Author Archives: Margaret Stieben

The Olympics, sex, and gender in the physiology classroom

Are there sex based difference in athletic performance before puberty?

In the past few years most state legislatures have considered laws stating that only members of the female sex can participate in girl’s and women’s sports (37 states in 2021 alone), and as of April 20, 2022 fifteen states have adopted such legislation (1). There have also been several well publicized instances of transwomen competing for championships in women’s sports (for example see 2, 3, 4). The International Olympic Committee, the NCAA, and other sports governing bodies have also recently revised their policies regarding the inclusion of transwomen in women’s sports (5, 6).  All of this has resulted in students in my exercise physiology classes commonly asking questions about sex-based differences in sports performance and the inclusion of transwomen in women’s sports.

In a previous PECOP Blog (7) I briefly summarized the sex-based advantages men have in athletic performance in adults, and the research evaluating the effects of testosterone suppression and cross sex hormone use on factors that influence athletic performance. In this PECOP Blog, I will briefly summarize the sex based prepubertal differences in athletic performance and touch on puberty blockers.

A 2012 report from the CDC indicated there were no differences between 6–11-year-old boys and girls in performance on physical fitness tests (8).  Many sports leagues for pre-pubertal children are not separated by sex since the focus is developing basic sports skills rather than competition (9). Furthermore, some scholars have stated that there are no differences in athletic performance between boys and girls prior to the onset of puberty, and that it is only the increased testosterone secretion during puberty that causes males to outperform females in athletic competition (10, 11).

On the other hand, evaluations of fitness testing in children as young as 3 years old shows that boys perform better than girls of the same age on tests of muscular strength, muscular endurance, and aerobic fitness (12-17).  For example, Tomkinson et al. (17) observed that at age 9 boys are running an average of 3.2% faster than girls of the same age during the last stage of a 20 m shuttle run (Figure 1).  In a separate evaluation Tomkinson et al. (16) reported that at age 9 boys have a bent arm hang time that is an average of 48.1% longer than girls of the same age (Figure 2).

Furthermore, youth records from USA Track & Field (18) in the 8-and-under age group and in the 9-10-years-old age group (who can reasonably be assumed to be pre-pubertal) show that boys outperform girls in all events (Table 1).  The smallest difference in track and field records between boys and girls is 0.94% in the 8-and-under 100 m run, with the largest difference being 38.42% in the 8-and-under javelin throw.  We recently analyzed top 10 data for national performance from Athletic.net in 100 m, 200 m, 400 m, 800 m, 1500 m, and 1600 m running events for children in the 7-8 and 9–10 year-old age groups for the years 2019-2021 and found that across all events 7-8-year-old boys were 4.4 ± 1.9% faster than girls, and 9-10-year-old boys were 5.4 ± 1.8% faster than girls (figure 3; not yet published data).  Youth records from USA swimming also show that in 19 out of 23 events the national records for 10 and under boys are faster than girls by an average of 1.72% (19).  It is important to note that in competition the difference between first and second place often comes down to as little as 0.02% difference in speed (Data to be presented at the 2022 ACSM Annual Meeting).

There is no question that the differences in running performance between prepubertal boys and girls is less than the 10-13% difference in running performance observed between post-pubertal boys and girls, and between adult men and women (10, 11, 20).  And there is no question that the large increases in circulating testosterone experienced by boys during puberty is responsible for most of the differences in athletic performance between post-pubertal boys and girls, and between adult men and women (21).  But the existence of differences in athletic performance between prepubertal boys and girls is well demonstrated (12-19).  Juxtaposing the statements of no pre-pubertal athletic differences between boys and girls (8, 10, 11) and the evidence demonstrating that there are pre-pubertal athletic differences between boys and girls (12-19) can facilitate an interesting discussion about data collection, sample size, data analysis, and other factors that may contribute to these contradictory findings.

When explaining the biological causes of the prepubertal athletic advantages in boys, a good starting point is to discuss the differences in growth and development between boys and girls and to explain the processes of sex determination and sex differentiation (22).  Sex determination occurs at conception with the conferral of sex chromosomes.  Six weeks later, sex differentiation begins to become apparent and during the remainder of development the gonads and genitalia acquire male or female characteristics.  During sexual differentiation, the presence of the SRY gene on the Y chromosome along with androgen exposure and anti-Müllerian hormone cause the internal and external genitalia to follow the male developmental pathway. In the absence of the SRY gene on the Y chromosome, lack of androgen exposure, and lack of anti-Müllerian hormone the female developmental pathway occurs. Of course these few brief sentences fail to cover the myriad of complex interactions of genes, primordial stem cells, and hormones that regulate sex development, and the possible differences and disorders that can occur. But it is remarkable that with all of the possible missteps that can happen during sexual differentiation and development, sex can be accurately and easily identified at birth 99.83% of the time (23).

Further substantiating the important role of sex in growth and development are the World Health Organization fetal growth charts (24), which indicate small but meaningful sex-based differences with male fetuses being consistently larger than female fetuses.  Similarly, substantiating the important role of sex in growth and development, the Centers for Disease Control and Prevention have different growth charts for boys and girls from birth through adolescence with boys having consistently higher values for body mass and body height (25).

With an eye towards physical fitness and athletic performance, starting at birth and continuing throughout youth girls have more body fat and less fat-free mass than boys. For example, Davis et al. (26) in an evaluation of 602 infants reported that at birth and age 5 months, infant boys have larger total body mass, body length, and fat-free mass while having lower percent body fat than infant girls. In an evaluation of 20 boys and 20 girls ages 3-8 years old, matched for age, height, and body weight Taylor et al. (27) reported that the boys had less body fat, lower percent body fat, and a higher bone free lean body mass than the girls, such that the girls’ fat mass was 52% higher than the boys, while the bone-free lean tissue mass was 9% lower. In an evaluation of 376 prepubertal [Tanner Stage 1] boys and girls, Taylor et al. (28) observed that the boys had ~22% more lean mass, and ~13% less body fat (when expressed as percent of total body mass) than did the girls. In a review of 22 peer reviewed publications on the topic, Staiano and Katzmarzyk (29) concluded that girls have more total body fat than boys throughout childhood and adolescence.  It is a tenet of exercise science that having more lean body mass provides athletic advantages, so it is reasonable to conclude that having more lean body mass contributes to the prepubertal sex-based male athletic advantages.

It is worth noting that serum testosterone concentrations in boys are higher for the first 5 months after birth than in girls (30). Testosterone concentrations are then similar between boys and girls until the onset of puberty, when testosterone concentrations increase 10-20-fold in boys.  Given the well know anabolic and androgenic effects of testosterone, the higher testosterone levels in newborn boys likely contributes to the sex related differences in body size and composition in newborns.  It is unknown how much the lingering sex-linked differences in body size, body composition, physical fitness, and athletic performance are due lasting effects of the higher testosterone levels in newborns, and how much the differences are due to Y chromosome or other sex-linked effects.

Strongly suggesting that sex linked differences in physical fitness and athletic performance in children before puberty are due to biological factors, Eiberg et al. (13) measured body composition, VO2max, and physical activity in 366 Danish boys and 332 Danish girls between the ages of 6 and 7 years old.  Their observations indicated that absolute VO2max was 11% higher in boys than girls, while relative to body mass the boys’ VO2max was still 8% higher than the girls.  Accelerometry based measurements of physical activity indicated that when boys and girls regularly participated in the same amount and intensity of physical activity, the boys had higher measured physical fitness than the girls.  When the findings of Eiberg (13) are taken collectively with the findings of large scale school based physical fitness testing in children that also shows pre-pubertal boys outperforming girls in measurements of aerobic fitness, muscular strength, and muscular endurance (12, 14-17), the youth records from USA Track & Field (18) showing that pre-pubertal boys outperform girls in all events, and the 10 and under records from USA Swimming showing that boys outperform girls in 19 out of 23 events (19), there exists strong evidence that there are differences in physical fitness and athletic performance between boys and girls before puberty.

And finally, this discussion arising from laws stating that only members of the female sex can participate in girl’s and women’s sports can lead to questions about the effects of puberty blockers on physical fitness and athletic performance in prepubertal children.  Puberty blockers are correctly known as gonadotropin-releasing hormone agonists (GnRHa), which disrupt the normal pattern of secretion of as gonadotropin-releasing hormone causing the pituitary gland to stop producing follicle-stimulating hormone and luteinizing hormone. Unfortunately, there is minimal research on the effects of puberty blockers on factors that influence physical fitness and athletic performance.

To the best of my knowledge, there is no research on the effects of puberty blockers on muscle strength, running speed, or other measures of athletic performance.  Indeed, Klaver et al. (31) is the only published research that I am aware of that has evaluated the use of puberty blockers on any athletic performance related factor, and this is only on body composition. Klaver et al. (31) demonstrated that the use of puberty blockers in Tanner stage 2-3 teenagers increased body fat and decreased lean body mass in transgirls, but the use of puberty blockers did not eliminate the differences in body composition between transgirls and comparable female teenagers. Roberts and Carswell (32), concluded that there is no published research that sufficiently characterizes the impact of puberty blockers on growth or final adult height.  Thus, the effect of prescribing puberty blockers to a male child before the onset of puberty on the physical components of athletic performance is almost entirely unknown. This becomes a great point in a discussion to remind students of the ever-evolving nature of science.  Any further discussion on this topic becomes speculation or can be removed from the realm of physiology and into metaphysical discussions of what is or is not fair.  Such metaphysical discussions can be fascinating, and also heated, so caution is advisable when proceeding outside of the realm of physiology in a physiology classroom.

In summary, there is strong evidence that even before puberty there are sex-based differences in physical fitness and athletic performance with boys running faster, jumping farther and higher, and demonstrating greater muscle strength than girls of the same age.  These pre-pubertal sex based differences are smaller than the differences in post pubertal teens and adults, but the differences are likely meaningful in terms of competition.  There is currently insufficient evidence to determine what effects puberty blockers have on physical fitness and athletic performance in children.

References

  1. Lavietes M. (April 13, 2022) Kentucky Legislature overrides governor’s veto of transgender sports ban [online]. NBCNews.com  https://www.nbcnews.com/nbc-out/out-politics-and-policy/kentucky-legislature-overrides-governors-veto-transgender-sports-ban-rcna24303 [Accessed April 20, 2022]
  2. Barnes K.  (March 17, 2022)  Amid protests, Penn swimmer Lia Thomas becomes first known transgender athlete to win Division I national championship. [online]. espnW.com. https://www.espn.com/college-sports/story/_/id/33529775/amid-protests-pennsylvania-swimmer-lia-thomas-becomes-first-known-transgender-athlete-win-division-national-championship [Accessed April 20, 2022]
  3. Ellingworth J, Ho S.  (August 2, 2021) Transgender weightlifter Hubbard makes history at Olympics. [online]. APNews.com https://apnews.com/article/2020-tokyo-olympics-sports-weightlifting-laurel-hubbard-e721827cdaf7299f47a9115a09c2a162 [Accessed April 20, 2022]
  4. Morton V.  (June 3, 2019)  CeCe Telfer, Franklin Pierce transgender hurdler, wins NCAA women’s national championship [online]. Washingtontimes.com  https://www.washingtontimes.com/news/2019/jun/3/cece-telfer-franklin-pierce-transgender-hurdler-wi/ [Accessed April 20, 2022]
  5. Yurcaba C.  (January 22, 2022) NCAA’s new trans athlete guidelines sow confusion amid Lia Thomas debate [online]. NBCnews.com https://www.nbcnews.com/nbc-out/out-news/ncaas-new-trans-athlete-guidelines-sow-confusion-lia-thomas-debate-rcna13073 [Accessed April 20, 2022]
  6. Nair A, Nair R, Davis T.  (April 8, 2022) Transgender women unable to compete in British Cycling events as policy suspended [online]. Reuters.com https://www.reuters.com/lifestyle/sports/british-cycling-suspend-transgender-participation-policy-2022-04-08/[Accessed April 20, 2022]
  7. Brown G. (August 18, 2021). The Olympics, sex, and gender in the physiology classroom [online].  PECOP Blog. https://blog.lifescitrc.org/pecop/2021/08/18/the-olympics-sex-and-gender-in-the-physiology-classroom/ [Accessed April 20, 2022]
  8. Ervin RB,  Wang CY, Fryar CD, Miller IM, and Ogden CL. [online] Measures of Muscular Strength in U.S. Children and Adolescents, 2012.  NCHS Data Brief No. 139, December 2013. (https://www.cdc.gov/nchs/products/databriefs/db139.htm; accessed April 6, 2022)
  9. Wells MS, Arthur-Banning SG.  The Logic of Youth Development: Constructing a Logic Model of Youth Development through Sport. J Pakr & Rec Admin.  26: 189-202, 2008
  10. Handelsman DJ. Sex differences in athletic performance emerge coinciding with the onset of male puberty. Clin Endocrinol (Oxf). 87:68-72, 2017
  11. Handelsman DJ, Hirschberg AL, Bermon S. Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance. Endocr Rev. 39:803-829, 2018
  12. Catley MJ, and Tomkinson GR. Normative health-related fitness values for children: analysis of 85347 test results on 9-17-year-old Australians since 1985. Br J Sports Med 47: 98-108, 2013.
  13. Eiberg S, Hasselstrom H, Gronfeldt V, Froberg K, Svensson J, and Andersen LB. Maximum oxygen uptake and objectively measured physical activity in Danish children 6-7 years of age: the Copenhagen school child intervention study. Br J Sports Med 39: 725-730, 2005.
  14. Latorre Roman PA, Moreno Del Castillo R, Lucena Zurita M, Salas Sanchez J, Garcia-Pinillos F, and Mora Lopez D. Physical fitness in preschool children: association with sex, age and weight status. Child Care Health Dev 43: 267-273, 2017.
  15. Tambalis KD, Panagiotakos DB, Psarra G, Daskalakis S, Kavouras SA, Geladas N, Tokmakidis S, and Sidossis LS. Physical fitness normative values for 6-18-year-old Greek boys and girls, using the empirical distribution and the lambda, mu, and sigma statistical method. Eur J Sport Sci 16: 736-746, 2016.
  16. Tomkinson GR, Carver KD, Atkinson F, Daniell ND, Lewis LK, Fitzgerald JS, Lang JJ, and Ortega FB. European normative values for physical fitness in children and adolescents aged 9-17 years: results from 2 779 165 Eurofit performances representing 30 countries. Br J Sports Med 52: 1445-14563, 2018.
  17. Tomkinson GR, Lang JJ, Tremblay MS, Dale M, LeBlanc AG, Belanger K, Ortega FB, and Leger L. International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. Br J Sports Med 51: 1545-1554, 2017.
  18. (December 19, 2018)  American Youth Outdoor Track & Field Records.  [online] USATF http://legacy.usatf.org/statistics/records/view.asp?division=american&location=outdoor%20track%20%26%20field&age=youth&sport=TF  (accessed April 20, 2022)
  19. (2022) National Age Group Records [online]. USA Swimming. https://www.usaswimming.org/times/popular-resources/national-age-group-records (accessed April 20, 2022)
  20. Millard-Stafford M, Swanson AE, Wittbrodt MT. Nature Versus Nurture: Have Performance Gaps Between Men and Women Reached an Asymptote? Int J Sports Physiol Perform. 13:530-535, 2018
  21. Levine BD, Joyner MJ, Keith NR,  Bagish AL, Pedersen BK, Schmidt W, Stachenfeld N, Girard O, Nagatomi R, Foster C, Okazaki K, Stellingwerf T, Jiexiu Z, Robson SJ, Bailey DM, Bosch A, Murphy RM, Qiu J, Lollgen H, Mitchell J, Kearney J, Scott JM, Lundby C, Steinacker J, Trappe S, La Gerche A, Masuki S, Roach R, Schneider S, Millet G, Kohrt WM, Roberts WO, Kraus WE, Benjamin HJ, Koning JJ, Gatterer H, Wehrlin JP, Charkoudian N, Lawley JS, Hopman MTE, Hawley J. The role of testosterone in athletic performance. [online] https://web.law.duke.edu/sites/default/files/centers/sportslaw/Experts_T_Statement_2019.pdf (accessed April 6, 2022).
  22. Rey R, Josso N, Racine C. Sexual Differentiation. 2020 May 27. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Online]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905232. (Accessed April 6, 2022)
  23. Sax L. How common is intersex? a response to Anne Fausto-Sterling. J Sex Res. 39:174-8, 2002
  24. Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Neerup Jensen L, Giordano D, Cecatti JG, Abdel Aleem H, Talegawkar SA, Benachi A, Diemert A, Tshefu Kitoto A, Thinkhamrop J, Lumbiganon P, Tabor A, Kriplani A, Gonzalez Perez R, Hecher K, Hanson MA, Gülmezoglu AM, Platt LD. The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight. PLoS Med. 14:e1002220, 2017
  25. Centers for Disease Control and Prevention.  Clinical Growth Charts  [online] https://www.cdc.gov/growthcharts/clinical_charts.htm; (Accessed April 6, 2022)
  26. Davis SM, Kaar JL, Ringham BM, Hockett CW, Glueck DH, and Dabelea D. Sex differences in infant body composition emerge in the first 5 months of life. J Pediatr Endocrinol Metab 32: 1235-1239, 2019.
  27. Taylor RW, Gold E, Manning P, and Goulding A. Gender differences in body fat content are present well before puberty. Int J Obes Relat Metab Disord 21: 1082-1084, 1997.
  28. Taylor RW, Grant AM, Williams SM, and Goulding A. Sex differences in regional body fat distribution from pre- to postpuberty. Obesity (Silver Spring) 18: 1410-1416, 2010.
  29. Staiano AE, Katzmarzyk PT. Ethnic and sex differences in body fat and visceral and subcutaneous adiposity in children and adolescents. Int J Obes (Lond). 36:1261-9. (2012).
  30. Senefeld JW, Lambelet Coleman D, Johnson PW, Carter RE, Clayburn AJ, Joyner MJ. Divergence in Timing and Magnitude of Testosterone Levels Between Male and Female Youths. JAMA. 324:99-101, 2020
  31. Klaver M, de Mutsert R, Wiepjes CM, Twisk JWR, den Heijer M, Rotteveel J, Klink DT. Early Hormonal Treatment Affects Body Composition and Body Shape in Young Transgender Adolescents. J Sex Med 15: 251-260, 2018.
  32. Roberts SA, Carswell JM. Growth, growth potential, and influences on adult height in the transgender and gender-diverse population. Andrology. 9:1679-1688, 2021.
Dr. Greg Brown is a Professor of Exercise Science in the Department of Kinesiology and Sport Sciences at the University of Nebraska at Kearney where he has been a faculty member since 2004. He is also the Director of the General Studies program at the University of Nebraska at Kearney. He earned a Bachelor of Science in Physical Education (pre-Physical Therapy emphasis) from Utah State University in 1997, a Master of Science in Exercise and Sport Science (Exercise Physiology Emphasis) from Iowa State University in 1999, and a Doctorate of Philosophy in Health and Human Performance (Biological Basis of Health & Human Performance emphasis) from Iowa State University in 2002. He is a Fellow of the American College of Sports Medicine and an American College of Sports Medicine Certified Exercise Physiologist.
Cultivating Belonging through Asynchronous Discussion Assignments and “State Your Perspective”

Advancing diversity, equity, and inclusion (DEI) within college classrooms, whether virtual or in-person, has perhaps never been as high a priority as now. One outcome of pandemic teaching has been critical evaluation of historic teaching practices, placing the onus on instructors to provide inclusive learning environments that are responsive and adaptive to a wide range of individualized circumstances. At the same time, some students have expressed feeling isolated and disconnected from peers, reducing motivation and academic persistence. Cultivating a sense of community and belonging in educational spaces, for all learners, is a current hot topic in higher education. In fact, two recent PECOP blogs have centered around the related idea of incorporating team-building practices to enrich learning in physiology education (From a Group to a Team: Medical Education Orientation Curriculum for Building Effective Teams and Developing a Community of Practice in an A&P Course)

Belonging, or the belief that one’s individual abilities and attributes are valued, respected, and on par with others’ abilities, is a strong driving force for persistence in STEM fields (1, 2, see also the Iowa State University Center for Excellence in Learning and Teaching webpage: Foster a Sense of Belonging and the Indiana School of Education Building a Sense of Community for All resources). I am not an expert on this, yet I care about supporting the community of learners within the courses that I teach.  This led me to ask: What can I do to build students’ understanding of physiology while also deepening their belief that they belong here, in my classroom, which in turn may foster resilience, persistence, and improved satisfaction within college-level coursework?

Collaborative work is included in all courses I teach. These collaborations take different forms based on the learning goals for the course, learner characteristics (first year versus fourth year students, for example), and topic complexity. Summarized below is one course activity I have used which aims to: (1) help students master challenging physiology concepts through peer-to-peer interactions, (2) develop communication skills related to expressing ideas about human function (a highly-valued professional skill),  and (3) build community and a sense of belonging.

Asynchronous Discussion Assignments and “State Your Perspective”. One course I teach is an in-person, large lecture-style Human Physiology service course for second, third, and fourth year undergraduate students (as well as a handful of graduate students) from biomedical sciences, biomedical engineering, pharmacy interest, public health, and other STEM programs. Many students express trouble “learning how to learn” human physiology, which can be quite different compared with the academic work typical for their varied primary programs of study. They also report feeling isolated in a large classroom and that they have trouble finding study groups, which they value while preparing for exams.

Traditionally, exams in this Human Physiology course were comprised predominantly of multiple choice questions and a few short answer questions (e.g., 3-4 sentences in length). I recently found myself asking: WHAT IF students moved from providing short written explanations on exams that lacked detail due to time constraints to having sufficient time to carefully think through how to explain a physiological process? And, WHAT IF this activity could be designed in such a way to help students recognize what they understand (and what they don’t understand) in advance of an exam, giving them the opportunity to review course materials and try again? And, WHAT IF groups of students were working through this together, leveraging peer-to-peer learning?

These questions, along with experiences from the online and blended instruction I have been doing for many years, gave rise to incorporating asynchronous, online discussion assignments that students would complete in small groups (6-8 students per group). The goal was to give students an opportunity to practice using appropriate anatomical and physiological terminology to precisely describe how the human body functions in a relatively low-stakes setting that supported peer interactions. Students were given a discussion prompt (see below for examples) to which they posted an initial response in the LMS-based virtual discussion forum. Next, all group members were responsible for reviewing their peers’ initial posts and providing two follow-up responses, adding to and building upon the initial physiological descriptions. There were a total of four sets of discussion assignments, one per unit, across the semester. While the discussion assignment structure remained similar from unit to unit, the expectation to communicate increasingly complex ideas was inherent within the discussion prompts.

Specifically to address DEI and belonging, students were to begin their initial responses with a “State Your Perspective” statement. “State Your Perspective” entailed providing a 1-2 sentence summary statement to describe the context by which the topic at hand was viewed. In Human Physiology, this might be knowledge based on prior coursework, the focus of the lab in which they worked, practical clinical experiences for those who work in health care settings, and such. While ice-breaker introductions are frequently incorporated into group work, the use of bolder “State Your Perspective” language is intentional. It helps to move from a generic introduction that generally alludes to differing background experiences to an explicit and purposeful statement intended to summarize the specific context for the way a particular physiological function is understood.

Here are excerpts of the discussion prompts and how “State Your Perspective” is modeled for students.

UNIT 1 Discussion Prompt: One theme for UNIT 1 has been to develop connections between new information and previously-known concepts in order to understand how the human body works:  What have you learned in prior courses that apply to human physiology? Specify (1) the prior knowledge/what you knew before this course, and (2) the new ideas presented UNIT 1 that expands upon your background knowledge and therefore your understanding of human function.

  • “State Your Perspective”: Include a 1-sentence introduction at the beginning of your initial post that includes your major and anything else important for your group members to know that provides context for your perspective. For example “I am a third year biomedical sciences student and I work in a research lab that studies RNA, therefore I have learned ….”.
  • As you will see, some of your group members may have academic backgrounds that are different from yours, and they might present concepts in a different way. This is great! We hope the discussions become more interesting from sharing multiple ways to view the same physiological concept.

UNIT 2 Discussion Prompt: Prepare an answer to one of the Exam 2 Study Guide prompts to share with your group members. Include at least one type of conceptual model within your response: how one “Core Concept of Physiology” can be used to remember this process [see Reference 3 for information about the Core Concepts of Physiology], an originally-created concept map, an analogy, an annotated figure, or another self-generated study tool.

  • Begin your response with a 1-sentence “State Your Perspective” that provides context for your response. For example “I am a pharmacy interest student, and it is important for me to learn about neurotransmitters and receptors because ….”

UNIT 3 Discussion Prompt: Summarize one physiology concept presented in UNIT 3 for your group members, in your own words and including the appropriate anatomy and physiology terminology. Suggested length:  4-6 sentences. NEXT: Create four different 1-sentence statements about your topic, including two statements that are TRUE and two statements that are FALSE (but don’t identify which is which, see below).

  • Begin with a 1-sentence introduction, similar to previous discussion forums so that your new group members understand something about your perspective. Example: “I am an interdisciplinary studies student interested in healthcare; therefore, I found the lecture on hypertension really interesting ….”
  • For your responses to classmates: Carefully review each statement. Select one that you think is false and provide a physiological rationale to support your reasoning. Next, make the appropriate corrections to turn it into a TRUE statement.

Teaching Hint #1: This is manageable in a large lecture course of 150-250 students because I have teaching assistants who understand their primary responsibility is to regularly engage directly with students in the small-group discussions and provide feedback for correct and incorrect descriptions (this is a high priority for students. Practically speaking, this equates to each TA managing 6-10 groups of ~8 students each.

Teaching Hint #2: Once the grading is completed, I ask the TAs to summarize what they learned about how students learn physiology. This has been a good way to mentor TAs and prompt thoughts about their own teaching philosophies. I sometimes ask them what they would change (nothing like grading 50+ discussion assignments based on a poorly-worded prompt…). In fact, this is how the UNIT 3 true/false statements came to be; a graduate student proposed it as a way to incorporate greater critical thought and reasoning within discussion assignments.

So what did students think about this type of discussion assignment? Here are examples of comments provided on the end-of-class evaluation forms, paraphrased and in aggregate form (i.e., these are not actual student comments but represent themes in responses):

  • The discussion assignments were a good way for me to think critically about one idea then communicate my understanding of human function to my peers.
  • Discussions were a great way to see what my classmates were doing to learn human physiology that I could apply to my own learning—my group members proposed study strategies and ways of thinking about the human body that I hadn’t thought of before.
  • I enjoyed learning from my peers, who might know something more than me based on their experiences outside of class.
  • Even though this was a large lecture course with quite a bit of content presented online, I enjoyed interacting with my peers, the professor, and TAs in the discussions. I felt like everyone was there to support my learning.

Despite initial skepticism, very few students conveyed negative comments about the discussion assignments or described them as “busy-work”.

Beyond student feedback, here are a few subjective comments conveying my personal observations about classroom dynamics that arose from this course activity.

  • By design, one aim of “State Your Perspective” statement was to help students recognize that they hold certain views on a topic based on their background experiences. For some 20-something year-olds, it might not be intuitive that they, in fact, have certain perspectives and attitudes that they bring into group work. “State Your Perspective” has the potential to be affirming—when articulating prior experiences it can become more explicit, to ourselves and others, that we all have something unique to contribute to group work.
  • Sharing perspectives, along with the underlying narrative (but briefly, in 1-2 sentences), seemed to normalize the idea that we all have different backgrounds and experiences so OF COURSE we may hold different perspectives, or ways of viewing things.
  • Because the context for why discussion prompts were answered with a particular focus was evident, it seemed to reduce the pressure that every student should know “everything”. Instead, over time and through several rounds of discussions, students became more comfortable talking about what they understood and what they didn’t understand. Clarifications could be made and misperceptions could be corrected by peers, who almost always demonstrated remarkable diplomacy and kindness toward their classmates.
  • In some cases, the online and asynchronous nature of these discussions seemed to reduce barriers with regard to asking for help. It seemed to move students from a mindset of “I should know this but I don’t/everyone knows this but me” to the non-threatening “This is a topic maybe I need to ask about.” Students seemed less self-conscious when asking questions.

In summary, collaboration during small group, asynchronous discussion assignments seemed to promote a sense of community and belonging among students in a Human Physiology for non-majors course. As the instructor, it was rewarding to see improvement in students’ abilities to explain physiological processes across the semester. It was also extremely rewarding to see the great care exhibited by students to be inclusive and supportive of their peers.

 

References:

  1. Herman J, Hilton M. Supporting Students’ College Success The Role of Assessment of Intrapersonal and Interpersonal Competencies (Consensus Study Report of the National Academies of Sciences, Engineering, and Medicine). Washington, DC: The National Academies Press, 2017.
  2. Wilton M, Gonzalez-Nino E, McPartlan P, Terner Z, Christoffersen RE, Rothman JH. Improving academic performance, belonging, and retention through increasing structure of an introductory biology course. CBE Life Sci Educ, 18:1-13, 2019.
  3. Michael J, Cliff W, McFarland J, Modell H, Wright A. The Core Concepts of Physiology A New Paradigm for Teaching Physiology. New York: Springer, 2017.
My Perspective: I am an Associate Professor of Instruction in the Department of Health and Human Physiology at the University of Iowa. I am the Program Director for the B.S. Human Physiology program, which serves approximately 625 majors. I am also an active participant in several undergraduate student success initiatives at the collegiate level.  The most rewarding part of my job is learning about how students learn physiology, in their own words. I solicit student feedback for their academic experiences regularly.

Jennifer Rogers, PhD

Associate Professor of Instruction

Department of Health and Human Physiology

University of Iowa

 

Developing a Community of Practice in an A&P Course

This blog is about striving to create a Community of Practice (CoP) to engage students in Situated/Social Learning by using Team-based activities and assessments along with the web-based social learning annotation platform, Perusall.

We have all experienced those “Aha” moments when something we were struggling with suddenly becomes clear.  Think back to a time when you experienced real/durable learning.  When I did that, three things popped into my mind:  a hallway discussion in graduate school with classmates in my neurophysiology class about the Goldman-Hodgkin-Katz equation; American Physiological Society – Institute of Teaching and Learning (APS-ITL) conferences/interaction with Physiology Educators Community of Practice (PECOP); and the Community of Practice at HCC via the Instructional Development Center (IDC) which organizes and facilitates Best Practices and Faculty Academy.  And what this made me realize was that I learned best in a social setting with peers rather than isolated in my room/office tackling a topic by myself.  Although this was new to me, Lave and Wenger realized this long ago.

Lave and Wenger put forth the social learning theory of situated learning and communities of practice (CoP) in the early 90s.  Core ideas of their theory are that learning is identity formation through social participation and that communities of practice are groups of people (communities), brought together by a need for shared learning (domain) for something they do together (practice) and learn how to do it better as they interact regularly (Lave and Wenger, 1991; Wenger, 1998). And I believe, in a classroom setting, this should be framed within a significant learning environment. See Fink (2003) for explicit steps that can be taken to create an environment conducive to learning.

While a CoP is often discussed relative to professional societies, I believe that a CoP can develop within an A&P course and bring about durable learning through social interaction.  In this case, then, the domain includes the students who are in the course to learn A&P – shared learning needs; the community includes the class as well as the community within student groups/teams; and the practice includes interactions and participation in evidence-based teaching best practices from the resources those produce.

The following infographic is a summary of best practices in evidence-based teaching (Petty, 2006) which Michaelson and Sweet (2011) suggest can be met by and are a part of Team-based Learning (TBL). These include Visual presentation and graphic organizers which are met in my classes by team projects; feedback and assessment for learning; cooperative learning; reciprocal teaching e.g., peer instruction; whole-class interactive teaching; requiring concept-driven decisions e.g., concept questions and higher-order thinking levels for summative assessments.  This provides a very strong rationale for using TBL.  And TBL, by its very nature, promotes social learning.

Michaelsen and Richards (2005) identified the four key components of TBL: group formation; meaningful team assignments; routine feedback; and accountability.  The following infographic includes the components of TBL and summarizes some of the ways they are addressed in my courses.  I will go into more detail on some of these throughout the blog.

Formation of diverse teams is very important for the successful use of team-based learning.  In the physical classroom, I used a ‘show of hands’ to questions asked on the first day of class and had the students line up, then I counted them off into the appropriate number of groups. Questions used were: “How many have ……had me as an instructor before?; had medical terminology?; a college degree or certificate?; been born outside of IL?” etc.  This provides transparency in how the teams are formed and lets students know what things the instructor thinks are important to include in each team.

For the virtual, online-synchronous classroom, I use the web-based platform, CATME Smarter Teamwork, Team-maker tool.  Team-maker tool page can be found at this link.  The Team-maker tool simplifies the team-assignment process, for the virtual classroom, and creates diverse teams.  Instructors decide which criteria will be used to form teams/student groups.  For example, it is helpful for team members to have similar work schedules to facilitate group work.  It is also helpful for team members to have dissimilar GPAs.  Instructors can also write custom questions and criteria to add to the Team Maker Tool survey.  CATME Smarter Teamwork platform is a product of and administered by Purdue University.  General information about the CATME Smarter Teamwork platform can be found at this link.

In addition to properly forming teams, teams must be properly managed. Team members should receive feedback regarding their effectiveness in the team early and often.  I use Peer Evaluation (PE) Surveys administered by the CATME Smarter Teamwork platform to help teams and team members become more effective.  The TBL community uses the phrase “forming, storming, and norming,” to describe phases teams go through during the semester.  PE surveys helps teams to progress to the norming phase more quickly.  Team members are evaluated in 5 areas: contributing to the team’s work, interacting with teammates, keeping the team on track, expecting quality, and having relevant knowledge, skills, and abilities.

Three PE surveys are administered over the course of the semester.  The first two PE surveys (week 5 and week 10) were formative and the third one (week 15) was summative.  Students’ PE score is based on how well they evaluate their teammates and how well their teammates evaluate them.  I used the ‘additional questions’ option for each PE survey.  They provide information on team dynamics and effectiveness which is very helpful to identify teams that are struggling which might require instructor intervention. Survey results can be viewed and then released to the students.  Students receive anonymous information on how their teammates evaluated them compared with how students evaluated themselves and this provides encouragement when they have rated themselves lower than their peers and praises students whose teammates have rated them highly. It is important to emphasize that students are evaluating, not judging, their teammates.  The CATME Smarter Teamwork website has a plethora of resources for instructors and students to help improve team effectiveness.

In addition to the CATME Smarter Teamwork PE surveys the Peer Evaluation form obtained from the University of Buffalo Case Study Workshop I attended is used to evaluate teammate participation in the team projects.  This evaluation produces a score that is used as a multiplier to the grade on the team project which helps to improve student accountability.

To promote learning, team development, and provide timely and frequent feedback, I use Just-in-time-teaching, combined with Peer Instruction (PI) and Concept Questions that are assessed using a classroom response system (Learning Catalytics) in a manner described by Mazur (1991).  Students are to complete pre-class reading assignments followed by a pre-quiz in the Learning Management System (LMS).  The pre-quizzes check for knowledge comprehension as well as identify confusing topics which are the focus of the concept questions used in the ensuing class meeting.  Each concept question has an individual round followed by a team round.  Students answer the individual questions on their own from memory.  Once students have answered the individual questions, they are instructed to discuss it with their teammates, using all available resources before the question is asked again.  These activities provide formative feedback to students and the instructor alike and provides practice for team-based summative assessments which focus on the conceptual application of material and strive for more authentic assessments with questions situated in a clinical scenario.  Learning Catalytics, the classroom response system used in my classes, has a variety of question types that can be used to write questions that require lower-order or higher-order thinking skills.

Additionally, the PI and team interaction help students negotiate their identity in the group and facilitates new learning, which are earmarks of social learning in a community of practice.  Of course, all of this is dependent upon students coming to class prepared.

Much to my dismay, even though pre-quizzes are given to hold students accountable, rather than read the assignment, they tend to ‘hunt and peck’ in the textbook or search Google for answers which are out of context and don’t really answer the question.  Funnily enough, pre-class reading assignments and pre-quizzes didn’t even hold Harvard physics students accountable to complete the reading assignments.  So, Eric Mazur and his team developed the social annotation platform Perusall.  Information about the platform can be found at this link.

Perusall allows for/encourages social interaction ‘outside’ of class and uses programs like those used in social media. Students annotate pre-class reading assignments and can comment on classmates’ annotations, “like” comments, and ask and answer questions; they are not reading/processing material alone. Students can interact with classmates in the entire class, rather than only with their teammates, which expands the community for social learning.  By clicking on an annotation in a pre-reading assignment a current conversation window opens, and the thread of conversation shows who made comments and when they were made.  This shows the asynchronous social interaction taking place in Perusall, and documents social learning taking place outside of class.  It lets the students know they are not alone in their struggle to understand a topic and offers opportunities for students to offer explanations and suggestions to help classmates learn.

Using Perusall helps students to become better prepared for in-class activities.  Following the adoption of Perusall, 88% of students annotated 80-100% of the pre-class reading assignments throughout a semester. Whereas only 69% of students completed 80-100% of the pre-quizzes associated with the pre-class reading assignment before using Perusall.  Completing the pre-quiz, as mentioned above does not necessarily indicate that students read the assignment.  They may have just Googled the answers.

So far, I have talked about Perusall as a social annotation platform that encourages students to thoughtfully annotate reading assignments as a way to promote social learning and a sense of community which is one of the main reasons I use Perusall and why I believe Perusall helps to build a CoP in my courses.  However, I think it is important to point out that the adoption implementation of Perusall is very easy and offers valuable features without adding to the instructional load.  Once the course is set up, which does not take long, there is little to no extra work for the instructor.  The quality of the annotations is graded automatically using a machine algorithm to assess intellectual content.  Also, with a click of a tab, instructors receive a ‘confusion report’ listing the top three points of confusion with the top three annotations articulating the confusion and other analytic reports. Perusall also automatically sends emails to students who have missed reading assignments.  For anyone interested in viewing a course in Perusall a demo course has been set up – course code = CHAPMAN-GJZQV.  To access the course, follow this link and click the ‘register’ link provided on the page.  Once the registration is complete there will be an option to enroll in a course, click on that tab and enter the course code listed above.  Or just jump into the deep end of the pool and register as an instructor just to see how easy and intuitive the platform is to use.

By putting students into diverse, permanent/fixed student groups the sense of community can grow. During group work and the social annotation of reading assignments throughout the semester, students negotiate their identity in the group, negotiate new learning, and work together to learn anatomy and physiology. The following photo is of a team on the last day of the semester.  The “CEO” of the team made the t-shirts using team members’ identities negotiated throughout the semester and gave them to all teammates near the end of the semester.

When it works properly a Community of Practice can develop.  I have witnessed tremendous learning in my classroom which is the result of helping my students create a community of practice within the framework of efforts to create a significant learning environment and allowing students to socially interact via team-based activities/assessments and social interaction while annotating pre-class reading assignments.

References:

Fink, L.D. (2003) Creating Significant Learning Experiences: An Integrated Approach to Designing College Courses, Jossey-Bass, San Francisco, CA.

Lave, J. Wenger, E. (1991) Situated Learning: Legitimate Peripheral Participation. Cambridge UK: Cambridge University Press.

Michaelsen, L. K., Knight, A. B., and Fink, L. D. (2004) Team-Based Learning: A Transformative Use of Small Groups in College Teaching. Sterling, Va.: Stylus.

Michaelsen, L. K., Parmelee, D. X., McMahon, K. K., and Levine, R. E. (eds.). (2008) Team-Based Learning for Health Professions Education: A Guide to Using Small Groups for Improving Learning. Sterling, Va.: Stylus.

Michaelsen, L., & Richards, B. (2005). Commentary: drawing conclusions from the team-learning literature in health sciences education: a commentary. Teaching and learning in medicine, 17(1), 85-88.

Michaelson, L.K., and Sweet, M.  Team-based Learning.  (2011) New Directions for Teaching and Learning.  no. 128. Wiley Periodicals, Inc. Published online in Wiley Online Library. DOI:10.1002/tl.467.

Petty, G. (2006) Evidence-Based Teaching. Gloucestershire, U.K.: Nelson-Thornes, 2006.

Wenger, E. (1998) Communities of Practice Learning, Meaning and Identity. Cambridge, UK: Ca

After a post-doctoral fellowship at Washington University School of Medicine, Jane began her academic teaching career at Benedictine University in the graduate programs in exercise physiology.  After that Jane taught in the Physician Assistant Programs at Rosalind Franklin University and the University of Kentucky. For the past 18 years Jane taught Anatomy and Physiology at Heartland Community College in Normal, IL, where innovative, student-centered instruction is encouraged. For the last decade, Jane employed Just-in-Time Teaching with Peer Instruction and concept questions assessed with a classroom response system.  Recently, permanent, fixed teams were used in her classes, along with team-based summative assessments, as well as with in-class and post-class forced retrieval activities. Jane is a Professor Emerita of Biology and had served as the Anatomy and Physiology course coordinator.

Jane received her B.S. from Eastern Illinois University, her M.S. from Illinois State University, and her Ph.D. from Marquette University.

mbridge University Press.

Assessing Students’ Learning — Not Their Googling Skills! — in an Online Physiology Course

As of March 2020, when the SARS-COV-2 pandemic sent teachers and students home to figure out online instruction and learning, I had been teaching high school biology/AP biology for 27 years and anatomy & physiology at the two local community colleges for 7 years. Since I had been practicing flipped coursework for years, I knew that my biggest challenge would be how to fairly assess my students and their learning. This challenge would be compounded by an at-home virtual testing environment without any proctoring.

As I pondered the best approach to my assessment challenge, I was naturally drawn to the College Board’s 2012-13 redesign of the AP (Advanced Placement) Biology curriculum and examination. In the redesign, the AP curriculum focuses on four “Big Ideas” or broad themes covering a number of subtopics/concepts that are further broken down into learning objectives for students. The examination focuses on measuring student learning and skills using what the College Board (AP Higher Education, 2012-2013) calls an “evidence-centered-design approach that parallels the curriculum’s understanding-by-design approach.” The examination consists of a mix of multiple-choice and short-answer/free-response questions. I know from my many years of grading student AP essays/short answers that, when students turn to Google for their answers, they often fail. Students will frequently regurgitate the rubrics for grading the prompts rather than dissecting and answering the question. Subsequently, the students fail to demonstrate their own learning or understanding of the material. This is unfortunate as it is also a missed opportunity for feedback, correction and/or remediation.

In designing a new accelerated online physiology course, I really wanted the course assessments to mimic the AP Biology style of assessments. I wanted them not only to be aligned with course objectives, but to require students to think about and demonstrate the skills and concepts they were learning. I was skeptical, but hopeful I could also find an approach in which I would not have to rewrite the entire examination from scratch each term. In my search for related pedagogies, I ran across an article in the May 2020 HAPS Educator, “Testing in the Age of Active Learning: Test Question Templates Help to Align Activities and Assessments,” and recognized the name of one of the authors, Dr. Greg Crowther (Everett Community College, Everett, WA) from a previous association. I reached out to Greg and requested some more details about Test Question Templates (TQTs). What I found was a pedagogical gold mine!

The TQTs are based on somewhat general learning objectives, much like the four Big Ideas of the AP Biology exam. Students often ignore these learning objectives because they don’t know what they mean or how they will be assessed, but TQTs are formatted as input-output statements that tell the student exactly what they will be assessed on. Two examples (“Example A” and “Example B”) are provided for the students, followed by a prompt encouraging students to create their own test question following the template format.

The timing of my find was perfect for incorporating TQTs into the design of the new course. Since I am totally online, I took the time to video each TQT. On video, I present the input-output statement for each TQT and present Example A, along with approaches to answering the question or solving the problem. My TQT videos are attached to a weekly discussion board in the course management system, where students are then encouraged to work on solving Example B and creating a third example. I frequently visit the discussion board and provide feedback and guidance as needed throughout the week.

Below is an example of a TQT input-output statement and examples given to students ahead of the examination in the discussion board and used to model the examination question:

TQT 3.1. Given the chemical structure or chemical formula of an ion or molecule (chemical structure or text description), list the most likely mechanism(s) by which it crosses cell membranes.

  • Example A: See structure below left. By which process(es) is this molecule most likely to cross cell membranes? Explain your reasoning. [add chemical structure of a molecule like urea]
  • Example B: See structure below right. By which process(es) is this molecule most likely to cross cell membranes? Explain your reasoning. [add image of a peptide like insulin]
  • Example C: Make up an example (think of an ion or molecule that you’ve heard of) and ask your classmates!

In the previous unit, students had been instructed on chemical structures/formulas and bonding properties. In this unit, students are asked to extend and apply their understanding of chemical structures, bonding properties (polar, nonpolar, ionic) with their new knowledge of cell membrane structure (phospholipid) and cell transport mechanisms (passive or active).

Examinations are carefully aligned with the objectives, formative assessments and exact input-output statements given to students in the TQTs. The examination contains 10-11 short answer questions and approximately 25-30 multiple choice questions. I have added a statement on the examination for students to sign, reminding them not to use any outside resources (people, notes, internet….) along with the consequences for doing so. Students are reminded to use what they are learning in the course to answer and solve exam problems/questions. I explain to students how I will know if they don’t follow the rules.

I will admit that the new course has gotten off to a rough start. For reasons I can only guess at, more than half my students are procrastinating until the last minute to start assignments (lecture, reading, lab, formative assessments, TQTs…). This approach is not consistent with my suggestions to space out their learning, practice, or repetition of concepts that we know is so important to learning and applying the information to new situations.

Not surprisingly, students who participated during the week and spaced-out lecture segments, formative assessments and TQTs did much better on the examination than those who did not. Those who chose alternative approaches to the course material often googled their way through the examination and failed miserably. Using Google, they could identify a molecule, how it is made, and where it is found, but they couldn’t answer the questions asked.

It has taken several examinations to convince many of the students that physiology is not simply about googling or memorizing facts, but about developing critical thinking skills and a higher-order understanding of the material that will persist beyond the course. More students are now actively preparing, studying and asking more complex questions throughout the week than previously (as evidenced by the course management system analytics and student contact). Many have shown improvement not only on their overall exam scores, but in their demonstrations of reasoning on assignments and exams.

After the initial rough weeks of getting students on board, students are now reaching out via email to report progress in their learning, growth, and ability to connect the material to their work as CNAs and Medical Assistants.  For example, one young man in the course writes, “As we’ve progressed onward to future chapters I feel like my knowledge is increasing gradually and I personally feel that like I CAN do this, it has been a struggle I’m not going to lie and say it was a breeze but, I feel like I’m truly getting a ton of knowledge from these chapters, I’ve found much interest on the systems we’ve been studying especially with the TQT examples and formative questions that you help me with your feedback.” Another young lady states, “I am sorry I am not doing well. I have never been forced to study before and though the TQTs are hard I am finding that I am learning a lot and am really interested in learning more. I am glad I didn’t give up.”

In summary, both the AP Biology redesign assessment questions and the TQTs have allowed me to better assess my students’ knowledge and skills. These approaches have also given me insight into student misconceptions and helped me provide feedback, remediation, and other support as needed. I can easily write (or rewrite) questions based on the TQT input/output statements without having to rewrite entire examinations each term. Students are learning that simply googling will not let them ace the exams; instead, they are learning to more carefully read the questions and answer the questions based on their own understanding.

“ACKNOWLEDGMENTS: The author thanks Greg Crowther for help implementing TQTs and for feedback on this blog post.”

References:

  1. AP Higher Education (2012-2013). AP Course and Exam Redesign. https://aphighered.collegeboard.org/courses-exams/course-exam-redesign
  2. Crowther, G., Wiggins, B., Jenkins, L. HAPS Educator (May 2020). “Testing in the Age of Active Learning: Test Question Templates Help to Align Activities and Assessments.”
    Julie Gallagher, professor of anatomy and physiology, has been teaching at Barstow Community College (Barstow, CA) since 2014 and was a high school AP Biology teacher for 27 years at Serrano HS (Phelan, Ca).  Believing in equity and inclusion, Professor Gallagher has built state-of-the-art online anatomy and physiology courses, focused on helping all students succeed.
From a Group to a Team: Medical Education Orientation Curriculum for Building Effective Teams

I am part of a small team of Core Educators in the pre-clerkship undergraduate medical education program at the Lewis Katz School of Medicine at Temple University (LKSOM).  Last year we introduced a new curriculum to our medical students.  Part of this restructuring involved changing the format of the week-long orientation for first year students.  Operating under the new title of Transition to Medical School (TTMS), we introduced education programming amongst traditional orientation activities in which we specifically address the importance of teamwork, while providing a three-part series of 1.5- to 2-hour sessions given over three days to allow the students to get to know each other, learn about team dynamics in education and medicine, and develop their small teams; practice with patient cases to get experience with a type of active learning activities which form part of the backbone of their pre-clerkship education; reflect on the previous two sessions as part of their team’s norming process.  The focus of this blog is to describe the first session of this series, which was designed to dismantle preconceived notions of team learning, highlight the potential impact of high functioning teams, and participate in asset mapping to aid in forming of teams.

A problem which we identified as we transitioned to more case-based learning leading up to the curricular change, and that was particularly highlighted during the transition to virtual and then hybrid teaching and learning during the Covid-19 pandemic, was that medical students often struggle to learn in dysfunctional small groups if they do not first gain the skills to create and sustain high functioning, collaborative teams. Ineffective group dynamics led to limitations in students learning the material and resulted in less buy-in of the value of the case-based activities.  In addition, the downstream effects of dysfunctional team dynamics are well documented and include poor patient outcomes1. This is important as our competencies include preparing students for working in patient care teams.

We began the first education session with a word cloud activity to allow students and faculty to learn about the students’ pre-conceived ideas regarding group work.  Students were asked to submit using software (we used mentimeter.com) a word or phrase that came to mind when we said “group work”; the app then collated and displayed their responses in a figure composed of words.  Words which were submitted by multiple participants appeared larger in the word cloud (see figure for an example of a word cloud).  In our word cloud (not shown) the most frequently submitted words included “collaboration”, “communication”, “stressful”, “teamwork”, “frustrating”, and “compromise”.  Other words and phrases which appeared included “painful”, “judgment”, “overwhelming”, “open minded”, “unequal effort”, “hearing every voice”, “more work”, “understanding”, “innovative”, “constructive”, “helpful” “divide and conquer”, and “mixed bag”.  It was evident and probably not surprising that there was a range of responses from the more skeptical or negative to the more positive and enthusiastic.

Next, we shared information gathered from the literature with regards to the importance of small group, active learning in medical education.  The literature indicates that students who participate in small group learning activities demonstrate improved levels of critical thinking as compared with their peers who participate in lecture-based activities only2-4.  It has also been shown that small group work promotes communication skills5, active learning, cooperation, engagement, and retention of material6.

We then spent a few minutes reviewing the importance of diverse, effective teams in medicine.  The literature indicates that vulnerable patients with multiple chronic conditions have many doctors on their care team.  The number of people involved in a patient’s care is also increased by the nature of interprofessional roles in medicine.  Care teams include physicians (attendings, fellows, residents), medical students, nurses, physician assistants, nurse practitioners, medical assistants, pharmacists, case managers, social workers, physical and occupational therapists, technicians, pathologists, lab specialists, front desk personnel, billing specialists, and many more.  Therefore, it is imperative that students practice their communication and teamwork skills to provide their patients with the best possible care.

We also described to the students the difference between a “group” and a “team”.  A “group” can be defined as a number of people who are associated together in work or activity and has a set leader.  The group members may not work with each other but report directly to that leader, only hold themselves accountable, and rarely assess progress or celebrate successes7.  Revisiting the list above from our students’ word cloud activity, “unequal effort”, “divide and conquer”, and “more work” may be used to describe this kind of group.  In contrast, a “team” includes a small number of people with complimentary skills, who are committed to a common goal and purpose, who set performance goals and hold themselves mutually accountable.  They may share leadership and value open-ended discussion and active problem-solving7.  The terms “open minded”, “hear every voice”, “collaboration”, and “communication” from our students’ word cloud are aspects of a team.

Next, we asked the students to move into their assigned teams of 6-7 students for an asset mapping activity.  The goal of asset mapping is to create more equitable team dynamics by having students identify their own assets and share them with their team.  Each team was assigned to stay together for their first semester courses, so this experience not only allowed the students to think about their contributions to the team, but also served as an icebreaker in a classroom setting for the students before they began their first course.  We used an asset map (see figure) we adapted from George Pfeifer and Elisabeth Stoddard from Worcester Polytechnic Institute, who authored “Equitable and Effective Teams: Creating and Managing Team Dynamics for Equitable Learning Outcomes”8 and from Cliff Rouder of Temple University’s Center for the Advancement of Teaching, who authored “Asset Mapping: An Equity-Based Approach to Improving Student Team Dynamics”9.  Students were given time individually to complete their asset map, and then were instructed to share parts of their maps with their teammates.  Anecdotally, we were impressed with the depth of conversations, the degree of engagement and participation with each team, and the enthusiasm the students shared with each other.  An anonymous RedCap survey was given to the students after TTMS ended, and 87% of responding students indicated they found the asset mapping session useful (response rate was 97% of the class).

The Association of American Medical Colleges (AAMC) reports 11% of students in medical schools identify as historically underrepresented in medicine.  At LKSOM, our current M1 and M2 classes are both comprised of ~30% students who are historically underrepresented in medicine.  Our students come from a diversity of backgrounds and lived experiences, and have varying interests, skills, passions, and responsibilities.  Asset mapping provided a mechanism by which our students could initially learn about and from each other, and later led to conversations which allowed the teams to set their goals and expectations, and hopefully work towards providing a more equitable experience.  Asset mapping can be used to reassess team dynamics and for forming new teams as students progress through the curriculum.  This tool can also be used to help students optimize team dynamics for those who are struggling or underperforming.

This is an example of how sharing the literature with respect to the value of small group learning, team dynamics, and the role of asset mapping was useful in the building of teams in the first semester of medical school.  However, these tools could be adapted and used for learners at any level, or for team building within our departments.

The LKSOM Core Educator Team includes: Jill Allenbaugh MD, Bettina Buttaro PhD, Linda Console-Bram PhD, Anahita Deboo MD, Jamie Garfield MD, Lawrence Kaplan MD, David Karras MD, Karen Lin MD, Judith Litvin PhD, Bill Robinson PhD DPT, Rebecca Petre Sullivan PhD

 

References:

  1. Mitchell R, Parker V, Giles M, Boyle B. The ABC of health care team dynamics: understanding complex affective, behavioral, and cognitive dynamics in interprofessional teams. Health Care Manage Rev. 2014 Jan-Mar;39(1):1-9. doi: 10.1097/HCM.0b013e3182766504. PMID: 24304597.
  2. Tiwari, Agnes & Lai, Patrick & So, Mike & Yuen, Kwan. (2006). A Comparison of the Effects of Problem-Based Learning and Lecturing on the Development of Students’ Critical Thinking. Medical education. 40. 547-54. 10.1111/j.1365-2929.2006.02481.x.
  3. Charles Engel (2009) An Internet Guide to Key Variables for a Coherent Educational System Based on Principles of Problem-Based Learning, Teaching and Learning in Medicine, 21:1, 59-63, DOI: 10.1080/10401330802384888
  4. Kamin, Carol & O’Sullivan, Patricia & Younger, Monica & Deterding, Robin. (2001). Measuring Critical Thinking in Problem-Based Learning Discourse. Teaching and learning in medicine. 13. 27-35. 10.1207/S15328015TLM1301_6.
  5. Walton H. Small group methods in medical teaching. Med Educ. 1997 Nov;31(6):459-64. doi: 10.1046/j.1365-2923.1997.00703.x. PMID: 9463650.
  6. Van Amburgh JA, Devlin JW, Kirwin JL, Qualters DM. A tool for measuring active learning in the classroom. Am J Pharm Educ. 2007 Oct 15;71(5):85. doi: 10.5688/aj710585. PMID: 17998982; PMCID: PMC2064883.
  7. Katzenbach, JR & Smith, DK. (2005). The discipline of teams. Harvard business review. 83. 162-+.
  8. Pfeifer, Geoffrey and Elisabeth A. Stoddard (2019). “Equitable and Effective Teams: Creating and Managing Team Dynamics for Equitable Learning Outcomes” in Kristin Wobbe and Elisabeth A. Stoddard, eds. Beyond All Expectations: Project-Based Learning in the First Year.
  9. Rouder, C (2021). Asset Mapping: An Equity-Based Approach to Improving Student Team Dynamics.  Temple University Center for the Advancement of Teaching.  https://teaching.temple.edu/edvice-exchange/2021/03/asset-mapping-equity-based-approach-improving-student-team-dynamics.
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 in the Department of Biomedical Education and Data Science and the Department of Cardiovascular Sciences, and as 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, in the biomedical sciences graduate program, 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, the Golden Apple Award in 2017 and 2021, and the Excellence in Education Award, Year 2 in 2020 from LKSOM, and the Excellence in Undergraduate Teaching Award from Neumann University in 2012.
Pandemic Adaptations for PECOP and the 2022 ITL!

The American Physiological Society (APS) Physiology Educators Community of Practice (PECOP) and Institute on Teaching and Learning (ITL) were created to build connections among physiology educators and to promote the sharing of evidence-based teaching practices in physiology education. Due to the COVID-19 pandemic, the 2020 ITL and other PECOP activities were shifted to a virtual format. Virtual ITL Week included daily two-hour interactive sessions. Session topics and speakers were selected from the original conference schedule, with emphasis on topics that would assist educators during the pandemic. Registration was free, attracting nearly 500 registrants, a five-fold increase over normal ITL attendance. International educator participation was more than double that of previous ITL meetings. Long-term impacts of this unplanned “experiment” include plans for virtual components at some future ITL meetings, a PECOP webinar series open to the public, and an online professional skills training course for new physiology educators. An editorial describing these outcomes has recently been published in Advances in Physiology Education (https://journals.physiology.org/doi/full/10.1152/advan.00245.2020).  Please join PECOP for free by registering your email at the LifeSciTRC (https://www.lifescitrc.org) and select “PECOP Member” in your user profile.  The 2022 APS Institute on Teaching and Learning will be June 21-24 in Madison, WI (https://www.physiology.org/professional-development/meetings-events/itl-2022?SSO=Y).  The institute will engage educators in interactive sessions on best practices in teaching, learning and assessment.  Whether you are an experienced educator or new to teaching, ITL will challenge you to gain the skills needed to design and implement educational research in your classroom and learn how to share your findings with colleagues.  The institute includes plenary talks, concurrent workshops, poster sessions and time to network and connect with your colleagues.  Please keep checking the website to see when registration is ready!

Barbara E. Goodman, Ph.D., Professor of Physiology

Fellow of the American Physiological Society

Editor-in-Chief, Advances in Physiology Education

Division of Basic Biomedical Sciences

Room 224 Lee Medicine

Sanford School of Medicine of the University of South Dakota

 

Flipped and Distant Multi-Section Teaching: An A&P Course Director’s Perspective, Pandemic Plan, and Transition Back to the Classroom.
Historically, flipped classrooms have been around since the mid-2000s and began as bottom-up pilot experiments in a single classroom or section of a course at the will of an inventive instructor. With a robust body of literature deeming these modern content delivery models effective in achieving student success in the classroom and beyond, many educators in the sciences have adopted this approach to active learning. However, I doubt very few decided the pandemic-forced transition to distance learning was the right time to pull the trigger on flipped classroom implementation at the course director level in a multi-section course. I’m happy to share my wild idea and the wild ride we (myself and the A&P faculty at Jefferson) have been on while we were “building the plane as we flew it” over the past 2 years.

I direct A&P undergraduate courses at Thomas Jefferson University and manage a large staff (12 faculty) consisting of myself and a largely part-time adjunct workforce serving about 300 undergrads spread across 12 sections of lecture and 20 sections of lab. Since 2019 when I took the job at Jefferson we have been ballooning with growth and the demand for A&P courses has nearly doubled in the past 3 years. I was just getting used to the new course director role, when we were all challenged in March of 2020. Overnight I went from settling into my new job, to calling upon every skill and resource I had in my academic tool bag.

This unique choice to flip at the director level was borne out of pandemic-generated necessity for a means to deliver a single series of digital content of core A&P concepts, remotely, to all students to ensure an equitable experience across sections. The A&P courses at Jefferson have historically been face-to-face only with the exception of a few “snow days” with “take-home” assignments across the Spring semester during hard Philadelphia winters. The decision to flip a classroom in general aligns well with Jefferson’s active (Nexus) learning approaches, however a flipped distant digital classroom taught in a course director-led multi-section, multi-instructor course is something only a pandemic makes one crazy enough to dream up.

Additional rationale for the implementation of the flip in Fall of 2020 was to seize the day, using March of 2020 as an opportunity to fully revamp a dated class, albeit in a very stressful crisis mode. At that very infamous time, during widespread lockdown, emergency recordings of A&P lectures over slides were the go-to tool to preserve the integrity of the course. With a small amount of course director forethought and rock star faculty teamwork, those initial post-spring break A&P II content videos were recorded with the thought and intention to not waste any effort as the entire sequence would in all likelihood need to be converted to a digital format to carry the FA20/SP21 rising cohort of students though the standard 2 semester A&P sequence.

While I can currently say from the perspective of the course director/major course designer that the goal of generating a flipped classroom that works both at distance and in person was absolutely, successfully, met.  I cannot yet speak to the experience of the faculty members who were handed the curricula and directed to teach in a new modality adopted over a short summer break in July of 2020. In hindsight, the A&P faculty ended up being tested much more than the students with little prep time, and direction to teach in a way they may be unfamiliar with, the flipped classroom, online. A plan for reflection and a revelation of the faculty member experience is in the works.

To better describe the design, active learning is implemented both equitably and autonomously across sections. All sections share the same assignment types, but not necessarily identical assignments nor the same instructor. All students must give two “teach-back” presentations where the student is tasked with becoming an expert on a single learning outcome (LO), and then “teaching-back” that learning outcome to a classroom audience of students. “Teach backs” account for about 25-30% of synchronous class time. The other 70-75% of synchronous class time is devoted to reviewing core concepts, demonstrating study strategies, and facilitating active learning activities. The active learning activities are curated by the course director with the intention that the individual instructors modify and adjust activities as they go, but have a safety net of resources to deliver the course as is.

Noteworthy, not all activities were totally unknown to the faculty with institutional knowledge when the new core curricula materials were shared. There were some upcycled former laboratory activities that were really “dry” classroom friendly labs. For example, basic sensory tests could be done at home with any willing quarantine mate. Activities requiring materials did have to wait for in person days. The future goal is to add more in-house generated collaborative work to the shared instructor pool to elevate each iteration of the course. However, “not fixing anything that wasn’t already broke” was deemed a resourceful jumping off point.

The course, now, is robust and both A&P I & II lab and lecture have run online in FA2020/SP2021. The course is now mid re-test during our first in person semester back, FA2021/SP2022, with the same content and resources generated in crisis mode March 2020-Summer2020-Fall 2020. We, transitioned synchronous lecture back to masked-face-to-masked-face in person learning in Fall of 2021 and the course is running as planned. No major changes needed to be made to Canvas sites housing core lecture content to make the shift back to in person. Courses were relatively easy to share and copy over to individual instructors prior to the start of the semester to allow time for autonomous course personalization.

The story is still in progress as we have only just begun to experience Spring of 2022. The course is being tested in another way now, with a virtual start and a mid-semester transition back to in person as the pandemic distance learning challenges keep coming. At this point I’m very grateful to say the course can also seamlessly transition with little notice from remote-to-face-to-face and back again. Collaborative drawing activities on white boards work on digital white boards with screen sharing. Paper worksheets can also be completed digitally and collaboratively in small digital break out rooms. Not every activity will transfer perfectly, but that is what makes a growing pool of shared instructor resources important and valuable. The flipped classroom does not have to be grassroots anymore. A growing body of generous teacher networks, education organizations, and professional societies continue to share and widely make active learning resources available to all and often, free.  And finally, there is also nothing like a global pandemic bearing down under uncompromising deadlines to force a little creativity and development of new ideas to share back to the community.

**Illustration by Andrea Rochat, MFA

Dr. Nanette J. Tomicek is an Assistant Professor of Biology in the College of Life Sciences at Thomas Jefferson University, East Falls where she has been a faculty member since 2019. Currently, she directs the undergraduate introductory A&P courses serving a variety of basic science, and clinical-track majors. Dr. Tomicek specializes in large lecture course, and multi-section course management and has previously done so at both Penn State (2006-2017) and Temple Universities (2017-2019). Her current work focuses on pedagogy, active learning, laboratory, and excellence in biology education. Dr. Tomicek is also an adjunct faculty member for Penn State World Campus in the Eberly College of Science. She has been teaching a special topics course, The Biology of Sex for almost 10 years and is an expert in reproductive physiology and digital course delivery. Past doctoral work at Penn State and research interests include developing targeted cardiovascular therapeutics for aging women, examining downstream estrogen receptor signaling pathways in the heart in an ovariectomized rat model of aging and estrogen deficiency. Dr. Tomicek earned her Ph.D. in Spring of 2012 at Penn State in the Intercollege Graduate Degree Program in Physiology, and is a proud active member of the Human Anatomy and Physiology Society.
Pourquoi? Course Redesign: A Story of How and Why.

This is a story of why and how my courses underwent an all-encompassing course redesign.

Why?

Once upon a time, early during my tenure at Heartland Community College, the nursing faculty invited the A&P instructors to lunch to discuss what was covered in the A&P courses because the nursing students were replying that they “didn’t learn that” in A&P.

The dialog went like this: “Do you teach the autonomic nervous system?”

“Yes, we do!”

“The students say they didn’t learn that.  Do you teach the cranial nerves?”

“Yes, we do!”

“The students say they didn’t learn that.”

Etc.

After that meeting, I had a revelation that rocked my world: I wasn’t teaching, and the students weren’t learning!

Then the question was what to do about it? Retirement or Remediation?  Well, shortly after my revelation the economy tanked so retirement wasn’t an option.  Remediation, on my part, was the only course of action to take. I went back and hit the books.

I found and used many excellent resources and used parts of all, but it wasn’t until I was searching for how to assess conceptual understanding that I found methods that were used for the major redesign of my courses.

How?

When I hit the books, I read that third graders could learn to do physics.  So, I thought there should be no reason that the method developed by a physics professor/research scientist at Harvard, couldn’t be used for A&P courses at Heartland. Therefore, I chose to redesign my courses using a combination of Just-in-Time Teaching (JiTT), Peer Instruction (PI), and Concept Questions (CQs) that are assessed with clickers, in a manner described by Eric Mazur.

It is very important to make expectations known. In the first week of class, students are asked to complete an anonymous, on-line introductory questionnaire (Mazur, 1997).  This helps to make sure that the student’s expectations conform to what will be taking place in class.  The results of this questionnaire are compiled into a handout and discussed in class.  This questionnaire is followed up with another questionnaire (Mazur, 1997) during the fourth week of the semester to identify is there is anything I can do to improve the in-class experience to help their learning and to address any expectations that are contrary to what we are doing in class.  The result of using these questionnaires is an improved sense of cooperation.

The first week of the semester is also used expressly to help students get acclimated with the flow of the course and the technology used in class with several non-graded assignments and assessments completed just for practice.   Students must become familiar with the Learning Management System (LMS) and the classroom response system (CRS).

Basically, how it works is students are given pre-class reading assignments and are required to take a pre-quiz following the completion of the reading assignment which are posted in the LMS.    In one way, the quizzes are used to check for reading comprehension.  In another way, the pre-quizzes allow the students to identify and verbalize areas of confusion.  This emphasizes that knowledge acquisition occurs outside of the classroom so that in class, based upon their input, the focus is placed on what students are having difficulty with.

The last question of the pre-quizzes is the JiTT part of the pre-quiz.  “Please tell me briefly what single point of the reading that you found most difficult or confusing.  If you did not find any part of it difficult or confusing, please tell me what you found most interesting.” (Mazur, 1997) Many times students tell me something they found interesting when they didn’t answer any of the questions correctly.  So, they indirectly tell me they don’t know what they don’t know.  In either case, their feedback determines the topics for discussion the next day.

Generally, there are about three topics that are identified from the pre-quizzes.  CQs to be used in class are written for those topics.  The following flow-chart demonstrates how it works in class.  This process forces students to think through the arguments being developed and provides a way to assess their understanding of the concept.

Questions can be written to begin easy and progress to more conceptual content such as application and prediction questions, etc.  This allows for scaffolding of knowledge to occur.  It is important to monitor discussions to keep students on task, find out how students are thinking, and to identify possible sources of confusion.

The CQs are assessed with the classroom response system.  Sometimes technologies fail so it is good to have a back-up plan.  I have letter cards available in such situations.  The CQs and are graded upon completion, not on correctness.  Doing so encourages cooperation among students.  Students must be continually reminded that it is okay to get questions wrong and by just committing to an answer will help produce more durable learning.

Tangible benefits from the redesign include:

For most of the CQs asked throughout a semester the percentage of correct responses after PI were greater than before PI.  Students were able to convince their classmates what the correct answer was.  Occasionally, the percent of correct responses following PI was lower than before PI.  This was usually due to a poorly worded or ambiguous question, or a discussion between a student who was confidently wrong and one who was correct but not confident.

Persistence after the redesign was greater than before the redesign.  Before the redesign 18% of students ended up dropping the course; after the redesign only 12% of the students ended up dropping.

Students liked using the classroom response system and student discussions. Students responded to open ended questions on anonymous, end of the semester surveys: “Discuss your thoughts on the use of clickers in the classroom”; “Please discuss your thoughts on the ‘convince your neighbor’ portion of the course.”  Numerical value to their responses were assigned on this Likert scale: 4 = really liked; 3 = liked; 2 = disliked; 1 = really disliked.  The mode/median for the responses regarding using clickers was 4; and 3 for responses regarding the ‘convince your neighbor’ portion of the course.  In their responses, students also raised some concerns: “my partner never did the readings, so he wasn’t a lot of help; but it did help me to try to explain things to him;” “convincing your neighbor never really helped me mainly because my neighbor was never sure.”

Intangible benefits of the redesign include:

Students are conversing using the language of the discipline and are provided with an opportunity to identify and verbalize what they don’t know.  Answering the CQs is a form of forced retrieval which leads to more durable learning. Students must formulate arguments to support their position when “convincing their neighbors.” And lastly, by listening to student discussions instructors can identify confusing questions, misconceptions, students with clear answers, students with faulty logic/reasoning or who are confidently wrong, etc.

The following are recommendations to address issues of concern identified by students and the instructor.

Recommendations:

  1. To reinforce the importance of pre-class reading assignments, in addition to the reading assignments posted to the LMS along with the pre-quizzes, give the students a hardcopy of all the reading assignments in the first week of the semester and post it to an informational page in the LMS.
  2. Explicitly tell the students that work outside of class is expected. The following chart is provided to the students so that they can visualize the general layout of the course.
  3. To reduce knowledge voids and the influence of confidently wrong students, encourage students to seek advice from classmates all around them rather than those sitting next to them. If you use Learning Catalytics (LC) as a classroom response system, it can be set to run the class automatically which will tell each student who they should consult with.  The instructor sets up the parameters (i.e., three students, with different answers, within a certain number of seats or if it is in a small class – anywhere in the room) but LC uses a sophisticated program to reduce the influence of confidently wrong students.  Having diverse permanent/fixed teams and having students discuss the CQs with their teammates also addresses this issue.
  4. To alleviate some anxiety from this non-traditional format students are given lecture notes. Traditional lectures aren’t given, but students are given the next best thing – the lecture notes.
  5. To help motivate the students and to reinforce the importance of meaningful learning and moving away from rote memorization exams should have 50% conceptual questions.

So, there you have it – the why and how I completely redesigned my courses.  Is that the end of the story, you ask?  Of course not.  Teaching is an iterative process and with anonymous, end of the semester input from students, self-reflection, and professional development, the changes have been continual.  Perhaps, in a future blog, I will write the tale of why and how this course redesign evolved and changed overtime.

References for Redesign and Remediation:

Bransford, J.D., Brown, A.L., Cocking, R.R., eds. (2000). How people learn: Brain, mind, experience, and school. Washington, DC: National Academy Press.

Broida, J. (2007). Classroom use of a classroom response system: What clickers can do for your students. Upper Saddle River, NJ: Prentice Hall.

Bruff, D. (2009) Teaching with classroom response systems: Creating active learning environments. San Francisco, CA: Jossey-Bass.

Bybee, R.W. (ed.) (2002).   Learning science and the science of learning. Arlington, VA: NSTA Press.

Duncan, D. (2005). Clickers in the classroom: How to enhance science teaching using classroom response system. San Francisco, CA: Pearson Addison Wesley Benjamin Cummings.

Ellis, A. B., Landis, C.R., & Meeker, K. Classroom assessment techniques: ConcepTests. http://www.flaguide.org/cat/contests/contests2.php

Fink, L. D. (2003). Creating significant learning experiences: An integrated approach to designing college courses. San Francisco, CA: Jossey-Bass.

Finkel, D.L. (2000). Teaching with your mouth shut. Portsmouth, NH: Boynton/Cook.

Herreid, C.F, ed. (2007). Start with a story: The case study method of teaching college science. Arlington, VA: NSTA Press.

Mazur, E. (1997). Peer instruction: A user’s manual. Upper Saddle River, NJ: Prentice Hall.

Michael, J. A. & Modell, H. I.  (2003) Active learning in secondary and college classrooms: A working model for helping the learner to learn. Mahwah, NJ: Lawrence Erlbaum Associates.

Novak, G. M., Patterson, E. T., Gavin, A. D., & Christian, W., (1999). Just-in-Time Teaching: Blending active learning with web technology. Upper Saddle River, NJ: Prentice Hall.

Sullivan, W.M. & Rosin, M.S. (2008).  A new agenda for higher education: Shaping a life of the mind for practice. San Francisco, CA: Jossey-Bass.

Woditsch, G.A. & Schmittroth, J. (1991). The thoughtful teachers guide to thinking skills. Hillsdale, NJ: Lawrence Erlbaum Associates.

After a post-doctoral fellowship at Washington University School of Medicine, Jane began her academic teaching career at Benedictine University in the graduate programs in exercise physiology.  After that Jane taught in the Physician Assistant Programs at Rosalind Franklin University and the University of Kentucky. For the past 18 years Jane taught Anatomy and Physiology at Heartland Community College in Normal, IL, where innovative, student-centered instruction is encouraged. For the last decade, Jane employed Just-in-Time Teaching with Peer Instruction and concept questions assessed with a classroom response system.  Recently, permanent, fixed teams were used in her classes, along with team-based summative assessments, as well as with in-class and post-class forced retrieval activities. Jane is a Professor Emeritus of Biology and had served the Anatomy and Physiology course coordinator.

Jane received her B.S. from Eastern Illinois University, her M.S. from Illinois State University, and her Ph.D. from Marquette University.

 

Using Reflection to Help Find Certainty in an Uncertain Time

As we begin the spring 2022 semester, we are met with yet another uncertain path ahead. Will I have to teach remotely? Will I be able to teach in person? Will I have the option? What will be the option for students? Will all of this change in a few weeks? How are the students going to handle another stressful semester? The list goes on. I certainly do not have the answers to any of the aforementioned questions, but the recent (and not so recent) uncertainty has prompted me to spend time reflecting on my courses and teaching practices.

But, before I dive into that, here’s a bit on my background to help with the context of this reflective exercise. First, I am relatively new to the teaching profession, and I started my first tenure track position in the fall of 2017, after an exhilarating and challenging visiting position the year before (2016-2017). As a visiting professor I found my calling as an educator and mentor, and while I was working more than I ever thought possible, I loved every minute of it. As you may remember from your first few years of teaching, these first years are filled with exponential growth as an instructor, faculty member, and person. I was developing new courses almost every semester and/or making significant changes to previously used courses. I worked with colleagues at my institution and others, soliciting feedback on how I could improve assessments, student engagement, and advising. Needless to say, very little was the same semester to semester – lots of editing and revising. And right as I’m starting to get the swing of things, mid-way through year 3, BAM – COVID! As a relative newcomer to the classroom, when COVID hit in the spring of 2020, I had a mere 3.5 years of teaching in the pre-COVID era and very little consistency in my coursework (or so I thought). And since then, every semester since the start of COVID has been different in terms of course delivery, assessments, and student engagement. Some courses have been fully remote, some hybrid, some in person, some switched back and forth with student options also constantly changing. It’s exhausting to think about.

As a result of all of this inconsistency, when I started planning for yet another uncertain semester (spring 2022) I decided to spend some time thinking about what has been consistent in my courses throughout the years (both before and after COVID). To obtain additional data, I also reviewed those dreaded course evaluations in order to review feedback that wasn’t from my own biased brain. While somewhat scary, this reflective activity allowed me to sort out a few things that paint a clear picture of “my classroom” regardless of the delivery method or state of the world:

 

  • ORGANIZED – If you were to run a word cloud on all of my course evals the largest word would most likely be “organized” or some iteration of that. And for those that know me, this probably isn’t a huge surprise. I am organized, perhaps a bit over-organized, and this is very clear in my course design. Students take this as a positive – I know, or at least look like I know, exactly where this course is headed, and they trust me to lead them on this journey.

 

  • OVER-COMMUNICATION – The second largest word on the world cloud would be “communication”, and possibly to the point of over-communication. While not every student requires reminders of assignments or expectations, some do. Different modes of communication are helpful too: in person, e-mail, LMS, video chat, etc. Students seem to need more communication during the COVID semesters than in previous ones and I’ve found that my ability to “over-communicate” helps students stay on track and always know the expectations. Plus, I’m hoping that my practice of over-communication helps students feel more comfortable reaching out to me when they need help.

 

  • ACTIVE – From the beginning I did not want my classroom to be one of those that students just passively attended. I wanted them to be excited to come to class at 8:00 am because they knew that they were going to be put to work and be engaged in their learning. This is absolutely a hard sell, especially at 8:00 am, and it takes time for some students to warm up to the idea, while a few never do (and they note that very clearly in the evals). However, for the majority of students, the active classroom is a welcoming and fun learning environment (these comments are more pleasant to read in the evals). Plus, it’s just more fun to teach!

 

  • FLEXIBLE – While flexibility has been of utmost importance during COVID, I noticed that I also had a bit of flexibility in my pre-COVID classroom as well. Flexibility with learning speeds and styles, flexibility with my own content deadlines, flexibility with student requests, and even homework or project deadlines (to an extent). This was absolutely something that I had to work on early on in my teaching career, but I learned a lot from listening to my students and their needs in the classroom and they appreciate my ability to work with them as they struggle.

 

  • CHALLENGING and SUPPORTIVE – Students note that my courses are challenging, but feasible. Yes, I have high expectations, of which they are aware (see above), but they also know I’m here to help them and work with them when they are struggling (with the course or otherwise). The connections we can develop with students are unlike any other, and I love seeing them grow throughout their educational journey.

 

  • EXCITING – Students commented on my ability to be “excited” about anatomy and physiology. (Who isn’t?!?!) I don’t know if this is just because I have more energy than they do at 8:00 am, but I’ll take it. A&P is EXCITING and apparently that is clear both in person and on camera. Also, apparently, I appear taller on camera.

Now, while things are still a bit crazy and uncertain, I encourage you to reflect on your own teaching practices both before and during COVID to uncover some commonalities in your classroom.  We will probably never go back to exactly the way things were pre-COVID, so stopping and reflecting may be a great exercise to help move forward. Spend some time noting what is similar and maybe even what is different. Particularly if you are new to this profession, such as I am, this activity may help you learn a bit more about your teaching style and classroom practices. Then share your revelations with others and encourage them to do the same, perhaps even in the comments section below.

Postscript: Total coincidence that this is similar to the January 13th blog topic, which is also a great reflective exercise. Looks like we are on similar paths. Happy reflecting!

Jennifer Ann Stokes is an Assistant Professor of Kinesiology at Southwestern University in Georgetown, TX. Jennifer received her PhD in Biomedical Sciences from the University of California, San Diego (UCSD). Jennifer’s courses include Human Anatomy and Physiology (I and II), Nutritional Physiology, Intro to Human Anatomy and Physiology, Medical Terminology, and Psychopharmacology. Jennifer is also actively engaged with undergraduates in basic science research (www.stokeslab.com) and in her free time enjoys trail running, cycling, hiking, and baking cookies and cakes for her colleagues and students.
Looking back and moving forward. The importance of reflective assessment in physiology education.

At the end of the 1986 movie Platoon, the protagonist (Chris Taylor, played by Charlie Sheen) provides a very moving monologue that starts “I think now, looking back, we did not fight the enemy, we fought ourselves. The enemy was in us. The war is over for me now, but it will always be there, the rest of my days.”

When Platoon was first released in theaters I was in high school.  I was enthralled with Platoon, and it has held a very special place in my memories ever since.  The ending monologue has echoed through my mind at the end of almost every semester that I have been a faculty member (albeit with a few changes. No insult or mocking of the movie is intended, this is simply my effort to take a powerful cinematic scene and apply it to my personal situation).  My end of semester monologue goes something like this “I think now, looking, back, I did not teach the students but I taught myself. The student was within me.  The semester is over for me now, but it will always be there, the rest of my days.”  And with that, I begin reflective assessment of my teaching.

For many educators, assessment is a dirty word and a necessary evil.  Hall and Hord (1) reported that faulty experience anxiety about assessment because of a lack of understanding of the process or importance of assessment.  Faculty may also disdain participating in assessment due to concerns about accountability, or due to concerns about accreditation negatively impacting their careers (2). Often, faculty also view assessment reports as things that need to be prepared and submitted to meet requirements imposed on faculty from an administrative office within their institution, or some outside accrediting agency, but think that assessment reports are not really pertinent to the day-to-day work of education (3).  To help overcome hesitancy to fully engage in the assessment process Bahous and Nabhani (4) recommend that institutions hire a full-time assessment officer to work one-on-one with faculty.  All of these are relevant to the formal process of assessment and submitting data and reports to meet institutional or organizational requirements.  When done the right way, these assessment reports can be valuable tools in education.  But what I want to discuss in this blog post is a more informal form of assessment that I think all educators should do, and probably already do, which is reflective assessment.

Students and faculty alike perceive Physiology as a very challenging academic subject (5, 6).  The concepts are difficult, and there is a lot of terminology.  Our understanding of physiology is continually expanding, but yet students often still need to have a firm concept of the basic fundamentals before moving on to more complex and in-depth information.  Physiology is often taught in a system by system approach, yet the systems do not operate independently of one another so at times it may feel like the cart is put before the horse in regards to helping students to understand physiological processes. All of these issues with the difficulty of teaching physiology make reflective assessment an important part of teaching.

Quite simply, no matter how well we taught a class or a concept, as educators we may be able to teach better the next time (7, 8).  Perhaps we can tweak an assignment to make it better fit our needs.  Or perhaps we can provide a new resource to our students, like an appropriate instructional video or a scholarly article. Or maybe it’s time to select a new textbook.  Or maybe we have seen something in Advances in Physiology Education or on the PECOP Blog that we would like to incorporate into our teaching practice.  Whatever the reason, reflective assessment provides an opportunity for us to ask ourselves two very simple, but very important questions about our teaching:

  1. What went well in this class, and what didn’t go as well as planned?
  2. What improvements are we willing to make to this course to improve student learning?

The first question is important for identifying strengths and weaknesses in our courses.  We can ponder what went well, and ask why it went well.  Has it gone well each semester? Or did it go well because of changes we made in our teaching?  Or did it go well because of other changes, such as a change in prerequisite courses?

As we ponder what didn’t go as planned, we can also contemplate why things didn’t go as planned.  I think anyone who has taught through the COVID pandemic can identify lots of unforeseen and unusual disruptions to our courses.  But we can also use reflective assessment to identify ongoing problems that deserve some attention.  Or we can identify problems that have previously not been problems, and make a note to monitor these issues in future courses.

The second question, about what changes are we willing to make, is also extremely important.  Sometimes a problem may be outside of our control such as course scheduling, who teaches the prerequisite course, or other issues.  But if the identified problem is something we can control, such as the timing of the exams, or the exam format, or laboratory exercises, then we need to decide if the problem arises from something we are willing to change and then decide how and what to change.  Can the problem be addressed through the acquisition of new instrumentation?  Can the problem be addressed by changing textbooks?  Some of the problems may be easy to solve, while others might be more difficult.  Some problems might require funding, and so funding sources will need to be identified.  But this is where reflective assessment can really help us to prioritize changes to our teaching.

I ask myself these questions throughout the semester as I grade tests and assignments, but in the midst of a semester there is often not time to really ponder and make changes to my classes.  During the semester I keep a teaching diary to make note of the thoughts that come to me throughout the semester. Then, after final grades are submitted and before the next semester begins there is more time to read through the teaching diary and to reflect and ponder about my teaching.  Often, in this less pressured time between semesters, by reviewing my teaching diary I can take a step back to reflect on problems during the semester and determine if this has been an ongoing issue in my classes or an isolated issue limited to only this one semester.  I often find that what seemed like a problem in the middle of the semester has resolved itself by the end of the semester.

Of course there are many other questions that can be asked as part of reflective assessment (7, 8), and any question can lead to numerous follow up questions.  But I think these two questions (1. What went well in this class, and what didn’t go as well as planned? 2.  What improvements are we willing to make to this course to improve student learning?) form the cornerstone of reflective assessment.  And reflective assessment can then lead to a career long endeavor to engage in action research to improve our teaching skills.

  1. Hall G, Hord S. Implementing change: Patterns, principles, and potholes (5th ed). New York: Pearson, 2019.
  2. Haviland D, Turley S, Shin SH. Changes over time in faculty attitudes, confidence, and understanding as related to program assessment. Iss Teacher Educ. 2: 69-84, 2011.
  3. Welsh JF, Metcalf J. Faculty and administrative support for institutional effectiveness activities. J Higher Educ. 74: 445-68, 2003.
  4. Bahous R, Nabhani M. Faculty Views on Developing and Assessing Learning Outcomes at the Tertiary Level. J General Educ. 64: 294-309, 2015.
  5. Slominski T, Grindberg S, Momsen J. Physiology is hard: a replication study of students’ perceived learning difficulties. Adv Physiol Educ. 43:121-127, 2019.
  6. Colthorpe KL, Abe H, Ainscough L. How do students deal with difficult physiological knowledge? Adv Physiol Educ. 42:555-564, 2018.
  7. Pennington SE. Inquiry into Teaching: Using Reflective Teaching to Improve My Practice. Networks, An Online Journal for Teacher Research 17, 2015. https://doi.org/10.4148/2470-6353.1036
  8. Reflective Teaching Practices. Int J Instruc. 10: 165-184, 2017. NM, Artini LP, Padmadewi NN. Incorporating Self and Peer Assessment in Reflective Teaching Practices. Int J Instruc. 10: 165-184, 2017.
    Dr. Greg Brown is a Professor of Exercise Science in the Department of Kinesiology and Sport Sciences at the University of Nebraska at Kearney where he has been a faculty member since 2004. He is also the Director of the General Studies program at the University of Nebraska at Kearney. He earned a Bachelor of Science in Physical Education (pre-Physical Therapy emphasis) from Utah State University in 1997, a Master of Science in Exercise and Sport Science (Exercise Physiology Emphasis) from Iowa State University in 1999, and a Doctorate of Philosophy in Health and Human Performance (Biological Basis of Health & Human Performance emphasis) from Iowa State University in 2002. He is a Fellow of the American College of Sports Medicine and