Author Archives: Margaret Stieben

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

     

When will my teaching return to normal?

When the COVID-19 pandemic forced me to shift all teaching online in March 2020, I scrambled to modify and adapt my course-based undergraduate research experiences (CUREs) as well as my student-centered discussion-based animal physiology course to a remote format. Working fully from home I felt like I never left my computer. And I got a taste of what some of my students were experiencing in dealing with unstable Wi-Fi, constant interruptions, and a less than ideal learning environment. In the animal physiology course, modifying a flipped teaching format that was being used prior to the pandemic helped smooth the transition to online instruction; the pre-class preparation resources and the active learning materials that were already in place for flipped teaching were helpful in this transition, letting us focus on reconfiguring learning activities and assessments from the face-to-face format to the online platform (1, 2). In my lab courses, students prepared research proposals rather than research progress reports since they were unable to work in the lab and generate their own data.

In the second half of the spring 2020 semester, assignment due dates morphed into shifting targets rather than fixed goals, and other assignments were just dropped as I was simply too tired to adapt them to an online format. That summer, I spent hours and hours thinking about the structure of each of my courses, including the assignments, activities, and assessments, and what I could/would/should revise for the next offering of the course. I struggled with the uncertainty of planning for teaching in the Fall 2020 semester without knowing “how” classes would be. As the pandemic spiked in Houston and I continued to work from home, there was one key question that was always in the back of my mind: “What do I really want my students to learn and how can I help them get there?” (see 2).

Although I had requested an exemption from dual delivery for my lab courses, which were scheduled to meet in person, I wasn’t sure we would meet for class until the semester actually started. In over 20 years of teaching undergraduate labs, I have never seen students as happy to come to lab as they were last year – and none of them complained on those days when lab sessions went longer than scheduled. For most of them, this course was their only face-to-face class and they were genuinely hungry for in-person interactions.

For both semesters of the 2020-2021 academic year, faculty and students at Rice faced the challenges of not only the mode of instruction but also shortened semesters. The Fall 2020 semester was shortened from 15 to 13 weeks – students did not return to campus after the Thanksgiving holiday. The Spring 2021 semester started 3 weeks later than usual, and in-person classes were delayed until the fourth week of the semester due to a spike in COVID-19 cases in Houston. To add to this stress, we lost a full week of classes the fourth week of the semester due to a freak winter storm in Texas – so in-person meetings for my lab classes that had exemptions from remote delivery did not begin until Week 5 of the semester. Because of the winter storm, the spring semester was also shortened to 13 weeks of instruction. Additionally, throughout the spring semester there were 5 days that classes were not offered – these “Sprinkle Days,” which were in lieu of a week-long spring break, were especially challenging for faculty because we were not permitted to have any assignments due the day of or the day after a Sprinkle Day. These days with no classes disrupted the rhythm and flow of a “normal” semester for both faculty and students, especially for courses with multiple sections, where we had to stagger work and assignments over multiple weeks.

With shortened Fall 2020 and Spring 2021 semesters, faculty had less time to offer course material, and students had less time to work on projects in the lab and less time to learn content in lecture courses.  Lab courses were mostly in-person for the entire year but with limited occupancy in each lab room, which was the biggest adjustment for student teams to work on their open-ended research projects together – the entire team of students was not always able to work in the lab at the same time; whole class meetings were held via Zoom. Additional safety precautions, such as wearing face shields in addition to masks and having plexiglass dividers at the student work benches, made communication more challenging as it was harder to talk and hear each other during lab. Lecture courses that were less than 25 or 40 students (Fall 2020 and Spring 2021, respectively) were allowed to be in-person in larger rooms that allowed for a 6-foot physical distance. Lecture courses that were greater than 25 or 40 students, respectively, were all online and were dual delivery.

The Fall 2021 semester was supposed to return to normal, with all classes meeting fully in-person. But due to some problems with COVID tests for the incoming class of students, we had yet another delay to the start of the semester – and when we started mid-week, we were online only for the first couple of weeks. We have now returned to full occupancy in the teaching labs, and face shields and plexiglass dividers are no longer required so the lab environment is much improved. We continue to use Zoom for some of the class meetings as it is easier for students to share presentations and for instructors to create short course videos. Although we anticipate an on-time, fully in-person start to the spring semester, we still must plan for alternative instruction as we do not know what will happen over the winter break with the omicron variant and the infection rate in Houston and elsewhere.

These past two years have been mentally draining and physically exhausting! The pandemic definitely heightened the need for empathy and compassion in my teaching (see 3). In both lab-based and lecture-based courses, I modified my teaching to

  • Balance flexibility, expectations, and rigor: in addition to reducing the number of assignments, I established flexible due dates for most assignments with “soft” or “hard” deadlines
  • Adapt assessments and feedback: assignments were modified so students could submit them online in our Learning Management System (Canvas), and I gave them more opportunities to revise their work throughout the semester
  • Make the syllabus “An Invitation to Learn:”
  • Connect with students: I now hold my “office hours” via Zoom, which gives me more flexibility for meeting with students outside of regular class hours
  • Create/seek new opportunities for learning: I seek ways to give students more choice and ownership of their work and expand the course content by bringing in guest speakers from Rice or other institutions, either over Zoom or in-person
  • Think of learning goals more broadly: I considered what outcomes are important to help students learn how to think like a scientist and be a good citizen.

One positive outcome of the pandemic-motivated changes to my teaching is confirmation that authentic assessment of student learning is about so much more than just exams or grades! Incorporation of formative assessments that are either low-stakes or completion grades give students opportunities to engage in learning both during and outside of class. Scaffolding of major assignments throughout the semester encourages students to focus on individual components, improve their time management skills, and incorporate my feedback into revisions of their work. In the classroom, students work on both team and individual projects throughout the semester, encouraging collaboration and creativity.

Many of the adaptations I made for instruction during the peak of the pandemic increased student engagement and improved learning, and I will continue to use these approaches post-pandemic. For example, two major changes I implemented as a direct result of the pandemic in the animal physiology course were to 1) shift the weighting of exams from 70% of the overall course grade to 25-30% and 2) make all exams “open resources.”  (Illustration of Kristin Neff’s three steps for self-compassion, graphic recording by Johnine Byrne)

I realize more than ever the role I can and must play in helping students focus on the “big picture” as they learn critical concepts and skills so they don’t get overwhelmed with facts and details. I now incorporate these meta-questions into an end-of-the-semester reflection where I ask students to think about what they have learned:

  • What is one thing from this course that you want to take with you?
  • What one thing did you learn in this course that you will never forget?! How has that changed you?
  • What was the hardest part of this course? What did you do to cope with the difficulty of that aspect?
  • What was your favorite part of this course?

After overcoming my initial resistance to change and dealing with much angst about whether or not my efforts were actually helping students learn, I now accept and have even come to embrace this “new normal” of teaching, which includes both face-to-face and synchronous and asynchronous online instruction for lecture- as well as laboratory-based courses. The silver lining in the COVID-19 cloud is I am much more adaptable and confident in my abilities to change my teaching strategies when necessary to prioritize supporting students and creating learning experiences that include everyone.

As we enter year three of the pandemic, most of us recognize that our teaching will likely never return exactly to the way it was pre-pandemic and appreciate that it shouldn’t be the same as before. That being said, Michael S. Roth reminds us that “Everything Won’t Be Different” (5) and the lessons we have learned during the pandemic with regards to “inequality, connection, and compassion” should continue to shape and guide our teaching as we resume in-person interactions with students and colleagues. I end this post with a reminder that the mental health of faculty and staff is also important – for us to create a compassionate learning environment for our students, we must be kind to ourselves (5,6).

 

  1. Beason-Abmayr B, Caprette DR, Gopalan C. Flipped teaching eased the transition from face-to-face teaching to online instruction during the COVID-19 pandemic, Adv Physiol Edu 45: 384-389, 2021; https://doi.org/10.1152/advan.00248.2020.
  2. Beason-Abmayr B. What do I really want my students to learn about animal physiology? January 2021; https://blog.lifescitrc.org/pecop/2021/01/11/what-do-i-really-want-my-students-to-learn-about-animal-physiology/
  3. Schacter HL, Brown SG, Daugherty AM, Brummelte S, Grekin E. Creating a Compassionate Classroom. INSIDE HIGHER ED, December 1, 2021; https://www.insidehighered.com/advice/2021/12/01/compassionate-teaching-yields-most-benefits-opinion.
  4. Roth MS. Everything Won’t Be Different. INSIDE HIGHER ED, January 18, 2021; https://www.insidehighered.com/views/2021/01/18/three-lessons-pandemic-should-guide-colleges-future-opinion.
  5. Illustration of Kristin Neff’s three steps for self-compassion, graphic recording by Johnine Byrne; https://www.lionsroar.com/three-steps-for-self-compassion-illustrated/
  6. Neff KD. The Development and Validation of a Scale to Measure Self-Compassion, Self and Identity 2: 223-250, 2003; DOI: 10.1080/15298860390209035
Beth Beason-Abmayr, PhD, is a Teaching Professor of BioSciences at Rice University in Houston, TX, and a faculty fellow of the Rice Center for Teaching Excellence. She has developed multiple course-based undergraduate research experiences (CUREs) and a student-centered animal physiology course. She is a past recipient of the George R. Brown Award for Superior Teaching and the Teaching Award for Excellence in Inquiry-Based Learning at Rice. She is a leader with the National Institute on Scientific Teaching (NIST) and co-director of a 2022 Regional Summer Institute (SI). She also is a longtime judge for the International Genetically Engineered Machine (iGEM) competition and a member of the iGEM Judging Program Committee. Beason-Abmayr is chair of the American Physiological Society’s 2022 Institute on Teaching and Learning and is an associate editor for Advances in Physiology Education. She earned her PhD in physiology and biophysics at The University of Alabama at Birmingham.

 

Expanding “normal” in physiology

We are not formal authorities, rather informal allies who have enacted a few small classroom and content related changes related to diversity and inclusivity in our medical school. We hope that our experience will help you in your pursuits in the education of all students.

It took someone in power (a Departmental Leader and Course Director) to act. Author KSC recognized that key person group diversity content was missing and that societal and student sentiment had shifted. This was in the early fall following the 2020 “Black Lives Matter” demonstrations.  Knowing that even with firm institutional commitment, change would take time, author KSC inserted intentional diversity and inclusivity curricular time into the Cardiovascular Systems course (USA medical year 2, 5-week Fall course) in 2020. The social determinants of healthcare and related topics received some curricular coverage but were less present in foundational coursework. Three required elements were added to the course that would both have learning objectives and corresponding assessment items, as assessment often indicates importance in coverage and content to students.

Having passion and insight does not mean that this person must deliver the content. Author TEW was the person selected to deliver the material since the topic of “normal” had been informing his teaching for several years, especially in developing physiology content for Pediatrics and Gerontology medical blocks and an understanding that 50% of people could be excluded if sex as a biological variable is not included.  In 2017, author TEW also led a teaching workshop at the International Union of Physiological Sciences in Brazil with the goal of challenging physiology educators from across physiology societies to include sex and lifespan material in physiology education and to teach these differences not as special topics but as “normal” physiology.

The three elements covered included: sex, lifespan (older and younger), and USA person groups with historic health disparities. One lecture (“Normal” physiology and how it changes across the lifespan and between sexes – covering respiratory, renal, and cardiovascular systems) and 6 podcasts (Selected sex-specific issues in BP control & hypertension, Selected race & ethnicity issues in BP control & hypertension, An innovative approach to hypertension care in African American males, Sex-specific physiology: CV signs and symptoms, Sex-specific physiology: Heart disease, and CV epidemiology delineated by race and ethnicity) were incorporated and spaced within an integrative organ-based content.  We attempted to have material that was race/culture-informed but not race/culture based, which allows some separation of social constructs, the individual vs. person group, and a determinant vs. prevalence. In other Year 2 medical courses, Department physiologists added information on historical bias in normative prediction equations (pulmonary function testing and glomerular filtration rate) as well as environmental justice and air quality.  These other additions were in the form of one to a few formally presented slides, part of a case presentation, or as a brief class discussion topic.

Were the additions easy? No. It took curricular time, administrative support, and a great deal of learning on our part. Documents such as APS Medical Physiology Learning Objectives do not directly address diversity and inclusivity to guide the field in what is important to include.  Perhaps as a Society this is a change we can implement.  Some take-homes for physiology educators: 1) no matter your background, you can contribute (very few people have formal training in this area), 2) collaborate with other faculty, 3) obtain feedback from all person groups and from students, as perception and intent can be quite different, 4) be intentional and precise with wording, and 5) implement small changes. We encourage you to expand “normal” physiology in one or two ways this upcoming semester, but do not be surprised if students are quite interested and request more.

 

 

 

 

 

Ken Campbell is a Professor and Director of Graduate Studies in the Department of Physiology. He also in the Co-course Director of the Cardiovascular Course in the Year 2 medical curriculum University of Kentucky College of Medicine.

 

 

Thad Wilson is a Professor and Director of the Graduate Certificate in Physiology Teaching in the Department of Physiology. He also is the Co-course Director of the Respiratory Course in the Year 2 medical curriculum and teaches physiology in several of the other medical courses at University of Kentucky College of Medicine.

 

 
The trepidatious return to in-person instruction during the COVID-19 pandemic: valuable lessons applied from online teaching using Lt in the face-to-face classroom

 

To say that the past 20 months of higher education have been a hardship is a gross understatement. The speed at which educators have embraced new technologies to bridge the pivot to virtual instruction has been remarkable.

This has been particularly difficult in courses where hands-on experiences are the norm, such as in anatomy and physiology laboratory courses. Instructors of laboratory courses where students must gain practical skills and experience the process of science found themselves relying on new (to them) technologies to fill the gap in their newfound teaching methods during the forced switch to virtual instruction (1, 4). As such, many platforms stood out amongst a sea of offerings for physiology educators.

Adapting pedagogical approaches in the virtual landscape is not a new phenomenon for anatomy and physiology educators with many successful reports providing best practices to adapt didactic and laboratory methods to online or hybrid learning (2, 3) long before the COVID-19 pandemic. Although online approaches have demonstrated an effectiveness in achieving course objectives, effective combinations of both online and face-to-face instruction must be investigated to help accommodate the convenience that online approaches offer students as we adjust to the return to in-person modalities.

Our experiences at the University of the Incarnate Word (UIW) have mirrored our colleagues in the scramble to identify suitable stand-ins for laboratory courses that still provide as robust an experience as possible. Thanks to a fortuitous introduction during the January 2020 CrawFly Workshop we now host annually at UIW in association with ADInstruments, we were introduced to the Lt suite of laboratory courses, most notably their Human Physiology and Anatomy packages. While we were impressed by the capabilities of their labs and lessons, any thoughts of immediate use were placed on the backburner as we already had the Spring 2020 curriculum planned out – or so we thought.

During the confusing and uncertain switch to virtual instruction in March of 2020, fraught with pandemic panic, we haphazardly pieced together the second half of our virtual lab curriculum relying on any lab simulations we knew of that were free and easily accessible to our students. Following this “dumpster fire” of a semester, we reassessed our future directions for what we were sure was going to be another traipse into the virtual landscape, and we knew that our Frankenstein approach would not be suitable going forward. That is when the decision to completely redesign our Anatomy and Physiology I and II Lab curriculum using Lt was made.

Beginning in the Fall of 2020, 12 laboratory activities were selected from the pre-built modules and lessons available in Lt for human anatomy and physiology that met our pre-determined course objectives for both BIOL 2121 (Anatomy and Physiology I Lab) and BIOL 2122 (Anatomy and Physiology II Lab). We used these pre-built lessons as the outline for each lab and edited the material to accommodate an online lab experience. Where the ADInstruments PowerLab stations, sensors, and electrodes would normally be used for data acquisition with Lt software, we replaced these sections with either videos or descriptions of how data would be collected for each lab. These sections providing the theory and sample protocols were followed by using the Lt sample data sets for students to complete data analysis and formulate conclusions. To help facilitate virtual dissections, we took advantage of the dissection videos and guides provided in the pre-built Lt labs that students could refer to in lieu of having their own specimens at home. The final product allowed us to replace the hands-on experience preferred in an undergraduate anatomy and physiology lab in the best way possible when virtual instruction was our only option.

To gauge student satisfaction with this new platform, and importantly to determine if the educational goals for our students were being met, a survey was designed and administered to students at the end of the semester. This was used to adjust the lab offerings and fine-tune the activities that were used again in proceeding semesters. Figure 1 shows an improvement in the overall rating for Lt where students provided scores in between 1 and 5 with 5 being the highest rating from Fall 2020 to Spring 2021 by just over 8% (from a score of 4.18 to a score of 4.53 in the spring semester). Both semesters were conducted using remote instruction; therefore, the increase is attributed to improvements made to the existing labs in spring based on student feedback.

Moving forward to Fall 2021, our labs returned to mostly in-person instruction with only 30% offered with either asynchronous online or synchronous online instruction. The same Lt Student Survey was administered as the current semester has come to an end and the data demonstrate a further increase in the overall rating for Lt with an average rating of 4.7 (Figure 1). Although we hypothesize that this increase is mostly attributed to the transition back to in-person instruction as students mostly cited comments similar to, “Visually and physically being able to carry out the experiment and dissection labs,” or “Being able to learn things in person and on Lt really helped my learning and broadened my knowledge,” when asked, “What are one to three specific things about the course or instructor that especially helped to support student learning?” This indicated to us that the more hands-on approach with the return to in-person instruction was helping to support our students’ learning.

Importantly, when asked, “If you took an Anatomy and Physiology Lab online in a previous semester, and are currently taking an Anatomy and Physiology Lab in-person with Lt, what about your experience has changed or improved?” students replied with comments such as, “Definitely improved from A&P1 lab, still used Lt in lab but in person as well helped,” or “The labs have definitely improved and the course work… I think that I learned better in person than online.”

Given the data we have collected thus far, we are learning that while students appear to prefer in-person lab instruction, the flexibility provided by the online Lt lab platform still allows for the inevitability of students in quarantine who are unable to attend in-person labs. And although we are still in a period of uncertainty and flux, we think we are finding an effective combination of online and in-person lab instruction to best serve our students and maintain the rigor expected of an undergraduate anatomy and physiology lab experience.

References:

1.       Alves, N., Carrazoni, G. S., Soares, C. B., da Rosa, Ana Carolina,de Souza, Soares, N., & Mello-Carpes, P. (2021). Relating human physiology content to COVID-19: a strategy to keep students in touch with physiology in times of social distance due to pandemic. Advances in Physiology Education, 45(1), 129.

2.       Anderson, L. C., & Krichbaum, K. E. (2017). Best practices for learning physiology: combining classroom and online methods. Advances in Physiology Education, 41(3), 383.

3.       Attardi, S. M., Barbeau, M. L., & Rogers, K. A. (2018). Improving Online Interactions: Lessons from an Online Anatomy Course with a Laboratory for Undergraduate Students. Anatomical Sciences Education, 11(6), 592-604.

4.       Lellis-Santos, C., & Abdulkader, F. (2020). Smartphone-assisted experimentation as a didactic strategy to maintain practical lessons in remote education: alternatives for physiology education during the COVID-19 pandemic. Advances in Physiology Education, 44(4), 579.

Dr. Bridget Ford is an Assistant Professor in the Department of Biology at the University of the Incarnate Word (UIW) in San Antonio, Texas. She obtained her bachelor’s degree at St. Mary’s University in Biological Sciences with a minor in Chemistry. She then went on to earn her Ph.D. in Molecular Medicine at UT Health San Antonio in 2012. Bridget completed her postdoctoral fellowship training at the United States Army Institute of Surgical Research in the Extremity Trauma and Regenerative Medicine task area and at UT Health at San Antonio between the Magnetic Resonance Imaging Division and the Department of Medicine.

 

Bridget serves as the Anatomy and Physiology I and II Lab Course Coordinator and teaches Anatomy and Physiology I and II lecture courses, Endocrinology, and Cell Biology at UIW. She is dedicated to mentoring undergraduates in the research laboratory where her research focuses on understanding the molecular mechanisms involved in renal cell injury in diabetic kidney disease. The overall goal she has for all her trainees is to apply what they learn in the classroom to ask scientific questions in the quest to become independent and creative thinkers.