Category Archives: Active learning

“Is integrated curriculum disintegrating the holistic approach among smart learners?”

I feel smart learners are becoming surface learners in the integrated curriculum by juggling with only the learning outcomes included in the blueprint without processing the information. They calculate the bare minimum content required just to pass. They are not ready to come out of their comfort zone to progress by acquiring hard-core concepts at the level of application and synthesis. They appear in a module exam and stop relating it to other modules.

Integrated curriculum is being implemented at the cost of lack of ownership by subject specialists. System-based modules lay the foundation of disciplines on Anatomy but not on the themes associated with clinical features like chest pain. When diseases are studied within systems, the integration is itself disintegrated into anatomical boundaries.

Problem-based learning from which students can derive their own learning outcomes to solve the scenario remains the only hope to integrate the systems, as diseases seldom restrict themselves to one system. As assessment drives learning, PBL may be assessed by case-cluster-MCQs and integrated viva by relevant subject specialists. Being a student-centered methodology, adding to the burden of an integrated curriculum involving multiple subjects, PBL is usually neglected by the student body. There is a dire need to innovate PBL and make it interesting by using students as simulated patients and by allowing them into doctor-patient-role-play, whereas the remaining students may be engaged in healthy critique and feedback along with critical thinking, leadership and teamwork to achieve academic as well as social learning. PBL workshops with faculty and students may be beneficial.

The relatively new concept of “patients as educators of students” may be practiced by recruiting actors and real patients carefully through interviews and seeking their consent for history-taking and/or physical examination. Feedback and assessment by simulated patients may contribute to real-patient safety. Their video may be created as a future learning resource. Smart learners need smart teachers to handle them along with their modern curriculum.

Prof. Dr. Samina Malik

HOD Physiology, University College of Medicine and Dentistry, The University of Lahore

PBL Country head for Pakistan, Asia-Pacific Association on PBL in Health Sciences (APA-PHS)

Secretary General, South Asian Association of Physiologists

Masters in Med Edu student at Dundee university, UK

Member APS, Teaching of Physiology section (Member No. 00307332)
Dramatization: The Marriage of Theater and the Teaching of Physiology

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

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

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

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

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

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

Who in heaven let me teach them!!!

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

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

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

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

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

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

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

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

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

 

 

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

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

Happy teaching

helena@vt.edu

References:

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

 

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

This post shares my reflection on making asynchronous learning materials during COVID19. I taught physiology to years 1 and 2 medical students at Newcastle University Medicine Malaysia. My usual approach in the classroom is: passive – active – passive i.e. I would first clarify the concepts in which students listen passively, ask questions to push students to think actively, back to passive again, and so forth.

 

When the pandemic hit Malaysia and the country went into complete lockdown, teachers were asked to decide if they wanted to make their teaching session synchronous or asynchronous. It was a stressful time as it was just my third year of teaching, and I still had a lot to learn about teaching. Fortunately, this happened during the semester break, and I had time to ponder these potential issues. Synchronous online sessions happen in real time, just like an in-person teaching session but online. Asynchronous sessions, on the other hand, allow students to go through the learning materials at their convenience.

 

I chose to make all my teaching sessions asynchronous after reflecting on several issues which the students and I might encounter if they were synchronous sessions. The student demography in the university consists of both local (Malaysian) and international students (ranging from Australia, to South Asia, and all the way to Canada). Considering where the students were from, the first problem with conducting synchronous sessions would be the time difference. After making adjustments, we had only a couple of hours a day where the schedule was appropriate for everyone.

 

Using Zoom for teaching was my first time, I needed to take into consideration student engagement, internet connectivity (both students’ and mine), glitches etc. Taken together, I realized that there were more things that were not within my control for a synchronous session, so asynchronous session was the better choice: the students could just go through the materials at their convenience. They could learn at their own pace without the need to stress themselves (and myself) about internet connectivity during a synchronous session or waking up at 5 in the morning; And I could avoid real-time technical issues in the middle of a teaching session. What’s left is student engagement. How do I engage students during asynchronous teaching? What can I do to motivate the students to complete the seemingly ‘boring’ hour-long lectures when they were on their own? Once I decided to make asynchronous materials, I actually felt relief in a way as I just needed to focus on making the materials rather than worried about other issues.

 

When I started working from home during the semester break, I had productivity anxiety which I had not experienced before. I began watching videos and reading articles which people shared on how to be more productive. This was when I discovered the Pomodoro technique. In general, this time management technique improves productivity by breaking down the work day into 25-minute blocks (also called Pomodoro’s) with 5-minute breaks in between the blocks. This actually gave me the idea on how I could help the students to go through the asynchronous learning materials with ‘less suffering’, as well as to achieve more when they were on their own.

 

I divided an hour-long lecture into three parts: Part 1, Part 2 and Summary which mimicked the block mentioned above. Parts 1 and 2 were recorded lectures that were 20-25 minutes long, and the Summary was a short, 5-minute roundup of what had been mentioned. Within the recorded lectures, I also prepared activities for students to assess their own understanding (active learning). For instance, after describing the structure of the skeletal muscle, I inserted another diagram of muscle fibers and asked students to pause the video to try and label the diagram. After explaining the two-neuron model, receptors and the neurotransmitters in the autonomic nervous system lecture, I prepared another diagram and students were asked to pause the video to fill in the blanks. When students resumed the video, I explained the answers. The videos were uploaded into Microsoft Stream and the links to the videos were shared on the university learning management system. I could easily track the number of views of the videos.

 

In between the two parts, there was a 5-minute-long interlude that mimicked the break in Pomodoro technique. A variety of activities was used in the interlude, including a short reading or fun fact related to the previous part. For instance, a question that required students to apply what they learned from the previous part; or games such as crossword puzzles, drag-and-drop for students to match the meanings with the terminology; or in the muscle physiology lecture, a short reading on rigor mortis were given in the interlude. Students could skip this if they wanted to but I encouraged them to follow the activities in the interlude to take a break from the passive listening, and do something active.

 

Other small things I did with this ‘Pomodoro arrangement’ of the learning materials included a clear instruction and the estimated time required to complete it. These are common if one is familiar with taking online courses. Clear instructions and estimated time of completion helped setting goals and expectations for the students the moment they opened the asynchronous learning materials. This might seem trivial, but it’s one of the keys of getting things done.

 

I included captions to all my videos to improve accessibility. Particularly for the new students, they might need time to get used to my accent and certain terminology. On top of that, captions could also be useful to English speakers to improve comprehension (1). PLYmedia found that videos with captions are more engaging and the viewers tend to watch until the end (1). These are something that I wanted for my videos as well. In fact, the sound quality, the accent of the teachers, the internet connection, and whether English is the student’s first language, could all affect the quality of synchronous teaching without proper captions. I would acknowledge that adding captions could be troublesome. When I first tried to edit the caption generated automatically by Microsoft Stream, I was amused by how bizarre it was, full of errors. However, I was actually glad as it reminded me to put efforts into my speaking and pronunciation (especially if you do not have a good microphone). One thing that I learned was that YouTube actually has a better AI system in terms of generating captions, the accuracy rate was high. After getting used to recording videos and adjusting how I speak, I didn’t have to do much editing in my subsequent videos. I also took caption-editing as an additional step to assess the contents of my videos.

 

The completion rate of the videos was 100% based on the number of views recorded in Microsoft Stream and students showed great appreciation about the captions in their feedback. When I asked them privately how they felt about the ‘Pomodoro arrangement’, some students said that they felt accomplished whenever they finished the 20-plus-minutes long videos and were motivated to continue. I believe this is the effect of the original Pomodoro method. Although COVID19 is pretty much ‘over’ in most countries and in-person teaching has resumed, I think this ‘Pomodoro arrangement’ could still be beneficial in blended learning. One might argue that there is no need to deliberately include the ‘breaks’ for the students since the students can just pause an hour-long video on their own. But I see no reason why we can’t actively make this happen by breaking up the lectures into smaller chunks and inserting fun active learning in between.

References:

[1] Albright, Dann. “7 Reasons Your Videos Need Subtitles [Infographic].” Uscreen, 18 Nov. 2020, www.uscreen.tv/blog/7-reasons-videos-need-subtitles-infographic/.

Dr. Tan received his BSc and MMedSc from the University of Malaya, Malaysia, and his Ph.D. from the National University of Singapore. He then worked at Newcastle University Medicine Malaysia (2018-2021) as lecturer, teaching physiology to years 1 and 2 medical students. Currently, he is a lecturer at the Chinese University of Hong Kong (Shenzhen), teaching physiology and histology to years 1 & 2 medical students.
The Great Student Disengagement

With excitement and anticipation for a “return to normal,” faculty, staff and administrators were especially excited to launch Spring semester 2022.  People were vaccinated, students would be attending class with their peers on campus, and extracurricular activities would return to campus. However, it was soon discovered that a return to campus would not mean a return to “normal.”

In addition to the period of “great resignation” and “great retirement,” we soon discovered that a return to campus could be described as the “great student disengagement.”  Faculty observed concerning student behaviors that impacted academic success. Students on our campus have been vocal about their desire to remain at home and on MS TEAMS/ZOOM©. Classroom sessions were required to shift and were often a mixed modality (high flex) as students and faculty underwent COVID protocols that required remote attendance. In a curriculum in which all sessions are mandatory (approximately 20 hours each week in a flipped environment), students requested far more absences in the spring semester than ever before. Even when students were physically present in class, blatant disengagement was observed by faculty.  Attempts to appeal to students’ sense of responsibility and professionalism had little impact in changing behavior.

In attending the Chairs of Physiology meeting at Experimental Biology (EB), student disengagement was an impactful topic of discussion. Somewhat surprisingly, it quickly became apparent that the environment on our campus was somewhat ubiquitous across all institutions of higher education represented in the room that day. Although we shared similar observations, few potential solutions were offered.

Serendipitously, on the final day of EB meetings, the Chronicle of Higher Education published an article by Beth McMurtrie titled “A Stunning Level of Student Disconnection.”  The article shared insight gained from faculty interviews representing a wide range of institutions:  community colleges, large public universities, small private colleges, and some highly selective institutions. Ms. McMurtrie shared stories of faculty who described how students’ brains are “shutting off” and limiting their ability to recall information. The article reports that far fewer students show up to class, those who do attend often avoid speaking, and many students openly admit that they do not prepare for class or complete assignments. Faculty commonly described students as defeated, exhausted, and overwhelmed.

Although specific causes of the “great student disengagement” have not been substantiated, many believe it is the after-math of the pandemic. It seems plausible that the learning environment became more individualized and flexible with fluid deadlines and greater accommodations during the pandemic. Thus, a return to normal expectations has been difficult.

It also seems reasonable that amid the more pressing issues of life (deaths within families, financial struggles, spread of disease), students are reporting high levels of stress, anxiety and general decline in mental health. Perhaps being absent or disengaging while in class (being on cell phones/computers, frequently leaving the room) are simply avoidance mechanisms that allow the student to cope.

Although post pandemic conditions have brought student disengagement to our awareness, some faculty have seen this coming for years.  In a 2020 Perspectives on Medical Education article by Sara Lamb et al. titled “Learning from failure: how eliminating required attendance sparked the beginning of a medical school transformation,” the authors reported low attendance rates, at times as low as 10%, which they attempted to fix with a mandatory attendance policy.  However, over the next six years, student dissatisfaction rose due to the inflexible and seemingly patronizing perception of the policy. This led students to strategize ways to subvert the policies while administration spent significant time attempting to enforce them.  To address the situation, the school transitioned away from required to “encouraged” and “expected” for learning activities.  This yielded both positive and negative results, including but not limited to: increased attendance to non-recorded activities which students deemed beneficial to their learning; reduced attendance to activities that were routinely recorded and posted leading to increased faculty discouragement; reduced administrative burden and tension; and increased student failure rate and feelings of isolation and loneliness.  The authors go on to describe efforts to mitigate the negative outcomes including empowering faculty with student engagement data, and training in active learning pedagogies to enhance student engagement.

As the definitions and root causes of student disengagement pre-date COVID and are somewhat ambiguous, finding effective solutions will be difficult. Perhaps the rapid evolution of teaching and learning brought about by COVID now dictates an evolution of the academic experience and the rise of scholarly projects to address both causes and solutions.

Suggestions on solving the disengagement crisis were published by Tobias Wilson-Bates and a host of contributing authors in the Chronicle of Higher Education dated May 11, 2022. Although we will leave it up to the reader to learn more by directly accessing the article, a list of topics is helpful to recognize the variety of approaches:

  1. Make Authentic Human Connections
  2. Respect Priorities
  3. Provide Hope
  4. Require Student Engagement
  5. Acknowledge that Students are Struggling
  6. Fight Against Burnout

Although we rely on faculty to address student disengagement, it is also useful to consider the stressful environment of faculty. In addition to experiencing the same COVID conditions that students experience, faculty are being asked to continue to provide up-to-date content, utilize engaging teaching modalities, become skillful small group facilitators, as well as advise, coach and provide career counseling.  It is perhaps not surprising that faculty may also feel stressed, isolated, and burned out, surmising that nothing they do makes much difference – opting instead to remain hopeful that students will bounce back.

Regardless of the learning environment on your campus, it is safe to say that now is the time to come together as faculty, students and administrators to discuss the best path forward. Collectively we can work together to set solutions into motion and gather evidence for our effectiveness. It is time to leverage our shared experiences and lessons learned over the past several years of transitioning away from and back into face-to-face classroom instruction. Such reflection and study will support teaching and learning as we all seek to find a “new normal” that meets the needs of students, faculty, and administration alike.

Lamb, Sara & Chow, Candace & Lindsley, Janet & Stevenson, Adam & Roussel, Danielle & Shaffer, Kerri & Samuelson, Wayne. (2020). Learning from failure: how eliminating required attendance sparked the beginning of a medical school transformation. Perspectives on Medical Education. 9. 10.1007/s40037-020-00615-y.

A Stunning Level of Student Disconnection  https://www.chronicle.com/article/a-stunning-level-of-student-disconnection

How to Solve the Student Disengagement Crisis https://www.chronicle.com/article/how-to-solve-the-student-disengagement-crisis

 

Mari Hopper, PhD, is an Associate Dean for Pre-Clinical Education at Ohio University Heritage College of Osteopathic Medicine where she facilitates the collaboration of faculty curricular leadership and their engagement with staff in curricular operations.  Dr Hopper’s areas of professional interest include curricular development, delivery and management; continuous quality improvement including process efficiency and the development of positive learning environments and work culture; and mentorship of trainees in medical education.
Leah Sheridan, PhD, is a Professor of Physiology Instruction at Ohio University Heritage College of Osteopathic Medicine where she serves in curriculum innovation, development and leadership. Dr. Sheridan’s areas of professional interest include the scholarship of teaching and learning, physiology education, and curriculum development.
Developing a Community of Practice in an A&P Course

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References:

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

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

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

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

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

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

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

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

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

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

mbridge University Press.

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

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

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

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

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

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

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

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

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

**Illustration by Andrea Rochat, MFA

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

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

Why?

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

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

“Yes, we do!”

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

“Yes, we do!”

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

Etc.

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

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

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

How?

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

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

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

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

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

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

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

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

Tangible benefits from the redesign include:

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

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

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

Intangible benefits of the redesign include:

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

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

Recommendations:

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

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

References for Redesign and Remediation:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 
Course-based Research Experiences Help Transfer Students Transition

As transfer student numbers increase at 4-year institutions, we need to provide opportunities for the formation of learning communities and research experience. Course-based research experiences allows for both. Students receive course credit toward their degree, work on independent research, and engage with peers and faculty in a small setting.

Several studies have been conducted to show the advantages of undergraduate research as a value-added experience. (1,2,4,6,8). As an R1 university, we have a tremendous amount of resources devoted to STEM research – but we are unable to accommodate all of our undergraduates who are looking for lab experience. The development of course-based research experiences (CUREs) across colleges and universities has increased the availability of research opportunities for undergraduates. (1,3,5). In addition, they have provided an increased sense of community and interaction with faculty – two factors that were highly valued by all students. The question for us was how can we provide more of these courses given space and personnel constraints and are there student populations that might benefit more directly from these courses?

Several years ago, we increased the number of transfer students we accepted from community colleges and elsewhere. But there was no transfer-specific programming for those students and they had little sense of community. Transfer students tend to be a much more diverse student population in several ways. Their average age is higher than our incoming first-year class, they are more likely to be PELL Grant-eligible (40% of transfer vs 20% of first-year students), first-generation college students (30% of transfer vs 15% of first-year students) and are more likely to work and live off-campus. Although they recognize the value of community and research experience according to surveys, they often state they don’t have the time to invest as they are trying to graduate as quickly as possible.

We received a grant through HHMI (in part) to train faculty to develop CUREs specifically for transfer students. STEM courses that “counted toward graduation” was a way to get buy-in from the students and to be funded by grants and aid. All transfer students needed additional life science courses to complete their degree, and this was a course that wasn’t transferred in through the community colleges so there was space in their degree audits. These were small enrollment courses that lent themselves to forming cohorts of student learning communities as they proposed hypotheses, designed and implemented their experiments, and presented their findings to the class. This allowed transfer students to receive course credit toward graduation in a lower-stress way during that first transition semester.

Course-based Research Experiences Help Transfer Students Transition

Lisa Parks 9.30.2021

Figure 1

Cell Biology CURE Example:

Testing whether environmental compounds or other chemicals induce cell death

Protocols Provided:  Cell seeding and growth, Cell counting, Measuring cytotoxicity, Bradford Assay, Western Blot, Immunofluorescent Analysis

There are thousands of chemicals and compounds that either potentially affect cell growth, metabolism, and death.

This project has a lot of room for student individuality. Students could do endocrine disruptors, for example, or Parkinson’s disease related compounds (i.e., things that kill mitochondria), environmental toxicants, heavy metals, etc. They could test across cell types, concentrations, diseases, etc.  They could use the cancer cells and we could get a screen of compounds. Or they can pre-dose with a potential protectant (GSH?) and then expose the cells to something toxic to see if cell death can be attenuated.

This is particularly important because one issue we struggle with is that students with a 2-year associates degree automatically receive credit for all general education requirements through the NC Articulation Agreement. This means that transfer students are left with stacks of required difficult STEM courses with little opportunity to balance their course load for their remaining semesters. In addition, they are often trying to graduate “on time” so they are starting at a new, much larger, state university with little formal introductory programming and often, unfairly heavy STEM course loads. This isn’t the best way to set these students up for success. We found our transfer students falling behind in GPA and time to graduation. Tracking transfer students that take these first-semester CUREs will help us see if this approach increases student retention in the STEM majors, their graduation rates, and through surveys, their feelings of community at NCSU.

Teams of tenured or tenure-track research faculty and teaching-track faculty along with a handful of post-docs continue to develop these courses. As you can imagine, COVID interrupted this effort as we scrambled to go online and closed our lab spaces to undergraduates, but the CURE development continued.  Anecdotally, we noticed an increased collaboration and a sense of community among the faculty that extended beyond the workshop training. This has been seen in several studies at other institutions (7,9). As these labs have been developed, it has led to increased team teaching, research projects, and publications. Teaching faculty have had another mechanism for staying current and being engaged in research and literature while giving them another outlet for scholarly work. Research faculty have had another mechanism for exploring side projects that they may not have had the time or funds to pursue in their own labs and allowing them an opportunity to get into the classroom.

Faculty write up or discuss a proposal with each other – an idea that they wish they had time or space to devote to. It’s typically no more than a page. Students take it from there. They spend the first third of the semester learning techniques and protocols, and writing their experimental designs. The rest of the semester is devoted to implementing their experiments, presenting results and receiving feedback at weekly lab meetings, and re-working or replicating their experiments. Final findings are presented as a poster session in our main lobby where all faculty and students are encouraged to stop by. A sample CURE is provided in the box.

As this approach to teaching has increased in our department, it has begun to influence space allocation within the buildings. We are beginning to influence how future buildings are designed and how renovations to existing space can accommodate this approach. We have begun to question whether we need large amphitheaters for 300+ students in a classroom and we are starting to see how we can divide up that space into learning labs and rooms with moveable chairs and tables – facilities that will promote the formation of learning communities and critical thinking skills as opposed to memorization of content.

Thank you to Dana Thomas and Jill Anderson for collecting and providing data about our transfer students.

REFERENCES

  1. Auchincloss LS, Laursen SL, Branchaw JL, Eagan K, Graham M, Hanauer DI, Lawrie G, McLinn CM, Pelaez N, Rowland S, Towns M, Trautmann NM, Varma-Nelson P, Weston TJ, Dolan EL. Assessment of Course-Based Undergraduate Research Experiences: A Meeting Report. CBE Life Sci Educ 13(1):29-40, 2014.
  2. Banasik MD, Dean JL. Non-Tenure Track Faculty and Learning Communities: Bridging the Divide to Enhance Teaching Quality. Inn Higher Educ 41: 333-342, 2016.
  3. Bangera G, Brownell SE. Course-Based Undergraduate Research Experiences Can Make Scientific Research More Inclusive. CBE Life Sci Educ 13: 602-606, 2014.
  4. Beckham J, Metola P, Strong L. Year-long Research Experiences in Drug Discovery May lead to Positive Outcomes for Transfer Students. FASEB Journal 31:S1. 589.8, 2017.
  5. Eagan MK, Hurtado S, Chang MJ, Garcia GA, Herrera FA, Garibay JC. Making a Difference in Science Education: The Impact of Undergraduate Research Programs. Am Educ Res J 50:683-713, 2013.
  6. Griswold W. Launching Sustainability Leadership: Long-Term Impacts on Educational and Career Paths in Undergraduate Research Experiences. J Coll Sci Teach 49:19-23, 2019.
  7. Kezar A. Spanning the Great Divide Between Tenure-Track and Non-Tenure-Track Faculty, Change: The Magazine of Higher Learning, 44:6, 6-13, 2012. DOI: 10.1080/00091383.2012.728949
  8. Nagda BA, Gregerman SR, Jonides J, von Hippel W, Lerner JS. Undergraduate Student-Faculty Research Partnerships Affect Student Retention. Rev of Higher Educ 22:55-72, 1998.
  9. Ward HC, Selvester PM. Faculty Learning Communities: Improving Teaching in Higher Education, Educational Studies, 38:1, 111-121, DOI: 10.1080/03055698.2011.567029
Lisa Parks is a Professor of Teaching and Director of Undergraduate Programs in Biological Sciences at North Carolina State University. In addition to her regular teaching load of cell biology and advanced human physiology, she has helped develop several courses and is currently developing several course-based research opportunities for transfer students. She has been a participant, a mentor, and a current grant recipient with the Howard Hughes Medical Institute where she was bitten by the “research as pedagogy – inquiry-based learning – critical thinking” bug. She gladly drops what she is doing to talk about this. Lisa received her BS in Zoology from Duke University and her PhD in Biology with a concentration in cell physiology at Georgia State University.
Using Google Jamboard for Collaborative Online Learning in Human Physiology

Active and cooperative learning strategies are useful tools for engaging students in the classroom and improving learning (Allen & Tanner, 2005; García-Almeida & Cabrera-Nuez, 2020; Montrezor, 2021). These learning strategies require students to engage with course content by “seeking new information, organizing it in a way that is meaningful, and having the chance to explain it to others” (Allen & Tanner, 2005, p. 262). Both active and cooperative learning emphasize peer interactions and give students opportunities to demonstrate understanding.

The COVID-19 pandemic provided an opportunity for instructors to practice new pedagogies in face to face, hybrid, and remote learning environments. Prior to the pandemic, I often asked students to use the classroom white boards collaboratively to draw diagrams, processes, and outline concepts. Given limitations on face to face interactions in hybrid and remote classes, I used Google’s Jamboard to recreate this in-class experience for a virtual Human Anatomy & Physiology course. Students were Exercise and Health Science majors and minors. The course was offered in 15, three-hour class periods over a four-week course block in spring 2021. The three-hour class periods necessitated a variety of pedagogies to maintain student engagement.

Jamboard is a virtual white board space that can be used collaboratively by sharing a link with others. Before sharing, the link settings must be adjusted to allow any user with the link to edit the Jamboard. Each board can hold up to 20 different frames, or white board spaces, which can be modified by adding figures, text, drawings, and sticky notes. I began the first day of class demonstrating to students how to use Jamboard. We started with a blank frame and I asked students to add “sticky notes” to the board with thoughts about how they would stay engaged with the course during our three-hour meeting time. Students also practiced using various editing tools such as the pen, textbox, and creating shapes. The students and I both found Jamboard very user friendly and easy to navigate.

In subsequent classes, I created specific Jamboard frames prior to class with the outline of an activity or figures. Some frames were created for the class to contribute to collaboratively, similar to a jigsaw format. For example, a picture of a neuron was added to one frame (Figure 1).

Preassigned student groups worked in Zoom breakout rooms to identify one anatomical location and describe its primary function on the neuron. Each group was assigned a different neuron structure and reported back to the class after their group work. During the cardiovascular physiology unit, student groups were each assigned one component of the cardiac cycle on a Wigger’s diagram. Groups worked in Zoom breakout rooms to identify their component of the cycle and write an explanation on the diagram. Groups also collaboratively completed a chart with each group completing one row or column in the chart (Figure 2). Jamboard was also useful for students to order and label steps in a physiological process. In the skeletal muscle unit, students worked in groups to correctly order the steps of muscle contraction. Each group was assigned one picture on the Jamboard frame, groups placed their picture in the correct order and used a textbox or sticky note to describe the picture.

 

 

 

 

 

For other activities, frames were created once and duplicated for each group with the group number noted at the top of the frame. Frames containing concept map instructions or feedback loop skeletons were duplicated for each group. For example, groups worked in Zoom breakout rooms to design a concept map demonstrating the relationships between cell membrane components (Figure 3) or outline a control system for different responses to deviations for homeostasis. During the homeostatic control system activity, each group was assigned a different control system. Groups reported back to the class as a whole and described their work to the class (Figure 4).

 

At the end of the course, students were surveyed about our Jamboard use. Of 17 students, 11 completed the survey. Overall, students indicated that Jamboard was an effective learning (100%, n=11) and group engagement tool (100%, n=11). In open-ended responses, students indicated that Jamboard was most effective for engaging in collaboration and checks for understanding during class. They especially liked that Jamboard helped create an in class feeling and kept them engaged with their class and their group in an interactive way. Even though groups were often labeled on Jamboard (e.g.- one frame labeled “Group 1 Concept Map” or a diagram with a “1” and arrow pointing to a specific area for identification for Group 1), several students remarked that they liked the anonymity provided by Jamboard and the lower perceived pressure to answer correctly. Students listed labeling diagrams (n=10), creating concept maps (n=7), and drawing physiological processes (n=6) as their favorite Jamboard activities. The students also appreciated that the boards were available after class for review. I posted the Jamboard link to our learning management system (Canvas) and students could return to the boards to review after class. 100% (n=11) of student respondents indicated they went back to the Jamboards two or more times after class to review.

From the instructor perspective, Jamboard provided an easy online collaborative tool for teaching physiology. Jamboard was user-friendly, flexible, and easy to set up before or during class. I found that my students were able to sustain engagement during three hours of remote class. The Jamboard group assignments were not graded, but asking student groups to report back to the class was effective motivation for producing quality group work. Challenges associated with Jamboard were consistent with most online activities including student access to a computer and reliable internet. Students occasionally had issues accessing the board anonymously if they were logged into their personal google accounts.

In moving back to face to learning, the Jamboard activities could be easily done on a whiteboard; however, collaborative drawing and annotating diagrams and charts might still be difficult without appropriate projectors or smartboard technology. Additionally, extra steps involved in taking a picture of the white board and uploading the picture to a course webpage may be barriers to making the collaborative work available after class for review. Jamboard could also be used for out of class individual or group assignments such a pre- or post- class assignments or for brainstorming activities. While the class size in the present example is quite small (17 students), use of Jamboard in these ways would be easily adaptable to larger classes and may improve student engagement in large classes (Essop & Beselaar, 2020)

 

Overall, Jamboard was an effective online collaborative tool for teaching and learning human physiology. Jamboard was user-friendly, easy to prepare before class, and kept students engaged with the class and their groups.

 

 

 

 

 

 

 

References

Allen, D., & Tanner, K. (2005). Infusing Active Learning into the Large-enrollment Biology Class: Seven Strategies, from the Simple to Complex. Cell Biology Education, 4(4), 262–268. https://doi.org/10.1187/cbe.05-08-0113

Essop, M. F., & Beselaar, L. (2020). Student response to a cooperative learning element within a large physiology class setting: Lessons learned. Advances in Physiology Education, 44(3), 269–275. https://doi.org/10.1152/advan.00165.2019

García-Almeida, D. J., & Cabrera-Nuez, M. T. (2020). The influence of knowledge recipients’ proactivity on knowledge construction in cooperative learning experiences. Active Learning in Higher Education, 21(1), 79–92. https://doi.org/10.1177/1469787418754569

Montrezor, L. H. (2021). Lectures and collaborative working improves the performance of medical students. Advances in Physiology Education, 45(1), 18–23. https://doi.org/10.1152/advan.00121.2020

Dr. Mary Stenson earned her B.S. in Biology from Niagara University and her M.S. and Ph.D. in Exercise Physiology from Springfield College. She is an Associate Professor of Exercise Science and Sport Studies at the College of Saint Benedict/Saint John’s University in Saint Joseph, Minnesota. Dr. Stenson teaches exercise physiology, research methods, anatomy & physiology, and health & fitness. Her research focuses on recovery from exercises and improving health of college students. Dr. Stenson mentors several undergraduate research students each year and considers teaching and mentoring the most important and fulfilling parts of her work.
Pandemic, Physiology, Physical Therapy, Psychology, Purpose, Professor Fink, Practical Exams, and Proficiency!

Pandemic

To say that the COVID-19 pandemic has affected education would be an understatement.  Physical distancing measures that were introduced across the world to reduce community spread of SARS-CoV-2 (the COVID-19 pathogen), necessitated a cessation or reduction of in-person instruction, and the introduction of what has come to be known as “emergency remote education”(1, 2).  Emergency remote education or teaching (ERE or ERT) is different from remote or online education in that, it is not planned and optional, but rather, a response to an educational emergency (3).

Physiology for Physical Therapy Students

Against the backdrop of the COVID-19 pandemic, as I was trying to keep my primary research program on regenerative and rehabilitative muscle biology moving forward (4), engaging with the scientific community on repurposing FDA-approved drugs for COVID-19 (5, 6), and working on the Biomaterials, Pharmacology, and Muscle Biology courses that I teach each year; I was requested to take on a new responsibility.  The new responsibility was to serve as the course master and sole instructor for a 3-credit, 15-week course on Physiology and Pathophysiology for Professional Year One (PY1) Doctor of Physical Therapy (DPT) students.  I had foreseen taking on this responsibility a couple of years down the road, but COVID-19 contingencies required that I start teaching the course in January 2021.  I had always believed that within the Physical Therapy curriculum, Anatomy, Physiology and Neuroscience, were courses that could only be taught by people who were specialists – i.e. you had to be born for it and should have received a level of training needed to become a master of Shaolin Kung Fu (7).  With less than a year to prepare for my Physiology and Pathophysiology course, and with the acknowledgment that I was not trained in the martial art of Physiology instruction, I looked for inspiration.  The Peter Parker Principle from Spider-Man came to mind – “With great power comes great responsibility” (8).  Unfortunately, I realized that there was no corollary that said “With great responsibility comes great power”.  Self-doubt, anxious thoughts, and frank fear of failure abounded.

Psychology and Purpose

Call it coincidence, grace, or anything in between; at the time when I started preparing to teach Physiology and Pathophysiology, I had been working with a psychological counselor who was helping me process my grief following my father’s passing a couple of months before COVID-19 was declared a pandemic.  In addition to processing my grief, through counseling, I had also started learning more about myself and how to process anxious thoughts, such as the fear of failing in my new superhero role of teaching Physiology and Pathophysiology to Physical Therapy students.  Learning how to effectively use my “wise mind” (an optimal intersection of the “emotional mind” and “reasonable mind”), writing out the possible “worst outcomes” and “likely outcomes”, practicing “self-compassion”, increasing distress tolerance, working on emotional regulation, and most importantly embracing “radical acceptance” of the things I cannot change, helped me work through the anxiety induced by my new teaching responsibility.  This does not mean that my anxiety vanished, it just means that I was more aware of it, acknowledged it, and worked my way through it to get to what I was supposed to do.  I also learned through counseling that purpose drives motivation.  I realized that my anxiety over teaching Physiology was related to the value I placed on the teaching and learning of Physiology in Physical Therapy and other health professions.  Being a Physical Therapist and Physiologist who is committed to promoting movement-centered healthcare, I found motivation in the prospect of training Physical Therapists to serve as health educators with the ultimate goal of improving human movement.  Therefore, the idea of developing a course that would give my students a solid foundation in the Physiology and Pathophysiology of Human Movement began to excite me more than intimidate me.  The aspects of my personality that inspired me to publish a paper on the possible pathophysiological mechanisms underlying COVID-19 complications (5), stirred in me the passion to train the next generation of Physical Therapists, who through their sound knowledge of Physiology would likely go on to transform healthcare and promote healthier societies through movement (9).

The point about purpose being a positive driver of motivation, mentioned above, has been known to educational psychologists for a while.  When students see that the purpose of learning something is bigger than themselves, they are more motivated to learn (10).  So, rather than setting up my course as a generic medical physiology course, I decided to set it up as a Physiology and Pathophysiology of Human Movement course that is customized for human movement experts in training – i.e. Student Physical Therapists.  I set my course up in four modules – Moving the Body (focused on muscle and nerve), Moving Materials Around the Body (focused on the cardiovascular and pulmonary systems), Fueling Movement (focused on cellular respiration and the ATP story), and Decoding the Genetics of Human Movement (focused on how genetic information is transcribed and translated into proteins that make movement possible).

Professor Fink

For those of you who have not heard of Professor Steven Fink, you should look him up (11).  A Ph.D.-trained Physiologist and former member of the American Physiological Society (APS), Professor Fink has posted over 200 original educational videos on YouTube, covering Anatomy, Physiology, Pharmacology, and other subjects.  I had found his YouTube videos several years ago, while looking for good resources for my Pharmacology course, and never stopped watching them ever since then.  I would watch his videos while exercising, and listen to them during my commute (and sometimes even during my ablutions!).  There were two topics in Physiology that scared me the most – cellular respiration and genetics.  I had learned these topics just well enough to get me through high school, four years of Physical Therapy School, one year of Post-Professional Physical Therapy training, six years of Ph.D. training in a Physiology laboratory, six years as a Postdoctoral Fellow (also in a Physiology laboratory), and several years as an Assistant Professor in Physical Therapy.  However, despite the “few years” I had spent in academia and my 10+ years being a member of the APS, I never felt that I had gained mastery over the basic physiology of cellular respiration and genetics.  So, when I started preparing to teach Physiology, I decided to up my number of views on Professor Fink’s videos on cellular respiration and genetics.  Furthermore, I reached out to Professor Fink and asked him if he would serve as a teaching mentor for my new course and he very kindly agreed.  I am fortunate to be a teacher-scholar in a department and university, which places a high priority on teaching, and supports training in pedagogy and the scholarship of teaching and learning through consultation with experts within and outside the university.  As part of our mentoring relationship, Professor Fink gave feedback on my syllabus, course content, testing materials and pedagogical strategies.  He also introduced me to “Principles of Anatomy and Physiology, 16th Edition, by Gerard J. Tortora, Bryan H. Derrickson, which proved to be a useful resource (ISBN: 978-1-119-66268-6).  Through all these interactions, Professor Fink demonstrated that a person can be a “celebrity professor” and still be a kind and gentle human being.  Having him as my teaching mentor played a significant role in building my confidence as a physiology teacher.  Research shows that academic mentoring is related to favorable outcomes in various domains, which include behavior, attitudes, health, interpersonal relations, motivation, and career (12).

Practical Exams

As the COVID-19 pandemic rolled on through the Winter, Spring/Summer, and Fall semesters of 2020, it became certain that I would have to teach my Physiology and Pathophysiology course in a virtual environment come January 2021.  I had to figure out a way to make sure that the learning objectives of my course would be met despite the challenges posed by teaching and testing in a virtual environment.  Therefore, I came up with the idea of virtual practical exams for each of the four modules in my course.  These practical exams would be set up as a mock discussion between a Physical Therapist and a referring health professional regarding a patient who had been referred for Physical Therapy.  Students would take the exam individually.  On entering the virtual exam room, the student would introduce themselves as a Student Physical Therapist and then request me (the referring healthcare professional) to provide relevant details regarding the patient, in order to customize assessment, goal setting and treatment for the patient.  With the patient’s condition as the backdrop, I would ask the student questions from the course content that was relevant to the patient’s condition.  A clear and precise rubric for the exam would be provided to the students in keeping with the principles of transparency in learning and teaching (13).

Proficiency

As we went through the course, the virtual practical exams proved to be an opportunity to provide individualized attention and both summative and formative feedback to students (14).  As a teacher, it was rewarding to see my Physical Therapy students talk about cellular respiration and gene expression with more confidence and clarity than I could do during my prior 12+ years as a Ph.D.-trained Physiologist.  It was clear to me that my students had found a sense of purpose in the course content that was bigger than themselves – they believed that what they were learning would translate to better care for their patients and would ultimately help create healthier societies through movement.

In the qualitative feedback received through a formal student evaluation of teaching (SET) survey, one student wrote “Absolutely exceptional professor.  Please continue to do what you are doing for future cohorts.  You must keep the verbal practical examinations for this class.  Testing one’s ability to verbally explain how the body functions and how it is dysfunctional is the perfect way to assess if true learning has occurred.”  Sharing similar sentiments, another student wrote “I really enjoyed the format of this class. The virtual exams in this class forced us to really understand the content in a way that we can talk about it, rather than learning to answer a MC question. I hope future students are able to learn as much as I did from this class.”

Closing Remarks

When I meet students for the first time during a course, I tell them that even though I am their teacher, I am first a student.  I let them know that in order to teach, I first need to learn the content well myself.  Pandemic pedagogy in the time of COVID-19-related emergency remote education has reinforced my belief that, the best way to learn something is to teach it.  Thanks to my Physiology and Pathophysiology of Human Movement course, I learned more about myself, about teaching and learning, and of course about cellular respiration and genetics.  Do I now consider myself a master of Physiology instruction?  No!  Am I a more confident physiology teacher?  Yes!  Has writing this article made me reflect more on what worked well and what needs to be fine-tuned for the next iteration of my Physiology and Pathophysiology course?  Yes!

REFERENCES:

  1. Williamson B, Eynon R, Potter J. Pandemic politics, pedagogies and practices: digital technologies and distance education during the coronavirus emergency. Learning, Media and Technology. 2020;45(2):107-14.
  2. Bozkurt A, Jung I, Xiao J, Vladimirschi V, Schuwer R, Egorov G, et al. A global outlook to the interruption of education due to COVID-19 pandemic: Navigating in a time of uncertainty and crisis. Asian Journal of Distance Education. 2020;15(1):1-126.
  3. Hodges C, Moore S, Lockee B, Trust T, Bond A. The difference between emergency remote teaching and online learning. Educause review. 2020;27:1-12.
  4. Begam M, Roche R, Hass JJ, Basel CA, Blackmer JM, Konja JT, et al. The effects of concentric and eccentric training in murine models of dysferlin-associated muscular dystrophy. Muscle Nerve. 2020.
  5. Roche JA, Roche R. A hypothesized role for dysregulated bradykinin signaling in COVID-19 respiratory complications. FASEB J. 2020;34(6):7265-9.
  6. Joseph R, Renuka R. AN OPEN LETTER TO THE SCIENTIFIC COMMUNITY ON THE POSSIBLE ROLE OF DYSREGULATED BRADYKININ SIGNALING IN COVID-19 RESPIRATORY COMPLICATIONS2020.
  7. Wikipedia contributors. Shaolin Kung Fu – Wikipedia, The Free Encyclopedia 2021 [Available from: https://en.wikipedia.org/w/index.php?title=Shaolin_Kung_Fu&oldid=1026594946.
  8. Wikipedia contributors. With great power comes great responsibility – Wikipedia, The Free Encyclopedia 2021 [Available from: https://en.wikipedia.org/w/index.php?title=With_great_power_comes_great_responsibility&oldid=1028753868.
  9. American Physical Therapy Association (APTA). Transforming Society – American Physical Therapy Association [Available from: https://www.apta.org/transforming-society.
  10. Yeager DS, Henderson MD, Paunesku D, Walton GM, D’Mello S, Spitzer BJ, et al. Boring but important: a self-transcendent purpose for learning fosters academic self-regulation. Journal of personality and social psychology. 2014;107(4):559.
  11. Fink S. ProfessorFink.com [Available from: https://professorfink.com/.
  12. Eby LT, Allen TD, Evans SC, Ng T, Dubois D. Does Mentoring Matter? A Multidisciplinary Meta-Analysis Comparing Mentored and Non-Mentored Individuals. J Vocat Behav. 2008;72(2):254-67.
  13. Winkelmes M. Transparency in Learning and Teaching: Faculty and students benefit directly from a shared focus on learning and teaching processes. NEA Higher Education Advocate. 2013;30(1):6-9.
  14. Alt D. Teachers’ practices in science learning environments and their use of formative and summative assessment tasks. Learning Environments Research. 2018;21(3):387-406.
Joseph A. Roche, BPT, PhD.  Associate Professor.  Physical Therapy Program.  Eugene Applebaum College of Pharmacy and Health Sciences.  

I am an Associate Professor in the Physical Therapy Program at Wayne State University, located in the heart of “Motor City”, Detroit, Michigan.  My research program is focused on developing regenerative and rehabilitative interventions for muscle loss arising from neuromuscular diseases, trauma and aging.  I have a clinical background in Physical Therapy and have received intensive doctoral and postdoctoral research training in muscle physiology/biology.

https://www.researchgate.net/profile/Joseph-Roche-2

https://scholar.google.com/citations?user=-RCFS6oAAAAJ&hl=en