Category Archives: Active learning

Less is more – focusing on the core concepts

When it comes to teaching a subject in depth and breadth, an instructor may face the challenges of limited time versus unlimited contents. To this end, the instructor may focus on covering as much as possible material in a lecture, or on the key concepts that help prioritize contents and overarch a myriad of information. The former strategy is highly content-centered and can be overwhelming to both the instructor and students, and in fact, studies have shown that instruction time is not necessarily proportional to learning outcome [1]. By contrast, the latter strategy makes time for the instructor and student to interact, discuss, and apply the key concepts to problem solving activities, which fosters an active and interactive learning environment. In line with the evidence showing that students benefit more from an active and interactive learning experience [2], educators have called for less coverage and more inquiry aiming high beyond just the facts so that student’s learning can be enhanced by talking, writing, and collaborating [3-4].

How can one effectively prioritize contents by focusing on the key concepts pertaining to the latter strategy? One of the possible ways is to use learning objectives or anticipated learning outcomes to navigate content prioritization. It is overwhelming to start with materials for teaching planning due to fast growing research and knowledge explosion. However, using a backward design may change the game. Backward design of a course starts with developing clear learning objectives, which aligns selection of lecture contents with anticipated learning outcomes [5-6]. For instance, to accomplish the objective of building students’ critical thinking skills, an instructor will strategically plan time for not only covering materials but also information processing and application. Other than concentrating student learning on facts only, the class will be fueled by problem-based collaborative learning. To this end, it is critical for the instructor to elaborate the key principles or concepts, the very guides students need to address complex problems that demand more than simple factual answers. The collection of facts relevant to the class can be provided as supplemental information or resources for students to look up for problem solving, while it can limit student learning as a major commitment of memorization.

Mastery of basic principles plus being detail-oriented is required for success in experimentation and authentic research in a lab course [7]. To this end, students are expected to pay attention to experimental details in addition to core concepts, raising the question as to how course contents can be prioritized. First, the strategy of backward design still applies. Secondly, the learning objectives or anticipated learning outcomes can be defined such that they focus on core principles and transferrable or interchangeable skills. For instance, the course Laboratory Techniques in Molecular Nutrition covers several sets of lab techniques, one of which is immunoassays. Immunoassays represent a set of methods based on antigen-antibody binding reactions, including Western blotting (WB), immunoprecipitation (IP), co-immunoprecipitation (co-IP), chromatin immunoprecipitation (ChIP), ChIP sequencing (ChIPsec), immunohistochemistry (IHC), immunocytochemistry (ICC), and enzyme-linked immunosorbent assay (ELISA). Each method may take 1-2 weeks (5 hours/week) to cover the principles and operational procedures, and the set of immunoassays alone may occupy a semester. Obviously, it is very challenging to elaborate on each of the immunoassays within a semester given the limited time and resources, plus the needs to cover non-immunoassay techniques. However, it is practical for students to learn about the techniques within 4-5 weeks (5 hours/week) with a prioritized focus by elaborating on the core concepts shared by the eight immunoassays and contrasting the major differences among them. The core principles are shared by all the immunoassays regarding immobilization, blocking, immunobinding, washing, and detection processes. Yet, they are different in assay microenvironments including the solid phases, blocking solutions, antibodies, targets of interest, washing solutions, and detection reagents and instruments. Priority can be given to elaborating the core concepts and major differences (1-2 weeks) and to practicing the most used and accessible immunoassays such as WB, IP, and ELISA (3 weeks).

Practically, use of flipped classrooms can further enhance students’ mastery of key concepts and their ability to apply the concepts to solving problems. In a flipped classroom, the instructor lectures less in class but the course materials and recorded lectures are uploaded to the course management site (e.g., Canvas) for students to study in advance. Students tend to learn more through problem-solving activities with the instructor and peers in class that build critical thinking skills. As such, the learning outcomes can be increased and go beyond the contents by enhancing students’ critical thinking skills, which will benefit their lifelong learning after college.

Taken together, focusing on facts less in class but targeting core concepts and knowledge application more may serve as an effective strategy to build students’ critical thinking skills. The “less” by no means refers to an easy class. Instead, both the instructor and students spend more time outside the class preparing and studying course materials. This is to prepare everyone for more higher-order-thinking activities (e.g., analysis, evaluation, and application) in class. The “less” for “more” pedagogy may benefit student’s lifelong learning experience.


References and further reading

[1] Andersen SC, Humlum MK, Nandrup AB. Increasing instruction time in school does increase learning.

Proc Natl Acad Sci USA. 2016 Jul 5;113(27):7481-4.

[2] Dolan EL, Collins JP. We must teach more effectively: here are four ways to get started. Mol Biol Cell. 2015 Jun 15;26(12):2151-5.

[3] Luckie DB, Aubry JR, Marengo BJ, Rivkin AM, Foos LA, Maleszewski JJ. Less teaching, more learning: 10-yr study supports increasing student learning through less coverage and more inquiry. Adv Physiol Educ. 2012 Dec;36(4):325-35.

[4] DiCarlo SE. Too much content, not enough thinking, and too little fun! Adv Physiol Educ. 2009 Dec;33(4):257-64.

[5] Allen D, Tanner K. Putting the horse back in front of the cart: using visions and decisions about high-quality learning experiences to drive course design. CBE Life Sci Educ. 2007, 6(2): 85–89

[6] Hills M, Harcombe K, Bernstein N. Using anticipated learning outcomes for backward design of a molecular cell biology Course-based Undergraduate Research Experience. Biochem Mol Biol Educ. 2020 Jul;48(4):311-319.

[7] DiCarlo SE. Cell biology should be taught as science is practiced. Nat Rev Mol Cell Biol. 2006 Apr;7(4):290-6.

Dr. Zhiyong Cheng received his PhD in Analytical Biochemistry from Peking University, after which he conducted postdoctoral research at the University of Michigan (Ann Arbor) and Harvard Medical School. Dr. Cheng is now an Assistant Professor of Nutritional Science at the University of Florida. He has taught several undergraduate- and graduate-level courses (lectures and lab) in human nutrition and metabolism (including metabolic physiology). As the principal investigator in a research lab studying metabolic diseases (obesity and type 2 diabetes), Dr. Cheng has been actively developing and implementing new pedagogical approaches to build students’ critical thinking and problem-solving skills.
Synchronous and asynchronous experiences in Advanced Exercise Physiology Courses: what teaching tools work best for my students?

Covid-19 caught all of us off guard, but educators were hit particularly hard and uniquely. I already have flipped classroom teaching and active learning, so the transition was not too difficult for me. However, I found myself incorporating many technological innovations. Was I doing too much? Which features were helping my students, and which ones were overwhelming? In this blog, I want to share some of the strategies I used with undergraduate students taking Advanced Exercise Physiology synchronously and asynchronously.


Additionally, within this blog, I am sharing the student’s perceptions of these technological innovations. In total, fifty-two students enrolled in different sections of “Advanced Exercise Physiology” culminating undergraduate experience (CUE) were invited to participate in a short survey regarding their learning experiences during this current Spring 2021 semester. A total of thirty-nine (n=39) students completed the confidential survey about whether different technological innovations helped them understand the material and study.

Who completed the survey?

Figure 1: Fifty-two students enrolled either in synchronous or asynchronous undergraduate advanced exercise physiology sections were invited to participate, and thirty-nine (n=39) responses were obtained. Seventy-two percent of the responders were enrolled in the asynchronous section, and 27.78% were enrolled in the synchronous section.



Video assignment for glucose metabolism

 During pre-COVID-19 times, I would teach using active-learning team-based instruction. For the first team-based assignment, student teams were asked to discuss and explain in easy terms one of the most difficult topics for my students: glucose metabolism. For this activity, I would bring Legos, markers of different colors, magnets, and other toys; and students were asked to use the materials and make a video of the complete oxidation of a glucose molecule. This in-class, graded assignment seem to help students to understand the metabolic pathways.  I modified the project due to distance learning, so each student has to create a video using any material desired to explain in simple words (without chemical formulas). This assignment is based on the constructivism theory of learning. It makes it innovative because the students learned that glucose is a six-carbon molecule that has to be fully “broken down” (oxidated) through different stages. Once they understand the steps, they could “name” each step and each enzyme. Some students used coins, Legos, or wrote down the step while explaining the process verbally. Some examples of the submissions can be seen in the links below:

Example submission glycolysis  one and example complete glucose oxidation.

 Students perception on making a video assignment for glucose metabolism

Figure 2: Students’ responses to the question “Having to make the video of metabolism in assignment two helped me understand glucose metabolism.” 71.43% responded true (it was helpful), and 28.57% responded false (it was not helpful)




Incorporation of Virtual Lab Experiences using Visible Body and Lt Kuracloud platforms.

One of the main concerns for me was to maintain and increase engagement while teaching virtually or remotely. I incorporated the Lt Kuracloud, a platform for interactive assignments, immediate feedback, videos, and physiology laboratory experiences in all my courses. I took advantage of the free trial, and I used it for some assignments. I received unsolicited emails from students expressing how helpful they found these assignments.  I also used Visible Body Anatomy and Physiology, which I used for lectures. I recommended it to students as supplemental material and for self-graded quizzes. Visible Body Anatomy and Physiology is available at no cost to students as our Institution’s library obtained the subscription for all the students.

Students’ perceptions: “How helpful do you find the following features? “

Figure 3: Responses to the question: How helpful do you find the following features (from 0 to 100 being 0 not useful to 100 very useful). The mean value for assignments in Lt Kuracloud was 79.08/100 (sd= 21), and for Visible Body was 74.74/100 (sd= 24)


Old Reliable Discussion Board

I recently completed my training on Quality Matters (QM) certification (1), and so my courses follow the rubrics of QM Higher Education General Standards. Specifically, QM Module 1 suggests using an introductory welcoming video encouraging the students to introduce themselves to the class using a video, a meme, a photo, or text. The best, and probably the only feature on Blackboard to do this is the “Discussion Board.” The discussion board is a great feature that allows students to increase participation. After all, students are the biggest consumers of social media, videos, and memes. The Discussion Board should be the closest FERPA approved version of TikTok or Facebook, right? WRONG! It worked fine for the first thread entitled “welcome,” most of the students responded by typing to answer the questions. Nobody made a voice thread, a meme, or a video. Afterward, I encouraged participation on the discussion board by posting questions and suggesting posting questions on the discussion board. After a few “virtual crickets” on Discussion Board, I quit posting questions there and developed interactive lectures with pop-up quizzes. As expected, Discussion Board was not very popular among my students.

Students’ perceptions: “How helpful do you find the discussion board on Blackboard? “

 Figure 4: Responses to the question: How helpful do you find the following features (from 0 to 100 being 0 not useful to 100 very useful). The mean value for the discussion board was 43.08/100 (sd= 25).

 Interactive pre-recorded lectures

Pre-recorded lectures are integral components of my synchronous and asynchronous course sections. These are developed using the interactive feature in Camtasia, in which I developed animated lectures. Thus, students are asked to watch the lessons and complete short quizzes that provide immediate feedback. If the concept is mastered, the student continues watching. If not, they are redirected to the lecture or part of the lecture where the concept is explained.

 Students’ perceptions: “How helpful do you find the interactive pre-recorded lectures? “

Figure 5: Responses to the question: How helpful do you find the following features (from 0 to 100 being 0 not useful to 100 very useful). The mean value for interactive pre-recorded lectures was 79.27/100 (sd= 16.8), and for Visible Body was 81.74/100 (sd= 17.8)


Quizlet and Quizlet live game

Like many educators worldwide, I teach my students and support their learning throughout our virtual synchronous meetings. Indeed, this is not easy. One day, as I was finishing my class, I heard screams and laughs! My ten-year-old was having so much fun in his most favorite subject. What is going on? I asked, “it was a close one,” my son said, “I got second place.”  It turned out that he was playing a “Quizlet Game.” Quizlet and Quizlet live have been used by teachers and students to reinforce learned material. I decided to try it, and I created a teacher profile to play games during the remote lectures. Every class, I started a Quizlet game; students use their phones or computers to play a race (team and individual). They play a “race” at the beginning of the class and again at the end of the class. This low-risk activity provides me with important information about misconceptions or concepts that are not mastered yet. Students play again towards the end of the class. This simple activity takes 10 minutes of instruction (5 minutes each “race”). However, it has been proven to be both helpful and fun for the students. Quizlet live was used only in my synchronous classes, but the Quizlet study sets were available to both synchronous and asynchronous sections.

I used this with graduate students enrolled in Human Physiology in the previous semester, and it was a hit! Students loved it, and class after class, this became very competitive. Not only were my students very well prepared for class, but also the competition made it so much fun!

Similar to Quizlet are such programs as Kahoot, Brainscape,  and others that are available for free or very affordable options.

Students’ perceptions: “How helpful do you find Quizlet study sets and Quizlet live? “

Figure 6: Responses to the question: How helpful do you find the following features (from 0 to 100 being 0 not useful to 100 very useful). The mean value for Quizlet sets was 76.86/100 (sd= 24), and for Quizlet live was 68.31/100 (sd= 28). One limitation is that most responders were students in the asynchronous section who did not participate in Quizlet live games.


MS Teams meetings and/or virtual office hours

 I chose Microsoft Teams (MS) for my virtual meetings simply because it is widely adopted at my Institution, and I prefer to keep it simple for students. For my synchronous section, I used a flipped virtual model, in which we meet once per week, and the other day they work on their own on assignments. I did this to avoid screen burnout students in the synchronous section. However, I have been happily surprised with students attending remote classes and the various office hours I provide. Yes, I do provide different office hours; very much this semester, I made every space available on my calendar as extra office hours. I realize that for many, meeting online for “virtual office hours” is more accessible to them (and perhaps less intimidating) than attending office hours in my office, as we did pre-pandemic.

Why did I offer so many office hours? First of all, because I could. Since I can’t conduct research studies with humans during the pandemic, it freed some time I had set aside for data collection to teaching.

Additionally, not driving to and from campus saved me an average of 75 minutes per day, which allowed me to have another office hour option. In reality, I did not use all these hours in meetings with students. Many times nobody needed to meet. However, there were a couple of times in which I’d meet with a student who was struggling. Not with the class or the content. But struggling with life, some students had somebody close to them sick or dying; some lost their job or financial aid, some were working exceptionally long hours as essential workers. For some, isolation was too much. One student, in particular, told me recently, “I do not have any questions today; I just needed some social interaction.” Flexible and various virtual office hours seemed beneficial for students, particularly for those in asynchronous e-learning experiences.

Students’ perceptions: “How helpful do you find the MS Teams meetings and virtual office hours? “


Figure 7: Responses to the question: How helpful do you find the following features (from 0 to 100 being 0 not useful to 100 very useful). The mean value for MS Teams and Virtual Office Hours was 75.86/100 (sd= 21).




 Like most higher education instructors, I had to adapt quickly and shift to e-learning due to the pandemic. Fortunately, I had already taught online several times before and introduced several components to my flipped courses. However, I still struggled to find more interactive ways to keep my students engaged. Not only educators have to deal with the mental exhaustion of finding pedagogical tools that work in this new scenario when we have not had the time to produce evidence-based successful approaches to teaching remotely. But also, we are teaching distraught students. From the scarce but rapidly growing literature, we know that “our college students are currently struggling to stay hopeful and positive in the wake of the COVID-19 pandemic” (2). When asked about their feelings during the transition to virtual classes, students reported that they felt “uncertain” (59.5%), “anxious” (50.7%), “nervous” (41.2%), and “sad” (37.2%). (3) We have to teach students that are dealing with a lot of negative emotions and stress. We, educators, are also living with many of those emotions. My goal with this blog was to share some of my experiences teaching virtually and provide some ideas for any physiology educator that may need them.


Standards from the Quality Matters Higher Education Rubric, Sixth Edition. Quality Matters. Retrieved from Specific Review Standards from the QM Higher Education Rubric, Sixth Edition

  • Munsell, S. E., O’Malley, L. & Mackey, C. (2020). Coping with COVID. Educational Research: Theory and Practice, 31(3), 101-109.
  • Murphy, L., Eduljee, N. B., Croteau, K. College Student Transition to Synchronous Virtual Classes during the COVID-19 Pandemic in Northeastern United States. Pedagogical Research,5(4), em0078.
Dr. Terson de Paleville teaches Advanced Exercise Physiology, Neuromuscular Exercise Physiology, and Human Physiology courses. Her research interests include motor control and exercise-induced neuroplasticity. In particular, Dr. Terson de Paleville has investigated the effects of activity-based therapy on respiratory muscles and trunk motor control after spinal cord injury. Additional research project involves the assessment of the effects of exercise training in elementary and middle school students on balance, visual efficiency, motor proficiency, motor control and behavior in the classroom and at home. Dr. Terson de Paleville is interested in elucidating any links between physical activity and academic skills and performance.


Repurposing the notecard to create a concept map for blood pressure regulation

One amazing aspect of physiology is the coordinated, almost choreographed function of millions of moving parts.  The body has mastered multitasking, maintaining hundreds of parameters within narrow and optimal ranges at the same time.  This very aspect of physiology fuels our passion and enthusiasm for teaching physiology and piques the interests of students.  The networks of numerous overt and subtle interdependent mechanisms and signaling pathways between multiple organs and tissues that regulate plasma calcium or energy intake, for example, also represent major challenges to understanding and learning physiology for students.  We ask our students to combine the wisdom of two old sayings: “You can’t see the forest for the trees’, and “The devil is in the details.”  They need to understand both the bigger picture of the whole animal and the nuanced interlinking of mechanisms, and even molecules, that seamlessly and dynamically maintain different parameters within narrow ranges.  It can be frustrating and discouraging for students.  Furthermore, passing with high marks in systems physiology or anatomy-physiology II is a criterion for eligibility to apply to various health profession programs.  As educators we must acknowledge the complexity of physiology and find ways to help our students literally see and master smaller sections of the larger regulatory network so they can recreate and master the larger network.

For even the best prepared student, as well as the student who cannot take all recommended prerequisite courses for A&P-II or basic physiology, the collection of numerous parts, mechanisms, equations and connections, principles, and laws can represent an obstacle to learning.  Student comments such as, “There is so much to know.”, “It’s so complicated.”, and “Physiology is hard.” are accurate and fair, but also warrant validation.  A little bit of validation and communicating the challenges we encountered as students goes a long way in helping our students’ willingness to endure and continue to strive.  Physiology courses are not impossible, but they are difficult and might well be the most difficult courses a student takes.  I will not pretend or lie to my students.  If I were to dismiss physiology as a whole or a given concept as easy and simple, I risk my student thinking they should be learning principles effortlessly or instinctively and begin to doubt themselves and give up.  It helps to confess apprehensions you yourself felt when first learning various physiological concepts or phenomena.  As a novice physiology student, I had many moments at which I wanted to tap out.  ne major example was my introduction to the beautiful, albeit daunting display of all the electrical and mechanical events that occur in only the heart during a single cardiac cycle in just 0.8 seconds, i.e., the Wiggers diagram.  Every time I project this diagram on the screen, I give students a moment to take it in and listen for the gasps or moans.  I admit to my students that upon seeing that diagram for the first time I looked for the nearest exit and thought to myself, ‘Are you kiddin’ me?”  Students laugh nervously.  They sigh in relief when I tell them that my professor broke down the diagram one panel at a time before putting all together; his approached worked, and that is what I will do for them.  Dr. Carl Wiggers was committed to teaching physiology and developed the diagram over 100 years ago as a teaching tool for medical students (1).  The diagram is instrumental in teaching normal cardiac physiology, as well as pathophysiology of congenital valve abnormalities and septal defects.  Nevertheless, students still need help to understand the diagram.  Again, here an example of the function of just one organ, the heart, being a central element to a larger network that regulates a major parameter – blood pressure.  Learning regulation of blood pressure can be an uphill battle for many students.

Cardiovascular physiology is typically a single unit in an undergraduate physiology course, and it is often the most challenging and difficult exam of the semester.  Several years ago, when preparing to teach this section in an AP-II course I felt compelled to find ways to help students break-down and reconstruct pieces of complex regulation of blood pressure.  I considered the many high-tech digital learning resources and online videos available to our students but wondered whether those resources help or hinder students.  I was also looking for tools that would facilitate multisensory learning, which is shown to yield better memory and recall (2).  Despite all these high-tech resources, I noticed students were still avid users of notecards and were convinced they held the secret to success in AP-I and thus, must also be the key to success in AP-II or systems physiology.  I found this quite amusing, because we used notecards back when I was in college in the 80s – when there were no digital learning platforms and highlighters only came in yellow.  Students tote around stacks of hand-written, color coded notecards that grow taller as the semester progresses, but often their comprehension and ability to connect one concept or mechanism to the next does not increase with the height of the stack.  Students often memorize terms on note cards but cannot readily connect the mechanism listed on one card to that on the next card or explain the consequence of that mechanism failing.  Around this time a non-science colleague was talking to me about her successful use of concept maps with her students.  To me, concept maps look a lot like biochemical pathways or physiological network diagrams.  It dawned on me.  I did not need to reinvent the wheel or make a newer better teaching tool.  I simply needed to help my students connect The Notecards and practice arranging them to better pattern regulatory networks.  Students were already writing a term on one side of the card and a definition and other notes on the back.  Why not build on that activity and more deliberately guide students to use cards to build a concept map of the network for regulation of blood pressure which is central to cardiovascular physiology?


Blood pressure is a physiological endpoint regulated by a nexus of autoregulatory, neural and hormonal mechanisms and multiple organs and tissues.  Blood pressure is directly dependent on cardiac output, vascular peripheral resistance, and blood volume, but can be altered by a tiered network of numerous neural, hormonal and cellular mechanisms that directly or indirectly modulate any one of the three primary determinants.  The expansive network, e.g., numerous organs and tissues, and multiple and intersecting effects of different mechanisms within the network, e.g., the renin-angiotensin-aldosterone system modulates both vascular resistance and blood volume) make it difficult to see the network in its entirety.  Nevertheless, students must understand and master the entire network, the individual mechanisms, and the nuances.  Thus, in preparing for the cardiovascular section and planning how to implement the concept map, I made a list of all components that comprised the regulatory network for blood pressure with the first terms being blood pressure, cardiac output, vascular peripheral resistance, and blood volume.  At this point in the semester, the students had learned the basics of cellular respiration and metabolism.  I began the very first cardiovascular lecture with an illustration of the human circulatory system projected on the screen as I worked at the white board.  In the center of the board, I drew a cell with a single mitochondrion and three simple arrows to indicate the use of glucose and oxygen to convert ADP to ATP.  Guided through a series of questions and answers, students collectively explained that the heart must pump blood through arteries and veins to deliver oxygen and glucose and fat needed to generate ATP, as well as to remove carbon dioxide and other wastes.  Using the illustration of the human circulatory system, I then carefully explained the human circulatory system is a closed system comprised of the blood (the medium carrying oxygen, nutrients, CO2 and other wastes), the heart (the pump), and the arterial and venous vessels (the conduits in which blood flows from the heart to the tissues where oxygen and nutrients are delivered and CO2 and other wastes are removed).  If adequate pressure is sustained, blood continues to flow through veins back through the heart and to the lungs to unload CO2 and reoxygenate blood and then back to the heart to make another round.  I further explained blood pressure must be regulated to ensure blood flow to tissues optimally matches both metabolic need for oxygen and nutrients and production of CO2.  On the board, I then wrote “Blood Pressure (BP)” and stated that because this is a closed circulatory system, blood pressure changes in direct response and proportion to cardiac output or volume of blood pumped out of heart into systemic vessels in one minute, the total volume of blood in the system, and the vascular resistance that opposes flow and will be predominantly dependent vasoconstriction and vasodilation.  I wrote the terms “Cardiac Output (CO), Blood Volume (BV), and Vascular or Total Peripheral Resistance (VPR) one at a time underneath BP, each with an arrow pointing directly to BP.  I stated that any factor that changes cardiac output, blood volume, or vascular resistance can indirectly alter blood pressure.  For example, a change in heart rate can change cardiac output and thus, alter blood pressure.  I then distributed the series of hand drawn diagrams shown below.  As I pass out the sheets and display on slides, I tell them they will be learning about all these various factors and mechanisms and will be able to recreate the network and use it as a study aid.

To get students started, I handed out the list of cardiovascular terms, hormones, equations, etc. and several small pieces of paper, e.g., 2”x2” plain paper squares, to each student.  [I found free clean scratch paper in various colors in the computer lab and copy room recycling bins.]  Students can also take their trusty 3”x5” cards and cut each in half or even quarters or use standard-size Post-It® notes.  I explained that as I introduce a term or mechanism they will write the term or conventional abbreviation on one side of the paper and the definition and pertinent information on the other in pencil for easier editing.  [I emphasized the importance of using conventional abbreviations.]  For example, Blood Pressure would be written on one side of the paper and ‘pressure exerted against vessel wall’ on other, along with ‘mm Hg’, and later the equation for mean arterial pressure (MAP) can be added.  I had my own set of terms written on Post-It® notes and arranged BP, CO, BV, VPR and other terms on a white board so they could see the mapping of functional relationships take shape.  As new concepts were taught and learned, e.g., CO = Stroke Volume (SV) x Heart Rate (HR), the respective terms were added to the concept map to reflect the physiological relationships between and among the new mechanism to the existing mechanisms or phenomena already in the concept map.  In that case, on the back of the CO paper or card one might write “volume of blood ejected from ventricle in one minute into aorta”, “CO = HR x SV“, “If HR is too fast, CO will decrease!”, “Right CO must equal Left CO!”  I explained students can lay out their terms on a table, floor, their bed, etc.  I reminded students how important it was to say the terms out loud as they wrote the terms in their best penmanship.  This helps students slow down and deliberately think about what they are writing and refer to their lecture notes or textbook (be it an actual book or e-book).  I had given students copies of the complete concept map of all terms but did not dictate exactly what they should write on the back of the cards.  The small size of the paper or card, almost forces students to annotate explanations; this helped them better encapsulate their ideas.  I was open to checking their annotation and reflecting back to students the apparent meaning of their word choice.  While studying alone or with study partners, students were encouraged to audibly define terms and relationships among mechanisms as they arranged their maps in the correct configuration.  They were encouraged to ‘shuffle the deck’ and recreate subsections of the network to understand mechanistic connections at different points in the network.  Because I had given them the diagrams or concept maps for cardiac output, blood volume, and vascular resistance, students were able to check their work and conduct formative assessments alone or in groups in an accurate and supportive manner.

Students expressed that manually arranging components allowed them to literally see functional and consequential relationships among different mechanisms.  The activity complemented and re-enforced quizzes and formative assessments already in use.  It’s not a perfect tool and certainly has room for improvement.  There are quite a few pieces of paper, but students found ways to keep the pieces together, e.g., binder clips, Zip-lock bags, rubber bands.  Nonetheless, it is simple, portable, and expandable concept map students can use to learn cardiovascular physiology and represents a tool that can be applied to teach and learn other regulatory networks, such as those of the digestion-reabsorption-secretion in the GI tract and calcium homeostasis.

  1. Wiggers C. Circulation in Health and Disease. Philadelphia, PA: Lea & Febiger, 1915.
Alice Villalobos, Ph.D., is an assistant professor in the Department of Medical Education at the Texas Tech Health Sciences Center in Lubbock, Texas.  She received her biology from Loyola Marymount University and her Ph.D. in comparative physiology from the University of Arizona-College of Medicine.  Her research interests are the comparative aspects of the physiology and stress biology of organic solute transport by choroid plexus.  She has taught undergraduate and graduate courses in integrative systems physiology, nutrition and toxicology.  However, her most enjoyable teaching experience has been teaching first-graders about the heart and lungs!  Her educational interests focus on tools to enhance learning of challenging concepts in physiology for students at all levels.  She has been actively involved in social and educational programs to recruit and retain first-generation college students and underrepresented minorities in STEM.


Motivating students to make the most of group projects

Implementation of group projects in class represents an important pedagogical strategy to engage students in active learning. Specifically, it may promote collaborative learning, problem-based learning, evidence-based learning, team-based learning, and peer instruction. Students may benefit from group projects in different ways, including but not limited to: (1) practicing teamwork skills (e.g., communication, collaboration, interdependence, and accountability), and (2) building problem-solving skills (e.g., reasoning, critical-thinking, knowledge applying, trouble shooting, and concept constructing). As such, implementation of group projects has been increasingly observed in higher education across disciplines including nutritional and metabolic physiology [1-4].


However, not all students favor group projects. The common complaints may arise from time commitments and unequal contributions [2]. Some students may prefer to work alone on assignments in which they can easily take control of the pace and spend less time to earn high scores. This view is true in some sense, but students will miss the benefits of collaborative learning, team-based learning, and peer instruction. In general, it takes more time to accomplish a project as a group than as an individual because time is needed to build an effective team. However, the effects or benefits of group projects on student learning are profound, as mentioned above. To be society or career ready, for instance, students are not evaluated by scores alone but also by soft skills such as teamwork, accountability, adaptability, flexibility, and resilience. In terms of contributions, some students may feel short of chances to express themselves because of dominating group members, while others may complain about free riders who take less responsibility in group projects but earn the same scores [2]. The paradoxes can be addressed by motivating students to actively participate in and make the most of group projects.


First, let students enjoy the freedom to select topics of interests for their group projects. Interest can significantly motivate students to make efforts exploring evidence for answers. Nevertheless, the project topics proposed by students are by no means random; instead, the themes should fit in with the course content and learning objectives. In order for a project to overarch the interests of a group of students, the instructor may facilitate setting up the groups based on student interests. In addition, the instructor’s guidance is critical for the project initiation, where adjustments are necessary to customize the project question or theme such that it takes into account every member’s interests and learning objectives.


Secondly, balance group size to fulfill key roles. Group size affects group dynamics and the performance. Group oversizing increases the difficulty of engaging each member in the discussion or activities within limited time, which results in free riding and unequal contributions. A group size of 3-5 students is considered reasonable; a group size of 2 students may still work, but it lacks the typical group dynamics of assigning and rotating roles. In a 5-student group, the roles can be assigned as a facilitator (to moderate group discussion), a challenger (to raise counter-arguments and alternative explanations), a recorder (to take notes of group discussion), a reporter (to summarize and report the outcome of group discussion), and a timekeeper (to keep the group on track of time and deadlines). For a smaller group, the facilitator may take an additional role of “timekeeper”, and the challenger or recorder may take an additional role of “reporter”. More importantly, role rotation motivates students to play different roles in a group, which can prevent students from dominating in a group discussion or project and eliminate free riding. Role rotation motivates students to put themselves in others’ shoes, which promotes mutual understanding and trust that foster stronger teamwork. To this end, the instructor may direct students to divide a group project into sub-sections such that the key roles can be played by each member of the group via role rotation.


Third, have individual contributions weighed for group project grading. It is common that all members earn the same score for a group project. However, having individual contributions weighed for group project grading will motivate students to maximize their talents and potential in solving problems and executing the project. Practically, let students acknowledge or sign their contributions when they submit the assignment, and accordingly, grading rubrics can be designed such that both individual and collective merits of a group assignment are weighted. For instance, an oral presentation can be easily assessed by the relevance, depth, innovation, readiness, and communication skills for each individual portion, and by the overall hypothesis, rationale, logical flow, presentation transitions, and convincingness for the collective merits. This practice may increase the workload on the instructor and teaching assistants, but it significantly boosts the motivation of students to do the best they can for a group project.


Lastly, effectively apply anonymous peer evaluation. Group projects demand a variety of outside class efforts and activities, and a generic evaluation or rating of peer contributions would not suffice. Instead, the anonymous peer rating should be specified in detail such as the responsiveness, promptness, the amount of literature contributed, and the performance in discussion, presenting and challenging different viewpoints, and setting and achieving goals. The itemized rating or guide can keep the peer evaluators on track and evaluation straightforward. In addition, it is critical to provide timely evaluation so that students know how they are doing and what to improve, and so they may take prompt actions to improve later group work. If a group project consists of multiple subsections, an anonymous peer evaluation can be installed for each subsection with the average being taken as the final rating. If there is no subsection in a group project, an anonymous peer evaluation can be installed in halfway and at the conclusion of the project, with the average being taken as the final rating. Timely and multiple peer evaluations motivate students to reflect and find effective ways to work together as a group. By contrast, using a single peer evaluation for the group project only tells students about their performance but does not produce the motivation or opportunities to identify and fix issues for improvement.


In summary, implementation of group projects in class may benefit student learning in many ways [1-4]. Here I described some practical strategies that motivate students to fully participate and make the most of group projects. These practices may also address concerns raised by students and instructors about unequal contributions or free riding [2].


References and further reading

[1] Benishek LE and Lazzara EH. Teams in a New Era: Some Considerations and Implications. Front. Psychol. 2019, 10, 1006. doi: 10.3389/fpsyg.2019.01006

[2] Chang Y, Brickman P. When Group Work Doesn’t Work: Insights from Students. CBE Life Sci Educ. 2018, 17(3), ar42. doi: 10.1187/cbe.17-09-0199.

[3] Rathner JA, Byrne G. The use of team-based, guided inquiry learning to overcome educational disadvantages in learning human physiology: a structural equation model. Adv Physiol Educ. 2014, 38(3), 221-8. doi: 10.1152/advan.00131.2013.

[4] Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open 2019, 9, e028280. doi:10.1136/bmjopen-2018-028280

Dr. Zhiyong Cheng received his PhD in Analytical Biochemistry from Peking University, after which he conducted postdoctoral research at the University of Michigan (Ann Arbor) and Harvard Medical School. Dr. Cheng is now an Assistant Professor of Nutritional Science at the University of Florida. He has taught several undergraduate- and graduate-level courses (lectures and lab) in human nutrition and metabolism (including metabolic physiology). As the principal investigator in a research lab studying metabolic diseases (obesity and type 2 diabetes), Dr. Cheng has been actively developing and implementing new pedagogical approaches to build students’ critical thinking and problem-solving skills.
Spring 2020*: The asterisk denotes community made all the difference.

Spring 2020 is often denoted with an asterisk.  The asterisk means different things to different people.  For many people it means, “Things will never be the same.”  COVID-19 has changed the venues from which we teach, but not our commitment to continually improve our teaching.  We have adapted our lectures, labs, and office hours to online platforms to keep students and ourselves safe.  I am no seer, but once classes moved online in mid-March I knew this would be a long haul from which I must learn and never forget.  After submitting final grades, I asked myself, “What have you learned?  Which practices will you continue to implement to create a better learning environment for students irrespective of world health status or platform?”  My asterisk on Spring 2020 is community.

For Spring 2020 I was assigned three sections of an upper level exercise nutrition course and one section of basic exercise physiology.  Each was a critical course.  Kinesiology majors must pass exercise physiology before any other upper level kinesiology course; this was a new course for me.  The exercise nutrition course, which I taught the prior semester, includes an in-class presentation with a hefty point value; it also is the departmental assessment tool for communication skills.  Over the last several years the level of stress and anxiety among undergraduate students in my physiology courses has been progressively increasing, nearly choking their joy of learning.  Colleagues in other fields observe similar trends.  The majority of students taking physiology courses seek careers in health professions.  Given the competitive nature of the respective training programs, students are driven to earn that A.  Add to that the worry of paying for tuition, rent, food, books, computers, and transportation and complicated academic and social transitions from high school to college.  Their family expectations loom over them.  Some students are full-time students, but also full-time parents.  For first-generation college students these circumstances may bear even greater weight.  Thus, while preparing for Spring 2020 I decided to approach that semester with greater compassion for students.  This led to my forming a community of learners in each class a priority.  Ultimately, this helped me better meet the needs of my students during that first phase of the pandemic.

Webster defines compassion as “sympathetic consciousness of others’ distress together with a desire to alleviate it.”  In preparing for Spring 2020, I identified aspects of each course that presented major challenges for students and represented sources of stress, anxiety, frustration, and discouragement.  I hoped to address those challenges and thereby, alleviate a source of stress.  Most exercise physiology students had not taken biology or basic physiology; thus, I had to teach them basic cell biology and basic physiology so they could better understand the significance of acute responses to exercise.  Based on my past experience teaching the exercise nutrition course, students needed more confidence speaking in public.  Furthermore, any given student might have known just two or three other students by name and were hesitant to speak in general.  I had to help them feel more at ease so they could talk and think out loud among their peer group.  We each want to belong to a community.  We value our individuality, but we are social beings.  Students must feel accepted and comfortable in class, so they can ask and answer questions within a small group or entire class.  A critical component of learning is not answering a question, but verbally defending that answer and exchanging ideas with others.  Many are afraid to answer incorrectly in front of others.  The classroom must be a safe place.  As the teacher, I am responsible for creating a sense of community.  While I did a great job getting to know my students’ names, faces and fun facts, I wasn’t helping students know each other.  For both courses I decided to include more activities that required students to talk directly to each other and become accustomed to speaking out loud.  With 20-25 students per class, it was feasible.  I would sacrifice class time and not be able to cover as much material.  So be it.  Students would master the fundamentals, learn to apply the knowledge, and have a shot at enjoying learning and becoming life-long learners.  Coming to class and learning might even become a reprieve from other stressors. 

How could I create community among unacquainted 20+ students?  Provide opportunity to interact as a class or in pairs or groups as often as possible.  I had to be persistent, kind, and patient.  The first day of classes I explained my intention was that students become familiar with each other, so that they were comfortable asking and answering questions and contributing to discussions.  This would facilitate learning and help me better gauge their understanding.  This also might help them find a study partner or even make a new friend.  I told them I made it a point to learn everyone’s name as soon as possible and would call on each student numerous times.  I made it clear that I know when people are shy; I promised to be kind and not call on them until they were ready.  Each day I arrived as early as possible and cheerfully greeted each student by their preferred name and asked open ended questions, e.g., ‘How are your other classes going?”  At least once a week, students worked in pairs to complete worksheets or quizzes; we would reconvene as a class and I would call on different pairs to answer.  I called on different pairs each time, so every group had chance to speak.  I encouraged them to work with different classmates for different in-class activities.  Initially, there was resistance, but I consistently commended them for their efforts.  Gradually, more students would proactively raise their hands to be called on, and it could get pretty loud.   

On the first day of the nutrition classes I also announced the presentation assignment and that we’d get started on it the 1st week of classes by forming pairs and by becoming accustomed to talking in front of the class.  To let them know that dread of public speaking is shared by all, I confessed to feeling nervous before every lecture; however, I love teaching and channel that nervous energy to keep the lectures upbeat.  I explained they might never get over the nervousness of public speaking, but they can learn nothing is wrong, being nervous is expected; it will become easier.  The trick is to start small.  So, at the start of every class period, one or two students would be asked to stand up, introduce themselves, and tell the class what they found most interesting from the last lecture.  The other students would give the presenter their undivided attention.  For shy students, I spoke directly but quietly to them before class and suggested that they could focus on me while they spoke.  After each introduction I cheerfully thanked students as positive re-enforcement.  These introductions also served to highlight what was covered in the last class.  Because each nutrition course class met 3 times a week for 50-minute sessions, students interacted frequently.  For the exercise physiology course, students worked in pairs to complete a ‘1-2-3 plus 1’ worksheet with questions on three key concepts from the previous lecture and one question on new material in the upcoming lecture.  They worked on questions for 5 minutes, and then I would call on different pairs to answer questions and explain sticking points for about 10 minutes.  It also was the transition into that day’s new material.  This class met twice per week for 80 minutes each session; thus, plenty of time remained even after the 15-minute Q&A.  They were grasping the integration of cellular mechanisms at the cellular and systems levels.  The time and effort to plan and execute these activities was well worth it.  Students were learning and enjoying class, as well as getting to know each other.  By late February communities had formed.  Each class had a friendly and inclusive feeling, and attendance was nearly perfect.  Even shy students began echoing my greetings or waving and smiling at classmates arriving to class.  Individual classes had their own running jokes.   

The week before Spring Break universities were discussing whether or not students would return to campuses after the break.  COVID-19 was here.  The Thursday and Friday before Spring Break were the last days I met with students in person.  I confirmed the rumors.  Students would not return to campus after the break, and all courses would be entirely online.  I clarified that I would present lectures ‘live’ at the regularly scheduled class times.  I opened the floor to discussion.  If I knew their concerns, I’d have a better chance at maintaining the sense of community.  Students were completely honest.  Seniors were sad, because graduation would be cancelled.  Students were hoping they could keep their jobs here in town to pay rent.  Athletes on scholarships worried that if the season were canceled they’d lose funding.  Others would be learning from their parents’ homes, which had no Internet access.  The most common concern was whether they would be as successful learning online.  They were worried about the lack of accountability.  One student feared he’d stop attending lectures and miss assignments; one reason he came to class was that I called him by name and talked to him every day.  Another student doubted I’d have any personality when giving online lectures; I took this as a challenge.  Students in the nutrition classes were worried about presentations, which were taking shape and now had to be presented somehow.  They were scared.  Now, I was scared for them – but had the wherewithal to not say that out loud.  One student outright asked, ‘Is this even gonna’ work?!”  I admitted it would be a challenge, in part because I had never taught an online class, and this was my first pandemic!  They laughed nervously.  What a relief to hear them laugh!  Then, I remembered my goal to practice compassion and let that guide me.  I calmly stated the following, “This is not an ideal situation, but we will make it work, and I mean WE.  I will do my best to not make this situation any more difficult than it has to be.  I will communicate with you regularly, so read my emails.  If you have any problems or questions you must let me know immediately, so to give me a better chance to help you.  It will be ok.”  That this was the last time I would see my students in person.  It was a sad day.

I took my students’ concerns into account and still made my priority community.  If I could maintain that sense of community, they would be more likely to login to lecture and learn. I kept it as simple, direct, and familiar as possible.  I already had been posting all lecture notes and materials on the university’s learning management system (LMS) and using the drop box for homework submissions.  Thus, I opted to use the real-time video conferencing tool in the LMS to deliver, record and save lectures and hold office hours.  An ounce of prevention is worth a pound of cure.  I established the practice of sending each individual class a weekly email on Sunday afternoon that listed the week’s lecture topics, specific links to each lecture and office hours, due dates for quizzes, upcoming exams, announcements, and miscellaneous reminders.  The very first email included step by step instruction for logging into the LMS video conferencing tool (which had been proofread and tested by a colleague), and I attached the revised syllabus.  I kept these emails as upbeat as possible.  On the class website, I also posted important announcements, along with links to the live and recorded lectures.  I kept the class website uncluttered and organized to make it easy for students to find what they needed.  In the middle of a pandemic, it was absolutely essential to keep my promise to my students and myself and not to make learning or teaching online any more difficult than necessary. 

I continued teaching the fundamentals and worked to maintain that sense of community.  I opened and logged into the virtual lecture room 10-15 minutes before lecture started and would allow students to do the same.  I would still greet them as they entered, asked them to turn on the video at least once, so I could see their faces and make sure they were doing ok.  They would also greet each other.  I encouraged them to ask questions or comment directly using their mics or in the chat message feature.  As I lectured, I kept track of questions and answers to my questions; I would address students by name just as I had in person.  They learned quickly that they could use the chat feature to communicate with each other, sometimes not about physiology or nutrition.  I didn’t mind.  I also knew they missed being on campus and seeing classmates and friends, and they were isolated.  For the exercise physiology course, we continued the practice of starting each lecture period with the 1-2-3 plus 1 worksheet and still spend about 15 minutes on that activity; the students really valued this activity.  Because the practice proved to facilitate learning, I posted these questions on the class website, but also emailed the class a copy the day before to be sure they had a copy – a 5-minute task to keep them engaged and coming to class.  For the nutrition class, I offered an extra credit assignment, ‘Who is this?’  For one class, I had a list of 10 walk-up songs from different students; students had to name the artist and tell me the full name of the student who claimed that as their ‘walk-up’ song.  Another class had to name the student learning online the farthest distance from campus and name the student whose birthplace was farthest from campus; they also had to list the exact city, state or country and distance in miles.  The third class had to list the first and last names of all graduating seniors in the class and their career goals.  For extra points, they all participated.  It was meant to encourage them to stay connected and think about something else. 

We had a share of glitches and mishaps, but my students stepped up to the plate.  The lack of equal access to the Internet could not be more painfully obvious.  One exercise physiology student informed me that his only access to the Internet was his cell phone.  He took the initiative to asked whether I would accept images of hand-written 1-2-3 worksheets sent to me by email.  He never missed an assignment and made arrangements to borrow a friend’s laptop for exams.  A nutrition student, I will call Brett was learning from home in a small town about 2 hours from the nearest ‘real’ town; his family home had no Internet and a poor mobile phone signal.  He emailed to explain that once his dad got paid he would buy the equipment and he would be online soon.  He was concerned about missed quizzes and the respective points and missed lectures.  What do you say to that?  When you know you have all the power, you must use that power to do good and not make anyone’s life harder than it has to be.  I re-opened quizzes and sent him links to the recorded lectures; he wasted no time catching up.  Then there was the matter of the nutrition presentations.  Another lifeline.  Students continued to work together, sending presentation files to each other and to me.  Students taught themselves to use Zoom, Google Slides, and the LMS video conference feature.  No one complained.  Multiple pairs wanted to present during the same session, so they could be an audience, lend moral support, and ask questions.  The presentations were impressive.  Students were so enthusiastic.  However, my favorite presentation was by Brett and ‘Josh’; they presented via the LMS conference feature.  Brett’s Internet cut out completely on second slide; he tried to reconnect to no avail.  I remained calm; they remained calm.  They decided Brett would call Josh; Josh would hold his cell phone to the mic on his computer so I could hear Brett narrate his part of the talk.  Teamwork!  Let your students inspire you.

I left time at the end of each lecture to offer encouraging words and reminders to stay safe and take care of themselves.  I also would state that I looked forward our next meeting.  As the semester was winding down end-of-lecture discussions and questions become more serious.  Across all classes the basic questions were similar.  “Will I graduate on time?  How will this impact my career plans?  Do you think this will be over by the Fall?  Do you think they’ll have a cure soon?”  There was no sugar coating this.  I would validate their concerns and offer my honest opinion in a kind-hearted manner.  My last virtual lecture was on a Friday in May.  I decided to name each graduating senior, so the class could congratulate and applaud for them.  A student asked me to give a commencement speech.  She was serious.  I remembered what my gut told me back in mid-March, and so I began.  “I cannot tell you how proud of how hard each of you has worked and how well you worked together.  Life is hard.  It’s ok to be scared.  You have risen to the occasion.  Keep rising.  Learn all you can from this situation.  You are meant to do great things, however subtle or grand.  You will fall and make mistakes.  You will need help along the way and must help others on their journey.  It has been a privilege to work with you.  I will think of you often and wish you well.”  Spring 2020*  *Helping my students form a community, an inclusive safe place to learn, think out loud, be wrong, correct mistakes, and help each other.  That is the practice I will continue to implement to create a better learning environment for students irrespective of world health status or platform. 

Alice Villalobos, Ph.D., is an assistant professor in the Department of Medical Education at the Texas Tech Health Sciences Center in Lubbock, Texas.  She received her biology from Loyola Marymount University and her Ph.D. in comparative physiology from the University of Arizona-College of Medicine.  Her research interests are the comparative aspects of the physiology and stress biology of organic solute transport by choroid plexus.  She has taught undergraduate and graduate courses in integrative systems physiology, nutrition and toxicology.  However, her most enjoyable teaching experience has been teaching first-graders about the heart and lungs!  Her educational interests focus on tools to enhance learning of challenging concepts in physiology for students at all levels.  She has been actively involved in social and educational programs to recruit and retain first-generation college students and underrepresented minorities in STEM. 
Building bridges: Medical physiology teaching in China
Ryan Downey, Ph.D.
Assistant Professor
Co-Director, Graduate Physiology Program
Team Leader, Special Master’s Program in Physiology

Department Pharmacology and Physiology
Georgetown University Medical Center
Washington, D.C.

The Chinese Society of Pathophysiology hosted the 2019 Human Functional Experiment Teaching Seminar and the Second Human Physiology Experimental Teaching Training Course 25-27 October. Across two and a half days, educators from across China met at Jinzhou Medical University in the province of Liaoning to discuss and workshop the latest ideas in active learning and interactive teaching techniques. In many ways, especially in terms of the esteem in which this meeting is held by its attendees, this meeting was not dissimilar from the APS Institute on Teaching and Learning, which will hold its next biennial meeting this coming June in Minneapolis. For the 2019 meeting, the organizers decided to invite an international speaker, which is how I found myself on a plane headed to China. As part of my visit, not only did I get to attend the workshop hosted at Jinzhou Medical University, but also I was hosted by several of the meeting organizers at their home institutions to see their facilities. In this writeup, I will reflect on some of the observations that I made during the many different conversations that I had with the educators participating in the meeting.

The most common question that I got from my hosts was, “What kinds of technology do you use in your classrooms and labs and how do you use them?” What surprised me the most about this question wasn’t the actual question itself, but the perception that many of the educators at the meeting held that they were lagging behind in the implementation of using technologies as   teaching and learning tools. The large majority of teaching spaces that I visited were equipped with much the same technology as any classroom or lecture hall that I would find in an American university: computers, projectors, large-screen LCD displays, and power at every seat to accommodate student personal electronic devices. While there was the occasional technological oddity, such as a computer here or there that was still running Windows XP, the technology available to these educators was very much on par with the technology I would expect at any modern university, which is why I was surprised that the educators had the perception that they were behind in implementing different technologies. In my conversations with them, I discussed the use of audience response systems like iClicker and PollEverywhere as well as interactive elements like gamification through websites such as Kahoot!, but my emphasis in these conversations was exactly the same as I have with educators at home: we need to make sure that there is a sound pedagogical basis for any engagement we use with our students and that the technology doesn’t matter. I can use 3×5 colored  index cards to create an audience response system that functions as well as (or sometimes even better!) than clickers because no one has any problems with the WiFi while using a 3×5 card. The technology facilitates our instruction and should never drive it for the sake of itself.

A common thread of many discussions was the use of internet technologies in teaching. While there is much to be said about the limitations of the ‘Great Firewall’ of China and the amount of government regulation that occurs over their communications, it’s important to note how little these limitations affect the day-to-day activities of the majority of citizens. There are Chinese versions of almost every single internet convenience that we would take for granted that function at least as well as our American versions. Their social media system has grown to the point that many international users are engaging on their platforms. There are food delivery apps and the local taxi services have all signed on to a common routing system (at least in Beijing) that functions in a similar way to Uber or Lyft. In a side-by-side comparison between my phone and one of the other meeting participants, there is near feature parity on every aspect. From an educational standpoint, however, there are some notable differences. The lack of access to Wikipedia is a notable gap in a common open resource that many of us take for granted and there is not yet a Chinese equivalent that rivals the scope or depth that Wikipedia currently offers. Another key area in which internet access is limited is their access to scholarly journals. This lack of accessibility is two-fold, both in the access to journals because of restrictions on internet use as well as the common problem that we are already familiar with of journal articles being locked behind paywalls. The increasing move of journals to open access will remove some of these barriers to scholarly publications, but there are still many limits on the number and types of journal articles that educators and learners are allowed through Chinese internet systems.

The most common request that I received while attending the educators meeting was, “Tell me about the laboratories you use to teach physiology to your medical students.” I think this is the largest difference in teaching philosophy that I observed while in China. The teaching of physiology is heavily based on the use of animal models, where students are still conducting nerve conduction experiments with frogs, autonomic reflex modules with rabbits, and pharmacological studies in rats. These are all classic experiments that many of us would recognize, but that we rarely use anymore. One key area of the workshops were modules designed to replace some of these classic animal experiments with non-invasive human-based modules, such as measuring nerve conduction velocities using EMG. My response that the majority of our physiology teaching is now done through lecture only was met with a certain degree of skepticism from many of them because the use of labs is so prevalent throughout the entire country. Indeed, the dedication of resources such as integrated animal surgical stations runs well into the hundreds of thousands of dollars per laboratory room set up, and to facilitate the entirety of students each year, there are multiple labs set up at each university. As the use of non-invasive human experiments expands, an equal amount of space and resources are being given to setting up new learning spaces with data acquisition systems and computers for this new task. In this area, I think that we have much to gain from our Chinese counterparts as many of the hardest concepts in physiology are more easily elucidated by giving students the space to self-discover in the lab while making physiological measurements to fully master ideas like ECG waves and action potential conduction.

Upon returning home, I have been asked by nearly everyone about my travel experiences, so I think it may be worth a brief mention here as well. I cannot overstate the importance of having a good VPN service setup on all of your electronic devices before traveling. Using a VPN, I had near-normal use of the internet, including Google and social media. My largest problem was actually trying to access local Chinese websites when my internet address looked like I was outside of the country. I have had good experience with NordVPN, but there are several other very good options for VPN service. Carrying toilet paper is a must. There are lots of public restrooms available everywhere in the city, but toilet paper is either not provided or available only using either social media check-ins or mobile payments. For drinking water, I traveled with both a Lifestraw bottle and a Grayl bottle. This gave me options for using local water sources and not having to rely on bottled water. The Lifestraw is far easier to use, but the Grayl bottle has a broader spectrum of things that are filtered out of the water, including viruses and heavy metals, which may be important depending on how far off the tourist track you get while traveling. My final tip is to download the language library for a translator app on your mobile device for offline use so that you can communicate with others on the streets. When interacting with vendors and others not fluent in English, it was common to use an app like Google Translate to type on my device, show them the translated results, and they would do the same in reverse from their mobile device.

One of the themes across the meeting was building bridges — bridges between educators, bridges between universities, bridges across the nation and internationally. I’m glad to have had the opportunity to participate in their meeting and contribute to their conversation on building interactive engagement and human-focused concepts into the teaching of physiology. Overall, the time that I spent talking to other educators was useful and fantastic. Everyone I met and interacted with is enthusiastic and excited about continuing to improve their teaching of physiology. I left the meeting with the same renewed energy that I often feel after returning from our ITL, ready to reinvest in my own teaching here at home.

Ryan Downey is an Assistant Professor in the Department of Pharmacology & Physiology at Georgetown University. As part of those duties, he is the Co-Director for the Master of Science in Physiology and a Team Leader for the Special Master’s Program in Physiology. He teaches cardiovascular and neuroscience in the graduate physiology courses. He received his Ph.D. in Integrative Biology from UT Southwestern Medical Center. His research interests are in the sympathetic control of cardiovascular function during exercise and in improving science pedagogy. When he’s not working, he is a certified scuba instructor and participates in triathlons

Do You Want To Be On TV?

Last summer, some colleagues and I published a paper on how high school students can communicate their understanding of science through songwriting.  This gradually led to a press release from my home institution, and then (months later) a feature article in a local newspaper, and then appearances on Seattle TV stations KING-5 and KOMO-4.

It’s been an interesting little journey.  I haven’t exactly “gone viral” — I haven’t been adding hundreds of new Twitter followers, or anything like that — but even this mild uptick in interest has prompted me to ponder my relationship with the news media. In short, I do enjoy the attention, but I also feel some responsibility to influence the tone and emphases of these stories. In this post, I share a few bits of advice based on my recent experiences, and I invite others to contribute their own tips in the comments section.

(1) Find out how your school/department/committee views media appearances.  In April, I was invited to appear on KING’s mid-morning talk show, which sounded cool, except that the show would be taped during my normal Thursday physiology lecture!  My department chair and my dean encouraged me to do the show, noting that this sort of media exposure is generally good for the school, and so, with their blessing, I got a sub and headed for the studio.

(2) Respect students’ privacy during classroom visits.  After some students were included in a classroom-visit video despite promises to the contrary, I realized that I needed to protect their privacy more strongly. I subsequently established an option by which any camera-shy students could live-stream the lecture until the TV crew left.

(3) Anticipate and explicitly address potential misconceptions about what you’re doing.  I’ve worried that these “singing professor” pieces might portray the students simply as amused audience members rather than as active participants, so, during the classroom visits, I’ve used songs that are conducive to the students singing along and/or analyzing the meaning of the lyrics. (Well, mostly. “Cross-Bridges Over Troubled Water” wasn’t that great for either, but I had already sung “Myofibrils” for KING, and KOMO deserved an exclusive too, right?)

(4) Take advantage of your institution’s public relations expertise.  Everett Community College’s director of public relations offered to help me rehearse for the talk show — and boy am I glad that she did!  Being familiar with the conventions and expectations of TV conversations, Katherine helped me talk much more pithily than I normally do. In taking multiple cracks at her practice question about “how did you get started [using music in teaching]?” I eventually pared a meandering 90-second draft answer down to 30 seconds. She also asked me a practice question to which my normal response would be, “Can you clarify what you mean by X?” — and convinced me that in a 4-minute TV conversation, you don’t ask for clarifications, you just make reasonable assumptions and plow ahead with your answers.

(5) Ask your interviewers what they will want to talk about. Like a novice debater, I struggle with extemporaneous speaking; the more I can prepare for specific questions, the better.  Fortunately, my interviewers have been happy to give me a heads-up about possible questions, thus increasing their chances of getting compelling and focused answers.

Readers, what other advice would you add to the above?

Gregory J. Crowther, PhD has a BA in Biology from Williams College, a MA in Science Education from Western Governors University, and a PhD in Physiology & Biophysics from the University of Washington. He teaches anatomy and physiology in the Department of Life Sciences at Everett Community College. His peer-reviewed journal articles on enhancing learning with content-rich music have collectively been cited over 100 times.

Engaging students in active learning via protocol development

Physiology, particularly metabolic physiology, covers the fundamentals of biophysics and biochemistry for nutrient absorption, transport, and metabolism. Engaging pre-health students in experimentation may facilitate students’ learning and their in-depth understanding of the mechanisms coordinating homeostatic control. In addition, it may promote critical thinking and problem-solving ability if students are engaged in active learning.

Traditionally, students are provided instructions that detail the stepwise procedures before an experiment or demonstration. Although students are encouraged to ask questions before and during the experiments, an in-depth discussion would not be possible until they understand each step and the underlying principles. This is particularly true nowadays when commercial kits come with stepwise instructions where no explanation can be found of principles behind the procedure. The outcomes may contrast in three ways: (1) students are happy with the perfect data they acquire by following the instructions provided by the manufacturer, but they miss the opportunity to chew on the key principles that are critical for students to develop creative thinking; (2) students are frustrated as they follow the instruction but fail the experiments, without knowing what is wrong and where to start for trouble shooting; and (3) driven by self-motivation, students dig into the details and interact intensively with the instructor to grasp the principles of the procedure. As such, the students can produce reliable data and interpret the procedure and data with confidence, and in addition, they may effectively diagnose operational errors for trouble shooting. Evidently, the 3rd scenario demonstrates an example of active learning, which is desirable but not common in a traditional model of experimentation.

To engage students in active learning, one of the strategies is to remove the ready-to-go procedure from the curricular setting but request the students to submit a working protocol of their own version at the end of an experiment. Instead of a stepwise procedure (i.e., a “recipe”), the students are provided with reading materials that discuss the key principles of the analytical procedures. When students show the competency in the understanding of the principles in a formative assessment (e.g., a 30-min quiz), they are ready to observe the demonstrations step by step, taking notes and asking questions. Based on their notes and inspiration from discussion, each student is requested to develop a protocol of their own version. Depending on how detail-oriented the protocols are, the instructor may approve it or ask students to recall the details and revise their protocols before moving forward. Once students show competency in the protocol development, they are ready to conduct the steps in groups under the instructor’s (or teaching assistant, TA’s) supervision. Assessment on precision and accuracy is the key to examine the competency of students’ operation, which also provides opportunities for students to go back to improve or update their protocols. In the case of unexpected results, the students are encouraged to interpret and justify their results in a physiological setting (e.g., fasting vs. feeding states) unless they choose not to. Regardless, students are asked to go back to recall and review their operation for trouble shooting under the instructor’s (or TA’s) supervision, till they show competency in the experiment with reproducible and biologically meaningful data. Trouble shooting under instructor’s or TA’s supervision and inspiration serves as an efficient platform for students to take the lead in critical thinking and problem solving, which prompts students to go back to improve or update their protocols showing special and practical notes about potential pitfalls and success tips.

Often with delight, students realize how much they have grown at the end of experimentation. However, frustration is not uncommon during the troubleshooting and learning, which has to be overcome through students’ persistence and instructor’s encouragement. Some students might feel like “jumping off a cliff” in the early stage of an experiment where a ready-to follow instruction is not available. Growing in experience and persistence, they become more confident and open to pursue “why” in addition to “what”.

Of note, logistic consideration is critical to ensure active learning by this strategy. A single experiment would take up to 3-fold more time for the instructor and students to work together to reach competency. To this end, the instructor needs to reduce the number of experiments for a semester, and carefully select and design the key experiments to maximally benefit students in terms of skill learning, critical thinking, and problem solving. Furthermore, group size should be kept small (e.g., less than 3 students per group) to maximize interactive learning if independent experimentation by individuals is not an option. Such a requirement can be met either by increasing TA support or reducing class size.



Zhiyong Cheng is an Assistant Professor of Nutritional Science at the Food Science and Human Nutrition Department, University of Florida’s Institute of Food and Agricultural Sciences (UF/IFAS). Dr. Cheng received his PhD in Analytical Biochemistry from Peking University. After completing his postdoctoral training at the University of Michigan (Ann Arbor) and Harvard Medical School, Dr. Cheng joined Virginia Tech as a faculty member, and recently he relocated to the University of Florida. Dr. Cheng has taught Nutrition and Metabolism, with a focus on substrate absorption, transport, and metabolism. As the principal investigator in a research lab studying metabolic diseases (obesity and type 2 diabetes), Dr. Cheng has been actively participating in undergraduate and graduate research training.
The Large Lecture: Minor Adjustments, Major Impacts

Large lecture courses are hard, for both students and faculty alike, and while an exhaustive body of Scholarship of Teaching & Learning (SOTL) research boasts benefits of smaller classes (Cuseo, 2007), budgetary and a myriad of other restrictions leave many higher education institutions with few options for reducing class sizes.  Accordingly, many instructors are forced to figure out a way to best serve our students in this unideal setting.

Three years ago, in my first year as a full time faculty member, I found myself teaching one of these large lecture classes.  There were ~250 students, split across two sections, piled into an outdated auditorium.   The setting was intimidating for me, and if one thing was certain, it was that however intimidated I felt, my students felt it even harder (and as an aside, three years later, I still find myself, at times, intimidated by this space).  So, in a high-stakes, pre-requisite course like Anatomy & Physiology that is content-heavy and, by nature, inherently intense, what can be done in a large lecture hall to ease the tension and improve student learning?

When looking to the SOTL research for evidence-based recommendations on student engagement and active learning ideas in high-enrollment courses such as mine, I quickly became overwhelmed with possibilities (not unlike a kid in a candy store).  Before I knew it, finding meaningful ways to reshape my class in the best interest of the student became defeating – how was I supposed to overhaul my course to integrate best-practice pedagogy while still juggling the rest of my faculty responsibilities?

Thankfully, last year a colleague introduced me to a book, Small Teaching: Everyday Lessons from the Science of Learning, by James Lang.  Admittedly – I still have not finished this book (rest assured – I am currently in a book club studying this book, so I WILL finish it!); that being said, Lang’s powerful message about the significance of small changes resonated with me pretty early on in the text.  Minor, thoughtful adjustments to the daily classroom routine are capable of eliciting substantial impacts on student learning.  In other words, I did not need to reinvent the wheel to better serve my students; instead, I set a goal for myself to try out one or two small, reasonable adjustments per semester.  While I am still navigating best-practice teaching and experience a healthy dose of trial-and-error, here is what I have found useful thus far:


1. Learning names. This is perhaps the most straightforward, obvious classroom goal, but when you have a large number of students, something as simple as learning student names can quickly slip through the cracks.  Now, I appreciate that implementing this goal takes considerable time and intention, and depending on the structure of your high-enrollment course, it may or may not be feasible.  In my course, for example, it is a two-part series, which means I have the same students for an entire academic year rather than one semester.  Moreover, in addition to lecture, I have all of my students in smaller lab sections.  Accordingly, I have plenty of opportunity to interact with students and pay attention to names.

From a purely anecdotal observation, if and when a student musters up the courage to ask a question in the large auditorium, addressing them by name appears to increase the likelihood of the student asking again.  Moreover, it seems to have an impact on other students in the classroom, too; anecdotally, I have noticed in lectures where I address student questions using student names, the number of different students asking questions appears to increase.  Overall, addressing students by name seems to communicate a message that students in our classrooms are not simply a body in a seat or a number in the system, but they are a member of a learning community.

2. Finding an inclusive platform for voicing questions. Despite reaching a point in the academic year where everyone knows each other by name, some students will never feel comfortable enough raising their hand to ask questions in the big lecture hall. Knowing this, along with the notion that student confusion rarely exist in isolation, this semester I made it a point to explore alternative platforms for asking questions during lecture.  Cue in the Google Doc: this handy, online word-processing tool gave me a platform for monitoring student questions in real time during lecture.  On the logistical end, it is worth noting that I have a TA monitoring our Google Doc during lecture, so that when a stream of questions comes through, common themes in questions are consolidated into one or two questions.  A few times during the lecture, I will check in with our TA and address questions.  It is also worth mentioning that the document has been set up such that student names are linked to their comments; this was implemented as a measure to keep comments appropriate and on track.  So far, this has turned out to be a great platform, not only for students asking lecture questions in real time, but also for facilitating some really great discussion amongst students.


3. Holding students accountable for in-class activities.  I quickly realized in my large lecture class that students were generally unmotivated to participate in any in-class activity unless I collected it and assigned points (which, by the way, can be a logistical nightmare with 250 students).  Yet, as I learned in Making it Stick: The Successful Science of Learning, by Brown, Roediger, and McDaniel (a previous book club endeavor of mine), engaging students in activities like 5 minute recall exercises is widely supported as an effective tool for long-term learning and retention.  So, I decided to piggy back off my previous idea of the Q&A Google Doc, and open up an entire classroom folder where, in addition to our Q&A doc, students had daily folders for submitting in-class activities (again, in real time).  As of now, the way that it works is as follows: upon completing the short recall exercise, or other in-class activity, students will snap a photo of their work and upload it to our Google drive.  Then, I choose a piece of student work to display as we review the activity prompt, which has proven to be a great method for maintaining student accountability (I disclosed to the students that I will randomly choose a few days in the semester to award extra credit for those who submitted during class).  Additionally, this provides quick feedback to me (in real time) regarding student comprehension and common misunderstandings; in fact, I will occasionally choose to review a student submission that represents a common mistake to highlight and address a common problem area.

In summary, implementing these small changes has offered realistic approaches to improving my students’ experience and creating community in an otherwise challenging setting: the large lecture.  While I retain other long-term teaching goals that require more of a time commitment, Lang’s sentiment that small ≠ insignificant provides a solid ground for improvement in the present.


Brown, PC, Roediger, HL, and McDaniel, MA (2014). Making it Stick: The Successful Science of Learning.  Cambridge, MA: Harvard University Press.

Cuseo, Joe. (2007). The empirical case against large class size: Adverse effects on the teaching, learning, and retention of first-year students. Journal of Faculty Development: 21.

Lang, James (2016).  Small Teaching: Everyday Lessons from the Science of Learning. San Francisco, CA: Jossey-Bass.


Amber Schlater earned her B.S. from the University of Pittsburgh in Biological Sciences, and her M.S. and Ph.D. from Colorado State University in Zoology; she also completed a two-year post-doctoral fellowship at McMaster University.  Currently, Amber is an Assistant Professor in the Biology Department at The College of Saint Scholastica in beautiful Duluth, MN, where she teaches Human Anatomy & Physiology, Super Physiology (a comparative physiology course), and mentors undergraduate research students.  Outside of work, Amber enjoys hiking, biking, camping, canoeing, and doing just about anything she can outside with her family.
It was Just a Bag of Candy, but Now It’s a Lung – Don’t Be Afraid to Improvise When Teaching Physiology

Many of us have been teaching the same course or the same topic in a team-taught course for many years.  I have been teaching the undergraduate Anatomy and Physiology-II (AP-II) course at a community college for four years.  People often ask, “Doesn’t it get old?  Don’t you get bored, teaching the same topic?”  Without hesitation, I answer, “No.” Why?  First, on-going research continually brings new details and insight to nearly every aspect of cell and integrative physiology.  You’re always learning to keep up with the field and modifying lectures to incorporate new concepts.  Second, you truly want your students to learn and enjoy learning and continually seek out ways to teach more effectively.  You try new approaches to improve student learning.  However, the third reason is truly why teaching physiology will never get old or dull.  No two students and no two classes are alike; individual and collective personalities, career goals, academic backgrounds and preparedness, and learning curves vary from class to class.  About half my students have not taken the general biology or chemistry courses typically required for AP-I or AP-II (these are not required by the college).  The unique combination of characteristics in each group of students means that on any given day I will need to create a new makeshift model or a new analogy for a physiological mechanism or structure-function relationship to help students learn.  Thus, even if all physiological research came to complete fruition, the teaching of physiology would still be challenging, interesting, and entertaining.  Many of my peers share this perspective on teaching physiology.

Irrespective of one’s mastery of integrative physiology, as teachers we must be ready and willing to think creatively on our feet to answer questions or clarify points of confusion.  A common mistake in teaching is to interpret the lack of questions to mean our students have mastered the concept we just explained, such as the oxygen-hemoglobin dissociation curve.  Despite the amazing color-coding of green for pH 7.35, red for pH 7.0 and blue for pH 7.5 and perfectly spaced lines drawn on that PowerPoint slide, your Ms./Mr. Congeniality level of enthusiasm, and sincerest intentions – you lost them at “The relationship of oxygen saturation of hemoglobin to the partial pressure of oxygen is curvilinear.”  You know you lost them.  You can see it in their faces.  The facial expression varies: a forehead so furrowed the left and right eyebrows nearly touch, the cringing-in-pain look, the blank almost flat stare, or my favorite – the bug-eyed look of shock.  Unfortunately, it will not always be obvious.  Thus, it is essential we make an effort to become familiar with the class as a group and as individuals, no matter how large the class.  Being familiar with their baseline demeanor and sense of humor is a good start.  (I have students complete ‘Tell Me About Yourself’ cards on the first day of class; these help me a great deal.)  During lecture, we make continual and deliberate eye contact with the students and read their faces as we lecture and talk to them, rather than at them.  In lab we work with and talk to each group of students and even eavesdrop as a means to assess learning.  Time in class or lab is limited, which tempts us to overlook looks of confusion and move on to the next point.  However, when students do not accurately and confidently understand a fundamental concept, they may have even greater difficulty understanding more integrated and complicated mechanisms.  You must recognize non-verbal, as well as subtle verbal cues that students are not following your logic or explanation.  In that immediate moment you must develop and deliver an alternative explanation.  Improvise.

As per Merriam-Webster, to improvise is to compose, recite, play, or sing extemporaneously; to make, invent, or arrange offhand; to fabricate out of what is conveniently on hand.  What do you have on hand right now to create or develop a new explanation or analogy?  Work with what you have within the confines of the classroom.  These resources can be items within arm’s reach, anything you can see or refer to in the classroom.  You can also use stories or anecdotes from your own life.  Reference a TV commercial, TV show, movie, song, or cartoon character that is familiar to both you and your students.  Food, sports, and monetary issues can be great sources for ideas.  I cook and sew, which gives me additional ideas and skills.  Play to your strengths.  Some people are the MacGyvers of teaching; improvisation seems to be a natural born gift.  However, we all have the basic ability to improvise.  You know your topic; you are the expert in the room.  Tap into your creativity and imagination; let your students see your goofy side.  Also, as you improvise and implement familiar, everyday things to model or explain physiological or structure-function relationships you teach your students to think outside the box.  Students learn by example.  My own undergraduate and graduate professors improvised frequently.  My PhD and post-doc advisors were comparative physiologists – true masters of improvised instrumentation.

Improvise now, and improve later.  Some of my improvised explanations and demonstrations have worked; some have fallen flat.  In some cases I have taken the initial improvised teaching tool and improved the prototype and now regularly use the demonstration to teach that physiological concept.  Here are three examples of improvisational analogies I have used for the anatomy of circular folds in the intestine, the opening and closing of valves in the heart, and the role of alveoli in pulmonary gas exchange.  Disclaimer:  These are not perfect analogies and I welcome comments.

Surface area in the small intestine.  Students understand that the surface area of a large flat lab table is greater than the surface area of a flat sheet of notebook paper.  A sheet of paper can be rolled into a tube, and students understand that the surface area of the ‘lumen’ is equal to the surface area of the paper.  In AP-I, students learned that microvilli increase the surface area of the plasma membrane at the apical pole of an epithelial cell, and many teachers use the ‘shag carpet’ analogy for microvilli.  Similarly, they understood how villi increase surface area of the intestinal lumen.  However, some students did not quite understand or cannot envision the structure of circular folds.  As luck would have it, I was wearing that style of knit shirt with extra-long sleeves that extend just to your fingertips.  I fully extended the sleeve and began to explain. “My sleeve is the small intestine – a tube with a flat-surface lumen (my arm is in the lumen) – no circular folds.  This tube is 28 inches long and about 8 inches around.  As I push up my sleeves as far as I can, and the fabric bunches up.  These messy folds that form are like circular folds.  And, now this 6 inch tube with all these circular folds has the same surface area as the 28-inch plain tube.”  (I sew; I know the length of my own arm and am great at eyeballing measurements.)

Heart valves open and close as dictated by the pressure difference across the valve.  This is integral to ventricular filling, ejection of blood into the lung and aorta, and the effect of afterload.  Heart valves are one-way valves.  A few students heard ‘pressure difference’ and were lost.  Other students had trouble understanding how stroke volume would decrease with an increase in afterload.  What can I use in the room?  There’s a big door to the lab, and it has a window.  It opens in one direction – out, because of the doorframe, hinges and door closure mechanism; it only opens, if you push hard enough.  I ran over to the door.  “The lab door is a heart valve.  It’s the mitral valve, the lab is the atrium, and the hallway is the ventricle.  The door only opens into the hall – the mitral valve only opens into the ventricle.  When it closes, it stops once it sits in the frame.”  I asked a student about my size to go outside the room, and push against the door closed – but let me open it; she could see and hear me through the window.  “As long as I push with greater force than she applies to keep it shut, the door or valve will open.”  The student played along and made it challenging, but let me open the door.  ‘Blood flows from the atrium into the ventricle, as long as the valve is open.  But, as soon as the pressure in the ventricle is greater than the pressure in the atrium the valve closes.”  The student forcefully pushed the door shut.  They got it!  Now, afterload …?  Back to the lab door.  “Now the lab door is the aortic valve, the lab is the left ventricle, and the hall is the aorta.  This valve will open and stay open as long as the pressure in the ventricle is greater than the pressure in the aorta.  The longer the valve is open, the greater the volume of blood ejected from the ventricle.  The volume of blood ejected from the ventricle in one beat is the stroke volume.  The pressure that opposes the opening of the aortic valve is afterload.  What happens with afterload?”  I then asked the tallest, strongest student in class to play the role of Afterload; he too got into the role.  “Afterload has now increased!  The pressure that opposes the opening of the valve has increased.  Will I or won’t I have to push harder to open the door – now that afterload has increased?”  The student is very strong; I can barely push the door open.  “I not only have to push harder, but I can’t keep the door or valve open for very long.  Look.  Even though the ventricle pressure is greater, the valve is open for a shorter period – so less blood is ejected and stroke volume decreases.”

Alveoli increase the surface area for gas exchange.  Students see the lungs as 2 large sacs, and the surface area available for gas exchange between air and blood is simply the inner lining of each sac.  However, each lung is made of millions of tiny air sacs or alveoli into which air flows.  How this anatomical arrangement greatly increases surface area for gas exchange is not intuitively obvious.  The overall size of the lung does not increase, so why would the surface area increase?  As luck would have it, it was Halloween.  I had brought a big bonus bag of individually wrapped bite-size candies to class.  “One lung is like this bag.  If we cut open the bag and measure the sheet of plastic, it would be about 18 inches by 12 inches or 216 square inches.  But if we completely fill it with candy, it might hold at least 150 pieces of candy.”  I quickly unwrapped one piece of candy, held up the wrapper, and estimated a single wrapper was 4 square inches.  “If we fill one bag with 150 pieces of candy, we then have 600 square inches of surface area.  Which would provide greater area for gas exchange: one big lung or millions of alveoli?”  I revised this particular improvised explanation using scissors, a ruler and two 11-oz bags of Hershey’s® kisses.  I carefully opened both bags and transferred kisses from one bag to the other, until it was completely full, i.e., 112 kisses, and taped it shut.  I then fully opened up the other bag; it was 10 inches x 8 inches or 80 square inches.  An individual kiss wrapper is 4 square inches; all 112 individual wrappers are 448 square inches.

My improvised analogies are not perfect, but they have served as great teaching tools.  If you can improve upon these, please do.  Share any suggestions you have and lastly, share your improvised explanations and analogies.  Thanks.

Alice Villalobos received her biology from Loyola Marymount University and her PhD in comparative physiology from the University of Arizona-College of Medicine.  She has been in the Department of Biology at Blinn College for 4 years where she teaches Anatomy and Physiology II and Introduction to Human Nutrition.  She guest lectures in undergraduate courses at Texas A&M University on the topics of brain barrier physiology and the toxicity of heavy metals.