauma. INSIDE HIGHER ED, June 3, 2020; https://www.insidehighered.com/advice/2020/06/03/seven-recommendations-helping-students-thrive-times-trauma.
4. McLean S, Attardi SM, Faden L, Goldszmidt M. Flipped classrooms and student learning: not just surface gains. Adv Physiol Educ 40, 47-55, 2016; doi:10.1152/advan.00098.2015.
The Editors of Advances in Physiology Education have recently changed Advances article types to clarify the broadness of articles in physiology and life science education which Advances would like to publish. Details of the article types are found at https://journals.physiology.org/advances/article-types. Advances articles do not have page charges and the journal is available online from publication. While the kinds of articles are not new, the new titles of the article types broaden the definitions of how educators can get credit for scholarship for many of the responsibilities that they have. Article types include:
- Education Research – hypothesis and data driven research papers with succinct reviews of background literature
- Teaching Innovations – educational innovations to improve teaching and learning that may not have rigorous assessment or evaluation
- Illuminations – good ideas conceived and tested in the classroom that may or may not have been successful
- Curriculum Development and Assessment – design and implementation of curricula at any level in any program with some references to its success
- Training and Mentoring – descriptions of projects for training and mentoring of students or other faculty with some evaluation of learning outcomes
- Sourcebook of Laboratory Activities in Physiology – detailed descriptions of activities and experiments for student laboratory settings with class testing (specific template)
- Historical Perspectives – scholarly essays about the history of physiology or particular physiologists
- Personal Views – essays that present philosophical perspectives on physiology education which may be provocative, pointed, candid, or reflective
- Staying Current – short reviews intended to help educators stay current with recent advances or new methods in physiology and learning science in order to better teach a concept
- Editorials related to the journal’s mission, Mini-Reviews as summaries of important new and emerging fields (often from presentations), Meeting Reports of an international or national meeting hosted by an academic institution or professional society (specific template), and Letters to the Editor (reaction to previously published work in Advances).
All types of papers are peer-reviewed except for Letters to the Editor. The Editors of Advances encourage you to write up some of these scholarly activities and submit them to the journal. Articles do not need to specifically be about physiology education. For more information, contact Barb Goodman at Barb.Goodman@usd.edu.
Barbara E. Goodman, Ph.D., Professor of Physiology, Sanford School of Medicine of the University of South Dakota, Editor-in-Chief, Advances in Physiology Education.
Barb received her Ph.D. in Physiology from the University of Minnesota and is currently a Professor in the Basic Biomedical Sciences Department of the Sanford School of Medicine at the University of South Dakota. Her research focuses on improving student learning through innovative and active pedagogy.
At the University of Minnesota, we teach a large physiology lecture/lab class directed at nursing and other allied health focused students. Around week 12 or 13 of a 14-week semester, we host a lab exercise we call “Project Day.” In this lab, students choose a learning objective, from one of the class sessions previously during the semester, and develop a way to teach this learning objective to their student peers. Students can make a poster, a work of art or a model. They can compose a song, write a poem or record a video. The sky is the limit as long as the project relates to a course objective, emphasizes physiology rather than anatomy and demonstrates a good faith effort.
After more than 15 years of project days, I have experienced an amazing variety of topics and approaches. I heard about the cardiac cycle in a song called “It’s how your heart works” sung by the Lady Lub Dubs. Cookies can be primary and secondary active transport proteins and M & Ms can be Na and K ions. A beaded bracelet can illustrate the phases of the menstrual cycle. Students can learn about renal physiology by playing a game called “Kidney Land.” Lady Gaga’s song, “Poker Face”, can be turned into a parody about the SRY gene. Pipe cleaners can be converted into contractile apparatus. Beer caps can be calcium ions. The functions of the autonomic nervous system can be dramatized in a play in which Mr. Sympathetic and Mrs. Parasympathetic are in divorce court because they cannot agree on anything.
Over the years, what I have enjoyed the most were the poster presentations. A song or a video can be a one-way performance but the posters spark interactions. Students stand by their posters during half the class, the TAs and the faculty circulate around the lab rooms. At the half way point we call “Switch” and the second half of students present as the first presenters circulate. The beauty of project day is the conversations sparked by all those posters. Conversations about the difference between negative and positive feedback, the difference between skeletal and smooth muscle, the difference between graded potentials and action potentials and the difference between steroid and peptide hormones.
During Project Day, the lab is brimming with enthusiastic questions.
· Do both cardiac and skeletal muscles have troponin?
· Can you help me understand why norepinephrine stimulates the heart but inhibits the intestines?
· When does the menstrual cycle go from negative feedback to positive feedback?
· Why do you need a bigger stimulus during the relative refractory period?
· Are you telling me that T3 works just like the steroids? How did I not know that?
As I circulated through the lab, I often asked, “why did you choose this topic?”
Sometimes students would say, “I picked this topic because I already knew it and felt confident about it”. Through my smile, I felt a twinge of sadness that the student decided to play it safe. More often, a student would say, “Well because I didn’t understand it and I wanted to.” Or they might say, “I got this wrong on the last exam and I want to make sure I get it right on the final.”
My next question was, “Do you understand it now?” A beaming smile would show me their answer.
At the end of the lab, we ask the students to engage in a metacognition exercise. After viewing the posters and other projects we ask, “Can you list three concepts that are still “muddy” for you? Are there three concepts that you realize you need to study more for the final?” We ask the students to write down those three concepts and then we ask them to promise that they will intentionally include those three concepts in their studying for the cumulative final exam.
During the Spring of 2020, we suddenly had to switch gears. The students submitted videos or PowerPoint slides of their projects. They were posted on the learning management site and students were invited to view them. Unfortunately, Project Day was not the same. We were missing a vital component……….the conversation!
What will we do this semester? We are going to ask the students to make a poster and take a picture of it or craft a poster from one power point slide to present on Zoom (https://zoom.us/). The students will be sent to breakout rooms and given the ability to share their posters. TA will be assigned to break out rooms to coordinate the poster presentations of the students. We are thinking about groups of 8-10 students. With 5-minute presentations and 5 minutes of questions for each poster, it should take 40-50 minutes. We will scramble the groups and have them present again. We will grade based on a simple rubric: did it address a learning objective, did it emphasize physiology, was it a good faith effort.
I can imagine that a poster session in zoom breakout sessions could lend themselves to a number of presentation types. Students could present on famous physiologists, on their own lab work or on a pathophysiologic application of a physiologic concept. Instructors could adjust their grading rubrics accordingly to meet their specific learning outcomes.
This activity would not have to be done synchronously either. Students could record a 5-minute presentation of their poster using a software called Flipgrid (https://info.flipgrid.com/). Students could upload their poster into Flipgrid, record their video and view the videos of others. This software then permits students to post a video response or question. Students could post a video, comment on 4 other videos and then return to record follow up videos, answering the questions of their peers about their own projects. This would make a great final project in a lab or a class.
Synchronous or asynchronous, the important element is that student poster sessions get students talking. As our friend Mary Pat Wenderoth often says, “The students who are doing the talking are the students who are doing the learning.”
Spring 2020 is often denoted with an asterisk. The asterisk means different things to different people. For many people it means, “Things will never be the same.” COVID-19 has changed the venues from which we teach, but not our commitment to continually improve our teaching. We have adapted our lectures, labs, and office hours to online platforms to keep students and ourselves safe. I am no seer, but once classes moved online in mid-March I knew this would be a long haul from which I must learn and never forget. After submitting final grades, I asked myself, “What have you learned? Which practices will you continue to implement to create a better learning environment for students irrespective of world health status or platform?” My asterisk on Spring 2020 is community.
For Spring 2020 I was assigned three sections of an upper level exercise nutrition course and one section of basic exercise physiology. Each was a critical course. Kinesiology majors must pass exercise physiology before any other upper level kinesiology course; this was a new course for me. The exercise nutrition course, which I taught the prior semester, includes an in-class presentation with a hefty point value; it also is the departmental assessment tool for communication skills. Over the last several years the level of stress and anxiety among undergraduate students in my physiology courses has been progressively increasing, nearly choking their joy of learning. Colleagues in other fields observe similar trends. The majority of students taking physiology courses seek careers in health professions. Given the competitive nature of the respective training programs, students are driven to earn that A. Add to that the worry of paying for tuition, rent, food, books, computers, and transportation and complicated academic and social transitions from high school to college. Their family expectations loom over them. Some students are full-time students, but also full-time parents. For first-generation college students these circumstances may bear even greater weight. Thus, while preparing for Spring 2020 I decided to approach that semester with greater compassion for students. This led to my forming a community of learners in each class a priority. Ultimately, this helped me better meet the needs of my students during that first phase of the pandemic.
Webster defines compassion as “sympathetic consciousness of others’ distress together with a desire to alleviate it.” In preparing for Spring 2020, I identified aspects of each course that presented major challenges for students and represented sources of stress, anxiety, frustration, and discouragement. I hoped to address those challenges and thereby, alleviate a source of stress. Most exercise physiology students had not taken biology or basic physiology; thus, I had to teach them basic cell biology and basic physiology so they could better understand the significance of acute responses to exercise. Based on my past experience teaching the exercise nutrition course, students needed more confidence speaking in public. Furthermore, any given student might have known just two or three other students by name and were hesitant to speak in general. I had to help them feel more at ease so they could talk and think out loud among their peer group. We each want to belong to a community. We value our individuality, but we are social beings. Students must feel accepted and comfortable in class, so they can ask and answer questions within a small group or entire class. A critical component of learning is not answering a question, but verbally defending that answer and exchanging ideas with others. Many are afraid to answer incorrectly in front of others. The classroom must be a safe place. As the teacher, I am responsible for creating a sense of community. While I did a great job getting to know my students’ names, faces and fun facts, I wasn’t helping students know each other. For both courses I decided to include more activities that required students to talk directly to each other and become accustomed to speaking out loud. With 20-25 students per class, it was feasible. I would sacrifice class time and not be able to cover as much material. So be it. Students would master the fundamentals, learn to apply the knowledge, and have a shot at enjoying learning and becoming life-long learners. Coming to class and learning might even become a reprieve from other stressors.
How could I create community among unacquainted 20+ students? Provide opportunity to interact as a class or in pairs or groups as often as possible. I had to be persistent, kind, and patient. The first day of classes I explained my intention was that students become familiar with each other, so that they were comfortable asking and answering questions and contributing to discussions. This would facilitate learning and help me better gauge their understanding. This also might help them find a study partner or even make a new friend. I told them I made it a point to learn everyone’s name as soon as possible and would call on each student numerous times. I made it clear that I know when people are shy; I promised to be kind and not call on them until they were ready. Each day I arrived as early as possible and cheerfully greeted each student by their preferred name and asked open ended questions, e.g., ‘How are your other classes going?” At least once a week, students worked in pairs to complete worksheets or quizzes; we would reconvene as a class and I would call on different pairs to answer. I called on different pairs each time, so every group had chance to speak. I encouraged them to work with different classmates for different in-class activities. Initially, there was resistance, but I consistently commended them for their efforts. Gradually, more students would proactively raise their hands to be called on, and it could get pretty loud.
On the first day of the nutrition classes I also announced the presentation assignment and that we’d get started on it the 1st week of classes by forming pairs and by becoming accustomed to talking in front of the class. To let them know that dread of public speaking is shared by all, I confessed to feeling nervous before every lecture; however, I love teaching and channel that nervous energy to keep the lectures upbeat. I explained they might never get over the nervousness of public speaking, but they can learn nothing is wrong, being nervous is expected; it will become easier. The trick is to start small. So, at the start of every class period, one or two students would be asked to stand up, introduce themselves, and tell the class what they found most interesting from the last lecture. The other students would give the presenter their undivided attention. For shy students, I spoke directly but quietly to them before class and suggested that they could focus on me while they spoke. After each introduction I cheerfully thanked students as positive re-enforcement. These introductions also served to highlight what was covered in the last class. Because each nutrition course class met 3 times a week for 50-minute sessions, students interacted frequently. For the exercise physiology course, students worked in pairs to complete a ‘1-2-3 plus 1’ worksheet with questions on three key concepts from the previous lecture and one question on new material in the upcoming lecture. They worked on questions for 5 minutes, and then I would call on different pairs to answer questions and explain sticking points for about 10 minutes. It also was the transition into that day’s new material. This class met twice per week for 80 minutes each session; thus, plenty of time remained even after the 15-minute Q&A. They were grasping the integration of cellular mechanisms at the cellular and systems levels. The time and effort to plan and execute these activities was well worth it. Students were learning and enjoying class, as well as getting to know each other. By late February communities had formed. Each class had a friendly and inclusive feeling, and attendance was nearly perfect. Even shy students began echoing my greetings or waving and smiling at classmates arriving to class. Individual classes had their own running jokes.
The week before Spring Break universities were discussing whether or not students would return to campuses after the break. COVID-19 was here. The Thursday and Friday before Spring Break were the last days I met with students in person. I confirmed the rumors. Students would not return to campus after the break, and all courses would be entirely online. I clarified that I would present lectures ‘live’ at the regularly scheduled class times. I opened the floor to discussion. If I knew their concerns, I’d have a better chance at maintaining the sense of community. Students were completely honest. Seniors were sad, because graduation would be cancelled. Students were hoping they could keep their jobs here in town to pay rent. Athletes on scholarships worried that if the season were canceled they’d lose funding. Others would be learning from their parents’ homes, which had no Internet access. The most common concern was whether they would be as successful learning online. They were worried about the lack of accountability. One student feared he’d stop attending lectures and miss assignments; one reason he came to class was that I called him by name and talked to him every day. Another student doubted I’d have any personality when giving online lectures; I took this as a challenge. Students in the nutrition classes were worried about presentations, which were taking shape and now had to be presented somehow. They were scared. Now, I was scared for them – but had the wherewithal to not say that out loud. One student outright asked, ‘Is this even gonna’ work?!” I admitted it would be a challenge, in part because I had never taught an online class, and this was my first pandemic! They laughed nervously. What a relief to hear them laugh! Then, I remembered my goal to practice compassion and let that guide me. I calmly stated the following, “This is not an ideal situation, but we will make it work, and I mean WE. I will do my best to not make this situation any more difficult than it has to be. I will communicate with you regularly, so read my emails. If you have any problems or questions you must let me know immediately, so to give me a better chance to help you. It will be ok.” That this was the last time I would see my students in person. It was a sad day.
I took my students’ concerns into account and still made my priority community. If I could maintain that sense of community, they would be more likely to login to lecture and learn. I kept it as simple, direct, and familiar as possible. I already had been posting all lecture notes and materials on the university’s learning management system (LMS) and using the drop box for homework submissions. Thus, I opted to use the real-time video conferencing tool in the LMS to deliver, record and save lectures and hold office hours. An ounce of prevention is worth a pound of cure. I established the practice of sending each individual class a weekly email on Sunday afternoon that listed the week’s lecture topics, specific links to each lecture and office hours, due dates for quizzes, upcoming exams, announcements, and miscellaneous reminders. The very first email included step by step instruction for logging into the LMS video conferencing tool (which had been proofread and tested by a colleague), and I attached the revised syllabus. I kept these emails as upbeat as possible. On the class website, I also posted important announcements, along with links to the live and recorded lectures. I kept the class website uncluttered and organized to make it easy for students to find what they needed. In the middle of a pandemic, it was absolutely essential to keep my promise to my students and myself and not to make learning or teaching online any more difficult than necessary.
I continued teaching the fundamentals and worked to maintain that sense of community. I opened and logged into the virtual lecture room 10-15 minutes before lecture started and would allow students to do the same. I would still greet them as they entered, asked them to turn on the video at least once, so I could see their faces and make sure they were doing ok. They would also greet each other. I encouraged them to ask questions or comment directly using their mics or in the chat message feature. As I lectured, I kept track of questions and answers to my questions; I would address students by name just as I had in person. They learned quickly that they could use the chat feature to communicate with each other, sometimes not about physiology or nutrition. I didn’t mind. I also knew they missed being on campus and seeing classmates and friends, and they were isolated. For the exercise physiology course, we continued the practice of starting each lecture period with the 1-2-3 plus 1 worksheet and still spend about 15 minutes on that activity; the students really valued this activity. Because the practice proved to facilitate learning, I posted these questions on the class website, but also emailed the class a copy the day before to be sure they had a copy – a 5-minute task to keep them engaged and coming to class. For the nutrition class, I offered an extra credit assignment, ‘Who is this?’ For one class, I had a list of 10 walk-up songs from different students; students had to name the artist and tell me the full name of the student who claimed that as their ‘walk-up’ song. Another class had to name the student learning online the farthest distance from campus and name the student whose birthplace was farthest from campus; they also had to list the exact city, state or country and distance in miles. The third class had to list the first and last names of all graduating seniors in the class and their career goals. For extra points, they all participated. It was meant to encourage them to stay connected and think about something else.
We had a share of glitches and mishaps, but my students stepped up to the plate. The lack of equal access to the Internet could not be more painfully obvious. One exercise physiology student informed me that his only access to the Internet was his cell phone. He took the initiative to asked whether I would accept images of hand-written 1-2-3 worksheets sent to me by email. He never missed an assignment and made arrangements to borrow a friend’s laptop for exams. A nutrition student, I will call Brett was learning from home in a small town about 2 hours from the nearest ‘real’ town; his family home had no Internet and a poor mobile phone signal. He emailed to explain that once his dad got paid he would buy the equipment and he would be online soon. He was concerned about missed quizzes and the respective points and missed lectures. What do you say to that? When you know you have all the power, you must use that power to do good and not make anyone’s life harder than it has to be. I re-opened quizzes and sent him links to the recorded lectures; he wasted no time catching up. Then there was the matter of the nutrition presentations. Another lifeline. Students continued to work together, sending presentation files to each other and to me. Students taught themselves to use Zoom, Google Slides, and the LMS video conference feature. No one complained. Multiple pairs wanted to present during the same session, so they could be an audience, lend moral support, and ask questions. The presentations were impressive. Students were so enthusiastic. However, my favorite presentation was by Brett and ‘Josh’; they presented via the LMS conference feature. Brett’s Internet cut out completely on second slide; he tried to reconnect to no avail. I remained calm; they remained calm. They decided Brett would call Josh; Josh would hold his cell phone to the mic on his computer so I could hear Brett narrate his part of the talk. Teamwork! Let your students inspire you.
I left time at the end of each lecture to offer encouraging words and reminders to stay safe and take care of themselves. I also would state that I looked forward our next meeting. As the semester was winding down end-of-lecture discussions and questions become more serious. Across all classes the basic questions were similar. “Will I graduate on time? How will this impact my career plans? Do you think this will be over by the Fall? Do you think they’ll have a cure soon?” There was no sugar coating this. I would validate their concerns and offer my honest opinion in a kind-hearted manner. My last virtual lecture was on a Friday in May. I decided to name each graduating senior, so the class could congratulate and applaud for them. A student asked me to give a commencement speech. She was serious. I remembered what my gut told me back in mid-March, and so I began. “I cannot tell you how proud of how hard each of you has worked and how well you worked together. Life is hard. It’s ok to be scared. You have risen to the occasion. Keep rising. Learn all you can from this situation. You are meant to do great things, however subtle or grand. You will fall and make mistakes. You will need help along the way and must help others on their journey. It has been a privilege to work with you. I will think of you often and wish you well.” Spring 2020* *Helping my students form a community, an inclusive safe place to learn, think out loud, be wrong, correct mistakes, and help each other. That is the practice I will continue to implement to create a better learning environment for students irrespective of world health status or platform.
|Alice Villalobos, Ph.D., is an assistant professor in the Department of Medical Education at the Texas Tech Health Sciences Center in Lubbock, Texas. She received her B.S.in biology from Loyola Marymount University and her Ph.D. in comparative physiology from the University of Arizona-College of Medicine. Her research interests are the comparative aspects of the physiology and stress biology of organic solute transport by choroid plexus. She has taught undergraduate and graduate courses in integrative systems physiology, nutrition and toxicology. However, her most enjoyable teaching experience has been teaching first-graders about the heart and lungs! Her educational interests focus on tools to enhance learning of challenging concepts in physiology for students at all levels. She has been actively involved in social and educational programs to recruit and retain first-generation college students and underrepresented minorities in STEM.|
Advances in Physiology Education is one of the family of journals published by the American Physiological Society (https://journals.physiology.org/journal/advances). Submissions of manuscripts to Advances cost nothing and accepted papers are available with free access from their initial posting online. Annually a printed copy of the journal with all 4 issues is available to those who request it. Publications in Advances are contributed from the global community of physiology educators and carefully peer-reviewed by expert colleagues. Of all the APS family of journals, 7 out of the 10 most accessed articles (full-text accesses) during 2019 were published in Advances. The top three accessed Advances articles are briefly described below.
Number 1 Most Accessed 2019:
“Applying learning theories and instructional design models for effective instruction” by Mohammed K. Khalil and Ihsan A. Elkhider from the University of South Carolina School of Medicine in Greenville, South Carolina, USA published on April 11, 2016 (Adv Physiol Educ 40:147-156, 2016). In this article from the Best Practices series, the major learning theories are discussed and selected examples of instructional design models are explained. The objective of the article is to present the science of learning and instruction as the theoretical evidence for the design and delivery of instructional materials in the classroom and laboratory. As of June 2020, this article has been downloaded 81,467 times!
Number 2 Most Accessed 2019:
“Measuring osmosis and hemolysis of red blood cells” by Lauren K. Goodhead and Frances M. MacMillan from the School of Physiology, Pharmacology, and Neuroscience of the University of Bristol, Bristol, UK published on May 19, 2017 (Adv Physiol Educ 41: 298-305, 2017). This article from the Sourcebook of Laboratory Activities in Physiology series, describes classroom laboratory experiments to help students visualize and appreciate osmosis (the movement of water and small molecules across selectively permeable membranes of mammalian cells). Animal blood is bathed in solutions with differing osmolarities and tonicities to explore the concept of water movement by osmosis and the resultant hemolysis. As of June 2020, this article has been downloaded 71,180 times.
Number 4 Most Accessed 2019:
“Attention span during lectures: 8 seconds, 10 minutes, or more?” by Neil A. Bradbury of the Department of Physiology and Biophysics of Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA published on November 8, 2016 (Adv Physiol Educ 40:509-513, 2016). This article presents a Personal View by reviewing the literature on the “common knowledge” and “consensus” that there is a decline in students’ attention 10-15 min into lectures. The author believes that the most consistent finding from his literature review is that the greatest variability in student attention arises from differences between teachers and not from the teaching format itself. Thus, it is the job of the instructor to enhance their teaching skills to provide not only rich content but also a satisfying lecture experience for the students. As of June 2020, this article has been downloaded 39,910 times.
The other four Advances articles in the top 10 most accessed in 2019 included an APS Refresher Course Report on “Smooth muscle contraction and relaxation” by R. Clinton Webb, a Best Practices series article on “Learning theories 101: application to everyday teaching and scholarship” by Denise Kay and Jonathan Kibble, an editorial on “The ‘African gene’ theory: it is time to stop teaching and promoting slavery hypertension hypothesis” by Heidi L. Lujan and Stephen E. DiCarlo, and a Staying Current review on “Recent advances in thermoregulation” by Etain A. Tansey and Christopher D. Johnson. These articles ranged from >20,000 to almost 30,000 downloads.
This short article shows the variety of offerings in Advances in Physiology Education and documents the global demand for these contributions to the literature.
Editor-in-Chief, Advances in Physiology Education
Barb Goodman received her PhD in Physiology from the University of Minnesota and is currently a Professor in the Basic Biomedical Sciences Division of the Sanford School of Medicine at the University of South Dakota. Her research focuses on improving student learning through innovative and active pedagogy.
|Uncertainty. We have all heard that word quite frequently lately. It tends to carry negative connotations and feelings of uneasiness. It seems the answer to every question these days is, “well, it depends”. As physiology educators, this is not new to us. How many times have we answered a student’s broad question with this same phrase? Regardless of how much active learning is accomplished in the classroom, students at all levels are tasked with preparing for and taking standardized tests. My children started taking assessments in preschool, multiple choice tests for grading purposes in kindergarten, and state assessment tests in 3rd grade. Then there will be standardized tests for admissions to college, graduate admissions, and licensing. It’s no wonder that some students are conditioned to study ‘to the test’ instead of having the goal of truly learning the material, and are hesitant to express when they don’t know something. I spent the first decade of my career teaching science at the undergraduate level and have spent the last five years teaching in the professional school setting, including medical, dental, and podiatry students. I have found that these health professions students in particular become especially aware of uncertainty when they start gaining experience with clinical cases and with patients. I also notice that they are uneasy with uncertainty even from the interactions in the classroom – they are high achieving students and don’t want to be wrong, to be perceived as not knowing an answer or a concept, of maybe feeling like they don’t belong. In truth, many students have the same questions, and the same feelings, but are hesitant to express them. It is known that dealing with uncertainty and ambiguity, especially in professions where people are serving patients whose health is at stake, can result in the experience of stress, anxiety, depression, and burnout (1). Wellness is an important consideration, especially in a climate where things seem to be changing day-to-day and we are provided limited information and answers. How one deals with uncertainty can lead to life and professional decisions including which career or specialty to pursue. While this concept is not novel, actually teaching students how to tolerate or even embrace uncertainty is a relatively new concept, one which I think should be made a more purposeful objective in our courses. What if instead of shying away from admitting we don’t know something, we learn how to accept it, and how to approach the problem to find the most effective answer? How do we best learn to tolerate uncertainty, and train our students how to cope with and learn from uncertainty? What are the benefits of embracing uncertainty? |
Bring uncertainty into the classroom Thoughtfully and purposely embedding uncertainty into activities in the classroom does several things. First, it allows students to learn that not every question has an absolute answer. Students need help shifting their mindset. This also encourages students to work with material at higher levels of Bloom’s taxonomy, like evaluation and application. Additionally, this helps create a culture in the classroom where asking questions and admitting to what we don’t know is a good thing, and brings value to classroom discussions. This allows students to bring in their own experiences in an attempt to work through a problem and arrive at an answer, enhancing students’ learning. Students can build their confidence as they find value in embracing the unknown as they learn to navigate the process to find the answers to their questions. The learning theory constructivism suggests that students build their own learning, that knowledge is built upon knowledge, and that it works best in context (2). This encourages students to bring their own experiences to the learning process, and the result is that each student may bring a different perspective and answer (3). These principles match well with the intention of teaching how to manage uncertainty. A goal is for students to be engaged and motivated in an active learning environment, allowing them to share ideas and build their knowledge based on their prior knowledge and experiences.
Leading to deeper learning To further expand the idea of students building their mental models, activities designed to allow for more open-ended thinking or answers, which build upon each other, can be utilized. For example, in the cardiovascular physiology component of our medical course, we build on the basic concepts in a series of small group sessions which encourage students to work in their teams to answer questions pertaining to these concepts. We may start with the principles of hemodynamics but eventually work our way to the integration of cardiac function and vascular function. These sessions require students to not only recall knowledge, but also apply information in a manner which may lead to uncertainty. They learn to question the severity of perturbations, the balance of factors which interact, and the cause and effect. We find students may become frustrated with the “it depends” answer, but they learn how to view the nuance and ask the appropriate questions. This type of exploration and learning transitions well to more clinical sessions, where students need to know which questions to ask, which tests to order, and which colleagues to consult.
Demonstrate uncertainty as educators and professionals In addition to our basic science session, I spend a lot of time teaching with clinical colleagues in the pre-clerkship medical classroom. We have a small cohort of core educators who participate in a special type of small group learning we call Clinical Reasoning Conferences. The core educators are either basic scientists or clinicians and come from different disciplines, bringing different experiences and expertise to each session. We are always joined by content experts in our sessions with the students as well. This means that we are likely to be in a session where we are not the content expert, but have immediate access to one. This gives us an opportunity to demonstrate uncertainty in the classroom, to students who feel constant pressure to know everything and to perform at the highest level. To be honest, it took a while for us to get comfortable with telling the students, “I don’t know”, but that “I don’t know” was, in reality, “I don’t know but let’s get the answer”, which gave us the opportunity to demonstrate how we get the answer. It could be a reference from the literature, a clinical resource, or a colleague. Students not only benefit from getting perhaps a more comprehensive answer to their questions, but also knowledge that no one can know everything or even how much is still unknown. It is imperative in medicine that they learn and practice how to find appropriate information in order to make the most informed decision when it comes to patient care. These practices have also been shared by other medical educators (1). Clinical Reasoning Sessions also include students teaching the material to their colleagues, and we make it clear in our expectations that we much rather they describe their process and maybe come up with an incorrect conclusion than have short, although correct, answers which do not demonstrate process and reasoning. Another goal is to allow the students plenty of chances to practice answering questions of a clinical nature posed by faculty, and allow them to become comfortable asking faculty questions, well before they start their clerkships.
Manage expectations In my experience, students appreciate the ability to give feedback and share their expectations of their courses and programs. They also align these with their own expectations of themselves. Faculty and course directors work to resolve the students’ expectations with their own, and to assist students in forming and revising their expectations of and their role and responsibilities within the course. Educating during a pandemic has shined a light on and challenged the way we manage these expectations. A word I have heard my colleagues use lately is grace; we should extend grace to our students, to ourselves, and ask for grace from others. This is another way we can demonstrate how we deal with uncertainty, which can hopefully serve as a soft teaching point for our students.
Outside of the science classroom Developing skills to help us manage uncertainty extends to outside of our classroom. We hope that students will take the lessons and continue to use them in other classes, or outside of school altogether. Medical schools often offer electives, some of which are tied to wellness or extracurricular subjects. For example, some of our electives include Artful Thinking, in which students hone their skills of observation, application, and context, and Fundamentals of Improv, so that students can work on skills of listening, support, creativity, and quick thinking and response. Other schools and programs offer similar experiences for students (4,5). The narrative medicine program emphasizes skills of reflective writing to focus on the human side of medicine, reminding why we’re here in the first place (6).
Challenging ourselves and encouraging our creativity One of the most important lessons I learned in the transition to remote and hybrid education over the past six months was to face the uncertainty with planning, reflection, and flexibility. I am the type to have a backup plan to my backup plan, which I realized gave me the flexibility to be more creative in my course design and preparation. I feel that my courses benefitted from my ability to challenge myself, because of uncertainty, and I intend to continue to reflect and employ what I consider my ‘best practices’ even when we move back into the in-person classroom in the future. We are exposed to uncertainty every day. How we choose to frame our mindset, to help our students and ourselves tolerate or even embrace uncertainty can bring benefits both in and outside of the classroom.
References and further reading Twelve tips for thriving in the face of clinical uncertainty, accessed 8/28/20 https://www.tandfonline.com/doi/pdf/10.1080/0142159X.2019.1579308 What is Constructivism?, accessed 8/28/20 https://www.wgu.edu/blog/what-constructivism2005.html Inviting Uncertainty into the Classroom, accessed 8/28/20 http://www.ascd.org/publications/educational-leadership/oct17/vol75/num02/Inviting-Uncertainty-into-the-Classroom.aspx Teaching Medical Students the Art of Uncertainty, accessed 8/28/20 https://www.cuimc.columbia.edu/news/teaching-medical-students-art-uncertainty The Alda Method, Alda Center for Communicating Science, accessed 9/4/20 https://www.aldacenter.org/alda-method Narrative Medicine Program, Accessed 9/4/20 https://medicine.temple.edu/education/narrative-medicine-program The Diagnosis, Prognosis, and Treatment of Medical Uncertainty https://www.jgme.org/doi/pdf/10.4300/JGME-D-14-00638.1 The Ethics of Ambiguity: Rethinking the Role and Importance of Uncertainty in Medical Education and Practice https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC5497921&blobtype=pdf Helping Students Deal with Uncertainty in the classroom https://www.edutopia.org/blog/dealing-with-uncertainty-classroom-students-ben-johnson Learning: Theory and Research http://gsi.berkeley.edu/media/Learning.pdf
Rebecca Petre Sullivan, Ph.D.
Associate Professor of Physiology
Lewis Katz School of Medicine at Temple University
|Dr. Rebecca Petre Sullivan earned her Ph.D. in Physiology from the Lewis Katz School of Medicine at Temple University and completed a Post-Doctoral Fellowship in the Interdisciplinary Training Program in Muscle Biology at the University of Maryland School of Medicine. She taught undergraduate biology courses at Ursinus College and Neumann University. As an Associate Professor of Physiology and a Core Basic Science Educator, she is currently course director in the Pre-Clerkship curriculum at LKSOM and at the Kornberg School of Dentistry; in addition to teaching medical and dental students, she also teaches physiology in Temple’s podiatry school and in the physician assistant program. She is a member of Temple University’s Provost’s Teaching Academy. She was the recipient of the Mary DeLeo Prize for Excellence in Basic Science Teaching in 2020 and a Golden Apple Award in 2017 from LKSOM, and the Excellence in Undergraduate Teaching Award from Neumann University in 2012.|